Distal Tibial Metaphyseal Fractures Research Articles

Modified elastic intramedullary nail internal fixation for distal tibial metaphyseal junction fracture.

To investigate the application of modified elastic intramedullary nail and the outcomes between modified elastic stable intramedullary nailing and traditional elastic stable intramedullary nailing in children with distal tibial metaphyseal junction fracture. A retrospective study was conducted. From January 2018 to January 2021, a total of 36 children with distal tibial metaphyseal junction fracture were treated in our hospital. All of them were treated with closed reduction and elastic stable intramedullary nailing internal fixation. A total of 18 children were treated by modified elastic stable intramedullary nailing and 18 children were treated by traditional elastic stable intramedullary nailing. Postoperative imaging, clinical efficacy, and complications were analyzed. The mean follow-up time was 20 (15-36) months in modified group and 22 (16-33) months in traditional group. There were no complications such as infection, loss of reduction, and unequal length of lower limbs in modified group while loss of reduction occurred in two cases in traditional group. In these two cases of loss of reduction, we preformed manual reduction and replacement of long leg casts, and there was no loss of reduction, and the patient achieved a good prognosis. In the last follow-up, American Orthopaedic Foot & Ankle Society score was used. In modified group, excellent outcome achieved in 17 cases, good outcome achieved in 1 case, and satisfactory therapeutic effect was achieved. In traditional elastic stable intramedullary nailing group, excellent outcome achieved in 14 cases, and good outcome achieved in 4 cases. There was no statistical difference in the scores between the two groups. It was concluded that modified elastic stable intramedullary nailing fixation is a safe and effective treatment.

Benefits of Poller Screw in Improving Radiological Outcomes after Intra-Medullary Nailing for Distal Tibia Fractures; A Retrospective Cohort Study.

To compare the radiological outcomes after fixation of distal tibia fractures with IM nail between patients in whom poller screw was used vs those in whom it was not used. A retrospective cohort study was conducted between 1st January 2009 to 31st June 2019 including patients treated with IM nail for distal tibial metaphyseal fractures. Patients were divided into 2 groups based on whether a poller screw was placed during surgery or not. The exposed group consisted of patients who underwent augmentation of IM nail with a poller screw, while control group included patients who underwent fixation with nail alone. All adult patients aged ≥18 years were included and patients with pathological fractures, known metabolic bone disease were excluded from the study. Follow-up x-rays were viewed through our hospital database and fracture healing was classified as either union, malunion or non-union based on radiographic parameters. A Radiographic Union Score in Tibia (RUST) score was calculated and a score of ≥9 was considered conclusive for complete union. 93 patients were included in the study with 21 patients in the exposed and 72 in the control group. According to the analysis, there were no significant differences in baseline characteristics of the study participants. The exposed group was found to be associated with increased rates of union and decreased non-union and mal-union rates compared to control group (P-value = 0.003). Mean RUST score was also noted to be significantly higher in exposed group compared to control group with a P-value of 0.025. Use of poller screw with IM nail in treatment of distal tibial fractures is important in improving post-operative outcomes and decreasing mal-union and non-union.

Fracture gap and working length are important actionable factors affecting bone union after minimally invasive plate osteosynthesis for the treatment of simple diaphyseal or distal metaphyseal tibia fractures

