Distal Tibiofibular Fractures Research Articles

Regional anesthesia in a patient with primary ciliary dyskinesia: A case report

BACKGROUND Primary ciliary dyskinesia (PCD) is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases, otolaryngological diseases, central nervous system abnormalities, reproductive system abnormalities, and cardiac function abnormalities. General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease. CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture. Three years prior, he had been diagnosed with PCD. At that time, he had experienced several episodes of pneumonia, sinusitis, and chronic middle ear infections, for which he underwent surgical interventions. At the current admission, he presented with cough and sputum but no other respiratory symptoms. A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe. For the surgical procedure and postoperative pain management, combined spinal-epidural anesthesia was employed. The patient’s postoperative pain score was measured by the numerical rating scale (NRS). On the day of surgery, his NRS was 5 points. By the second postoperative day, the NRS score had decreased to 2–3 points. The epidural catheter was removed on the fourth day following the operation. The patient was subsequently discharged no respiratory complications. CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD. The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.

Fibular Fixation in Same-Level Distal Third Tibiofibular Fractures: Is Fibular Fracture Regarded as a Secondary Importance?

Although most studies focused on the alignment or union of the tibia in same-level distal third tibiofibular fractures, the outcome of a concomitant fibular fracture is generally regarded as being of secondary importance in the literature. This study aimed to assess the outcomes of fibular fractures in same-level distal third tibiofibular fractures. In this retrospective study, we enrolled 111 patients with same-level distal third tibiofibular fractures treated at our institute between January 2016 and August 2020. Tibial fractures were stabilized with intramedullary nailing, and the cases were divided into two groups based on whether they additionally underwent fibular fixation (group 1, 57 cases) or not (group 2, 54 cases). Clinical and radiographic outcomes were used for the evaluation of tibial and fibular alignments, union of the tibia and fibula, number of interlocking screws in the distal tibial fragment, range of motion of the ankle joint, and complications. No statistically significant differences in the tibial union rate or mean tibial alignment were observed between the two groups on either the immediate postoperative or final radiographs. The fibular union rate in group 1 was significantly higher than that in group 2 (fibular nonunion, 0 vs. 15; p < 0.001). Statistically significant differences in fibular displacement were observed on immediate postoperative radiographs between patients with fibular union and those without it. At the final follow-up, the mean range of ankle motion and lower extremity functional scale scores did not differ between the two groups. Regardless of whether fibular fixation was performed, the overall tibial alignment with intramedullary nailing was well restored and the union rate of the tibia was comparable in the two groups. Fibular nonunion is not uncommon in unfixed fibula fractures. Displacement of the fibula as seen on immediate postoperative radiographs was related to fibular nonunion.

Treatment of post-lumbar sympathetic neurolysis neurologic complications using a transforaminal epidural block: A case report

Background: A lumbar sympathetic ganglion block is useful for controlling neuropathic pain. Although the procedure is relatively safe, the use of chemical neurolytic agents may cause neurological complications. We underwent lumbar sympathetic ganglion neurolysis, and thereafter, neurological complications occurred. There is no specific treatment for neurologic complications after neurolysis using chemical agents, and a patient-specific approach is required. In this case, the pain intensity decreased step-by-step after transforaminal epidural block and interlaminar epidural block. We wrote about this treatment experience.Case presentation: A 45-year-old male patient underwent closed reduction and external fixation surgery for a left distal tibiofibular fracture and was subsequently diagnosed with complex regional pain syndrome. Lumbar sympathetic ganglion neurolysis was performed for treatment, but sensory loss of the L2 and L3 dermatomes and adductor muscle weakness of the lower leg occurred. Transforaminal epidural block and interlaminar epidural block were repeatedly performed to treat complications, and these procedures helped control the symptoms.Conclusions: When neurological complications occur after lumbar sympathetic neurolysis, an excellent therapeutic effect can be expected if transforaminal epidural block is used together with palliative treatment.

Fibular fixation improves ankle functional outcomes and alignment in the intramedullary nailing of distal third tibiofibular diaphyseal fractures.

