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Yang X, Zhang X, Liu C, Zhang L, Wu F, Shen Q, Yu Y. Treatment of Distal Third Tibial Fractures with Anterior Soft Tissue Compromise through the Posterolateral Approach: Distal Third Tibial Fractures via the Posterolateral Approach. J Foot Ankle Surg 2024:S1067-2516(24)00215-1. [PMID: 39245431 DOI: 10.1053/j.jfas.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/27/2024] [Accepted: 09/01/2024] [Indexed: 09/10/2024]
Abstract
Distal third tibial fractures associated with anterior soft tissue compromise are a predictor of more complications and poor prognosis. The study aimed to introduce the treatment of such fractures through the posterolateral approach. From March 2020 and January 2022, 32 patients with distal third tibial fractures were plated through the posterolateral approach due to concurrent closed anterior soft tissue compromise. There were 30 male and 2 female patients with the mean age of 33 years (range, 20-53 years). The reduction quality of diaphyseal fractures was good (n=30) and acceptable (n=2). The reduction quality of articular fragments was anatomic (n=21), good (n=6), and fair (n=1). All anterior soft tissue injuries healed without surgical intervention. Follow-ups lasted 28 months (range, 25-34 months). The mean dorsiflexion of the injured and uninjured ankles were 17.8°±5.4° and 24.5°±6.6°, respectively (P<0.05). The mean plantar flexion of the ankles were 42°±8.8° and 46°±12.9°, respectively (P>0.05). The mean inversion of the injured and uninjured ankles were 15°±13.3° and 19°±12.4°, respectively (P<0.05). The mean eversion of the injured and uninjured ankles were 27.8°±16.9° and 32.9°±14.3°, respectively (P>0.05). The mean American Orthopaedic Foot and Ankle score was 90 (range, 68-100). Distal third tibial fractures with anterior soft tissue compromise can be plated through the posterolateral approach, resulting in good functional outcomes and minimum complications. LEVEL OF EVIDENCE: Therapeutic study, Level IV.
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Affiliation(s)
- Xiaoliang Yang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xu Zhang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Caixia Liu
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Liming Zhang
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Fan Wu
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Qiang Shen
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Yadong Yu
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Mishra J, Kumar Das T, Guglani K, Behera S, Zion N, Biradar P. Single-Incision Direct Lateral Approach Versus Dual-Incision Approach for Distal Tibial and Fibular Fractures. Cureus 2024; 16:e69516. [PMID: 39416565 PMCID: PMC11481409 DOI: 10.7759/cureus.69516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2024] [Indexed: 10/19/2024] Open
Abstract
INTRODUCTION Distal tibial and fibular fractures are typically the result of high-energy trauma. Open reduction and internal fixation (ORIF) are often used to reconstruct and reduce displaced fractures, especially intra-articular ones. These fractures can be addressed either by a dual-incision approach (medial approach for the distal tibia and lateral approach for the fibula) or by a single-incision direct lateral approach to fix both the tibia and fibula. The direct lateral approach avoids injury to the medial soft tissues. This study was conducted to compare the postoperative clinico-radiological and functional outcomes of the single-incision direct lateral approach and the dual-incision approach for distal tibial and fibular fractures. MATERIALS AND METHODS A prospective comparative cohort study of 40 patients was conducted. The patients were classified into two cohorts of 20 each based on the surgical approach: those who underwent a single-incision direct lateral approach and those who underwent a dual-incision approach for distal tibial and fibular fractures (procedure: ORIF with plating). The study was conducted from September 2022 to March 2024. A follow-up period of at least 12 months was carried out, comparing operative time, discharge time, and postoperative outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, ankle range of motion (ROM), Southampton wound score for wound healing, visual analog scale (VAS) pain score, and periodic radiographs at each follow-up. Complications were also studied. RESULTS The mean operative time was 95.06 ± 7.04 minutes for the single-incision approach and 109.89 ± 7.88 minutes for the dual-incision approach. The average blood loss was 202.41 ± 32.76 mL for the single-incision approach and 248.39 ± 28.18 mL for the dual-incision approach. The hospital stay was shorter in the direct lateral approach group, and the AOFAS score at 12 months was better in the direct lateral approach group (91.47 ± 2.55 for the single-incision approach vs. 83.33 ± 8.71 for the dual-incision approach). Postoperative wound healing was observed, and the Southampton wound score was compared. Overall, soft tissue complications were fewer in the direct lateral approach group. The postoperative VAS pain score was consistently lower in the single-incision direct lateral approach group, which also demonstrated better ankle ROM. The p-value was significant (<0.05) for these parameters. At the six-month follow-up, all patients exhibited clinical and radiographic healing and bone union, except for one case in the dual-incision group. A medial compound wound, treated by plastic surgery with flap cover intervention, was identified as one of the definitive indications for single-incision plating. CONCLUSION The single-incision approach was associated with better soft tissue healing, fewer wound complications, and superior ankle functional outcomes compared to the dual-incision approach.