IntroductionIndirect reduction of minimally invasive plate osteosynthesis (MIPO) can often result in delayed union in tibia fractures. This study evaluated several factors in MIPO in relation to bone union. HypothesisWe hypothesized that the fracture gap, plate – tibia distance, or working length would have a substantial effect on the tibia union rate. Materials and methodsForty-one patients with simple diaphyseal or distal metaphyseal tibia fractures who underwent internal fixation surgery using the MIPO technique were divided into two groups: patients with delayed union and patients without delayed union. Non-actionable factors involving AO/OTA classification, fibula fracture and actionable factors including postoperative fracture gap, plate – tibia distance, working length in relation to parameters of bone union were compared between the two groups. Also cumulative rates of bone union and risk factors of delayed union according to variables of interest were investigated. ResultsAO/OTA classification, site of fibula fracture, postoperative fracture gap, working length, and bone union rate of the two groups significantly differed (p<0.05). The cumulative rate of bone union during 1-year follow-up according to 43A tibia fracture, distal fibula fracture, fracture gap, and working length significantly differed between the two groups (p<0.05). By univariate Cox proportional hazards model, 43A tibia fracture, distal fibula fracture, facture gap, and short working length were risk factors for delayed union (p<0.05). DiscussionNon-actionable factors involving AO/OTA classification, distal fibula fracture and actionable factors including postoperative fracture gap, working length were significant factors affecting bone union after MIPO. The present study indicated that small fracture gap and long working length during MIPO might facilitate bone healing in tibia fracture. Level of evidenceIV; single-center retrospective cohort study.

Biomechanical comparison of three different surgical methods in the surgical treatment of distal tibial metaphyseal fractures. An animal model study.

The aim of this study is to investigate mechanical properties of minimally invasive plate osteosynthesis (MIPO), supracutaneousplating (SP), and unilateral external fixators (UEF) which can be performed for open tibial fractures. An unstable diaphysial tibia fracture was created in 60 fresh sheep tibia specimens by performing an osteotomy at the middle of bones. Specimens were divided into 3 groups. Specimens underwent fracture fixation with a standard MIPO technique, im-planting the plate 15 mm from the bone for SP group. Unilateral uniplanar external fixators were achieved for UEF group. First, thirty specimens (10 specimen for each group) were loaded vertically along the tibial axis to 1800 N. Second, other 30 preperated bones were used for cyclical loading to avoid metal fatigue. For dynamic tests, a 350 N force was applied for 10,000 cycles. In compression testing (vertical loading up to 1800 N) of the three fixation instruments; construct stiffness was highest in MIPO group when compared with SP and UEF groups. While the stiffness of the MIPO group was similar to SP group, it was statistically higher than UEF group (P=0.08 and P=0.002, respectively). SP group was significantly stiffer than UEF group (P=0.0021). The mean peak load was highest in SP group and lowest in UEF group. The peak load in SP group was similar to the MIPO group, it was statistically higher than the UEF group (P=0.743 and P=0.002, respectively). Based on the biomechanical properties from this in vitro animal model study, SP technique was biomechanically stronger than UEF and has similar biomechanical properties with MIPO in terms of axial loading.

Augmentation plate without bone graft in the management of distal tibial diaphyseal non-union

PurposeThe objective of this study was to assess the efficacy of augmentation plating with retaining of previous implant in situ in cases of non-united oligotrophic or atrophic aseptic distal tibial diaphyseal and metaphyseal fractures without bone grafting depending on the unified bone healing and non-union theory. MethodsThrough the period between December 2019 and December 2022, twelve patients with distal third tibial non-unions who were fixed at time of fracture either by intramedullary interlocking nails (seven cases) or by minimally invasive plate osteosynthesis (five cases) were included. Non-union was diagnosed on basis of absence of any healing progression in three months period or absence of fracture healing after six months from index surgery. All patients had oligotrophic or atrophic non-union. Augmentation plating through an anterolateral approach was done on average of 7.25 months after initial surgery (6–9 months). Circumferential exposure of the fracture site and debridement of fibrous tissue were not necessary. No bone grafting was done as no cases had major bone defect. ResultsAll patients achieved complete radiological union with a mean time of 21.8 weeks (range 18–30 weeks) that mean full callus formation in all cortices. All patients were walking independently after three months (13weeks) from surgery and returned to work even in cases of absent complete radiological union. No cases had been complicated with wound healing problems (infection or dehiscence). One patient had incomplete ankle dorsiflexion (10°) due to tight calf muscles and one patient had paresthesia on the dorsum of the foot that was not improved at last follow up (one year after surgery). ConclusionAugmentation plating is a safe and effective option for management of distal tibial diaphyseal nonunion even in cases of oligotrophic or atrophic non-union.

