International Journal of Medical and All Body Health Research  |  e-ISSN: 2582-8940  |  Double-Blind Peer Review  |  Open Access  |  CC BY-NC-SA 4.0

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     2026:7/4

International Journal of Medical and All Body Health Research

e-ISSN: 2582-8940 | Open Access

A Study on Functional Outcome of Various Modalities in the Management of Distal Tibial Fractures: A Prospective Analytical Study

Dr. Nitin Bansal, Dr. RL Sahu, Dr. Rajesh Bhatia

Postgraduate Student, Department of Orthopedics, Saraswathi Institute of Medical Sciences, Hapur, Uttar Pradesh, India; Professor, Department of Orthopedics, Saraswathi Institute of Medical Sciences, Hapur, Uttar Pradesh, India; Professor & Head, Department of Orthopedics, Saraswathi Institute of Medical Sciences, Hapur, Uttar Pradesh, India

Article Information

Volume / Issue7 / 3 (July-August 2026)
Pages275-281
AccessOpen Access

Publication Timeline

  • Received29 June 2026
  • Accepted27 July 2026
  • Published

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Abstract

Background: Distal tibial fractures remain a therapeutic challenge because of a compromised soft tissue envelope, poor bone stock, comminution, and difficulty in achieving rigid fixation. Management strategies range from conservative treatment to intramedullary nailing, plating, and hybrid external fixation, each with its own advantages and limitations depending on fracture pattern, soft tissue condition, and patient factors.
Objective: To evaluate and compare the clinical and functional outcomes of different treatment modalities used in the management of distal tibial fractures.
Methods: This prospective analytical study was conducted in the Department of Orthopaedics, Saraswathi Institute of Medical Sciences, Hapur, from March 2024 to February 2026, after institutional ethical approval and written informed consent. Forty-eight patients aged 15–64 years with AO type 43-A distal tibial fractures, including open Gustilo–Anderson type 1, 2, 3A, and 3B injuries, were enrolled and allocated to four treatment groups of 12 patients each: Group I – conservative management, Group II – intramedullary nailing, Group III – hybrid external fixation, and Group IV – plate osteosynthesis. Patients were followed up clinically and radiologically at regular intervals, and functional outcome was assessed at six months using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score. Data were analysed using ANOVA, with p < 0.05 considered statistically significant.
Results: The majority of patients were male (32; 66.7%), and the highest incidence was in the 25–34 year age group (15; 31.3%). Road traffic accidents were the most common mode of injury (28; 58.3%), and AO type A3 was the most frequent fracture pattern (22; 45.8%); 35.4% of fractures were open and 64.6% closed. The mean duration of follow-up was 7.5 months (range 6–13 months). The highest mean AOFAS score was recorded in the plate osteosynthesis group (86.2 ± 6.5), followed by intramedullary nailing (78.3 ± 9.2), hybrid external fixation (73.1 ± 10.3), and conservative management (69.2 ± 11.7); the difference between groups was statistically highly significant (p < 0.001). Good to excellent outcomes were achieved in 72.7% of the plating group, 54.5% of the nailing group, 45.5% of the hybrid fixator group, and 36.4% of the conservative group, with no poor outcome in the plating group. Complications occurred in nine patients, including non-union (2), malunion (1), ankle stiffness (3), and infection (3); no case of deep vein thrombosis, pulmonary embolism, or mortality was recorded.
Conclusion: Both intramedullary nailing and plate osteosynthesis offer satisfactory functional outcomes in distal tibial fractures, with plate osteosynthesis achieving the highest AOFAS scores in this series. Hybrid external fixation remains a valuable option in open and comminuted fractures with severe soft tissue injury, though it carries a higher complication rate, while conservative treatment retains a role in selected low-risk patients. An individualised approach based on fracture pattern, soft tissue status, and surgeon expertise is essential for optimising outcomes.
 