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Affiliation(s)
- Jitendra Mishra
- Department of Orthopaedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Tapan Kumar Das
- Department of Orthopaedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Kshitij Guglani
- Department of Orthopaedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Sudarsan Behera
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, IND
| | - Nego Zion
- Department of Orthopaedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Prasanna Biradar
- Department of Orthopaedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
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Hierholzer C, Neuhaus V, Pape HC. Frame concept using combined locked nail and plate osteosynthesis for treatment of osteoporotic distal tibial fractures (DiTiFra) how augmented fixationrigidity may help early weightbearing. Injury 2024; 55:111713. [PMID: 39018641 DOI: 10.1016/j.injury.2024.111713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Affiliation(s)
| | - Valentin Neuhaus
- Department of Traumatology, University Hospital Zurich, Switzerland
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Chaudhry YP, Gutierrez-Naranjo JM, Raad M, Ghanem D, Salazar LM, Goodrum JT, Luksameearunothai K, Zelle BA, Hasenboehler EA. Risk factors for malalignment after intramedullary nail treatment of distal tibia fractures with associated fibula fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3265-3273. [PMID: 39136728 PMCID: PMC11377517 DOI: 10.1007/s00590-024-04062-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/31/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE Malalignment of distal tibia fractures can lead to malunion/nonunion or alter the limb mechanical axis which may cause arthritis. Proposed methods to decrease malalignment include fibular fixation or multiplanar interlocking screws, however these remain controversial. This study aimed to identify factors associated with malalignment in distal tibial fractures with associated fibular shaft fractures. METHODS A retrospective review was performed of distal tibia fractures with associated fibular shaft fractures treated with intramedullary nailing at two level one trauma centers between 2015 and 2019. Cases involving malalignment (> 5° of deviation from anatomic axis on either coronal/sagittal axis) on final follow-up (minimum three months postoperatively) were compared to those without malalignment with regard to demographics, fracture characteristics, intraoperative characteristics, and complications. RESULTS The rate of malalignment was 13%. On multivariate analysis, multiplanar distal interlocking screw fixation (odds ratio [OR], 0.18; 95% confidence interval [CI] 0.03-0.92) was associated with a decreased rate of final malalignment, while nail diameter > 10 mm was associated with a higher rate (OR, 4.05; 95% CI 1.25-13.11). Fibular fixation was not associated with malalignment. CONCLUSION Multiplanar distal interlocking screws may protect against malalignment. Fibula fixation does not appear associated with a decreased rate of malalignment in distal tibia fractures treated with intramedullary nails. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yash P Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Avenue, Philadelphia, PA, 19131, USA.
| | | | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diane Ghanem
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luis M Salazar
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - Jason T Goodrum
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | | | - Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - Erik A Hasenboehler
- Holy Spirit Medical Center Penn State Health, Orthopaedic Institute of Pennsylvania, Camp Hill, PA, USA
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Fan Y, Leape CP, Hugard S, McCanne M, Thomson A, Wojtkiewicz GR, Weaver MJ, Collins JE, Randolph M, Oral E. A longitudinal rat model for assessing postoperative recovery and bone healing following tibial osteotomy and plate fixation. BMC Musculoskelet Disord 2023; 24:854. [PMID: 37907937 PMCID: PMC10617055 DOI: 10.1186/s12891-023-06942-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 10/07/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Rodent models are commonly employed to validate preclinical disease models through the evaluation of postoperative behavior and allodynia. Our study investigates the dynamic interplay between pain and functional recovery in the context of traumatic osteotomy and surgical repair. Specifically, we established a rat model of tibial osteotomy, followed by internal fixation using a 5-hole Y-plate with 4 screws, to explore the hypothesis that histological bone healing is closely associated with functional recovery. OBJECTIVE Our primary objective was to assess the correlation between bone healing and functional outcomes in a rat model of tibial osteotomy and plate fixation. METHODS Seventeen male Sprague-Dawley rats underwent a metaphyseal transverse osteotomy of the proximal tibia, simulating a fracture-like injury. The resultant bone defect was meticulously repaired by realigning and stabilizing the bone surfaces with the Y-plate. To comprehensively assess recovery and healing, we performed quantitative and qualitative evaluations at 2, 4, 6, and 8 weeks post-surgery. Evaluation methods included micro-CT imaging, X-ray analysis, and histological examination to monitor bone defect healing. Concurrently, we employed video recording and gait analysis to evaluate functional recovery, encompassing parameters such as temporal symmetry, hindlimb duty factor imbalance, phase dispersion, and toe spread. RESULTS Our findings revealed complete healing of the bone defect at 8 weeks, as confirmed by micro-CT and histological assessments. Specifically, micro-CT data showed a decline in fracture volume over time, indicating progressive healing. Histological examination demonstrated the formation of new trabecular bone and the resolution of inflammation. Importantly, specific gait analysis parameters exhibited longitudinal changes consistent with bone healing. Hindlimb duty factor imbalance, hindlimb temporal symmetry, and phase dispersion correlated strongly with the healing process, emphasizing the direct link between bone healing and functional outcomes. CONCLUSIONS The establishment of this tibia osteotomy model underscores the association between bone healing and functional outcomes, emphasizing the feasibility of monitoring postoperative recovery using endpoint measurements. Our overarching objective is to employ this model for assessing the local efficacy of drug delivery devices in ameliorating post-surgical pain and enhancing functional recovery.
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Affiliation(s)
- Yingfang Fan
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, 55 Fruit St. GRJ 1231, Boston, MA, 02114, USA
| | - Charlotte P Leape
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Shannon Hugard
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Madeline McCanne
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Thomson
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Boston College, Boston, MA, USA
| | | | - Michael J Weaver
- Department of Orthopaedic Surgery, Harvard Medical School, 55 Fruit St. GRJ 1231, Boston, MA, 02114, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Jamie E Collins
- Department of Orthopaedic Surgery, Harvard Medical School, 55 Fruit St. GRJ 1231, Boston, MA, 02114, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Randolph
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, 55 Fruit St. GRJ 1231, Boston, MA, 02114, USA
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA.
- Department of Orthopaedic Surgery, Harvard Medical School, 55 Fruit St. GRJ 1231, Boston, MA, 02114, USA.
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Lv C, Jiang C, Lv W, Zhang S, Li C. Effect of intramedullary nail fixation and internal plate fixation in distal tibia fracture surgery on post-operative wound infection in patients: A meta-analysis. Int Wound J 2023; 21:e14383. [PMID: 37828714 PMCID: PMC10828126 DOI: 10.1111/iwj.14383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/14/2023] Open
Abstract
Distal tibial fracture is the most commonly seen type of fracture of the lower extremities. Both intramedullary nail fixation (INF) and plate fixation (PF) have been used to treat distal tibial fractures, but the best way to treat them is still in dispute. The purpose of this meta-analysis is to compare INF versus PF fixation with respect to the incidence of injury. For studies that have been published between inception and June 2023, a systematic review has been carried out on PubMed, Embase, Cochrane Library and Web of Scientific databases. All of the trials that looked at INF and PF-related complications were enrolled. Data from the 13 primary results were analysed with RevMan 5.3. The meta-analyses comprised 13 randomized controlled trials (RCTs). INF indicates that there is a tendency for patients with distal tibia fractures to reduce the risk of operative site infection (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.40, 3.13; p = 0.0003) after surgery compared with PF. INF resulted in a reduction in total wound complications (OR, 14.20; 95% CI, 1.81, 111.57; p = 0.01) but shortened operation time (mean difference, 13.03; 95% CI, 2.08, 23.99; p = 0.02). In view of these findings, INF seems to be a preferred method of surgery for the treatment of distal tibial fractures with respect to the reduction of post-operative wound complications.
