Distal Tibial Fractures Research Articles

Clinical and radiological outcome of the locked plate osteosynthesis in distal metadiaphyseal tibial fracture according to the severity of comminution: Varus reduction would not be preferable with lower clinical outcomes.

The optimal treatment for distal tibial fractures remains a matter of debate. Nonetheless, plate osteosynthesis produces favorable results to intramedullary stabilization in aspects of alignment restoration. The aim of the study was to compare the radiologic and clinical outcomes of distal metadiaphyseal tibial fracture between a simple/wedge fracture (SWF) and a comminuted fracture (CF) using minimally invasive plate osteosynthesis (MIPO). This retrospective study analyzed patients with SWF or CF of the distal tibial metadiaphysis that was surgically treated with a locking compression plate. Postoperative radiographic assessments and the time to radiologic union were noted. Clinical assessments were evaluated using both the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the foot function index (FFI). Postoperative complications were documented. Seventy-one cases were analyzed over a mean follow-up period of 20.9 months. Thirty-six patients had SWF and 35 patients presented with CF. The mean time to radiologic union, amounts of postoperative coronal angulation, and incidence of malunion showed no statistical differences. Fibular fixation was more applied in the CF group (P < 0.001). Moreover, the clinical scores revealed no differences. Nonetheless, in the valgus union group, the AOFAS ankle-hindfoot score was 90.9 compared to 84.1 in the varus union group (P = 0.042) and the FFI was 9.2% compared to 20.2% in the varus union group (P = 0.017). Plate osteosynthesis for SWF or CF of the distal tibial metadiaphysis led to high union rates and good clinical outcomes. There was no significant difference in the radiologic and clinical results according to the presence of fracture comminution. Nonetheless, the valgus union group showed better clinical outcomes than the varus union group. Clinically, it would be preferred to avoid intraoperative varus reduction.

A systematic review of outcome reporting in clinical trials of distal tibia and ankle fractures : the need for a core outcome set.

To describe outcome reporting variation and trends in non-pharmacological randomized clinical trials (RCTs) of distal tibia and/or ankle fractures. Five electronic databases and three clinical trial registries were searched (January 2000 to February 2022). Trials including patients with distal tibia and/or ankle fractures without concomitant injuries were included. One reviewer conducted all searches, screened titles and abstracts, assessed eligibility, and completed data extraction; a random 10% subset were independently assessed and extracted by a second reviewer at each stage. All extracted outcomes were mapped to a modified version of the International Classification of Functioning, Disability and Health framework. The quality of outcome reporting (reproducibility) was assessed. Overall, 105 trials (n = 16 to 669 participants) from 27 countries were included. Trials compared surgical interventions (n = 62), post-surgical management options (n = 17), rehabilitative interventions (n = 14), surgical versus non-surgical interventions (n = 6), and pre-surgical management strategies (n = 5). In total, 888 outcome assessments were reported across seven domains: 263 assessed body structure or function (85.7% of trials), 136 activities (68.6% of trials), 34 participation (23.8% of trials), 159 health-related quality of life (61.9% of trials), 247 processes of care (80% of trials), 21 patient experiences (15.2% of trials), and 28 economic impact (8.6% of trials). From these, 337 discrete outcomes were described. Outcome reporting was inconsistent across trials. The quality of reporting varied widely (reproducibility ranged 4.8% patient experience to 100% complications). Substantial heterogeneity in outcome selection, assessment methods, and reporting quality were described. Despite the large number of outcomes, few are reported across multiple trials. Most outcomes are clinically focused, with little attention to the long-term consequences important to patients. Poor reporting quality reduces confidence in data quality, inhibiting data synthesis by which to inform care decisions. Outcome reporting guidance and standardization, which captures the outcomes that matter to multiple stakeholders, are urgently required.Cite this article: Bone Jt Open2022;3(10):832-840.