The study aims to determine the effect of fibular fixation on alignment and fracture healing of tibia, and ankle functional outcomes in the treatment of distal third tibiofibular diaphyseal fractures. Consecutive 111 patients (33 females and 78 males) with distal third tibiofibular diaphyseal fracture who met the inclusion criteria were included in the study. Patients were divided into two groups as those who underwent fibular fixation with tibia intramedullary nailing (study group) and those who did not (control group). Groups were compared in terms of demographic features, trauma and fracture characteristics, functional and radiological outcomes. No significant difference was observed between the groups in terms of demographic features, trauma characteristics, complications, and follow-up time (p > 0.05). Surgery time was significantly lower in the control group (p = 0.001). Ankle joint range of motion, AOFAS score, OMAS score, and full weight-bearing time were significantly better in the fibular fixation group (p = 0.023, p = 0.001, p = 0.001 and p = 0.039, respectively). Significantly better coronal alignment and sagittal alignment were found in the fibular fixation group (p = 0.001 and p = 0.001, respectively). Patients who underwent fibular fixation had significantly better radiological outcomes in terms of fibular rotation angle and ankle arthrosis (p = 0.000 and p = 0.022, respectively). Fibular fixation not only contributes to fracture union, early full weight-bearing, and alignment but also improves ankle functional outcomes in the distal third tibiofibular fractures treated with intramedullary nailing for tibia. Level III, retrospective study.

Metal allergy after osteosynthesis for distal tibiofibular fracture: a case report

Metal allergy after osteosynthesis for distal tibiofibular fracture: a case report

Minimally invasive plate osteosynthesis using the oblong hole of a locking plate for comminuted distal fibular fractures

BackgroundNonunion is a rare complication for distal fibular fractures. However, when there is a high degree of comminution, nonunion may occur. In this article, we describe a novel technique that uses the oblong hole of a locking plate to lengthen the fibula for fracture reduction. This technique is straightforward and allows for easy control of the comminuted fracture to restore length and rotation at the time of plate application without opening the fracture site.MethodsThirty-five consecutive patients, who were treated with the minimally invasive plate osteosynthesis (MIPO) technique for comminuted distal fibular fractures were retrospectively studied. The study included 19 men and 16 women, with a mean age of 47.0 years (range, 20 to 72). There were 3 lateral malleolar fractures with deltoid injury, 11 bimalleolar fractures, 7 trimalleolar fractures, and 14 distal tibiofibular fractures. The quality of fracture reduction was assessed by comparing the radiologic parameters (fibular length, talocrural angle, and medial clear space) between the affected ankle and the contralateral uninjured ankle.ResultsTwo patients were not reachable and 5 declined to visit the clinic. For these 7 patients, the latest outcomes that were measured prospectively were used. Postoperative radiographs showed well-aligned ankle mortise, with fibular length restoration. The mean Olerud-Molander ankle score was 82.1 ± 10.7 at a mean of 27.2 months (range, 12 to 58). There was one case of nonunion and one case of superficial peroneal nerve injury.ConclusionThe MIPO technique, using the oblong hole of a locking plate, achieved satisfactory restoration of length and rotation, bone union, and clinical outcomes for the comminuted distal fibular fractures.

Two-Stage Surgical Procedure in Intra-articular Distal Tibiofibular Fractures with Soft Tissue Injury: in Which Stage Should the Fibular Plate be Applied at Initial Surgery?

Introduction:The selection of the stage where fibular plate was performed in two-stage surgery of the intra-articular distal tibiofibular fractures with soft tissue injury is still controversial. The aim of the study was to compare the complications, radiological and functional outcomes between the patients who had fibular plate at initial or second phase during surgical management of such fractures.Materials and Methods:In this study, medical records of 47 patients who underwent a two-stage surgical procedure for intra-articular distal tibia fractures accompanying soft tissue injury were retrospectively examined. Delta frame was applied in all cases within 24 hours following admission to the emergency department in accordance with AO principles. Those cases where fibular plate was applied during the initial stage and the second stage were classified as Group 1 and Group 2 in order to compare recorded data between the two groups.Results:According to the results of the study, there were 25 cases in Group 1 and 22 cases in Group 2 in which fibular plate was applied at the first stage and the second stage, respectively. The mean follow-up was found as 27.7±7.0 months in Group 1 and 28.2±6.2 months in Group 2 (p=0.778). No difference was found between the two groups in terms of the age, sex, hospital stay, the time between two surgical procedures, tibiofibular angle and AOFAS scoring (p>0.05).These two groups were also similar in mechanism of injury, Denise-Weber or AO classification, rates of tibiofibular malalignment on post-operative CT, fibular rotation, intra-articular tibial step-off, tibial varus-valgus duration of union, rate of infection, fibular angulation and the presence of the flap/graft/debridement (p>0.05).Conclusion:In conclusion, two-stage surgical procedure in intra-articular distal tibiofibular fractures may be an effective method decreasing soft tissue complications. The timing of the open reduction and internal fixation of the fibula at different stages may not necessarily have an impact on the success of the post-operative tibial reduction, the total duration of surgery, syndesmosis malalignment or soft tissue complications.

