Comparative study between Expert nail tibia and minimally invasive plate osteosynthesis (MIPO) fixation in lower fourth tibial Fracture

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