UK FixDT

Effect of Locking Plate Fixation vs Intramedullary Nail Fixation on 6-Month Disability Among Adults With Displaced Fracture of the Distal Tibia: The UK FixDT Randomized Clinical Trial.

Costa ML, Achten J, Griffin J, et al. JAMA 2017 · PMID 29136444 · doi:10.1001/jama.2017.16429

Question

In displaced extra-articular distal tibial fractures, does locking plate fixation give better function than intramedullary nailing?

Design

Pragmatic multicentre RCT in UK trauma hospitals.

Patients

Adults aged 16 or over with an acute displaced extra-articular distal tibial fracture; open fractures and fractures involving the ankle joint were excluded.

Intervention

Locking plate fixation

Comparison

Intramedullary nail fixation

Primary outcome

Disability Rating Index at 6 months

Key result

Disability at 6 months did not differ significantly between plate and nail. Nailing gave significantly better function at 3 months.

Limitations

Surgeons and patients were not blinded, and the trial was not powered for rarer complications such as malunion.

Impact on practice

Either implant is reasonable for closed extra-articular distal tibial fractures; many UK surgeons favour nailing given the earlier functional recovery.