Supercutaneous plating: A case report of locking plate used as an external fixator

Introduction: Proximal and distal tibial fractures with a compromised soft tissue envelop still pose a treatment dilemma or challenge for the orthopedic surgeon LCPs have advantages of angular stability from the locking-head mechanism and less irritation when compared with traditional external fixators due to their low profiles. Here is a poster case report of the same.Case Report: A 37-year-old male, flouriest, from Badravathi who came to Orthopedic OPD after he had met with a road traffic accident on 23rd November 2020 and sustained injury to left leg. Plain radiograph revealed fracture of left tibia and fibula at the proximal and middle third junction. Arterial Doppler showed long segment poplitial artery thrombosis.As a definitive treatment patient underwent Open reduction and plate fixation of proximal third tibia with thromboembolectomy and venous grafting done. The limb post-operative went into compartment syndrome and emergency fasciotomy of left leg wasdone. Fasciotomy wound got infected and hence Vacuum assisted closure was applied. The same locking plate was removed and used as an external fixator. The External fixation plate for left tibia was removed and the patient was put on patellar tendon bearing cast and is showing good signs of union.Conclusion: For proximal fractures of the tibia, which are treated by external fixation using the LCP plate is a safe and reliable technique and excellent functional outcomes. There is a high rate of union with minimal complications rate. Its advantages also include ease of performing surgery and ease of removing plate after fracture healing. Though the use of locked plates as external fixators is not a generally acknowledged technique by many surgeons still it has become valuable modality in management.

Distal Tibia Apex Posterior Angulation: A Normal Anatomic Variant with Side-To-Side Symmetry

Category: Trauma; Ankle Introduction/Purpose: The native sagittal plane alignment of the distal tibia has not been well-described and has implications during the fixation of tibia fractures. Cavovarus foot alignment has been previously thought to influence gastrocsoleus tightness and the potential for anterior talar escape in the setting of an osseous injury in this region. However, the relationship between midfoot alignment and sagittal distal tibia morphology is undescribed. Characterization of this osseous anatomy may be helpful to achieve adequate sagittal alignment during the reduction of distal tibia fractures. The purpose of this study was primarily to characterize distal tibia sagittal morphology and ankle radiographic parameters, determine whether symmetry exists from side-to- side, and secondarily to identify any differences based on midfoot alignment. Methods: 112 patients (60 females, mean age 45.8 years) with bilateral lateral weight-bearing ankle radiographs were retrospectively evaluated (224 ankles). Midfoot morphology was classified as normal, planus, or cavus using Meary's angle (MA) (Planus: MA &lt;-4°, Normal: MA -4°≤x≤4°, Cavus: MA&gt;4°). The angle between the proximal diaphyseal (Line 1) and distal tibia (Line 2) axes was measured, and the location of the center of rotation of angulation (CORA) relative to the plafond was recorded (Figure 1). The horizontal distance (via a line parallel to the floor) from the distal tibia axis (Line 2) to the lateral talar process was measured, as well as the anterior distal tibial angle, and the plafond radius of curvature (ROC). Bilateral ankles and midfoot morphologies were compared using a Mann-Whitney U test and ANOVA, respectively. Correlation was assessed using linear regression. Results: The average distal tibia had 2° of apex posterior angulation with the CORA located 8.0 cm proximal to the plafond. There was no difference by laterality in magnitude of the angulation (p=.358) or distance from the plafond to the CORA (p=.901). The angulation increased as foot alignment transitioned from cavus (1.25°), to normal (1.89°), to planus (3.05°) alignment (r=.32; R2=.102; p&lt;.001). The angulation was larger in men (2.8°) than in women (1.4°) (p&lt;.001) and decreased with increasing patient age (r=.279, R2=.078, p&lt;.001). The lateral talar process was on average 5.9 mm anterior to the distal tibia axis (Line 2), more anterior with cavus versus planus alignment (6.7mm vs. 4.8mm) (p&lt;.001). The average anterior distal tibial angle and plafond ROC were 83.6° and 22.9 mm, respectively, with no significant differences by laterality or midfoot morphology (p&gt;.05 for both). Conclusion: The distal tibia has a consistent apex posterior bow that is symmetric from side-to-side, but variable from patient- to-patient. Distal tibia osseous morphology is related to midfoot alignment, sex, and age. Cavus alignment is additionally correlated with anterior translation of the lateral talar process relative to the distal tibia axis. Surgeons treating distal tibia fractures may consider the use of contralateral imaging as a reduction template to help restore patient-specific sagittal alignment. A tibial nail that ends anterior in the distal segment of a distal tibia fracture should prompt the surgeon to carefully evaluate whether sagittal alignment has been restored.