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Affiliation(s)
- Changli Lv
- Department of Paediatric SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityChina
| | - Cuifeng Jiang
- Department of Paediatric SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityChina
| | - Weifeng Lv
- Department of Paediatric SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityChina
| | - Shanshan Zhang
- Department of Hand and Foot SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Chengxue Li
- Department of Paediatric SurgeryPeople's Hospital Affiliated to Shandong First Medical UniversityChina
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7
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Rouf S, Malik A, Raina A, Irfan Ul Haq M, Naveed N, Zolfagharian A, Bodaghi M. Functionally graded additive manufacturing for orthopedic applications. J Orthop 2022; 33:70-80. [PMID: 35874041 PMCID: PMC9304666 DOI: 10.1016/j.jor.2022.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/22/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background Additive Manufacturing due to its benefits in developing parts with complex geometries and shapes, has evolved as an alternate manufacturing process to develop implants with desired properties. The structure of human bones being anisotropic in nature is biologically functionally graded i,e. The structure possesses different properties in different directions. Therefore, various orthopedic implants such as knee, hip and other bone plates, if functionally graded can perform better. In this context, the development of functionally graded (FG) parts for orthopedic application with tailored anisotropic properties has become easier through the use of additive manufacturing (AM). Objectives and Rationale: The current paper aims to study the various aspects of additively manufactured FG parts for orthopedic applications. It presents the details of various orthopedic implants such as knee, hip and other bone plates in a structured manner. A systematic literature review is conducted to study the various material and functional aspects of functionally graded parts for orthopedic applications. A section is also dedicated to discuss the mechanical properties of functionally graded parts. Conclusion The literature revealed that additive manufacturing can provide lot of opportunities for development of functionally graded orthopedic implants with improved properties and durability. Further, the effect of various FG parameters on the mechanical behavior of these implants needs to be studied in detail. Also, with the advent of various AM technologies, the functional grading can be achieved by various means e.g. density, porosity, microstructure, composition, etc. By varying the AM parameters. However, the current limitations of cost and material biocompatibility prevent the widespread exploitation of AM technologies for various orthopedic applications.
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Affiliation(s)
- Saquib Rouf
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Abrar Malik
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Ankush Raina
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Mir Irfan Ul Haq
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Nida Naveed
- Faculty of Technology, University of Sunderland, UK
| | | | - Mahdi Bodaghi
- School of Science and Technology, Nottingham Trent University, UK
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Ramalingam WG, Carry P, Brazell C, Calkins R, Linza-Moscati S, Stoneback J, Miller NH. Outcomes of displaced adolescent distal third tibia fractures: can we do better? J Pediatr Orthop B 2022; 31:e147-e153. [PMID: 34285160 DOI: 10.1097/bpb.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Because adolescent distal third tibia fractures pose treatment challenges, we aimed to identify factors predictive of failure among common treatment methods: casting without manipulation, closed reduction and casting (CRC) and open treatment. Among displaced fractures, we compared outcomes between CRC versus open treatment. Skeletally immature individuals (10-17 years) with extra-articular distal third tibia fractures at a level 1 trauma center (2011-2017) were retrospectively reviewed. Patient demographics, injury and treatment characteristics and complications were recorded. Radiographs were evaluated for unacceptable alignment (angulation >5°, translation >50%, and shortening >1 cm) and time to union. Of 140 individuals, casting was the most common treatment method (n = 81), followed by CRC under anesthesia/sedation (n = 38), and open treatment (n = 34). For fractures casted without manipulation, increased fracture severity based upon our novel grading system [hazard ratio (HR): 10.5, 95% CI, 4.2-27.5, P < 0.0001] was significantly related to treatment failure. Outcomes for a selected group of 47 initially displaced fractures (33 CRC and 14 open treatments) were evaluated. For CRC, 9 (27.3%) healed with malunion and 6 (18.2%) failed initial CRC, resulting in a treatment failure rate of 36.7%. For open treatment, 2 (14.3%) underwent hardware removal, 2 (14.3%) healed with malunion and one developed infection requiring reoperation. No fractures healed with malunion required surgical correction during the study period. The odds of persistent malalignment in CRC was 3.77 [95% CI, 0.44-32.60, P = 0.2274] times open treatment. Adolescent minimally displaced distal tibial fractures can undergo successful treatment with casting. However, displaced fractures have a higher chance of short-term failure with CRC. Close monitoring of displaced fractures in the adolescent is essential during conservative management.
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Affiliation(s)
| | - Patrick Carry
- Department of Orthopaedic Surgery, Musculoskeletal Research Center
| | | | - Ryan Calkins
- Department of Orthopaedic Surgery, Musculoskeletal Research Center
| | | | - Jason Stoneback
- Department of Orthopaedic Surgery, University of Colorado, Denver
| | - Nancy Hadley Miller
- Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
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Kellam PJ, Dekeyser GJ, Haller JM, Higgins TF, Rothberg DL, Marchand LS. Determining your implant: Templating a nail for the distal tibia fracture. Injury 2022; 53:789-797. [PMID: 34836630 DOI: 10.1016/j.injury.2021.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 02/02/2023]
Abstract
The goal of this article is to aid the orthopedic surgeon in determining whether an intra-medullary (IM) device for fixation of a distal tibia fracture is feasible. Using Computed Tomography (CT) scans of the fracture, this review demonstrates a simple way to determine whether two or even three distal interlocking screws are achievable in stable bone. Additionally, this paper offers a summary chart of commonly used tibial nails which can be used for planning purposes. Finally, a clinical summary of very distal tibial shaft fractures treated with IM fixation is provided.