A comparative study of radiological and functional outcome of multidirectional locking nail with locking plate for management of distal Tibial Metaphyseal fractures

A comparative study of radiological and functional outcome of multidirectional locking nail with locking plate for management of distal Tibial Metaphyseal fractures

Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) for Distal Tibial Metaphyseal Fracture: A Better Option

Objective: The objective of this study was to evaluate the radiological and functional outcomes in of treatment of fracture distal tibial metaphysis fixed with pre-contoured anatomical locking compression plate using minimally invasive percutaneous plate osteosynthesis (MIPO) technique. Methods: This was a prospective study conducted at Department of Orthopedic Surgery, Services Hospital Lahore. Total of 58 closed distal tibial metaphyseal fractures (AO classification 43A) included in the study. All patients were operated using anatomical LCP with MIPO technique. The functional outcome was assessed by Tenny &amp; Wiss criteria at 6 weekly intervals with final scoring at 24th week. Functional outcome was graded as excellent, good, fair and poor. Similarly, radiological outcome was also assessed at 6 week intervals using Hammer et al criteria and grade 3 labelled as union. Results: We observed excellent functional outcome in 48 patients (82.6%) and good outcome in 6(10.34%) at last follow-up. Radiological union was achieved in 100% (58) patients at 24th week. The average time of union was 16.5 weeks with a range of 12 to 23 weeks. Total 03 patients (5.17%) developed superficial wound infection which was successfully managed with antibiotic therapy and no surgical site deep infection reported. Conclusion: Results of this study advocate that treatment of distal tibial metaphyseal fractures with LCP by MIPPO technique is an effective modality resulting in low complication rate, high union rates and good functional outcome.

Bilateral simultaneous rotational ankle fractures: case series and literature review

Bilateral Simultaneous rotational ankle injuries are rare entities with little number of cases reported in literature. Unlike axial type ankle fractures, they tend to happen as a result of pivoting trauma on the supportive limb. We conducted a case series and literature review of patients who presented with simultaneous bilateral ankle injuries and discussed their presentation and imaging. A total of Four cases in our institute and 6 separate cases reported in literature were found who sustained bilateral simultaneous rotational ankle fractures. There were 10 cases, nine of which were simultaneous and symmetrical ankle injuries. Injuries found were; Maisonneuve fracture, Tillaux fracture, Syndesmotic injury, Lauge-Hansen’s supination external rotation (SER), pronation external rotation (PER), supination adduction (SAD), and pronation abduction (PA). Four cases were presented in our institute over the last 10 years. A single case was asymmetrical in nature given the presence of an associated distal tibial metaphyseal fracture. Bilateral rotational ankle injuries are rare entity presenting simultaneously unlike axial type ankle fractures. When they present, they are likely caused by higher mechanism of injury than typical unilateral rotational ankle fractures. SER injuries are the most commonly found mechanism in both unilateral and bilateral ankle injuries.

Use of poller screw in proximal and distal metaphyseal fractures of tibia treated with intra-medullary inter-locking nail: A prospective study of 25 patients

Introduction: Treatment of tibia metaphyseal fractures is still difficult. Interlocking tibial fractures is preferred because it allows for some load sharing, preserves extraosseous blood flow, avoids major soft tissue dissection, and is well-known by most surgeons. Nailing of metaphyseal fractures with a short proximal or distal fragment is linked to increased malalignment, especially in the coronal plane, non-union, and the necessity for subsequent treatments to accomplish union. Blocking screws (poller screws), temporary unicortical plating, alternative nail designs with variable proximal bends (proximal third fractures), and fibular plating have all been proposed to better nailing metaphyseal fractures (distal third fractures).''The study's goal was to see if poller screws might be used as a supplement to stability in tibia metaphyseal fractures treated with a statically locked intramedullary nail. Materials and Methods: It was a prospective trial in which 25 patients with extraarticular Tibia metaphyseal fractures presented between July 2020 and December 2021 were treated with an Intra-Medullary Inter-Locking nail augmented with Poller screws and observed for six months. Results: The average age was 45.92 years, with a male majority.