Postoperative distal tibiofibular synostosis: radiographic characteristics and the influence on ankle mobility

Objective: To investigate the clinical and imaging characteristics of distal tibiofibular synostosis in postoperative ankle fractures and its effects on the ankle mobility. Methods: The clinical and imaging data of 47 patients with distal tibiofibular synostosis treated surgically from October 1991 to June 2013 were analyzed retrospectively. There were 30 males and 17 females, aged from 15 to 68 years with a mean age of (39±13) years. The original fracture types, internal fixation profiles, imaging features of distal tibiofibular synostosis were recorded. Ankle range of motion (ROM) and complications at the last follow-up were also evaluated.The ROMs of healthy and fractured sides were compared with paired sample rank test. Results: The patients were followed up for 3 to 204 months (mean 25.4 months). Of the patients, 34(72.4%) were ankle fractures, 7(14.9%) were distal tibiofibular fractures, 1(2.1%) was tibiofibular shaft fracture, 2(4.3%) were tibial shaft fractures associated with lateral malleolus fracture and the resting 3(6.4%) were Pilon fractures. In patients with ankle fractures, 76.5%(26/34) of the synostosis occurred at the distal tibiofibular syndesmosis, while 23.5%(8/34) at the proximal of the tibiofibular sydesmosis; in patients with distal tibiofibular fracture, 85.7%(6/7) of the tibiofibular synostoses occurred at the fracture sites. The synostosis occurred at the level of syndesmotic screws in 8 patients (88.9%, 8/9) fixed with distal tibiofibular syndesmotic screws. And synostosis occurred at the sites of the distal locking screws in all (3/3) of the patients fixed with intramedullary nails. At the last follow-up, the active plantarflexion, active dorsiflexion and passive dorsiflexion in the affected side was 0°(0°, 5°), 2°(0°, 5°), 5°(0°, 10°) less than those in the healthy side, respectively (Z=-3.493, -4.491, -5.130, all P<0.05).During the follow-up, 4 patients complained of lateral ankle discomfort with no impact on daily life. Conclusions: Post-operative distal tibiofibular synostosis mainly occurs at the sites of fractures, distal tibiofibular syndesmotic screw sites and the sites of the distal locking screws of tibial intramedullary nails. ROM of the injured ankle decreases in comparison with that at the contralateral side, although no obvious symptoms are observed and no intervention needed.

Kirschner wire combined with external fixator for open comminuted distal tibiofibular fractures according to the concept of damage control orthopaedics

Objective To report the clinical efficacy of Kirschner wire combined with external fixator in the treatment of open comminuted distal tibiofibular fractures according to the concept of damage control orthopaedics. Methods A case series study was done on the clinical data of 15 open comminuted distal tibiofibular fractures which had been treated with kirschner wire combined with external fixation from January 2015 to August 2018 at Department of Orthopedics, Affiliated Hospital to Logistics College of Chinese People's Armed Police. They were 12 men and 3 women, aged from 27 to 62 years (mean, 46.5 years). By the Gustilo classification, there were one case of type Ⅰ, 4 cases of type Ⅱ, 7 cases of type ⅢA, 2 cases of type ⅢB and one case of type ⅢC. All the patients were treated with emergency debridement, tibial fixation using external fixator and fibular fixation using kirschner wire, followed by vacuum sealing drainage(VSD). Effective anti-inflammatory and other comprehensive treatments were given postoperatively. Regular follow-up was conducted to observe fracture healing and complications like osteomyelitis and bone disconnection. At the final follow-up, the American Orthopaedic Foot Ankle Society (AOFAS) ankle-hindfoot scale was used to evaluate the ankle function. Results All the patients were followed up for 12 to 18 months (mean, 12.8 months). Primary bone union was achieved in 13 cases (86.7%), delayed healing observed in one case (6.7%) and bone nonunion in one case (6.7%). No osteomyelitis occurred. By the AOFAS ankle-hindfoot scale, the ankle function was rated as excellent in 9 cases, as good in 4, as fair in one and as poor in one. Conclusions For patients with open comminuted distal tibiofibular fracture, treatment should be conducted according to the concept of damage control orthopaedics. After early thorough debridement, the tibia should be fixated using external fixator and the fibula using kirschner wire, followed by VSD, leading to economical cost and satisfactory clinical efficacy. Key words: Tibial fractures; Fibular fractures; External fixators; Bone nail; Damage control orthopaedics