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Affiliation(s)
- Patrick J Kellam
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Graham J Dekeyser
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Thomas F Higgins
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - David L Rothberg
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Lucas S Marchand
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
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Lu Y, Yang J, Xu Y, Ma T, Li M, Ren C, Huang Q, Zhang C, Wang Q, Li Z, Zhang K. An Approach to Intraoperatively Identify the Coronal Plane Deformities of the Distal Tibia When Treating Tibial Fractures with Intramedullary Nail Fixation: a Retrospective Study. Orthop Surg 2021; 14:365-373. [PMID: 34964267 PMCID: PMC8867441 DOI: 10.1111/os.13194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/07/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To develop a new approach to intraoperatively identify the presence of coronal plane deformities (both valgus and varus) when treating tibial fractures with closed reduction and intramedullary nail fixation. Methods A retrospective analysis was conducted by enrolling 33 consecutive patients with tibial fractures who received closed reduction and intramedullary nail fixation from January 2018 to January 2019 at our trauma center. Out of the 33 patients, 23 were males and 10 were females and the average age was 41 years (ranging 22 to 69 years of age). Standard anteroposterior and lateral preoperative radiographs were routinely performed. After intraoperatively inserting the tibial intramedullary nail through the standard entry point, the parallel relationship between the distal horizontal interlocking screw and the tibiotalar joint surface on the anteroposterior fluoroscopy was used to determine the occurrence of valgus or varus deformities of the distal tibial fragment. Radiographic and clinical outcomes were analyzed using the average interval from injury to surgery, the lateral distal tibial angle (LDTA) of the unaffected and affected sides, complications and the Olerud–Molander ankle score. Results All 33 patients were postoperatively followed for 13 to 25 months (mean 18.7 months). The fractures achieved bone union at an average of 4.3 months (ranging from 3 to 6 months). The total complication rate was 60.6% (20 cases), including four cases that showed deep vein thrombosis, one case showing an infection and delayed union and 15 cases showing slight to moderate anterior knee pain. The postoperative LDTA of the unaffected side measured 87.3° to 89.6 ° (average 88.7° ± 0.8°), and the LDTA of the affected side was 87.5° to 90.4° (average 88.9° ± 1.1°). There was no significant difference between the unaffected and affected sides (t = −1.865, P = 0.068). The intraoperative measurement indicated six cases of valgus angulation and three cases of varus angulation deformities, and all deformities were corrected during surgery. According to the Olerud–Molander ankle score, clinical outcomes demonstrated 22 excellent cases, eight good cases, two fair cases, and one poor case 12 months after surgery. Conclusion The parallel relationship between the distal horizontal interlocking screw and tibiotalar joint surface on intraoperative anteroposterior films were able to determine the onset of valgus or varus angulations of the distal tibial fragment in the fracture zone after the tibial intramedullary nail was inserted through the standard entry point.
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Affiliation(s)
- Yao Lu
- Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Jie Yang
- Department of Orthopedics Surgery II, Langfang People's Hospital, Langfang, China
| | - Yibo Xu
- Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Teng Ma
- Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Ming Li
- Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Cheng Ren
- Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Qiang Huang
- Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Congming Zhang
- Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Qian Wang
- Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Zhong Li
- Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Kun Zhang
- Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, China
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Lu Y, Wang G, Hu B, Ren C, Sun L, Wang Z, He C, Xue H, Li Z, Zhang K, Ma T, Wang Q. Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures. J Orthop Surg Res 2020; 15:422. [PMID: 32943096 PMCID: PMC7500032 DOI: 10.1186/s13018-020-01960-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches. Methods A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements. Results A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P > 0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P < 0.05). Conclusions In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, HongHui Hospital, Xi'an Jiaotong University, 555 Youyi East Road, Xi'an, 710054, Shaan'xi Province, China.,Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Gen Wang
- Orthopaedics Institute of Chinese PLA, 80th Hospital, 3770 Beigongxijie, Weifang, Shandong Province, China
| | - Bin Hu
- Department of Hematology, Xi'an Gao Xin Hospital, Xi'an, 710054, Shaan'xi Province, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, HongHui Hospital, Xi'an Jiaotong University, 555 Youyi East Road, Xi'an, 710054, Shaan'xi Province, China
| | - Liang Sun
- Department of Orthopaedic Surgery, HongHui Hospital, Xi'an Jiaotong University, 555 Youyi East Road, Xi'an, 710054, Shaan'xi Province, China
| | - Zhimeng Wang
- Department of Orthopaedic Surgery, HongHui Hospital, Xi'an Jiaotong University, 555 Youyi East Road, Xi'an, 710054, Shaan'xi Province, China
| | - Changjun He
- Yan'an University, Yan'an, 710000, Shaanxi, China
| | - Hanzhong Xue
- Department of Orthopaedic Surgery, HongHui Hospital, Xi'an Jiaotong University, 555 Youyi East Road, Xi'an, 710054, Shaan'xi Province, China
| | - Zhong Li
- Department of Orthopaedic Surgery, HongHui Hospital, Xi'an Jiaotong University, 555 Youyi East Road, Xi'an, 710054, Shaan'xi Province, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, HongHui Hospital, Xi'an Jiaotong University, 555 Youyi East Road, Xi'an, 710054, Shaan'xi Province, China
| | - Teng Ma
- Department of Orthopaedic Surgery, HongHui Hospital, Xi'an Jiaotong University, 555 Youyi East Road, Xi'an, 710054, Shaan'xi Province, China. .,Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Qian Wang
- Department of Orthopaedic Surgery, HongHui Hospital, Xi'an Jiaotong University, 555 Youyi East Road, Xi'an, 710054, Shaan'xi Province, China.
