Prospective and Retrospective analysis of Functional Outcome of Distal both bone Leg Fracture treated with Tibial Interlocking Nailing with and without Fibular plating: Comparative study

Abstract

AIM AND OBJECTIVE: To analyse the functional outcome of distal both bone leg fractures treated with Tibial Interlocking nail with and without supplementary fibular plating. MATERIALS AND METHODS: This is a prospective and retrospective study of 20 patients distal both bone leg fractures– 10 patients treated with interlocking nailing alone and 10 patients treated with interlocking nailing with supplementary fibular plating. The study was done after getting clearance from Hospital ethical committee. Those who fulfilled the inclusion criteria given below, were invited to participate in the study. Informed consent was obtained from all the patients willing to take part in the study. OUTCOME: Alignment and reduction preoperatively, postoperatively and at healing was the main outcome measured with an emphasis on loss of initial reduction on follow up. Fibular plating Fibular plating was selected for the following reasons, 1. correction of alignment before insertion of nail. 2. Maintaining the alignment or to improve the stability of bone implant complex. 3. For achieving rotational stability. Kalstrom-Olerud score was used to assess the functional outcome. It is an independent measurement, not influenced by other co-morbid conditions and associated injuries. RESULTS: All the relevant data were analysed. The Fractures treated with tibial interlocking nailing without fibular plating were analysed and 5 (50%) cases were malunited and deformed. Karlstrom- Olerud scoring was excellent in one (10%) patient, good in 5 Patients (50%), fair in 3 (30%) patients and poor in 1 (10 %) patients. The mean delay in surgery for this group is 2.2 weeks. Radiologically the mean post operative varus/valgus alignment was 8.6 degrees. The mean duration of time of union is 12.70 weeks. 4 patients needed cast support. The average follow up is 8 months( lowest – 4 months , longest – 18 months). All the fractures treated with supplementary fibular plating in addition to tibial interlocking nailing eventullay united in a mean period of 11.60 weeks Karlstrom-Olerud score was excellent in 6 fractures (60%), good in 3 patients (30%) and fair in 1 patient (10%) The mean delay between the injury and the surgery was 1.8 weeks. Radiologically the mean post operative varus/valgus alignment was 2.10 degrees. The alignment was maintained till union with the mean remaining the same in the coronal plane. The average follow up is 10.3 months (lowest- 6 months, longest – 24 months). The p value for varus/ valgus angulation with equal variances assumed is 0.0016 and with equal variances not assumed is 0.0064. Thus it is statistically significant that the p- value is < 0.05. The p- value for time of union is 0.3425( p value >0.05), so it is statistically insignificant. CONCLUSION: We conclude that fibular plating, when supplemented the intramedullary nailing of distal both bone fractures of leg, 1. Were effective in achieving the fracture alignment especially in fresh fractures. 2. Improves not only angular stability but also rotational stability. 3. Maintained the fracture alignment till union, preventing loss of initial Reduction