The assessment of the application of Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures

To determine the effectiveness and the safety of the Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures. The clinical data of 74 patients with intermediate or distal tibiofibular fractures treated between January 2015 and January 2017 were retrospectively analyzed. According to fixation methods, they were divided into internal fixation group (26 cases) and external fixation group (48 cases). There was no significant difference in the age, gender, cause of injury, type of fracture, time from injury to operation between 2 groups ( P>0.05). The intraoperative blood loss, fracture healing time, fixator removal time, and complications were recorded and compared. The final function evaluation criteria of Johner-Wruhs humeral shaft fracture were used to evaluate the function of the affected limb. The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al. Both groups were followed up 6-22 months (median, 14 months). All patients obtained the fracture healing. The intraoperative blood loss, fracture healing time, and fixator removal time were significantly higher in the internal fixation group than those in the external fixation group ( P<0.05). There were 1 case of plate exposure, 1 case of delayed fracture healing, and 1 case of plate fracture in the internal fixation group; and there were 2 cases of delayed fracture healing and 4 cases of soft tissue defect in the external fixation group; no significant difference was found in the incidence of complications between 2 groups ( χ2=0.015, P=0.904). The function of the affected limb was evaluated by Johner-Wruhs standard at 10 months after operation, the results was excellent in 19 cases, good in 5 cases, and fair in 2 cases in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 42 cases, good in 3 cases, and fair in 2 cases in the external fixation group, with an excellent and good rate of 95.7%; showing no significant difference between 2 groups ( χ2=0.392, P=0.531). The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al.at 4 months after operation, the results was excellent in 24 cases, fair in 1 case, poor in 1 case in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 46 cases, fair in 1 case, poor in 1 case in the external fixation group, with an excellent and good rate of 95.8%; showing no significant difference between 2 groups ( χ2=0.520, P=0.471). The use of Taylor spatial frame in the treatment of the intermediate or distal tibiofibular fractures can obviously reduce the healing time and complications than the internal fixation of the plate. It can reduce the fracture treatment cycle and is beneficial to the fracture healing and limb function recovery, which is relatively safe and reliable.

Posterior Tibial Artery Perforator-Based Adipofascial Flap for Skin Necrosis and Exposed Extensor Tendon after Fixation of Distal Tibiofibular Fracture

Posterior Tibial Artery Perforator-Based Adipofascial Flap for Skin Necrosis and Exposed Extensor Tendon after Fixation of Distal Tibiofibular Fracture

Posttraumatic Tibiofibular Synostosis After Treatment of Distal Tibiofibular Fractures in Children.

