Comparison of distal bolt locking (DSBLS) intramedullary nail and locked plate of distal diaphysis fractures of the tibia

ABSTRACT Introduction and Objective: In this study, it was aimed to clinically and radiologically compare the locking plate screws and bolted locking screws in patients with tibial distal diaphyseal fractures, who have been followed-up at Dicle University Faculty of Medicine, Orthopedics Clinic between 2011 and 2017. Materials and Methods: A total of 40 patents with tibial distal diaphyseal fractures, who admitted to the Dicle University Faculty of Medicine, Orthopedics Clinic between 2011 and 2017 and followed-up at least for 12 months, were examined retrospectively. In our study, 20 patients were included in the locking plate screwing group and 20 patients were included in the distal supportive bolt-locking screw (DSBLs) group. OTA/AO and Gustilo Anderson classification system, in open fractures, was used for determining the types of fractures. The functional results of the patients were evaluated using the AOFAS scoring system. Results: In our study, 13 of the patients were female and 27 were male. Of the male patients, 70% had nailing treatment and 65% had plate treatment. The mean age of the patients who underwent nailing treatment was 34.85 (18-74) yearsand the mean age of the patients underwent plate treatment was 39.85 (18-68) years. There was no statistically significant difference between the nail treatment and plate treatment groups in terms mean age (p>0.05). In the study, 30% of the patients who received nailing treatment and 35% of those who received plate treatment were found to be injured by non-vehicle traffic accident, and 20% of the nail treatment group and 30% of the plate treatment group were found to be injured by a simple fall. A statistically significant difference was found between the nail treatment and plate treatment groups in terms of Gustilo Anderson fracture classification (p<0.05). Nail treatment was more common in patients with type-2 (n=8) and closed (n=7) fractures, whereas most of the patients who undergo plate treatment had closed (n=15) fractures. While the mean AP radiograph angles of nail treatment group was 4.13°(1-13), this value for the plate treatment group was 2.94°(1-8). Lateral radiographs showed statistically significant differences according to the treatment method (p<0.05). The mean angle in lateral graphs was 1.50° (1-3) in the nail treatment group, whereas it was 3.12° (1-11) in those who received plate treatment. Radiology showed that there was a significant difference between the mean time to complete union, according to the treatment method (p<0.05). The mean time to complete union was 32.60±6.90 in patients who received plate treatment, whereas it was 29.00±9.87 (20-52) in patients who received nailing treatment. There was a statistically significant difference between the plate treatment and nail treatment group in terms of complete union time (p<0.05). The FWB time was found to be 7.70±2.34 (6-16) weeks in patients undergoing nail treatment and 23.00±6.85 (16- 44) weeks in plate treatment group. There was a statistically significant difference in terms of the FWB time between the patients who had undergone plate treatment and nail treatment (p<0.01). The FWB time was shorter in patients who underwent nail treatment. The mean AOFAS score of the patients who had plate treatment was 93.45±6.01 (84-100), and 91.00±9.12 (70-100) for the patients who underwent nail treatment. Conclusions: Recently developed DSBLs locking IM nails are as good as the locking plates in the distal tibial diaphysis fractures. Its superiority in terms of FWB and union times may reduce complications due to immobilization. Keywords: Tibial distal diaphysis, fracture, intramedullary nail, locked plate