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Özer M, Kesik K, Başbuğ V, Türkmen F, Kaçıra BK, Korucu İH, Çolak TS, Memik R. Eklem dışı distal tibia kırıklarının (AO-43A) tedavisinde intramedüller çivi ve minimal invaziv perkütan plak osteosentez uygulamalarının karşılaştırılması. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.461674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hu L, Xiong Y, Mi B, Panayi AC, Zhou W, Liu Y, Liu J, Xue H, Yan C, Abududilibaier A, Chen L, Liu G. Comparison of intramedullary nailing and plate fixation in distal tibial fractures with metaphyseal damage: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2019; 14:30. [PMID: 30683118 PMCID: PMC6347848 DOI: 10.1186/s13018-018-1037-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background Distal metadiaphyseal tibial fractures are commonly seen lower limb fractures. Intramedullary nail fixation (IMN) and plate internal fixation (PL) are the two mainstay treatments for tibial fractures, but agreement on the best internal fixation for distal tibial fractures is still controversial. This meta-analysis was designed to compare the success of IMN and PL fixations in the treatment of distal metadiaphyseal tibial fractures, in terms of complications and functional recovery. Methods A systematic research of the literature was conducted to identify relevant articles that were published in PubMed, MEDLINE, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov, and OVID from the database inception to August 2018. All studies comparing the complication rate and functional improvement of I2MN and PL were included. Data on the 12 main outcomes were collected and analyzed using the Review Manager 5.3. Results Eleven studies were included in the current meta-analysis. A significant difference in malunion (RR = 1.76, 95%CI 1.21–2.57, P = 0.003), superficial infection (RR = 0.29, 95%CI 0.13–0.63, P = 0.002), FFI (MD = 0.09, 95%CI 0.01–0.17, P = 0.02), and knee pain (RR = 3.85, 95%CI 2.07–7.16, P < 0.0001) was noted between the IMN group and PL group. No significant difference was seen in the operation time (MD = − 10.46, 95%CI − 21.69–0.77, P = 0.07), radiation time (MD = 7.95, 95%CI − 6.65–22.55, P = 0.29), union time (MD = − 0.21, 95%Cl − 0.82–0.40, P = 0.49.), nonunion (RR = 2.17,95%CI 0.79–5.99, P = 0.15), deep infection (RR = 0.85, 95%CI 0.35–2.06, P = 0.72), delay union (RR = 0.92, 95%CI 0.45–1.87, P = 0.82), AOFAS (MD 1.26, 95%Cl − 1.19–3.70, P = 0.31), and Disability Rating Index in 6 or 12 months (MD = − 3.75, 95%CI − 9.32–1.81, P = 0.19, MD = − 17.11, 95%CI − 59.37–25.16, P = 0.43, respectively). Conclusions Although no significant difference was seen between IMN and PL fixation with regards to the operation time, radiation time, nonunion, deep infection delay union, union time, AOFAS, and Disability Rating Index, significant differences were seen in occurrence of malunion, superficial infection, FFI, and knee pain. Based on this evidence, IMN appears to be a superior choice for functional improvement of the ankle and reduction of postoperative wound superficial infection. PL internal fixation seems to be more advantageous in achieving anatomical reduction and decreasing knee pain.
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Affiliation(s)
- Liangcong Hu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China
| | - Adriana C Panayi
- Department of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, 02152, USA
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China
| | - Yi Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China
| | - Jing Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China
| | - Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China
| | - Chengcheng Yan
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China
| | - Abudula Abududilibaier
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China
| | - Lang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Avenue, Wuhan, 430022, China.
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Terminal position of a tibial intramedullary nail: a computed tomography (CT) based study. Eur J Trauma Emerg Surg 2018; 46:1077-1083. [DOI: 10.1007/s00068-018-1000-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 08/20/2018] [Indexed: 11/27/2022]
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Molepo M, Barnard AC, Birkholtz F, Tetsworth K, Glatt V, Hohmann E. Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1617-1624. [PMID: 29797094 DOI: 10.1007/s00590-018-2231-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical and functional outcomes of failed plate fixation in distal tibia fractures salvaged with hexapod circular fixators. MATERIALS AND METHODS The database of a specialized limb reconstruction center was searched for all patients with failed plate fixation undergoing limb reconstruction with a circular external fixator between 2008 and 2017. Patients between the ages of 18-65 years, with a symptomatic distal tibia malunion or non-union following plate and screw fixation were included. The SF-12 and Foot Function Index (FFI) scoring systems were used to measure clinical and functional outcomes. RESULTS Ten patients with a mean age of 38 ± 13 years met the inclusion criteria. Seven patients had an infected non-union, two hypertrophic non-unions, and one a malunion. The mean follow-up was 41.7 ± 28.3 months. The mean duration of external fixation was 232.9 ± 146.6 days. The SF-12 demonstrated a mean score of 49.4 ± 7.7 for the physical component and a mean score of 55.3 ± 8.1 for the mental component. Five patients (50%) scored above 45 points for the SF12 physical component, and nine patients (90%) scored above 45 points for the mental component, indicating good outcome can be achieved. The mean FFI score was 24.9 ± 19.9, and six patients had a score below 14 points (good outcome). Radiological union was observed in all 10 patients at a mean of 29 ± 14 months. CONCLUSIONS The results of this study suggest that hexapod circular external fixation is an attractive surgical alternative for the treatment of failed plate fixation of distal tibial fractures, and can reliably achieve bony union and result in very satisfactory clinical outcomes. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Maketo Molepo
- Department of Orthopaedic Surgery, University of Pretoria, Pretoria, South Africa
| | | | - Franz Birkholtz
- Department of Orthopaedic Surgery, University of Pretoria, Pretoria, South Africa.,Walk-A-Mile Centre for Advanced Orthopaedics, Centurion, Pretoria, South Africa
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Brisbane, Australia.,Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia.,Orthopaedic Research Centre of Australia, Brisbane, Australia
| | - Vaida Glatt
- Orthopaedic Research Centre of Australia, Brisbane, Australia.,University of Texas Health Science Center, San Antonio, Tx, USA
| | - Erik Hohmann
- School of Medicine, University of Pretoria, Pretoria, South Africa. .,Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, PO Box 414296, Dubai, United Arab Emirates.