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

A prospective comparative study on osteosynthesis of distal tibial metaphyseal fractures with plating V/s intramedullary nailing

Background: Tibial fractures are the most common long bone fractures, while distal tibial fractures are even more complicated due to their proximity to the ankle and the close relationship with thin,Objectives: To assess and compare fractures' functional outcomes in Group A versus Group B. To assess the efficacy, advantages, and disadvantages of the treatment modalities and their complications. Materials and Methods: This is a comparative study done from October 2018 to March 2020 in the Department of Orthopaedics, Narayana Medical College, attached to Narayana general hospital, Nellore. In this study period total of 40 patients were taken for study as per inclusion criteria. The patients are randomized into two groups of 20 cases each. Group A treated with plating, and Group B was treated with intramedullary nailing. Results: In our study, the average duration for the radiological union in the intramedullary interlocking nail group was 20.1 ± 1.14 weeks and in the plating group, it was 24.1 ± 1.16 weeks. Thus, the union occurred significantly faster in the nailing group.3 patients from the plating group had delayed union. In this study, better ankle rom was noticed in the intramedullary interlocking nail group as compared to that of the distal tibia plating. Average dorsiflexion at the final follow-up was 12.8 degrees and 9.7 degrees in the intramedullary interlocking nail group and the distal tibia plating group.Conclusion: Intramedullary nailing has the advantages of shortened operating time, early weight-bearing decreased wound problems an early union of the fracture, decreased implant-related problems, and overall reduced morbidity.

Comparison of Closed Intramedullary Nailing and Percutaneous Plating in Distal Tibia Metaphyseal Fractures

Objective: To compare the closed intramedullary nailing and percutaneous plating in distal tibial metaphyseal fractures. Study Design: Retrospective study Place and Duration of Study: Department of Orthopaedics, Sialkot Medical College, Sialkot from 1st July 2019 to 31st December 2021. Methodology: One hundred patients who were suffering from distal metaphyseal fractures of the tibia bone were enrolled. Group A patients underwent closed intramedullary nails while group B were those who were treated through percutaneous plating. Prophylactic antibiotics were given to all enrolled patients until 24 hours’ completion of the surgery. Follow-up of the wound was done from day fifth of the surgery and removal of sutures was performed by 15th day of surgery. Patients were followed up for one and a half year for their AOFAS scoring. Results: There were 58.3% males in Group A presenting a majority while in Group B females were having a majority with 47.5%. There were more left side fractures such as 53% and treated with closed intramedullary nails than through percutaneous plating. There was not a significant difference in the pain, function or alignment in both groups. There were 87% patients in group A which requested implant removal after 15.5 months while 92% of patients from Group B demanded the same. Conclusion: Intramedullary nailing is slightly superior that have reduced post-operative wound complications as compared to plate fixation. Keywords: Nailing, Plating, Fractures, Surgical procedures

Functional outcomes of distal tibia fractures treated using the minimally invasive percutaneous plate osteosynthesis technique with a locking compression plate

Background: Distal metaphyseal tibia fractures are difficult to treat owing to their limited blood supply, subcutaneous location, and inadequate soft tissue blanket. Minimally invasive percutaneous plate Osteosynthesis (MIPPO) using a locking compression plate (LCP) is a widely used surgical treatment. It is beneficial for the management of distal tibia fractures. This study aimed to assess the functional outcomes of distal tibia fractures treated with the MIPPO technique with an LCP. Methods: The investigators have conducted this prospective study with thirty patients who presented with distal tibia fractures over 8 months. All patients fulfilling the inclusion criteria and exclusion criteria took part in the study. All the patients were surgically managed by the MIPPO technique with LCP under spinal or general anesthesia. The functional and radiological outcomes were evaluated with the American Orthopedic Foot &amp; Ankle Society (AOFAS) scale. Results: A sizable number of the patients were aged 40–60 years, with a mean age of 49.8 years. Most participants were male (66.67%). The mean duration of surgery was 72.60 ± 5.35minutes. The mean length of hospital stay was 7.22 ± 1.45 days.

