COMPARATIVE ANALYSIS OF OPEN REDUCTION PLATE OSTEOSYNTHESIS AND CLOSED REDUCTION IMIL NAILING FOR EXTRA-ARTICULAR DISTAL TIBIA FRACTURES

Abstract

Distal tibia fractures provide considerable difficulties in orthopedic trauma surgery owing to their intricate anatomy, inadequate soft tissue covering, and elevated risk of sequelae. This prospective comparative study, carried out at Saveetha Medical College and Hospital from January 2023 to January 2025, assessed 60 patients with extra-articular distal tibial fractures treated with either open reduction and internal fixation (ORIF) utilizing plate osteosynthesis (Group A, n=30) or closed reduction and internal fixation with intramedullary interlocking (IMIL) nailing (Group B, n=30). Patients were evaluated for time to union, complications, and functional results using the American Orthopaedic Foot and Ankle Society (AOFAS) and Olerud-Molander Ankle Score (OMAS). The results indicated a significantly reduced mean operative duration (72.4 vs. 92.5 minutes, p<0.001), expedited radiological union (18.5 vs. 20.8 weeks, p=0.02), superior functional scores (AOFAS: 88.6 vs. 85.2, p=0.04; OMAS: 85.4 vs. 81.6, p=0.03), and a lower incidence of wound-related complications (3.3% vs. 13.3%, p=0.04) in the nailing cohort. Nonetheless, plating yielded enhanced radiological alignment with a reduced incidence of malalignment (3.3% vs.10%). One patient in each group had nonunion. Both procedures demonstrated efficacy; however, IMIL nailing provided benefits in expedited healing, less wound morbidity, and superior functional results, while plating guaranteed accurate anatomical reduction. These data indicate that fixing selection should be tailored according to fracture morphology, osseous integrity, and patient-specific needs.