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16
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Chen Q, Song L, Fang J, Qin X, Lv T, Li X. Effectiveness of Diagnosis and Treatment of Spiral Fracture of the Distal Third of the Tibia Combined with Posterior Malleolus Fracture A Series of Ten Cases. J Am Podiatr Med Assoc 2018; 108:106-114. [PMID: 29634298 DOI: 10.7547/15-181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Spiral fractures of the tibia are often the result of torsion trauma. In clinical practice, this type of fracture is frequently complicated by posterior malleolus fractures. This study aimed to observe the effectiveness of diagnosis and treatment of these fractures in a single hospital in China. Posterior malleolus fractures are sometimes occult, occurring alongside spiral fractures of the distal third of the tibia; posttraumatic arthritis can result if they are missed. METHODS This study includes 128 consecutive patients with tibia fractures between May 1, 2008, and April 30, 2012. Patients in the early study period underwent radiography only, and subsequent patients underwent both radiography and computed tomography (CT). The causes of the fractures were evaluated. Intramedullar nailing was performed for the tibia fractures. Percutaneous cannulated screw fixation was used for the posterior malleolus fractures. Patients were followed up for a minimum of 3 months. RESULTS Twenty-eight patients had spiral fractures of the mid-distal third of the tibia. Ten of the 28 patients were complicated by posterior malleolus fractures. Diagnosis was initially missed in one early patient who underwent radiography only. Three cases of posterior malleolus fractures were identified by radiography. A CT was performed in all ten patients and showed that approximately 25% to 50% of the ankle joint surface of posterior malleolus fractures was involved. One early diagnosis was missed that had a displaced posterior malleolus fracture after intramedullary nailing. Using CT as the gold standard, radiography had sensitivity of 33.3%, specificity of 100.0%, positive predictive value of 100%, and negative predictive value of 73.9%. All correctly diagnosed patients healed well, without ankle pain. CONCLUSIONS Computed tomography helped identify most posterior malleolus fractures, and radiography alone might miss it. Intramedullary nailing and posterior malleolus screw fixation were straightforward and effective treatments.
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Affiliation(s)
- Qun Chen
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lijun Song
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiahu Fang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaodong Qin
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tianrun Lv
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Li
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Wenger R, Oehme F, Winkler J, Perren SM, Babst R, Beeres FJP. Absolute or relative stability in minimal invasive plate osteosynthesis of simple distal meta or diaphyseal tibia fractures? Injury 2017; 48:1217-1223. [PMID: 28302305 DOI: 10.1016/j.injury.2017.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/28/2017] [Accepted: 03/06/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Minimal invasive plate osteosynthesis in simple distal meta or diaphyseal tibia fractures can be applied using absolute (lag screw and neutralisation plate; LSN) or relative stability (bridge plate; BP). The primary aim of the study was to compare time to radiological union and time to full weight bearing in the two groups (LSN vs. BP). Reduction was performed either percutaneously or by a minimally open approach (mini open). Secondary aim was to analyse the number of complications between both groups. METHODS Retrospective single centre review of patients with a simple distal meta or diaphyseal tibia fracture operated with a Locking Compression Plate (LCP) between 2009 and 2015 in a Level one Trauma Centre. Postoperative radiographs were assessed in a standardised manner. Time to radiological fracture union and time to full weight bearing were observed. Callus index and postoperative complications were analysed. RESULTS Fifty-seven patients with a minimum follow-up of 6 months were analysed. Forty-eight patients had a shaft (AO/OTA Type 42) and nine a distal tibia fracture (AO/OTA Type 43). Forty patients were treated with using the LSN concept and 17 patients with the BP concept. Median time to radiological fracture union was statistically significant shorter (p=0.04) in the LSN group with 19 weeks compared to 27 weeks in the BP-group. Time to full weight bearing was 10 weeks in both groups. A total (including implant removal) of 35 reoperations were performed in the LSN-group and 18 in the BP-group. Wound healing disorders (deep surgical site infections) were seen less the LSN group in 3/40 (7.5%) compared to the BP-group with 3/17 (17.6%). In the LSN group, there was no statistical difference in time to union or weight bearing between a percutaneous or mini open approach. CONCLUSION Stable osteosynthesis of simple distal meta or diaphyseal tibia fractures leads to faster radiologic fracture healing without an increase in complications or number of revisions compared to bridge plating. If a percutaneous reduction is not feasible for the insertion of a lag screw, a mini-open approach does not lead to a delay in fracture healing.
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Affiliation(s)
- R Wenger
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland; Department of Hand-, Plastic- and Reconstructive Surgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland
| | - F Oehme
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - J Winkler
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - S M Perren
- Dischmastrasse 22, 7260, Davos-Dorf, Switzerland
| | - R Babst
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - F J P Beeres
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland.
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Li A, Wei Z, Ding H, Tang H, Liu Y, Shi J, Zhou H, Feng SQ. Minimally invasive percutaneous plates versus conventional fixation techniques for distal tibial fractures: A meta-analysis. Int J Surg 2016; 38:52-60. [PMID: 27993719 DOI: 10.1016/j.ijsu.2016.12.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/02/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This meta-analysis was performed to determine the effects of minimally invasive percutaneous plate osteosynthesis (MIPO) versus conventional fixation techniques (CFT) for treating distal tibial fractures. METHODS A literature search was performed in EMBASE, Medline, the Cochrane Library, and Web of Science. The trials searched were evaluated for eligibility. The Cochrane Collaboration's Review Manager software was used to perform meta-analyses. RESULTS Eight studies were enrolled, including five randomized controlled trials, one control-matched trial and two retrospective cohort trials. The meta-analysis revealed that MIPO has a longer operating time, longer radiation time and higher incidence rate of soft tissue irritation symptoms than those of CFT. There was no significant difference between the two techniques with regard to union time, the American Orthopedic Foot and Ankle Society (AOFAS), infection rate and various other complications. CONCLUSIONS The present meta-analysis showed that MIPO did not have obvious advantages over CFT in the treatment of distal tibia fracture. However, more rigorous randomized controlled trials are required in the future.
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Affiliation(s)
- Ang Li
- The Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Zhijian Wei
- The Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Han Ding
- The Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Haoshuai Tang
- The Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Yang Liu
- The Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Jiaxiao Shi
- The Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Hengxing Zhou
- The Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Shi-Qing Feng
- The Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
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Intramedullary Nail and Plate Combination Fixation for Complex Distal Tibia Fractures: When and How? J Orthop Trauma 2016; 30 Suppl 4:S17-S21. [PMID: 27768628 DOI: 10.1097/bot.0000000000000698] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Intramedullary nail and plate combination techniques have been described mostly for use in the proximal tibia. However, the nail and plate combination technique can also be used in the distal tibia, to counteract the deforming forces that cause construct failure and nonunion. In this article, we review pertinent anatomy and biomechanics and offer case examples that highlight the indications and applications of the nail and plate combination technique for distal tibia fractures.
