Comparative Study Between Intra Medullary Nail Fixation and Plate Fixation in Distal Tibia Fracture

Abstract

Background: Distal tibial fractures are among the most commonly encountered long bone injuries. A variety of treatment approaches have been explored for the management of displaced fractures in this region. The two commonly used methods include plate fixation and intramedullary nailing. The aim of our research was to assess and compare the effectiveness of intramedullary nailing and plate fixation in the treatment of distal tibial fractures. Materials and Methods: This prospective comparative study included 60 patients aged >18 years with extra-articular distal tibial fractures who underwent surgical fixation with either intramedullary nailing or plate fixation at Eastern Medical College Hospital, Cumilla, Bangladesh, from January to December 2025. Patients were divided into two groups: intramedullary nailing (n=30) and plate fixation (n=30). After obtaining informed written consent, data were collected through face-to-face interviews using a pretested structured questionnaire that included sociodemographic data, clinical findings, and pre- and postoperative outcomes. Follow-up assessments were performed at 4, 8, 12, and 24 weeks postoperatively, and complications were recorded each visit. Data was analyzed using SPSS version 25.0. Ethical approval was obtained from the Review Board of Eastern Medical College. Results: Most patients were in the 31-50 years age group in both the nail fixation (53.3%) and plate fixation (60%) groups, with comparable mean ages (38.59±12.7 vs 37.86±11.2 years). Males were slightly more common in both groups. Motorcycle accidents were the most frequent cause of injury, and AO Type A fractures were the predominant fracture pattern. Nail fixation showed significantly faster fracture union (20.1 vs 22.8 weeks, p=0.01) and earlier weight-bearing (15.1 vs 16.3 weeks, p=0.01) compared to plate fixation. The overall complication rate was higher in the plate fixation group (46.7%) than in the nail fixation group (23.3%), with infections occurring only in the plate fixation group. Conclusion: The findings of this study suggest that both intramedullary nailing and plate fixation are safe and effective for the treatment of distal tibial fractures. However, intramedullary nailing may be considered a preferable option due to its shorter operative time, reduced hospital stays, earlier full weight-bearing, and lower infection rate. Eastern Med Coll J. January 2026 Vol.11 No.1 : 60-65