Posttraumatic pediatric distal tibiofibular synostosis is a rare complication following fracture. This is a retrospective, multicenter case series of synostosis of distal tibiofibular fractures in children. The purpose was to evaluate the incidence and pattern of posttraumatic distal tibiofibular synostosis in children. Of the 604 pediatric distal tibiofibular fractures, 20 patients (3.3%) with synostosis after treatment of distal tibiofibular fractures were identified at 3 tertiary referral centers. There were 12 boys and 8 girls, with a mean age of 8.4±2.0 years (range, 3.7 to 11.5 y) at the time of injury. Medical records were reviewed, and serial radiographs were analyzed to determine fracture configuration, pattern of synostosis, and changes in the relative positions of the proximal and distal tibial and fibular physes and in the alignment of the ankle. The time from the occurrence of fracture until the recognition of the synostosis ranged from 2 to 6 months (mean, 2.8 mo). The most common fracture configuration was oblique tibial fracture combined with comminuted fibular fracture. There were 12 focal types and 8 extensive types. The proximal tibiofibular distance was decreased in 13 patients. Proximal migration of the distal fibular physis developed in all cases. Five patients exhibited ankle valgus of 10 degrees or greater with moderate or severe distal fibular shortening. Eight patients were symptomatic after synostosis and 12 patients were asymptomatic. We identified 2 patterns of synostosis after the treatment of pediatric distal tibiofibular fracture: focal and extensive. The focal type was more prevalent than the extensive type, which was more likely to occur due to high-energy injury. When a tibiofibular cross-union develops, it creates growth abnormalities that warrant observation and potential treatment, as it may lead to progressive deformity or ankle pain. Level IV.

Fracture restoration technique based on 3D printing used in distal tibiofibular fractures

Objective To explore a 3D printing model of fracture restoration which can be used in preoperative planning and design for distal tibiofibular fractures. Methods A retrospective analysis was performed of the 35 patients with distal tibiofibular fracture who had been treated from October 2015 to September 2016 at our department. Bilateral tibiofibular CT scan was performed in all the cases to obtain Dicom data. Using Mimics 15.0 software, cross sections were created at 5 cm, 10 cm and 15 cm above the knee joint at the bilateral upper tibiae and marked as PT5, PT10 and PT15. The long and short axles on the left and right sides were measured and compared (LL vs. RL; LS vs. RS). After the STL files for 3D models were generated using Mimics 15.0 software, a real-sized 3D model of the distal tibiofibular fracture and a mirror model of the contralateral tibiofibula were printed. The fracture lines were drawn and preoperative manoeuvre was performed on the mirror 3D printed model. The real operation used the implants preoperatively designed; the actual screw lengths were measured and compared radiographically with those designed in the preoperative manoeuvre. Results All the data were collected of the long and short axles on the 3 cross-sections (PT5, PT10 and PT15) of the left and right sides of the proximal tibia. The samples were paired into 6 groups. The correlation coefficients of paired samples were greater than 0.95, showing an ex-tremely strong correlation. The differences between the left and right sides showed no statistically significance in paired samples of LR-RL and LS-RS groups on PT5, PT10 and PT15 cross-sections (P >0.05). All the 35 cases received surgical operation. The postoperative X-ray review showed fine agreement between actual surgery and preoperative design in terms of screw length and accuracy. The deviations were in an allowable range, leading to satisfactory internal fixation. Conclusions A mirror 3D model of the healthy side is of clinical value to some extent because it can serve as one for an anatomically reduced fracture which can be used for preoperative manoeuvre and preparation of implants. The contrasts between the long and short axles on the 3 cross-sections may simplify and facilitate comparisons of bilateral similarity, avoid the blindness in direct application of the health side mirror model for preoperative planning. Key words: Ankle joint; Fractures fixation, internal; 3D printing technology

Intramedullary tibial nailing of distal tibiofibular fractures: additional fibular fixation or not?

The anatomy of the distal tibia accounts for reduced biomechanical stability and higher complication rates when treating distal tibiofibular fractures with an intramedullary tibia nail (IMTN). The goal of this study was to identify variables that affect the stability of IMTN. We assessed the value of additional fibular fixation, angular stable interlocking screws (ASLS) and multiplanar screw configuration in IMTN. A retrospective cohort study was performed including 184 distal tibial fractures and associated fibula fracture treated with IMTN. Relevant demographic, fracture-related (type and level of the tibia and fibula fracture) and operative variables (depth of the nail, screw type and configuration, use of polar screws, fibular fixation) were studied. Coronal and sagittal alignment was assessed directly and 3-6months after IMTN. Loss of reduction (LOR) was classified as 5-9° or ≥10°. 48.4% of the patients showed ≥5° LOR in one or both planes. Coronal LOR 5°-9° significantly correlated with low tibial fractures (p=0.034), AO/OTA type 43 distal tibial fractures (p=0.049), and sagittal LOR 5°-9° (p=0.015). Although sagittal LOR 5°-9° was associated with fibular fractures (non-fixated suprasyndesmotic, p=0.011), conversely we could not demonstrate the added value of (suprasyndesmotic) fibula fixation in IMTN. Coronal LOR ≥10° significantly correlated with AO/OTA type 43 distal tibial fractures (p=0.009). In contrast to multiplanar configuration, we found a clear benefit of ASLS in distal IMTN locking. The level of the tibial fracture (AO/OTA type) and (suprasyndesmotic) fibular fractures were the main determinants of LOR after IMTN. ASLS was found to increase the stability of IMTN. Due to heterogeneity, however, we could not demonstrate the value of fibular fixation in IMTN. Therefore, a future prospective study with uniform treatment strategy for IMTN of distal tibiofibular fractures, with or without fixation of the fibula, is mandatory.