A study of management of fracture proximal tibia by different modalities

The knee joint is one of the three major weight bearing joint in the lower extremity. Fractures that involve proximal tibia affect knee function and stability. These fractures can either be intra-articular or Extra-articular. Intra-articular fractures of proximal tibia are difficult to treat. Age, skin conditions, osteoporosis further increase the obstacles in the healing process. Various modalities of treatment are available but no ideal treatment has yet evolved. At the Chicago Orthopedic society in 1956 Manson Hole has rightly mentioned that “these fractures are tough” Complex kinematics of its weight bearing position and complex ligamentous stability and articular congruency are the main reason why these fractures are of concern to surgeon and cause disability to the patients. The mobility and stability of the lower limbs mostly depends upon a stable and functional knee joint. In most instances, intramedullary nailing has become the method of choice for the fixation of diaphyseal tibial fractures and has been extended to the treatment of proximal fractures. Reports have shown a high incidence of malalignment and loss of fixation associated with intramedullary nailing of proximal metaphyseal fractures.7Minimally invasive plate osteosynthesis techniques have recently been applied to fractures of proximal and distal tibia. Recently, the use of plate fixation utilizing minimally invasive techniques has been put forward as one way maintaining alignment in proximal tibial fractures. The purpose of this study is to study the available modalities of treatment of proximal tibia fracture in this institute and observe their functional result.

Is It Safe to Prep the External Fixator in Situ During Staged ORIF of Pilon Fractures? A Retrospective Comparative Cohort Study

Category: Trauma; Ankle Introduction/Purpose: Pilon fractures usually result from high energy mechanisms and are associated with signifcant soft tissue injuries in addition to complex fracture patterns. Treatment typically involves staged management with initial placement of an external fixator and subsequent definitive internal fixation once soft tissues are amenable. The purpose of this study was to compare the risk of fracture-related infection (FRI) and unplanned re-operation after staged open reduction and internal fixation (ORIF) of pilon fractures between cases in which elements of the temporizing external fixator (ex-fix) were prepped into the surgical field and cases in which it was completely removed prior to definitive fixation. Methods: This was a multi-surgeon retrospective comparative cohort study on patients 18 years and older with pilon fractures who underwent operative treatment over a ten-year period between January 1, 2010 to January 1, 2020 at an academic-level 1 trauma center. Medical records and radiographic images were reviewed for each patient to assess demographics, clinical characteristics and surgical outcomes. The primary outcome measures were FRI and unplanned re-operation, including arthrodesis and amputation. All analyses were completed using JMP Software (Version 15.0, SAS Institute Inc., Cary, NC), and an alpha of 0.05 was used for statistical significance. Results: 133 patients underwent staged ORIF, 47 with retained elements of the ex-fix prepped in situ for definitive ORIF and 86 with the ex-fix entirely removed. The overall rate of FRI was 23.3% while the overall rate of unplanned re-operation was 11.3% (4.5% rate of arthrodesis and 6.8% rate of amputation). There was no difference in FRI between the group in which ex-fix was prepped in versus the group in which it was completely removed (23.4% vs 23.3%, p=0.985) and no difference in overall rate of unplanned re-operation (10.6% vs 11.6%, p=0.863). Assessing the subset of patients with FRI, those with ex-fix prepped in had a higher prevalence of infection with MRSA and MSSA (81.8% vs 40%, p=0.021). Using alpha=0.05, and power=0.8, a sample size of 42 patients with FRI post-ORIF (27 with ex-fix prepped in, and 15 with ex-fix removed) would be needed to detect a difference in MRSA/MSSA bacteriology. Conclusion: Although there were relatively high complication rates in this cohort of pilon fractures treated with staged ORIF, prepping in elements of the external fixator did not lead to a significant increase in rates of fracture-related infection nor unplanned re-operation, including arthrodesis and amputation. This study offers clinical support regarding a common practice used to assist in reduction and definitive fixation of distal tibial pilon fractures.

