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Similar outcomes seen with nails, locked plates for proximal tibia fractures
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DENVER — Patients with proximal tibia fractures treated with nails compared with locked plates were not different with regard to radiographic, functional and patient-based outcomes, according to a presenter at the Orthopaedic Trauma Association Annual Meeting.
“We found no realistic or important differences in patient-reported outcome scores, weight-bearing, range of motion, revisions or complications,” Paul Tornetta III, MD, said during his presentation. “We did find this was a pretty significant injury for the patient, as the recovery is well over 1 year.”
In a multicenter, randomized controlled trial, Tornettta and colleagues identified 108 patients with A1-3 or C1 proximal tibia fractures, of which 99 patients were followed. Using a HIPPA-complaint web-based system, 52 patients were randomized to be treated with nails and 47 patients were treated with locked plates. At 3,6 and 12 months, investigators assessed patients for demographics, fracture characteristics, surgical variables, radiographs, walking ability, short musculoskeletal function assessment (SMFA), bother index and EuroQol-5D (EQ-5D). GraphPad software was used to compare treatment groups.
Results showed no differences between groups in demographics or injury patterns. Compartment syndrome was more common in patients treated with nails. Surgical time was not significantly different between patients treated with locked plates and those treated with nailing (180 vs. 155 minutes). There were 40% of nails done in relative extension and 42% had blocking screws.
In each treatment group, three patients experienced malalignment of more than 5°. The average patient could walk 10 blocks or more, walk stairs using a railing and needed no support at 1 year postoperatively. There were 7% of nails and plates that lacked around 5° of extension.
At 3, 6 and 12 months, no differences were seen in the SMFA, bother index, EQ-5D or EQ index. The average score was 28.4 for the SMFA, was 26.6 for the bother index, was 0.70 for EQ-5D and was 70 for EQ health at 1 year.
In the nail group, there were three deep infections. In the plate group, there was one deep infection and two superficial infections. Nonunions were seen in four patients in the nail group and in five patients in the plate group. There were 20 adverse events in the nail group and 17 adverse events in the plate group.
“The average patient regained full weight-bearing somewhere between 6 and 12 months, which is a bit later than anticipated,” he said. “At 1 year, 53% [of patients] were on no pain medications, while 16% were still on narcotics.” – by Monica Jaramillo
Reference:
Tornetta P, et al. Abstract 66. Presented at: Orthopedic Trauma Association Annual Meeting; Sept. 25-28, 2019; Denver.
Disclosure: Tornetta reports he is on the editorial or governing board for the Journal of Orthopaedic Trauma, receives intellectual property royalties from Smith & Nephew and receives publishing royalties, financial or material support from Wolters Kluwer Health.