J. Tracy Watson
KOLOA, Hawaii — A speaker at Orthopedics Today Hawaii said there were similar outcomes with the use of either a nail or plate for treatment of the distal tibia fractures and surgeons should choose their preferred treatment.
“They are fairly equal. Both have a low rate of complications if you do them well,” J. Tracy Watson, MD, said during his presentation. “You want to do what you do best and what you are most comfortable with.”
Watson said the degree of intra-articular pathology should also help drive most surgeons’ decision to either use a nail or plate but they should also consider the level of the tibia fracture, as well as soft tissue considerations, and shaft extension.
“I think you need to considerer all of those,” he said. “The degree of intra-articular pathology, I would agree, is the major deciding factor because the nail may or may not be able to address that.”
Surgeons should also distinguish whether there is a varus or valgus fracture to the fibula, according to Tracy. He said a valgus fracture should be plated laterally and a varus fracture should be plated medially.
In regard to tibial reduction, he said there is a higher rate of nonunion if a plate is used.
“You don’t have to necessarily plate unless you can’t get a reduction manually,” Watson said. “So, if you are having a tough time with the fibula fracture because they are difficult to reduce, consider plating the fibula. That will help you reduce the major fracture line — low malunion and malalignment.”
He said if surgeons decide to use a nail, they need an appropriate capture area with oblique screws to complete stability. – by Monica Jaramillo
Watson JT. Nail vs. plate for the distal tibia. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
Disclosure: Watson reports he is on the editorial panel for Journal of Bone and Joint Surgery, Journal of Orthopaedic Trauma, Clinical Orthopaedics and Related Research, Current Orthopaedic Practice and Orthopedics Today; is a consultant for Smith & Nephew, NuVasive, Bioventus, AOS and Zimmer Biomet; and is a chair for the American Academy of Orthopaedic Surgeons Biological Implants and Regenerative Medicine Committee.