Anterior Malleolar Fractures: Pathoanatomy, Classification and Treatment Options

Category: Trauma; Ankle Introduction/Purpose: The anterior distal tibial tubercle (Tillaux-Chaput tubercle) frequently fractures in the wake of malleolar fractures. It provides attachment to the anterior tibiofibular syndesmosis and may be considered a fourth or anterior malleolus (AM). In analogy to posterior malleolar fractures, AM fractures may extend into the tibial incisura and tibial plafond. We analyzed the pathoanatomy of AM fractures and associated injuries in ankle fractures in adults. Methods: Over a course of 9 years, 140 patients (average age 58.3 years) with 140 acute malleolar fractures (OTA/AO 44) involving the anterolateral distal tibial rim were analyzed with CT imaging. All components of the malleolar fractures were analyzed and classified. Fracture patterns were compared with those of all 1,379 patients treated for malleolar fractures at our institution during the same 9-year period. Patients with fractures of the tibial pilon (OTA/AO 43) and patients aged less than 18 years were excluded as the frequent anterolateral distal tibial fractures along the physeal growth plate in adolescents are beyond the scope of this analysis. Fractures were classified according to the most frequent patterns and possible treatment options. Results: Of the 140 AM fractures, 52.9% were classified type 1 (extra-articular avulsion), 35.7% type 2 (incisura and plafond involvement), and 11.4% type 3 (impaction of the anterolateral plafond). The fibula was fractured in 87.1%, the medial malleolus in 67.1%, and the posterior malleolus in 69.3%. Isolated AM fractures were seen in only 6 cases (4.3%). The severity of AM fractures correlated negatively with that of posterior malleolar fractures (p&lt;0.001). The proportion of pronation-abduction fractures increased and the proportion of supination external rotation fractures decreased with increasing severity of AM fractures (p=0.055). Fractures involving the AM had a prevalence of 12.6% of all ankle fractures and occurred significantly more frequently in pronation-type injuries (p&lt;0.001). No supination-abduction fractures were seen with AM involvement. The interclass correlation coefficient for the proposed classification of AM fractures was 0.961 (95% CI 0.933-0.980) for interobserver agreement and 0.941 (95% CI 0.867-0.974) for intraobserver agreement. Conclusion: Knowledge of the 3D pathoanatomy of AM fractures and associated injuries may help with surgical planning. CT imaging should be employed generously in the assessment of complex ankle fractures, particularly with pronation injuries. In analogy to posterior malleolar fractures, fixation of displaced AM fractures potentially restores syndesmotic stability, congruity of the tibial incisura thus facilitating fibular reduction and joint congruity at the anterolateral tibial plafond. Proposed treatment options include transosseous suture for syndesmotic avulsions (type 1), screw fixation for fractures involving the incisura and plafond (type 2), and elevation of the impacted plafond with buttress plating for type 3 fractures.

Prediction of Distal Tibial Articular Extension in Tibial Shaft Fractures

Category: Trauma; Ankle Introduction/Purpose: Diaphyseal tibial fractures account for approximately 1.9% of all adult fractures. A recent registry review in Finland found an annual incidence of 15.6 per 100,000 person-years in males and 11.5 per 100,000 person-years in women. There are several studies which have demonstrated a high proportion of diaphyseal tibial fractures have ipsilateral occult posterior malleolus fractures, this ranges from 22-92.3%. Recent work by Hendrickx et al has highlighted distal third and spiral tibial shaft fracture patterns as independent predictors of occult posterior malleolus fracture. Methods: Objectives Our primary outcome in this study was to identify any factors that could predict articular extension in tibial shaft fractures. Study Design &amp; Methods A retrospective review of a prospectively collected database was performed at Liverpool University Hospitals NH Foundation Trust between 1/1/2013 and 9/11/2020. The inclusion criteria were patients over the age of 16, with a diaphyseal tibial fracture and who underwent a CT of the affected lower limb. The articular fracture extension was categorised into either posterior malleolar (PM) or other fracture. Results: 764 diaphyseal tibial fractures were analysed, of these 300 had a CT and could be included. There were 127 intra- articular fractures. Of these, 83 (65.4%) cases were PM and 44 were other fractures. On univariate analysis, the PM fractures were associated with fibular spiral (p=-016) fractures and no fracture of the fibular (p=.003), lateral direction of the tibial fracture (p=.04), female gender (p=.002), AO classification 42B1 (p=.033) and an increasing angle of tibial fracture. However, on multivariate regression analysis the only significant factor was a high angle of tibia fracture. Other distal tibia fracture extensions were associated with no fracture of the fibular (p=.002), medial direction of tibia fracture (p=.004), female gender (p=.000), and AO classification 42A1 (p=.004), 42A2 (p=.029), 42B3 (p=035) and 42C2 (p=.032). On multivariate analysis. the lateral direction of tibia fracture, and AO classification 42A1 and 42A2 were significant factors. Conclusion: Distal tibia articular extension occurs in almost half of tibial shaft fractures. A number of factors were associated with the extension, however multivariate analysis did not create a suitable prediction model. Nevertheless, rotational tibia fractures with a high angle of fracture should have a low threshold of further investigation with a CT prior to surgical intervention.