Comparative Study of Fracture Outcome by Dynamic Compression Plating and Locking Compression Plating in Distal Tibial Fracture

Abstract Introduction Distal tibia fracture with or without fracture of fibula is very commonly encountered in young adults. The treatment protocol is mainly surgical with open reduction and internal fixation (ORIF) with plate and screw—contoured dynamic compression plating (DCP) or precontoured locking compression plating (LCP). In spite of advanced surgery, the outcome is not satisfactory with complications arising in 20 to 50% of patients. The purpose of this study was to determine the outcome and compare the two different modalities. Materials and Methods The study includes 30 patients having distal tibial metaphyseal fracture without articular involvement treated with ORIF with plate and screw, contoured intraoperatively DCP and precontoured LCP in the Department of Orthopaedics. Patients were followed up for 12 to 24 months. Results were analyzed clinically (pain, alignment, range of motion, and complication) and radiologically. The patients were assessed according to time of full weight bearing, time of union of fracture, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Foot Functionality Index score. Results The time of full weight bearing and time of union were found to be statistically significant in DCP and LCP. According to the grading of AOFAS score, in DCP, excellent: 3 cases (20%), good: 6 cases (40%), and fair: 6 cases (40%). In LCP, excellent 3 cases (20%), good 8 cases (53.33%), fair 4 cases (26.66%) were observed. Conclusion LCP offers stability with early weight bearing and quicker fracture healing. But both groups had the same score at the final follow-up.

Comparison of Radiological and Clinical Outcomes in Patients Treated with Standard Plating versus Intramedullary Nailing in Distal Tibial Fracture.

ObjectiveTo evaluate clinical and radiological outcomes including hindfoot alignment after plate vs intramedullary nailing (IMN) for distal tibia fracture and to define radiologic parameters that influence changes in hindfoot alignment.MethodsAmong 92 patients with distal tibia metaphyseal fractures treated from 2002 to 2015, 39 cases of intramedullary nailing and 53 cases of standard plate osteosynthesis were performed. Union rate and complication rate were compared in both groups. Radiographic measurements including hindfoot angulation, moment arm, calcaneal pitch angle, and Meary angle were evaluated at a minimum of 1‐year follow‐up. Hindfoot alignment changes after surgery were compared between both groups using student t‐test. Correlation and regression were analyzed between fracture alignment parameters and hindfoot alignment.ResultsAll patients ultimately healed, with an average union period of 26 weeks in both groups. The AOFAS and VAS scores were not significantly different between the two groups. Complications were similar between the two groups. Hindfoot alignment angle, calcaneal pitch, and Meary angle showed no significant differences between the groups. The hindfoot moment arm increased with valgus in the IMN group. A low correlation was detected between angulation at the fracture site in the coronal view and hindfoot alignment (angulation and moment arm) changes (R = 0.38). A significantly high correlation was noted only between transverse rotation and hindfoot alignment changes (R = 0.79).ConclusionsRotation in the transverse plane notably influenced changes in hindfoot alignment. And this suggests that patients with distal tibia fracture should be closely monitored for hindfoot alignment changes caused by intraoperative transverse rotation regardless of the fixation method.

