What’s the Claim?
A 5-year follow-up of an earlier, major randomized trial published in JAMA found no differences between a locking plate and an intramedullary nail for extra-articular distal tibial fractures in terms of residual disability, quality of life, or complications. The study enrolled patients whose fractures were within two “Müller squares” of the ankle. (I had to look up Müller square — Müller defined a square based upon the width of the patient’s distal tibia in order to have a measurement that normalizes height and skeletal size across patients of different sizes.) The study also found that for most patients, levels of disability leveled off about 12 months after surgery, and that according to the Disability Rating Index, the level of persistent disability — which stayed about the same from one year to five years of follow-up — was about 20%.