COMPARATIVE VARIATION OF RESULTS IN MANAGEMENT OF EXTRAARTICULAR DISTAL TIBIAL FRACTURES BY INTRAMEDULLARY NAILING VS MINIMAL INVASIVE PLATE OSTEOSYNTHESIS

Background: Distal metadiaphysealtibial fractures are commonly seen lower limb fractures. Intramedullary nail fixation (IMN) and Minimal invasive plate Osteosynthesis (MIPO) are the two mainstay treatments for tibial fractures, but agreement on the best internal fxation for distal tibial fractures is still controversial. This meta-analysis was designed to compare the success of IMN and MIPO fxations in the treatment of distal metadiaphysealtibial fractures, in terms of complications and functional recovery Aims: To evaluate the results of management of distal tibial fractures by Intramedullary nail and minimal invasive plate osteosynthesis Methods: The present study will be conducted on patients attending Emergency and outpatient department of Orthopaedics, GovernmentMedical College, OrailJalaun, UttarPradseh for the period of January 2019 to July 2021. A minimum of 30 cases will be taken in the study those who are fracture distal tibia. Result: In my thesis, we take total 60 patient which divided into two group of 30-30 patients. Group One for In Minimal invasive plate Osteosynthesis (MIPO) and Group Two for Intramedullary nail. Only signifcant difference seen in my study in length of incision in nailing length of incision is less as compare to plating group Conclusion:The study of management of distal tibia fracture by MIPO and IMN. I found that no significant difference in final result. In MIPO group only 2 patient have superficial infection and IMN group only 1 patient has superficial infection that means the rate of infection more in plating as compare to nailing.

The Use of the Ilizarov Fixator for the Treatment of Open and Closed Tibial Shaft and Distal Tibial Fractures in Patients with Complex Cases.

Open and closed fractures of the tibial shaft or distal tibia can be challenging for surgeons to treat if the fractures are accompanied by aggravating conditions, such as various accompanying diseases, pronounced soft tissue injuries, osteomyelitis, and/or noncompliance. The aim of this retrospective study was to present our approach and results with the Ilizarov fixator as a treatment option for such individually complex cases. Between 2005 and 2018, 20 patients were treated with the Ilizarov fixator for fractures of the tibial shaft/distal tibia. The indication for this was a 2nd- to 3rd-degree open fracture in 10 patients, a 1st-degree open fracture in one patient, and closed fractures in 9 patients. Aggravating conditions included soft tissue injuries, osteomyelitis, leg deformities, multiple traumas, smoking, alcohol/drug abuse, and obesity (BMI > 60). In addition to demographic data, the time of fixator treatment, complications, and the endpoint of consolidation were evaluated retrospectively. The mean time of fixator treatment was 29 (range 15-65) weeks. Complete fracture consolidation was achieved in 13 patients (65%) with the Ilizarov fixator. The mean follow-up period after fixator removal was 36 (range 2-186) months in 14 patients. Five patients with complete consolidation were lost to further follow-up. One patient was amputated. In six patients without union, internal osteosynthesis was carried out. The use of the Ilizarov fixator is a treatment option for individual high-risk patients with complicating courses but should be seen as a salvage procedure due to the high complication rate and long treatment process.

Comparative Outcome of Hybrid External Fixator Versus Primary Ilizarov Fixator in the Treatment of Open Distal Tibia Extra-Articular Fractures.

Because one-third of the tibia is subcutaneous throughout most of its length and its location, it is more prone to open fractures. Open distal tibia fractures are mostly due to RTA and sports injuries. The goal of treatment is to obtain a healed, well-aligned fracture; pain-free weight-bearing; and functional range of motion of the knee and ankle. 33 patients of the 18-60-year age group with open distal tibia extra-articular fractures (without vascular injury), less than 3weeks old trauma were included in the prospective study for 1year period (1st June 2019 to 31st May 2020). 17 cases were treated with the Hybrid external fixator (HEF) and 16 cases were treated with the Ilizarov fixator (IF). Significantly (P < 0.05), the mean duration of surgery was less in the HEF group (67.6min), faster union of open type-II fractures in the HEF group (16.4weeks), and also a higher AOFAS score at 6months in open type-II fractures in the HEF group (84.4). There were two cases of equinus deformity in the IF group and one case of valgus deformity in the HEF group. HEF and IF are both equally effective in the treatment of open distal tibia extra-articular fractures with the advantage of stable fracture fixation, early weight-bearing, preserving soft tissue, minimal periosteal stripping, and providing one-staged definitive intervention. However, HEF is preferred over IF in terms of less operating time, faster union, and a better functional outcome with minimal complications.