Distal metaphyseal tibial fractures: Is an IMIL nail an adequate implant? An observational study on the functional and radiological outcome

The purpose of this study is to evaluate the functional outcome as well as radiological outcome of distal metaphyseal tibial fractures treated with intramedullary interlocking nail after 6 months post surgery in terms of degree of functionality preserved and degree of malalignment respectively.This was an observational study conducted with 38 patients. Data was retrieved from the MRD. Patients were clinically assessed at 6 months interval and as and when needed by Karlstorm and Orleud Score. Fracture alignment post operatively and radiological union in two standard perpendicular (AP & Lateral) views were assessed. In patients operated in the past, their immediate post-operative and 6 month follow up x-ray was accessed. Functionality was assessed by available information in the patient chart and from present followup.6 cases (20%) had excellent results, 16 cases (55%) had good results, 7 cases (24%) had fair result (satisfactory/moderate) mostly for minor complaints of knee pain, ankle stiffness. 7 patients were unavailable for assessment of functionality. 1 patient had expired due to natural causes in conclusion Interlocking Intramedullary Nailing for Distal Metaphyseal Tibial Fractures is an acceptable line as it helps with early mobilization of the patient which helps in healing of the fracture and prevents joint stiffness thereby restoring complete motion. The construct is biomechanically stable. Fibular fixation with rush nails predisposed to delayed union, hence plating is recommended or revision of rush nailing to plating when feasible.

Distal tibia metaphyseal fractures treated with minimally invasive percuatneous plate osteosynthesis

Background: Tibia is the most commonly fractured bone amongst all long bones of the body. Fractures of the distal tibia are unique as the bone is subcutaneous with decreased muscular cover and decreased vascularity. Minimally invasive percutaneous plate osteosynthesis is a technique which is based upon the principles of limited soft tissue stripping, maintenance of the osteogenic fracture hematoma, and preservation of vascular supply to the individual fracture fragments while restoring the axial and the rotational alignment, and providing sufficient stability. Materials and Methods: This study was carried out at the Department of Orthopaedics, Navodaya Medical College Hospital and Research Centre, Raichur between the period Dec 2019 to Oct 2021. In this study, 30 patients with Distal Tibia Metaphyseal fracture were admitted at Navodaya Medical College Hospital and Research Centre, Raichur and examined according to protocol. The patients underwent Minimally invasive percutaneous plate osteosynthesis with Locking Compression plate. All cases were assessed using the IOWA ankle score and TEENY WISS radiological scoring. Results: The average fracture healing time was 16 weeks (range 12–20 weeks). According to the IOWA ankle score, excellent results were found in 16 (53%) patients, Good results were found in 11(37%) patients and fair results were found in 3(10%) patients. Superficial infection occurred in 5 patients (16%), no cases of deep infection, implant failure and malunion. Conclusion: Minimally invasive percutaneous plate osteosynthesis proves to be a safer technique in the management of Distal tibia metaphyseal fractures by providing good fracture healing, enabling rapid functional recovery, and avoiding major skin complications.

Results and complications of minimally invasive medial plate osteosynthesis for distal metaphyseal tibial fractures: A prospective case series from Vietnam

Introduction and importanceThe treatment of a fractures in tibial distal metaphyseal remained controversial. The purpose of this study was to assess the results and complications of minimally invasive medial plate osteosynthesis for distal metaphyseal tibial fractures. Material and methodFrom April 2014 to December 2019, 70 patients were enrolled in the study who were underwent MIPPO for metaphyseal tibial fractures using a medial distal tibial locking plate in our hospital. Wound healing, alignment, full weight bearing time, function, and complications were recorded. ResultsAll wounds primarily healed, just one fibular plating wound was deeply infected. All tibial fractures were solid union without secondary displacement. The average time back to walk without a crutch was 12,5 weeks. The mean AOFAS score was 89 at a mean of 15 months follow-up. There were seven cases of late infection, 14 patients of skin impingement by implants and nine cases of broken screws, who were older than 65 years old. No case was varus, valgus or rotation >5°. ConclusionMinimally invasive medial plate osteosynthesis for the distal metaphyseal tibial fracture is safe and effective. This technique decreases the incidence of complications and can help patients to resume their function early. The implant impingement, late wound infections and screw breakage were the quite common complications in old patients but these complications could be simply resolved and did not affect the overall rehabilitation and functions of the patient.