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Extra-articular distal tibia facture (AO-43A): A retrospective study comparing modified MIPPO with IMN. Injury 2016; 47:2352-2359. [PMID: 27492066 DOI: 10.1016/j.injury.2016.07.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/07/2016] [Accepted: 07/19/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE We introduce a new MIPPO procedure which is simple and effective for the treatment of extra-articular distal tibia facture (AO-43A). The aim of this retrospective study was to compare our modified MIPPO with IMN. MATERIALS AND METHODS This retrospective study included 64 patients treated with our modified MIPPO and 61 patients with IMN. The data of sex, age, operation time, blood loss, wound complications, mal-reduction, shortening and fracture healing was analyzed. RESULTS The operation time was significantly shorter in the MIPPO group than in the IMN group (56.0min vs. 85.0min, P<0.001). There were 5 patients (8.2%) in the IMN group and 2 patients (3.1%) in the MIPPO group who had wound complications (P=0.399). Mal-reduction occurred in 17 patients (27.9%) managed with IMN and in 3 patients (4.7%) who had MIPPO (P<0.001). Furthermore, no patients had a left/right difference in the length of the tibia of >1cm and nonunion in both groups. CONCLUSIONS Our results have shown that our modified MIPPO has enormous advantages over IMN for extra-articular distal tibia fracture (AO-43A).
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Functional outcome and general health status after treatment of AO type 43 distal tibial fractures. Injury 2016; 47:1519-24. [PMID: 27129909 DOI: 10.1016/j.injury.2016.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 03/24/2016] [Accepted: 04/11/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Distal tibial fractures are uncommon, but they result in poor overall outcome. The objective of this study was to assess functional outcome and general health status after the treatment of distal tibial fractures and identify factors that affect these outcome measures. PATIENTS AND METHODS A retrospective cohort study including 118 AO type 43 distal tibial fractures in 116 patients was conducted. With regard to articular involvement, fractures were classified as either simple (A1-B2, n=70) or complex (B3-C3, n=48). Twenty relevant demographic and operative variables were studied. Functional outcome, quality of life and pain were assessed using the Foot Function Index (FFI) and AOFAS ankle score, physical and mental SF-36, and Visual Analog Scale (VAS) questionnaires, respectively. RESULTS Over 75% of patients experienced noteworthy loss of ankle function. The general health status assessment showed markedly affected quality of life with more than two-third of all responding patients suffering from pain every day. In fact, complex fractures and increased complication rate were associated with worse functional outcome, whereas prolonged time to definite surgery affected both functional outcome and general health status significantly. CONCLUSIONS Complex distal tibial fractures were associated with poor functional outcome scores and delayed (-staged) surgery has been shown to prevent postoperative soft tissue problems. However, soft tissue injury associated with distal tibial fractures itself affected both the postoperative functional outcome and general health status as well. This should contribute to the understanding of treatment and outcome of distal tibial fractures. LEVEL OF EVIDENCE 3.
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Cisneros LN, Gómez M, Alvarez C, Millán A, De Caso J, Soria L. Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation. Indian J Orthop 2016; 50:123-30. [PMID: 27053800 PMCID: PMC4800953 DOI: 10.4103/0019-5413.177577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tibial platfond fractures are usually associated with massive swelling of the foot and ankle, as well as with open wounds. This swelling may cause significant decrease of the blood flow, so the state of the soft tissue is determinant for the surgical indication and the type of implant. This retrospective study compares the union times in cases of tibial plafond fractures managed with a hybrid external fixation as a definitive procedure versus those managed with a two stage strategy with final plate fixation. MATERIALS AND METHODS A retrospective study in a polytrauma referral hospital was performed between 2005 and 2011. Patients with a tibial plafond fracture, managed with a hybrid external fixation as a definitive procedure or managed with a two stage strategy with the final plate fixation were included in the study. Postoperative radiographs were evaluated by two senior surgeons. Fracture healing was defined as callus bridging of one cortex, seen on both lateral and anteroposterior X-ray. The clinical outcome was evaluated by means of 11 points Numerical Rating Scale for pain and The American Orthopedic Foot and Ankle Society ankle score, assessed at the last followup visit. Thirteen patients had been managed with a hybrid external fixation and 18 with a two-stage strategy with the final plate fixation. There were 14 males and 17 females with a mean age of 48 years (range 19-82 years). The mean followup was 24 months (range 24-70 months). RESULTS The mean time from surgery to weight bearing was 7 ± 6.36 days for the hybrid fixation group and 57.43 ± 15.46 days for the plate fixation group (P < 0.0001); and the mean time from fracture to radiological union was 133.82 ± 37.83) and 152.8 ± 72.33 days respectively (P = 0.560). CONCLUSION Besides the differences between groups regarding the baseline characteristics of patients, the results of this study suggest that in cases of tibial plafond fractures, the management with a hybrid external fixation as a definitive procedure might involve a faster union than a two-stage management with final plate fixation.
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Affiliation(s)
- Luis Natera Cisneros
- Department of Orthopaedics and Traumatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08026 Barcelona, Spain,Department of Orthopaedics and Traumatology, Hospital General de Catalunya, Street Pedro i Pons 1, 08190, Sant Cugat del Vallés, Spain,Address for correspondence: Dr. Luis Natera Cisneros, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Street Sant Quintí 89, 08026 Barcelona, Spain. E-mail:
| | - Mireia Gómez
- Department of Orthopaedics and Traumatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08026 Barcelona, Spain
| | - Carlos Alvarez
- Department of Orthopaedics and Traumatology, Cima Clinic, Passeig Manuel Girona 29, 08034 Barcelona, Spain
| | - Angélica Millán
- Department of Orthopaedics and Traumatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08026 Barcelona, Spain
| | - Julio De Caso
- Department of Orthopaedics and Traumatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08026 Barcelona, Spain
| | - Laura Soria
- Department of Orthopaedics and Traumatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, 08026 Barcelona, Spain
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23
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Nourisa J, Rouhi G. Biomechanical evaluation of intramedullary nail and bone plate for the fixation of distal metaphyseal fractures. J Mech Behav Biomed Mater 2015; 56:34-44. [PMID: 26655955 DOI: 10.1016/j.jmbbm.2015.10.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/24/2015] [Accepted: 10/31/2015] [Indexed: 10/22/2022]
Abstract
Surgical treatment of distal metaphyseal fractures remains problematic, and whilst both intramedullary nailing and bone plate fixation are known as the acceptable methods for the internal fixation of this kind of fractures, neither technique demonstrated satisfactory clinical outcomes. In this research, a finite element based investigation was made to compare these two fixation techniques for the fixation of distal tibia fractures from the biomechanics point of view. For this purpose, a 3mm transverse fracture gap was created at the distal metaphyseal region of tibia and fixed by use of either a nail or a plate. The von Mises stress, interfragmentary movements, and the production of different tissue phenotypes at the fracture site were calculated. Results of this study showed that plating offers more advantageous biomechanical conditions at the fracture site, in which it provides sufficient amount of axial interfragmentary movement and considerable amount of cartilage production, while intramedullary nailing restricts axial movements but causes high magnitude of shear movements. However, nailing is superior to plating from the mechanical point of view and provides earlier weight bearing. In addition, it was shown that by using composite materials, biomechanical behavior of both fixation techniques will be improved through decreasing risk of failure and promoting cartilaginous tissue production.