The lateral supramalleolar flap for the treatment of open foot and ankle fractures

The purpose of this study is to describe the efficacy of lateral supramalleolar flap as an option for soft tissue repair in open fractures of foot and ankle and to present the experience in 2 trauma units: Hospital Susana López de Valencia, Popayán Colombia, and Hospital Universitario de Santander, Bucaramanga Colombia. This is an observational, case series study including all patients with open fractures of foot and ankle who were treated from January 2016 to June 2021 and who required soft tissue coverage. Patients whose soft tissue injury was located on the anatomical area of the perforating peroneal artery, those with less than 6 months of follow-up and those who refused the proposed treatment were excluded. On the other hand, although literature reports flaps of up to 100 cm 2 [1], in our hands, this flap unsuitable for skin defects larger than 60 cm 2 , and other procedures such as free flaps should be considered in these cases. Thirteen patients were selected, 9 men and 4 women, with a mean age of 30 years (12–62 years) and mean follow-up duration of 10.3 months [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ]. In 11 patients, the mechanism of trauma involved a motorcycle accident. Mean flap size was 40 cm 2 (30–48 cm 2 ). Ten flaps survived with no acute problems, 2 presented with venous congestion and epidermolysis, which were treated conservatively, and 1 developed complete necrosis requiring reintervention. All interventions were performed by the authors belonging to the orthopedic trauma units from the involved hospitals. The lateral supramalleolar flap is an excellent alternative for the treatment of coverage defects caused by open foot and ankle fractures, producing satisfactory and predictable results in the hands of orthopedic surgeons with no specific training in microsurgical techniques. Level of clinical evidence: 4. • The treatment of open distal tibial, ankle, and foot fractures, represents a significant challenge, and it needs early coverage. • Microvascular techniques and free flaps are demanding procedures not always available in trauma centers. • The supramalleolar flap is a reproducible option for soft tissue coverage in distal tibial, ankle, and open foot fractures.

Functional Outcome of Closed Static Intramedullary Nailing with Distal two Plane Locking Versus Percutaneous Mippo Distal Tibial Locking Plate in Distal 3rd Tibia Metaphyseal Fractures

Objective: Aim of current study was to determine the functional outcomes of closed static intramedullary nailing with distal two plane locking versus percutaneous MIPPO distal tibial locking plate in distal 3rd tibia metaphyseal fractures. Study Design: Randomized clinical trial Place and Duration: Nishtar Hospital Multan/Qaisrani Medical Center Multan. Jan 2021-March 2022 Methods: There were 76 patients of both genders with age 15-60 years presented. All the patients had 3rd tibia metaphyseal fracture were admitted to hospital for surgery. Following the collection of informed written consent from enrolled patients, complete demographic information was gathered. Patients were equally divided into two groups. Group I received intramedullary nailing with distal two plane locking and group II received percutaneous MIPPO distal locking plate. Favorable and unfavorable outcomes among enrolled cases were compared. SPSS 22.0 was used to analyze all data. Results: There were majority males 22 (60.5%) in group I and 20 (52.6%) in group II. In group I mean age was 30.8±6.42 years with mean BMI 24.71±3.19 kg/m2 and in group II mean age was 31.14±3.58 years and had mean BMI 25.7±7.17 kg/m2. Falling, accidents, sports and lifting of heavy object was the most common cause of fractures. We found that intramedullary nailing was more effective as compared to MIPPO distal locking plate in terms of functional outcomes but difference was insignificant. Frequency of complications were higher in group II found in 14 (36.8%) as compared to group I in 4 (10.4%) cases. Conclusion: We concluded in this study that distal third tibial metaphyseal fractures were effectively operated by intramedullary nailing distal two plane locking and MIPPO distal locking plate but frequency of complications were higher in MIPPO group as compared to intramedullary nailing. Keywords: Metaphyseal Fractures, MIPPO Distal Platting, Intramedullary Nailling, Functional Outcomes, Complications

