Is the expert nail with poller screws superior to distal tibial locked plate in management of short oblique distal tibial fractures?: a prospective comparative randomized trial

Purpose
Distal tibial fractures are challenging to treat due to poor blood flow, which increases the risk of wound complications when plating methods are used. Intramedullary nails (IMN) offer a minimally invasive approach but may not provide as precise reduction or stability, especially in short oblique fractures. This study compares the outcomes of expert IMNs with the use of poller screws to lock plates.


Methods
In this randomized controlled trial, 65 patients were assigned to receive either expert IMNs with poller screws or distal tibial locked plates. Outcomes, including Olerud Molander Ankle Score, operative time, union time, and complications, were evaluated over 6 months.


Results
The IMN group showed significantly higher Olerud Molander Ankle Score at 3 and 6 months (P<0.0001 and P=0.0002) and shorter operative times (P=0.039). Both groups had similar complication rates, but the plate group had two nonunions.


Conclusion
Expert IMNs with poller screws provide better functional outcomes and shorter operative times than distal tibial locked plates in short oblique fractures, with similar complication rates. This randomized controlled trial was registered on ClinicalTrials.gov (ID: NCT06436365).