A.Mohamed, M., E.Al-Ashhab, M., A.Kandil, W. (2022). Comparative study between Expert nail tibia and minimally invasive plate osteosynthesis (MIPO) fixation in lower fourth tibial Fracture. Benha Journal of Applied Sciences, 7(9), 27-33. doi: 10.21608/bjas.2022.274270
M A.Mohamed; M E.Al-Ashhab; W A.Kandil. "Comparative study between Expert nail tibia and minimally invasive plate osteosynthesis (MIPO) fixation in lower fourth tibial Fracture". Benha Journal of Applied Sciences, 7, 9, 2022, 27-33. doi: 10.21608/bjas.2022.274270
A.Mohamed, M., E.Al-Ashhab, M., A.Kandil, W. (2022). 'Comparative study between Expert nail tibia and minimally invasive plate osteosynthesis (MIPO) fixation in lower fourth tibial Fracture', Benha Journal of Applied Sciences, 7(9), pp. 27-33. doi: 10.21608/bjas.2022.274270
A.Mohamed, M., E.Al-Ashhab, M., A.Kandil, W. Comparative study between Expert nail tibia and minimally invasive plate osteosynthesis (MIPO) fixation in lower fourth tibial Fracture. Benha Journal of Applied Sciences, 2022; 7(9): 27-33. doi: 10.21608/bjas.2022.274270
Comparative study between Expert nail tibia and minimally invasive plate osteosynthesis (MIPO) fixation in lower fourth tibial Fracture
Orthopedic surgery, Dept., Faculty of Medicine, Benha Univ., Benha, Egypt
Abstract
Background:Expert nail and MIPO techniques are two well-accepted and effective method in fixation lower fourth tibial fracture. Expert nail showed lower infection rate and faster time to healing but with more mal-alignment in reduction. While in MIPPO technique less mal-alignment reduction could be achieved but with more infection problems and slower rate of union.Purpose:compare the results of fixation of extra- articular lower fourth tibial fractures in adults by Expert nail vs. distal tibial plate with MIPO technique.Patients and methods:The study included 20 patients their ages were between 20-52years, they were 13 males and 7 females. The patients were 12 heavily active patients, 5 moderate active patients and 3 lightly active patients. 4 patients were hypertensive and one patient was diabetic. All 20 patients were with unilateral fracture,9 patients had the right side affected and 11 patients had the left side affected. Results:There was insignificant difference (P>0.05) in the MIPO group, 8 fractures (80%) united and one fracture (10%) had delayed union and one (10%) failed to unite. In the Expert nail group, 10fractures (100%) united. In MIPO group, one fracture united in rotational deformity (external rotation 25 degree). In Expert nail group 2 (20%) fractures united on coronal plane deformity. Mean time for union in Expert nail 14 ± 2.85 weeks, while in MIPPO group 17,07 ± 4.01 weeks. This showed statically significant for Expert nail (P value: 0.041). Expert nail showed faster time of union. while one developed resistant infection. In Expert nail group, 2 patients (20%) showed superficial infection. Antibiotics according to culture and sensitivity was administrated and the wounds become clean. In MIPPO group, 3 patients (30%) needed secondary surgeries (2 debridement, 1 revision). While in Expert nail group, one patient needed to secondary operation (fibular revision). In MIPPO group, 5 patients (50%) were graded as excellent, 4 patients (40%) good and one patient (10%) poor. In Expert nail group, 7 patients (70%) were graded as excellent, 2 patients (20%) good and one patient (10%) fair.Conclusion:both techniques can provide effective treatment and fixation for closed lower fourth extra-articular tibial fractures. Expert nail showing lower infection rate and faster time to healing but with more mal-alignment reduction. While in MIPO technique less mal-alignment reduction can achieve but with more infection problems and slower rate of union