Treatment of distal tibial metaphyseal fractures: Plating versus shortened intramedullary nailing

Background: Fractures in the distal tibial metaphysis are more complicated to treat than diaphyseal fractures. We compared treatment with plating to treatment with shorted intramedullary (IM) nailing. Methods: Patients with AO type 43A fractures were treated with plate fixation (group A, n = 14) or shortened IM nailing (group B, n = 13). We compared postoperative radiographic deformities, functional results (Iowa ankle scores), and symptoms (Olerud and Molander ankle scores). Results: All fractures had healed at final follow-up (mean, 33 month). Mean union times were 27.8 week (range, 18-36 week) in group A and 22.6 week (range, 18-30 week) in group B (P < 0.05). Mean postoperative valgus angulations were larger in group B (3.7°) than in group A (0.5°) (P < 0.05). However, malunions did not differ between groups (P < 0.05). Functional results and postoperative symptoms were similar. Conclusions: Both plate fixation and shortened IM nailing were effective for treating distal tibial metaphyseal fractures.