Minimally invasive elastic intramedullary nails and external fixation achieved satisfactory outcomes for multi-segment and long-spiral mild-to-moderate comminuted closed tibia-fibula fractures

Background: Treatment of severe comminuted tibia-fibula fractures is often complicated by non-union, delayed union, and malunion. The best surgical approach is controversial. Aim: To compare the clinical outcomes and complications of three methods of fixation: elastic intramedullary nails and external fixation (EINE), plates, and interlocking nails (IN). Methods: This was a retrospective cohort study of 86 diaphysealtibia-fibula fractures in 80 patients treated with EINE, plate, or IN. Treatment outcomes were compared in terms of the length of the hospital stay, time to union, and complication rates (loss of reduction requiring a reoperation, malunion, non-union, refracture, infection, and the need for a reoperation other than routine hardware removal). Mean follow-up was 17.4 months. Results: Length of hospital stay was similar among the three groups. Time to clinical union was longer with plate (P<0.05). Complications were more frequent with the interlocking nail (P=0.004). There was a loss of reduction in 7% of fractures treated with EINE, 11% of fractures treated with plate, and 13% of fractures treated with IN. Time to union was 12.5 +/- 5.6 months for EINE, 24.5 +/- 9.5 months for plate, and 14.5 +/- 8.2 months for IN. During follow-up, three patients (two with IN and one with EINE) had >= 2.0 cm of shortening of the affected limb; 25%, 43%, and 37% of patients treated with EINE, plate fixation, and IN, respectively, required a reoperation. Conclusion: Complication rates were similar between the three treatment approaches. Minimally invasive EINE for multi-segment and long-spiral mild-to-moderate comminuted closed tibia-fibula fractures achieved satisfactory outcomes and fast healing.