Abstract
Introduction The severity of intra-articular fractures of the distal tibia results from the morphological features of this segment, and therefore, bone injury is combined with trophic soft tissue disorders. Open reduction and internal fixation have a negative effect on reparative processes in the local morphological structures, and complications such as soft tissue necrosis, infection, infected and deforming osteoarthritis, or nonunion may develop. The aim was to show a clinical case of a stage-by-stage treatment of an intra-articular fracture of the distal tibia using minimally invasive methods, reduction with the Ilizarov apparatus and closed intramedullary osteosynthesis with a modified ChM nail. Results and discussion The Ilizarov apparatus was used for primary reduction and stabilization of the fracture that enabled to eliminate gross displacements and to align the axis of the segment. After the edema had ceased and soft tissue condition improved, closed intramedullary osteosynthesis was implemented with a modified ChM nail. Conclusion A staged approach to manage intra-articular fractures of the distal tibia enables to avoid additional soft tissue trauma and results in good clinical outcomes. The available metal intramedullary implants for intra-articular fractures are imperfect, but their modification may improve stability and decrease the risks of postoperative complications if the number of holes for locking is increased.
Highlights
The severity of intra-articular fractures of the distal tibia results from the morphological features of this segment, and bone injury is combined with trophic soft tissue disorders
The combination of bone and soft tissue trauma which is characteristic for such type of fractures does not always allow choosing a fixation method that will be optimal for the reparative process [1, 2]
In order to enhance the stability of fixation, we proposed a modified intramedullary ChM nail, which is supplied with holes in addition to five standard distal holes; two holes were formed in the sagittal direction at a distance of 1.00 and 2.5 cm above the horizontal plane of the fracture
Summary
The severity of intra-articular fractures of the distal tibia results from the morphological features of this segment, and bone injury is combined with trophic soft tissue disorders. Open reduction and internal fixation have a negative effect on reparative processes in the local morphological structures, and complications such as soft tissue necrosis, infection, infected and deforming osteoarthritis, or nonunion may develop. Open reduction (OR) and internal fixation (IF) is associated with a number of complications, such as soft tissue necrosis, infection and the development of purulent osteoarthritis, and slow consolidation. Complications in the early and long-term period and low functional outcomes after surgical interventions make the trauma surgeons search for more effective and less invasive methods of surgical treatment of these fractures [4, 5]
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