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Affiliation(s)
- Jalil Nourisa
- Amirkabir University of Technology, Faculty of Biomedical Engineering, Tehran, Iran
| | - Gholamreza Rouhi
- Amirkabir University of Technology, Faculty of Biomedical Engineering, Tehran, Iran.
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24
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Fadel M, Ahmed MA, Al-Dars AM, Maabed MA, Shawki H. Reply to comments on Fadel et al.: Ilizarov external fixation versus plate osteosynthesis in the management of extra-articular fractures of the distal tibia. INTERNATIONAL ORTHOPAEDICS 2015; 39:1457-1458. [PMID: 25913261 DOI: 10.1007/s00264-015-2762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Mohamed Fadel
- Orthopaedic and Traumatology Department, Minia University Hospital, Minia, Egypt,
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25
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Mao Z, Wang G, Zhang L, Zhang L, Chen S, Du H, Zhao Y, Tang P. Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis. J Orthop Surg Res 2015; 10:95. [PMID: 26078031 PMCID: PMC4481115 DOI: 10.1186/s13018-015-0217-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/08/2015] [Indexed: 01/31/2023] Open
Abstract
Background The choice between intramedullary (IM) nailing or plating of distal tibia fractures without articular involvement remains controversial. A meta-analysis of randomized controlled trials (RCTs) and observational studies was performed to compare IM nailing with plating for distal tibia fractures without articular involvement and to determine the dominant strategy. Materials and methods The PubMed, Embase, Cochrane Library databases, Chinese Wan-Fang Database, and China National Knowledge Infrastructure were searched. Results Twenty-eight studies, which included 1863 fractures, met the eligible criteria. The meta-analysis did not identify a statistically significant difference between the two treatments in terms of the rate of deep infection, delayed union, removal of instrumentation, or secondary procedures either in the RCT or retrospective subgroups. IM nailing was associated with significantly more malunion events and a higher incidence of knee pain in the retrospective subgroup and across all the studies, but not significantly in the RCT subgroup, and a lower rate of delayed wound healing and superficial infection both in the RCT and retrospective subgroups relative to plating. A meta-analysis of the functional scores or questionnaires was not possible because of the considerable variation among the included studies, and no significant differences were observed. Conclusions Evidence suggests that both IM nailing and plating are appropriate treatments as IM nailing shows lower rate of delayed wound healing and superficial infection and plating may avoid malunion and knee pain. These findings should be interpreted with caution, however, because of the heterogeneity of the study designs. Large, rigorous RCTs are required.
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Affiliation(s)
- Zhi Mao
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. .,Department of Microsurgery, PLA 205 Hospital, Guta Area, JinZhou, Liaoning, 121001, People's Republic of China.
| | - Guoqi Wang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Lihai Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Shuo Chen
- Department of Medical Information, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
| | - Hailong Du
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Yanpeng Zhao
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
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26
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Is there any difference in the management of extra-articular fractures of the distal tibia using Ilizarov external fixation versus plate osteosynthesis? INTERNATIONAL ORTHOPAEDICS 2015; 39:603-4. [PMID: 25662773 DOI: 10.1007/s00264-015-2681-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
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27
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Fadel M, Ahmed MA, Al-Dars AM, Maabed MA, Shawki H. Ilizarov external fixation versus plate osteosynthesis in the management of extra-articular fractures of the distal tibia. INTERNATIONAL ORTHOPAEDICS 2014; 39:513-9. [PMID: 25472753 DOI: 10.1007/s00264-014-2607-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 11/14/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the outcome of Ilizarov external fixation (IE) versus dynamic compression plate (PO) in the management of extra-articular distal tibial fractures. METHODS Between 2010 and 2011, extra-articular distal tibial fractures in 40 consecutive patients met the inclusion criteria. They were classified according to AO classification fracture type A (A1, A2, and A3). In a randomized method, two equal groups were managed using either IE or PO. PO was performed using open reduction and internal fixation (ORIF) and DCP through anterolateral approach. IE was done using Ilizarov frame. For the PO group, non-weight bearing ambulation was permitted on the second postoperative day but partial weight bearing was permitted according to the progression in union criteria clinically and radiologically. For the IE group, weight bearing started as tolerated from the first postoperative day. Physiotherapy and pin-site care was performed by the patient themselves. RESULTS Modified Mazur ankle score was applied to IE (excellent 10, good 10) and in PO (excellent 2, good 8, poor 6). Data were statically analysed using (Mann-Whitney test). The rate of healing in the IE group (average 130) was higher than the PO (average 196.5); plus, there were no cases of delayed union or nonunion in the IE group (p value 0.003). CONCLUSION It was found that IE compared with PO provides provision of immediate weight bearing as tolerated following postoperative recovery, irrespective of radiological or clinical healing with no infection, deformity or non-union.
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Affiliation(s)
- Mohamed Fadel
- Department of Orthopaedic Surgery and Traumatology, El-Minia University Hospital, 53 Mousa Ibn-Nosai, Nasr City, 11471, Cairo, Egypt,
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