Plating of distal tibial extra-articular fractures: is there a lesson to be learnt?

W.T. Oosthuysen, K.M McQuarrie, E. Crane, N.J. Madeley, C.S. Kumar

Introduction: The surgical care of extra-articular distal tibial fractures remains controversial. Numerous studies have been conducted comparing intramedullary nailing with plate fixation, but almost no studies have been done comparing the outcomes of different plating techniques. This study looks at the radiological outcomes of distal tibial fractures treated with either a direct medial or anterolateral plate, with or without plating of the fibula, to assess the outcome and complications associated with these 2 approaches.

Methods: This is a retrospective review of 80 patients with distal extra-articular tibial fractures, treated with an open reduction and plating, between 2008 and 2019 at Glasgow Royal Infirmary. Case notes and x-rays were reviewed to compare the rate of union, malunion and requirement for further surgery after these 2 types of plating.

Results: Of those tibial fractures fixed with only a medial plate, 78% united (28/36), 5% (2/36) had a non-union and 17% (6/36) a malunion. In the group treated with a combination of medial tibial and fibular plating, the figures were; 71% (15/21) united, 19% (4/21) non-unions and 10% (2/21) malunions. However, in the group treated with anterolateral plating of the tibia alone, only 53% (8/15) united, with a 20% (3/15) non-union and 13% (2/15) malunion rate. Additionally in this group, there were 2 patients (13%) with loss of fracture reduction within the first two months of fracture fixation, requiring revision surgery. Interestingly, of the 8 patients treated with anterolateral tibial and fibular plating, 88% (7/8) showed full union and only one (12%) had a non-union, with no malunions is this group.

Conclusion: It would appear that medial tibial and combination medial tibial and fibular plating, have superior outcomes compared to anterolateral plating. Results suggest, if anterolateral plating is done, this should be augmented by fibular fixation.