Efficacy comparison of absolute and bridging fixation in plate osteosynthesis for simple distal tibia fracture

Objective To compare the clinical efficacy between absolute fixation and bridging fixation in plate osteosynthesis for simple distal tibia fracture. Methods A retrospective case control study was conducted to analyze 41 patients with simple distal tibia fracture admitted to the Chongqing People's Hospital from January 2013 to November 2016. There were 24 males and 17 females, aged 24-70 years [(46.3±13.1)years]. According to AO/OTA classification, fractures weres was AO/OTA type 42A1 in 29 cases, type 42A2 in nine cases, type 42A3 in two cases, and type 43A1 in one case. All patients were treated with plate and screw fixation. According to the method of plate fixation, the patients were divided into the locking compression plate (LCP) absolute fixation group (14 patients), the LCP bridge fixation group (12 patients) and the LCP+ dynamic double thread locking screw (DDTL) bridge fixation group (15 patients). The patients were followed up by taking anteroposterior and lateral radiographs of tibia and fibula during outpatient visits 1, 2, 3, 6 months and 1 year after operation. The operation time, time to radiological fracture union, time to full weight bearing, callus index and complications were analyzed. Results All the patients were followed up for 12-18 months[(14.5±2.0)months]. In the LCP absolute fixation, LCP and LCP+ DDTL groups, the operation time was (74.3±15.6)minutes, (78.6±20.1)minutes and (82.5±24.6)minutes, respectively; the time to radiological fracture union was (4.3±1.5)months, (4.5±1.3)months and (4.6±1.4)months, respectively; the time to full weight bearing were (3.4±0.7)months, (3.5±0.6)months and (3.6±1.1)months, respectively (all P>0.05). There was no significant difference in complication incidence among the three groups (P>0.05). However, the callus index in the LCP+ DDTL group (1.19±0.13) was significantly higher than that of the LCP absolute fixation group (1.08±0.06) and that of the LCP group (1.09±0.09)(P<0.05). Conclusion For simple distal tibia fracture, both absolute and bridging fixation can attain good fracture union, and LCP combined with DDTL can better promote the formation of callus and facilitate the union. Key words: Tibial fractures; Fracture fixation, internal; Plates