Abstract
Background: Fractures of the distal third of the tibia represent unique management challenges because of poor soft tissue envelope, presence adjacent to ankle joint and compromised blood supply. Surgical treatment with locked intramedullary nailing (IMN) or locked plating is the current standard of care, but the best method, particularly in terms of functional outcomes, remains a matter of debate. Objective: This study aimed to compare the functional outcomes of locked intramedullary nailing versus locked plate fixation in patients with closed distal third tibial fractures. Methods: A prospective randomized trial was carried out between 202 patients who presented to the A&E with extraarticular distal 1/3rd Tibial Fractures. Patients were divided into the IMN group (101) and the plate fixation group (101). Operative time, intraoperative X-ray exposure, time to full weight-bearing, and hospital length of stay were recorded. Functional recovery was determined by a clinical and radiologic follow-up protocol. Results: IMN was associated with a shorter duration of surgery (3.29 weeks vs. 4.81 weeks), faster weight-bearing, a shorter hospitalisation period (, and more intraoperative X-rays. The two groups matched very closely in age, and there were no major changes in the long-term alignment. Conclusion: For distal third tibial fractures locked intramedullary nailing is superior to locked plate fixation for early functional outcomes and operational efficiency. Plate fixation is still helpful when the fracture is stiff to comprehend, though. Surgical treatment should be indicated based on the type of fracture and on patient characteristics.

Key words: Locked, Nail, Plate, Distal Third, Tibial, Fracture.