A prospective study on surgical management of complex proximal metaphyseal fracture of tibia with hybrid external fixation

Abstract

Background and Objectives: Fracture of Tibia shaft are the most common long bone fractures. The difficulty in treating the fracture of tibial metaphysis is exemplified by orthopaedists, who in the first half of 20th century, believed the injuries were so severe and operative repair was fraught with so many complications that the fracture was deemed not amenable for surgical reconstruction. Since there was no definitive protocol for the treatment of such fractures, the Hybrid External Fixator seemed suitable for such fractures as they combine the advantages of monolateral and circular fixation, Tensioned wires provide improved fixation in the peri-articular fragments. It allows early weight bearing and movement of the knee and ankle at all times.Methods: A Prospective study of 51 cases of surgically managed fractures of proximal Tibia using Hybrid External fixation undertaken at Department of Orthopaedics, J.J.M Medical College, Davangere from 1st June 2017 to 30th August 2020 who follow Inclusion and Exclusion criteria and followed up for a period of 6-24 months.Results: 9 patients were lost to follow up before removal of the fixator and were thus not included in the statistics. All the fractures consolidated at an average of 14 weeks and the fixators were removed. All but one of the studied fractures resulted in good union. Two proximal tibial fracture resulted in non-union. 14 patients developed pin tract infections which resolved with regular dressings.10 patients had stiffness of the knee joint. This was probably due to the patient incompliance to the physiotherapy regimen. 4 cases had delayed union which resulted in union after bone marrow injection and 2 case of non-union. Results according to the Iowa score of knee showed 5(12%) excellent, 32 (76%) good and 5(12%) fair results. Interpretation and Conclusion: Hybrid external fixator is simple, rapid and straightforward application, reduced surgical time, minimally invasive and adjustable. It has negligible complications and resulted in excellent results for this type of fractures.