Clinical performance of tibia bone plate system for fixation of tibia fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;In this study, we aimed to investigate the performance of the tibia plates system while treating the tibia fracture fixation. The objective of this study was to reduce the post-operative complications of proximal and distal tibia fracture by using indigenously manufactured implants (plates and screws).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this retrospective study, we studied the results of the tibia plate system in treatment of tibia fracture. A total of 34 consecutive patients were included in this study (24 males, 10 females and average age 48.6 years). Fracture type was classified as per the Muller AO classification of fracture. According to the AO classification, proximal and distal tibia fractures 41-A, 41-B and 41-C was observed with one year follow up period followed by physical exercises after one month of the surgery. The fractures were treated with wise-lock proximal and distal tibia plates.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;The outcomes of clinical treatment were obtained in our study; no pain (88.2%), mild pain (11.7%) after 1 year follow up. The follow up of patients was taken on 1 month, 6 months and 1 year according to visual analog scale (VAS) score. No implant related problem have been found like loosening, bending and corrosion. X-ray was used to check the union, non-union. Functional outcomes were assessed with VAS.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Treatment of tibia fracture with wise-lock proximal and distal tibia plate shows good outcomes with less complications.&lt;/p&gt;

Old but effective during this lockdown period a modifies pin plaster technique to treat distal tibia fractures

&lt;p class="abstract"&gt;There are various methods for treating fractures of the distal tibia. The purpose of this study was to introduce a modified technique of ‘pin in plaster’ in treating the distal 1/3rd tibia fractures. Fifteen patients with fractures of the distal tibia AO classification A1 and A2 were followed for one-year post-application of the cast. Patients were excluded if they had complicated fractures or grade III b fractures or crush injuries, with multiple injuries or any pathological fractures or with any nerve or vascular injuries. Range of movement and functional results were calculated periodically at the 3rd and 6th months. Three cases developed pin tract infection in the study, all of which were treated with oral antibiotics successful. The fibula was fixed with plating in selected cases There were no cases of nerve injuries and no cases of tendon injury. All the cases that were treated were successful and completely weight-bearing by the end of the 4th month. Our modified technique is simple quick and effective to restore anatomic congruity and maintain the reduction in fractures of the distal tibia.&lt;/p&gt;

Changes in operative treatment of tibia fractures in Finland between 2000 and 2018: A nationwide study.

Incidences of different tibia fractures are not well reported. Possible changes in the operative treatment methods have also not been studied. The aim of this nationwide registry study is to determine the incidence of operatively treated tibia fractures and investigate the possible changes in treatment methods in Finland between 2000 and 2018. All patients aged 16 years or older with operatively treated tibia fractures in Finland from 2000 to 2018 were included. The incidence of operatively treated proximal, diaphyseal, and distal tibia fractures per 100,000 person years by age, sex, mechanism of injury, and study year was calculated. Data were extracted from the Finnish National Hospital Discharge Register. A total of 5996 proximal, 6874 diaphyseal, and 5658 distal tibia fractures were reported during the 18-year study period, resulting in incidences of 7.2/100,000, 8.1/100,000, and 6.9/100,000 person years for operatively treated proximal, diaphyseal, and distal tibia fractures, respectively. Over the study period, a clear change in fixation method in distal tibia fractures was found as plating became popular in the beginning of the 21st century. During the last 5 years of the study period, nailing and plating were equally used. Operatively treated proximal tibia fractures are most common among older females while diaphyseal fractures are most frequent in young male patients. Distal tibia fractures occur most often among middle-aged people.

Analysis of 37 Cases of Distal Tibial Fractures by Percutaneous Fixation

Analysis of 37 Cases of Distal Tibial Fractures by Percutaneous Fixation

Intramedullary Nail Fixation by Suprapatellar and Infrapatellar Approaches for Treatment of Distal Tibial Fractures.