Eklem dışı distal tibia kırıklarının tedavisinde minimal invazif plaklı osteosentez ile intramedüller çivilemenin karşılaştırılması

Aim: Our study’s aim was to investigate the effectiveness of minimal invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) in extraarticular distal tibia fractures and to compare the outcomes of these two treatment methods.&#x0D; Materials and Methods: Between January 2008 and January 2015, 59 patients had extraarticular distal tibia fracture and treated with MIPO or IMN were evaluated retrospectively. Postoperative x-rays were evaluated for fracture consolidation and angular deformities. For the functional evaluations of the patients Olerud-Molender Ankle Scoring (OMAS) method was used and ankle joint range of motion was measured by goniometer.&#x0D; Results: At the last visit, all the fractures consolidated. Average union time was 16.1weeks (range, 12-24 weeks) in MIPO group and 15.5 weeks (range 10-24 weeks) in IMN group, respectively (p = 0.254). The mean OMAS scores were 67.5 (range 40–90) and 63 (range 30-90) in the IMN and MIPO groups, respectively (p= 0.12). The mean operation time was 95(range 45-115) minutes in IMN group and 75(range 40-100) minutes in MIPO group (p= 0.04). The mean operative radiation exposure times were 30(range 8-143) and 17 (range 5-65) seconds in IMN and MIPO groups, respectively (p= 0.03). Angular deformities were found in IMN group at 7 (23%) patients and in MIPO group at 5 (17%) patients, respectively. Soft tissue problems were seen in more patients in MIPO group.&#x0D; Conclusion: In conclusion, IMN and MIPO can be used safely in the treatment of distal tibial metaphyseal fractures. While IMN caused more angular deformity and more union delay, patients treated with MIPO had poorer functional results and more soft tissue problems.

Management of Tibial Metaphyseal Fractures Using JESS Fixator

Introduction: The management of proximal and distal tibia fractures remains challenging due to associated soft tissue injuries. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications. Aim: To assess the outcome of treatment of such fractures by the use of Joshi’s external stabilization system (JESS), which is a simple wire based, circular external fixator system. Materials and Methods: A prospective, uncontrolled study was done using JESS on 30 consecutive patients (20 patients of proximal tibial metaphyseal fractures and 10 of distal tibial metaphyseal fractures). Results: In our study, the most common mode of injury was road traffic accidents (21 cases), fall from height (6 cases) and slip injury (3 cases). The patients were operated at a mean interval of 3.2 days (range 1-6 days) due to associated poor soft tissue conditions. The patients were followed up for 24 weeks. Full weight bearing was allowed at 10 to 14 weeks. JESS frame was removed at mean duration of 13 weeks (range 12-16 weeks). According to knee society score (KSS), excellent result (score 80- 100) was seen in 12 patients (60%), good result (score 70-79) was seen in 4 patients (20%), fair result (score 60-69) in 3 patients (15%) and poor result (score &lt;60) in 1 patient (5%) of proximal tibial metaphyseal fracture. According to Olerud and Molander score (OAMS), excellent result (score 91-100) was seen in 5 patients (50%), good result (score 61-90) in 3 patients (30%) and fair result (score 31-60) in 2 patients (20%) of distal tibial metaphyseal fracture. The complication seen was superficial pin tract infection in 4 patients, which was managed by regular pin tract dressing and oral antibiotics. Delayed union (mean at 15.3 weeks) was seen in 2 patients with Schatzker type VI fracture and 1 patient with severe comminuted distal metaphyseal fracture. Conclusion: JESS is a simple, light, effective and cheap method and can be used as a definitive procedure to treat these fractures even with soft tissue compromise.