Fibular posterolateral approach and minimally invasive percutaneous plate osteosynthesis for treatment of type A3 distal tibiofibular fractures

Objective To report the treatment of type A3 distal tibiofibular fractures with the fibular posterolateral approach and minimally invasive percutaneous plate osteosynthesis (MIPPO). Methods We reviewed 61 patients with type A3 distal tibiofibular fracture (observation group) who had been treated with MIPPO and the fibular posterolateral approach from June 2011 to May 2015. Our control group included 78 patients with type A3 distal tibiofibular fracture who had been treated by traditional open reduction and internal fixation from April 2009 to September 2013. Interval between injury and surgery, surgical time, intraoperative bleeding, hospital stay, postoperative complications, X-ray Lane-Sandhu osteotylus score and limb weight-bearing score one year after operation were compared between the 2 groups. Results All the 139 patients were followed up for more than one year. There were significant differences between the 2 groups in terms of interval between injury and surgery (8.0±3.5 h versus 140.7±52.4 h), surgical time (66.2±7.2 min versus 92.1±6.6 min), intraoperative bleeding (59.8±12.8 mL versus 209.5±50.4 mL), hospital stay (9.4±1.9 d versus 26.1±15.7 d), postoperative complications, X-ray Lane-Sandhu osteotylus score (3.9±0.2 points versus 3.0±0.6 points) and limb weight-bearing score (3.9±0.1 points versus 3.0±0.7 points) one year after operation, favoring the observation group(P< 0.001). Conclusions In the treatment of type A3 tibiofibular fractures, MIPPO plus the fibular posterolateral approach is superior to the traditional open reduction and internal fixation because it can benefit fracture healing by shortening the time for preoperative preparation, surgery and hospitalization, and decreasing the amount of intraoperative bleeding and the incidence of postoperative complications. Key words: Tibial fractures; Fracture fixation, internal; Bone plate; Surgical procedures, minimally invasive

Complications after surgical management of distal lower leg fractures.

BackgroundOsseous healing of distal lower leg fractures can be prolonged and is often associated with wound healing problems because of the marginal soft - tissue and vascular supply in this area. Postoperative complications are frequent, and according to the literature, open reduction and plate fixation is thought to be associated with higher complication rates. The objective of this study was to evaluate the most common postoperative complications following intramedullary nailing or plate osteosynthesis of distal lower leg injuries with a focus on combined tibio-fibular fractures. The outcomes of patients with and without complications associated the two surgical techniques were compared.MethodsDuring a 5-year period, all surgically treated distal tibiofibular fractures were retrospectively collected from the clinical database and were evaluated for the presence of postoperative complications which included compartment syndrome, wound infection, delayed union and non-union, synostosis and rotational malalignment. Postoperative complications were reviewed and correlated with patient risk factors.ResultsA total of 199 patients were included in the study, and 75 complications were reported. The majority of complications were associated with closed fracture types treated with intramedullary nailing, delayed union being the most frequent. For open fractures, surgical treatment with plate fixation had a complication rate of 12% compared with 25% after intramedullary nailing.DiscussionIn general, distal lower leg fractures are associated with a high risk of postoperative complications. Distal diaphyseal tibial fractures that have been treated with intramedullary nailing devices have a higher risk of delayed union or non - union.ConclusionPlate fixation in distal metaphyseal fractures has a higher risk of problems related to wound healing and postoperative wound infections.

Z-plasty of the flexor hallucis longus tendon at tarsal tunnel for checkrein deformity.

