Locking Plate Vs Intramedullary Nailing in Extra Articular Distal Tibia Fracture a Comparative Study for Union Rates and Complications

Abstract

Background: Fractures of the distal tibia, particularly extra-articular patterns, are challenging to manage due to limited soft-tissue coverage and high complication rates. Optimal fixation—either locking plate or intramedullary nailing—remains debated. This study compared union rates, complication profiles, and functional outcomes between the two techniques.

Aim: To compare the outcomes of locking plate fixation and intramedullary nailing in extra-articular distal tibia fractures in terms of union rates and postoperative complications.

Methods: A prospective comparative study was conducted among 120 patients with extra-articular distal tibia fractures treated either with a locking plate (n=60) or intramedullary nail (n=60). Patients were followed for one year. Union time, complications, and functional outcomes were evaluated using clinical and radiological criteria and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Statistical analysis included t-tests, Chi-square tests, and relative risk estimates, with p<0.05 considered significant.

Results: Union by 24 weeks occurred in 90.0% of plated and 93.3% of nailed cases (p=0.51). Mean time to clinical union was shorter with nailing (14.8 ± 3.7 vs. 16.6 ± 4.1 weeks; p=0.007), as was radiological union (18.9 ± 4.5 vs. 20.7 ± 4.9 weeks; p=0.019). Wound complications were higher in the plating group (15.0% vs. 6.7%), while anterior knee pain was more frequent with nailing (13.3% vs. 1.7%; p=0.024). At 6 months, mean AOFAS scores favored nailing (86.7 ± 7.9 vs. 84.1 ± 8.4; p=0.041), but 12-month outcomes were comparable.

Conclusion: Both fixation methods provide reliable outcomes in extra-articular distal tibial fractures. Intramedullary nailing allows faster union and early rehabilitation with fewer wound complications, whereas locking plate fixation offers superior alignment control. Treatment selection should be tailored to fracture characteristics and soft-tissue conditions.