Keywords

Distal tibial fractureintramedullary nailinghybrid external fixationplate osteosynthesisconservative treatmentAOFAS scorefunctional outcome

References

  1. Bister V, Lenkkeri T, Parkkinen M, Lindahl J. Intra-articular distal tibial fractures cause a major burden to individual patients and also stress the public health care system. Injury. 2022;53:2888-92. [Google Scholar][Crossref]
  2. Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg Br. 1995. [Google Scholar][Crossref]
  3. Thompson JH, Koutsogiannis P, Jahangir A. Tibia fractures overview. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. [Google Scholar][Crossref]
  4. Hannigan GD, Pulos N, Grice EA, Mehta S. Current concepts and ongoing research in the prevention and treatment of open fracture infections. Adv Wound Care (New Rochelle). 2015;4:59-74. [Google Scholar][Crossref]
  5. Raju K, Smith TO, Hing CB, Solan MC, Nielsen DM. Surgical versus conservative interventions for treating tibial shaft fractures in adults. Cochrane Database Syst Rev. 2018;2018:CD011095. [Google Scholar][Crossref]
  6. Sarmiento A, et al. Functional bracing of tibial fractures. Clin Orthop Relat Res. 1989. [Google Scholar][Crossref]
  7. Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am. 2005;87:1213-21. [Google Scholar][Crossref]
  8. Kashyap S, Ambade R, Landge S, Salwan A. Impact of surgical timing on fracture healing in tibial shaft injuries: a comparative review of intramedullary nailing techniques. Cureus. 2024;16:e70978. [Google Scholar][Crossref]
  9. Marsh JL, et al. Hybrid external fixation for distal tibial fractures. J Orthop Trauma. 1995. [Google Scholar][Crossref]
  10. Chitten JJ, Balasubramaniam R. A comparative study of locking plate by minimally invasive percutaneous plate osteosynthesis versus closed interlocking intramedullary nail in extra-articular distal tibia fractures. Int J Res Orthop. 2021;7:557-60. [Google Scholar][Crossref]
  11. Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma. 2010;24(1):24-9. [Google Scholar][Crossref]
  12. Vallier H, Le T, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma. 2008;22(5):307-11. [Google Scholar][Crossref]
  13. Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P, et al. Distal tibia fractures: management and complications of 101 cases. Int Orthop. 2010;34:583-8. [Google Scholar][Crossref]
  14. Rüedi TP, Murphy WM. AO principles of fracture management. 2000. p. 519-36. [Google Scholar][Crossref]
  15. Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia—results in 20 patients. Injury. 2006;37(9):877-87. [Google Scholar][Crossref]
  16. Wang B, Zhao Y, Wang Q, Hu B, Sun L, Ren C, et al. Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2019;14(1):456. [Google Scholar][Crossref]
  17. Guo JJ, et al. Intramedullary nailing versus plating for distal tibial fractures: meta-analysis. J Orthop Trauma. 2010. [Google Scholar][Crossref]
  18. Li Y, Jiang X, Guo Q, Zhu L, Ye T, Chen A. Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop. 2014;38:1261-7. [Google Scholar][Crossref]
  19. Giannoudis VP, Ewins E, Taylor DM, Foster P, Harwood P. Clinical and functional outcomes in patients with distal tibial fracture treated by circular external fixation: a retrospective cohort study. Strategies Trauma Limb Reconstr. 2021;16:86-95. [Google Scholar][Crossref]
  20. Polat A, Kose O, Canbora K, Yanık S, Guler F. Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial. J Orthop Sci. 2015;20:695-701. [Google Scholar][Crossref]

How to Cite

Bansal, N., Sahu, R. L., & Bhatia, R. (2026). A Study on Functional Outcome of Various Modalities in the Management of Distal Tibial Fractures: A Prospective Analytical Study. International Journal of Medical and All Body Health Research, 7(3), 275-281. https://doi.org/10.54660/IJMBHR.2026.7.3.275-281

Bansal, Nitin, et al. "A Study on Functional Outcome of Various Modalities in the Management of Distal Tibial Fractures: A Prospective Analytical Study." International Journal of Medical and All Body Health Research, vol. 7, no. 3, 2026, pp. 275-281. https://doi.org/10.54660/IJMBHR.2026.7.3.275-281.

Bansal, N., Sahu, R. L. and Bhatia, R. (2026) 'A Study on Functional Outcome of Various Modalities in the Management of Distal Tibial Fractures: A Prospective Analytical Study', International Journal of Medical and All Body Health Research, 7(3), pp. 275-281. doi: 10.54660/IJMBHR.2026.7.3.275-281.

Bansal N, Sahu RL, Bhatia R. A Study on Functional Outcome of Various Modalities in the Management of Distal Tibial Fractures: A Prospective Analytical Study. International Journal of Medical and All Body Health Research. 2026;7(3):275-281. doi:10.54660/IJMBHR.2026.7.3.275-281

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