To review the outcome of Z-plasty of the flexor hallucis longus (FHL) tendon at the tarsal tunnel for checkrein deformity in 8 patients. Records of 6 males and 2 females aged 14 to 67 (mean, 39.5) years who underwent Z-plasty (lengthening) of the FHL tendon at the tarsal tunnel for checkrein deformity in the first and second toes by a single surgeon were reviewed. All patients had undergone 3 months of conservative treatment. The mean time from injury to surgical treatment was 8.4 (range, 5-12) months. All patients had associated injuries including distal tibiofibular fracture (n=6), distal fibular fracture (n=1), and crush injury aroundthe ankle (n=1); they were treated with intramedullary nailing (n=6), long leg splinting (n=1), and short leg splinting (n=1). After a mean follow-up of 3.4 (range, 1-7) years, the FHL tendon was lengthened by a mean of 1.7 (range, 1.6-1.8) cm, and the mean American Orthopedic Foot and Ankle Society hallux score increased from 59 (range, 52-67) to 89 (range, 80-90). No patient had recurrence, nerve injury, or tarsal tunnel syndrome, although one patient had sensory disturbance of the posterior tibial nerve in the forefoot, which resolved spontaneously at week 2. Z-plasty of the FHL tendon at the tarsal tunnel is a viable option for correction of checkrein deformity.

Evaluating Outcome of Distal Tibia and Fibula Fractures Treated with Intra Medullary Nailing

Choice of best treatment in tibiofibular fractures should be based on many affecting factors such as age, wound contamination's, presence of associated conditions and availability of stabilization devices. This study is aimed to evaluating outcome of distal tibia and fibula fractures treated with intra medullary nailing in Firoozgar hospital during 2012-2014. In this cross- sectional study which was conducted in Firoozgar hospital in 2012-2014, 40 patients with distal tibiofibular fractures who was candidate for IM nailing were evaluated. Operation was done by intramedullary nailing method. Patients were followed up at 2 weeks, 1, 3, 6 and 12 month after surgery. Radiographic evaluation of union in tibia with anteroposterior and lateral view, as well as complications was assessed in each visit. Data were enterd to SPSS and were analyzed. Fifty patients with mean age of 34.67 (SD= 12.98) years (46 (92) male and 4 (8) female) were evaluated. Four (10) patients remained non- union from whom 3 (7.5) underwent ORIF treatment. Mean time of complete union achievement was 6.34 (SD= 3.54) months. Fourteen malunion were seen in this study that 1 (7.14) was varus (7°) and 13 (92.85) were valgus. No cases of deep infection, nerve injury or compartment syndrome were seen. We conclude that reamed, locked IM. nailing is a good method for achieving union in distal tibial fractures. High rate of union, low complication and deformity correction was seen with this method. © 2016, Oriental Scientific Publishing Company. All rights reserved.

A Curious Distal Tibiofibular Neuropathic Fracture: A Case Report.

Therapeutic, Level IV: Case report.

English

INTRODUCTION: Distal tibial fractures are very commonly encountered by orthopaedic surgeons. Our aim is to study and compare clinical and radiological outcome in extra articular fractures of distal tibia treated by interlocking intramedullary nails and locking plates with reference to rate of healing, functional outcome and complications. MATERIAL AND METHODS: In this study 30 patients with distal tibia extrarticular fractures, AO type 43 A were randomly selected and 15 of them were operated with interlocking nailing and remaining 15 with a locking plate. The patients were regularly followed up for a period of 1year and were evaluated clinically and radiologically with respect to tenderness at fracture site, abnormal mobility, infection, pain on movement of knee, ankle joints and anteroposterior and lateral radiographs of the leg for union of the fracture. RESULTS: In Interlocking group average time for union was 17.43 weeks compared to 21.40 weeks in plating group which was significant (p value <0.05). Also the average time required for partial and full weight bearing in the nailing group was 4.4 weeks and 9.53 weeks respectively which was significantly less (p value <0.0001) as compared to 7.07 weeks and 13.29 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness and infection (superficial and deep) were seen in interlocking group as compared to plating group. KEYMESSAGE: we recommend fibular fixation whenever intramedullary nailing or locking plate fixation is used in distal tibiofibular fractures. We concluded that due to early weight bearing, early union of the fracture and decreased implant related problems and closed intramedullary interlocking