J Korean Orthop Assoc.  2014 Aug;49(4):285-293. 10.4055/jkoa.2014.49.4.285.

A Comparison of the Results between Intramedullary Nailing and Minimally Invasive Plate Osteosynthesis in Distal Tibia Fractures

  • 1Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea. ossoj@med.yu.ac.kr


The purpose of this study was to compare the results of treatment of distal tibial fractures between intramedullary (IM) nailing and minimally invasive plate osteosynthesis (MIPO).
Between January 2007 and February 2012, 57 patients (57 cases) were treated for distal tibial fractures. Thirty-two patients (32 cases) were treated with IM nailing (nail group) and the 25 patients (25 feet) were treated with MIPO (plate group). Clinical results were compared using range of motion (ROM) of the ankle joint, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Olerud-Molander score between nail group and plate group. Radiographic results were compared using mean bony union time, coronal and sagittal malunions, and shortening between the groups.
Mean ROM of the ankle joint was significantly larger in nail group until 6 months after surgery; however, it was not different between two groups at the last follow-up. AOFAS score and Olerud-Molander score were not different between two groups at the last follow-up. In the nail group, two malunions more than 5 degrees were observed in coronal and sagittal planes, respectively. One case showed non-union in the plate group, however, bone union was obtained after autogeneous bone graft.
Treatment using IM nailing is more advantageous in terms of postoperative rehabilitation than MIPO in distal tibial fractures.


tibia; distal tibia shaft fracture; interlocking intramedullary nailing; minimally invasive plate osteosynthesis

MeSH Terms

Ankle Joint
Follow-Up Studies
Fracture Fixation, Intramedullary*
Range of Motion, Articular
Tibial Fractures


  • Figure 1 (A) Initial ankle anteroposteroior and lateral radiographs show distal tibio-fibular shaft comminuted fracture. (B) Distal tibia fracture was fixed with expert tibial nail and fibular fracture was fixed with semitubular plate and Kirschner wires. (C) Bone union was obtained at 16 weeks after surgery.

  • Figure 2 (A) Initial ankle anteroposteroior and lateral radiographs show distal tibio-fibular shaft fracture. (B) The patient was treated by anteromedial minimally invasive plate osteosynthesis fixation using anatomical locking compression plate. (C) Bone union was obtained at 16 weeks after surgery.

  • Figure 3 (A) Initial ankle anteroposteroior and lateral radiographs and clinical photo show distal tibio-fibular shaft comminuted fracture with medial open wound. (B) The patient was treated by anterolateral minimally invasive plate osteosynthesis technique using anatomical locking compression plate. (C) Bone union was obtained at 21 weeks after surgery.

  • Figure 4 Graph showing the change in the range of motion (ROM) of the ankle joint over time in the nail group and plate group (*p<0.05).


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