ObjectiveTo compare the functional and alignment outcomes of intramedullary nail fixation using suprapatellar and infrapatellar approaches in treating distal tibial fractures.MethodsIn this retrospective study, 132 patients with distal tibial fractures (87 men, 45 women) ranging in age from 20 to 66 years were treated with intramedullary nails using the suprapatellar (69 patients) or infrapatellar (63 patients) approach. The radiographic alignment outcomes and ankle function were compared between the two groups. Multivariate logistic regression analyses were performed to determine which variety influenced ankle functional scores and whether the suprapatellar approach intervention demonstrated a protective effect.ResultsThe mean follow‐up time was 14.22 ± 2.31 months. The mean sagittal section angle of the fracture in the suprapatellar and infrapatellar approach groups was 3.20° ± 1.20° and 5.31° ± 1.23°, respectively (P < 0.001). The mean coronal section angle was 3.51° ± 0.89° and 5.42° ± 1.05°, respectively (P < 0.001). Three patients (4.3%) in the suprapatellar approach group and 15 patients (23.8%) in the infrapatellar approach group had poor fracture reduction (P < 0.001). The mean hind foot functional score and ankle pain score were 95.91 ± 4.70 and 35.91 ± 4.70 points, respectively, in the suprapatellar approach group and 85.20 ± 5.61 and 25.20 ± 5.61 points, respectively, in the infrapatellar approach group (P < 0.001 for both). In the comparison of ankle function, the multivariate logistic regression analyses demonstrated that the odds ratio in the suprapatellar approach group was about 7 times that in the infrapatellar approach group (odds ratio, 7.574; 95% confidence interval, 2.148–28.740; P = 0.002). Of the variants measured, the statistically significant risk factors for poor ankle function were AO type A3 (P = 0.016) and diabetes mellitus (P = 0.006). Sex and the operation interval were not statistically significant risk factors for poor ankle function.ConclusionIntramedullary nailing using the suprapatellar approach facilitates simple fracture reduction, excellent postoperative fracture alignment, and few complications, giving it obvious advantages over the conventional infrapatellar approach. Additionally, the suprapatellar approach is a prognostic factor associated with postoperative ankle joint function.

A Critical Analysis of Lateral Versus Central Endpoint in Distal Tibia Nailing: Does It Affect Alignment?

To evaluate the effect of a traditional "center-center" end point for distal tibia nailing in comparison with a lateral-of-center end point on fracture malalignment in a cadaver model. Nine matched pairs of human cadaveric lower-extremity specimens were used to model the effect of nail end point on fracture alignment in extra-articular distal tibia fractures. After simulation of the fracture through a standardized osteotomy, 1 member of each pair was fixed with an intramedullary nail using a "center-center" end point, whereas a lateral-of-center end point was used for the other member of the pair. Specimens were stripped of soft tissue, and digital calipers were used to measure fracture translation and gap medially, laterally, anteriorly, and posteriorly. Coronal plane angulation at each fracture was measured on the final mortise image. The average coronal angulation was 7.0 degrees of valgus (with a SD of 4.1) in central-end point specimens versus 0.2 degrees of valgus (SD = 1.5) in lateral-end point specimens ( P < 0.001). Lateral-end point specimens also demonstrated significantly less fracture gap medially (mean 0.2 vs. 3.1 mm for central-end point specimens, P < 0.001), anteriorly (mean 0.1 vs. 1.3 mm, P = 0.003), and posteriorly (mean 0.3 vs. 2.2 mm, P = 0.003). Lateral-end point specimens also showed less lateral translation (mean 0.6 vs. 1.6 mm, P = 0.006). Lateral-of-center nail end points may help surgeons restore native alignment in extra-articular distal tibia fractures and avoid valgus malalignment.

Comparison of Intramedullary Interlocking Nailing (IMLNG) and Minimally Invasive Plate Osteosynthesis (MIPO) in Treating Extra Articular Distal Tibial Fractures

Background: Due to limited blood flow and sparse soft tissue coverage, treating distal tibia fractures presents a considerable challenge for orthopaedic surgeons. Objective: Our study's objectives were to compare the outcomes of the two treatment modalities of minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) for extraarticular distal tibia fractures. Study Design: Randomized Controlled Trial Place and Duration of the Study: This study was conducted at Department of Orthopedic and Spine Surgery Sughra Shafi Medical Complex, Narowal from March 2021 to March 2022. Material Methods: During A total of 59 patients ( 30 in IMLN group and 29 in MIPO group), both male and female, with AO Type A, b and C distal tibial fractures lasting less than three days and ages ranging from 20 to 60, were enrolled for this research. At the most recent follow-up, clinical and radiological data were assessed. Results: The average duration to union was 21.9 weeks in the IMN group and 19.9 weeks in the MIPO group, and all of the examined patients eventually recovered. In the IMN group, the time to union was substantially greater (p= 0.001). Conclusion: Low operating, union, and hospitalisation times make MIPO advantageous. In order to lessen the morbidity of these patients, we advise using the minimally invasive plate osteosynthesis (MIPO) procedure as the first line of treatment for distal tibia fractures.. Keywords: Distal tibia fracture, minimally invasive plate osteosynthesis, intramedullary nailing,