Comparative Evaluation of Locking Compression Plate Versus Intramedullary Nailing in Distal Tibial Fractures

Abstract

Background: Distal tibial fractures are challenging due to limited soft tissue coverage and compromised vascularity. This study compared the clinical, radiological, and functional outcomes of locking compression plate (LCP) fixation and intramedullary nailing (IMN).

Materials and Methods: This prospective comparative study included 120 patients with distal tibial fractures, divided into LCP (n=60) and IMN (n=60) groups. Operative parameters, fracture union, functional outcomes using the AOFAS score, and postoperative complications were assessed over six months.

Results: Operative duration was significantly shorter with IMN than LCP (72.8 ± 13.4 versus 88.4 ± 15.6 minutes; p<0.001). Mean fracture union time was 17.6 ± 3.5 weeks with IMN and 19.2 ± 3.8 weeks with LCP (p=0.018). Six-month union rates were comparable (93.3% versus 91.7%). AOFAS scores were also similar (87.8 ± 8.2 versus 86.5 ± 8.6; p=0.398). Malunion was more frequent with IMN (10.0% versus 3.3%), whereas superficial infection was higher with LCP (10.0% versus 3.3%).

Conclusion: IMN offered faster recovery and earlier fracture union, while LCP provided better alignment control. Both techniques achieved comparable functional outcomes.