Elastic Nailing With Kirschner Wires Versus Plate Fixation for Distal Tibial Fractures in Adolescents

Distal tibial metaphyseal-diaphyseal junction fractures in adolescents can be difficult to treat because of the short distal fragment, proximity to the growth plate, and tendency toward displacement and malalignment. Elastic stable intramedullary nailing is minimally invasive and preserves the fracture biology, but fixation of the short distal fragment may be less stable. Supplementary Kirschner wires may improve rotational and angular stability. Plate fixation provides stable fixation and good control of alignment but may require greater soft-tissue dissection.

This study will be conducted at the Department of Orthopaedics Surgery, Sohag University Hospital. Eligible adolescents with displaced or unstable distal tibial metaphyseal-diaphyseal junction fractures requiring surgical fixation will be randomly assigned to one of two treatment groups. Group A will undergo elastic stable intramedullary nailing supplemented by one or two Kirschner wires. Group B will undergo plate fixation using a distal tibial locking compression plate. Randomization will be performed using a computer-generated sequence in a 1:1 ratio.

Patients will undergo clinical and radiological follow-up at 2 weeks, 6 weeks, 3 months, and 6 months. The primary outcomes are time to radiological union and fracture union rate. Secondary outcomes include coronal and sagittal alignment, time to full weight-bearing, AOFAS Ankle-Hindfoot Score, Lower Extremity Functional Scale, and complications including malunion, delayed union, nonunion, infection, implant irritation or failure, and reoperation.

Inclusion criteria

• Age 10-16 years.
• Patients diagnosed with distal tibial metaphyseal-diaphyseal junction (DTDMJ) fractures.
• Closed fractures or Gustilo-Anderson type I open fractures.
• Acute fractures presenting within two weeks of injury.
• Displaced or unstable fractures requiring surgical fixation.
• Open or partially open physis, as assessed on preoperative radiographs.

Exclusion criteria

• Patients younger than 10 years or older than 16 years.
• Fractures involving the distal tibial physis (Salter-Harris fractures).
• Intra-articular distal tibial fractures.
• Gustilo-Anderson type II and III open fractures.
• Pathological fractures.
• Fractures associated with metabolic bone disease or congenital skeletal disorders.
• Polytrauma patients requiring alternative treatment priorities.
• Previous fracture, deformity, or surgical intervention involving the affected tibia.
• Neurovascular injury requiring repair.