Surgical Treatment of Extra-Articular or Simple Intra-Articular Distal Tibial Fractures: External Fixation versus Intramedullary Nailing

OBJECTIVE: To compare intramedullary nailing (IMN) with external fixation (EF) in the treatment of tibial shaft fractures located within 5 cm of the ankle. SETTING: University teaching hospital. DESIGN: Retrospective comparative study. PATIENTS: Sixty-seven patients with a mean age of 48 years (range, 16-78 years; 24 women, 43 men). INTERVENTION: Thirty-three fractures were treated with EF from 1998 to 2004 and 34 fractures were treated with reamed IMN from 2004 to 2007. MAIN OUTCOME MEASURES: Olerud-Molander ankle score, RAND-36 Item Health Survey, and the number of secondary interventions. RESULTS: The healing time was 21 weeks in the IMN group and 23 weeks in the EF group (P = 0.53). One fracture in the IMN group and three in the EF group malunited (P = 0.62). Olerud-Molander ankle score was 75 in the IMN group and 74 in the EF group (P = 0.51). There was no difference in any of the RAND-36 subscores measuring physical functioning. More patients in the EF group had secondary intervention resulting from delayed healing (8 versus 1, P = 0.03). The patients in the EF group also needed more secondary interventions as a result of any complication (15 versus 2, P < 0.001). There was one deep infection in the IMN group. CONCLUSION: Distal extra-articular or simple intra-articular fractures can be treated with modern IMNs or nonbridging EF. Although functional results are similar, EF carries a significant greater risk of secondary interventions; based on these data, IMN is recommended.