Extra-articular Tibial Fractures Research Articles

Study of surgical management of distal 1/3rd extra articular tibia fracture with locking compression plate a prospective study

Study of surgical management of distal 1/3rd extra articular tibia fracture with locking compression plate a prospective study

The Lateral Para-Patellar Approach for Intramedullary Tibia Nailing in Distal Tibia Extra-articular Fractures: A Prospective Cohort Study.

The treatment of extra-articular distal tibiafractures is still a subject of debate and frequently necessitates surgical treatment, and intramedullary nailing (IMN) offers a minimally invasive approach with excellent results. Important factors in these procedures are positioning, operative duration, and radiation exposure. This study details the semi-extended lateral para-patellar approach for IMN of distal tibia extra-articular fractures and documents our findings regarding operative time, intra-operative radiation exposure, residual anterior knee pain, knee functional and radiological outcomes at six months follow-up. We reviewed the cases of 60 patients who underwent IMNfor distal tibia extra-articular fractures from May 2022 to March 2024, employing an extra-articular lateral para-patellar approach in the semi-extended position. Patients were evaluated clinically and radio-graphically for a minimum follow-up period of six months. Data collected included duration of surgery, intraoperative radiation exposure, and knee functional scorefor all patients. Assessment of fracture healing, residual deformities, residual anterior knee pain, and range of motion of the treated knee compared to the contralateral knee was done at a six-monthfollow-up. The average surgery duration was 54 ± 5 minutes, with intraoperative imaging averaging 48 exposures. The average time to union was 16 ± 3 weeks. Six months post-surgery, the mean Knee Society Score was 86.4 ± 3.5 (out of 100). At the six months follow-up, all patients exhibited clinical and radiographic healing, with only two cases showing mal-alignment (angular deformity <10 degrees).All patients regained a comparable range of motion in their knees. The semi-extended lateral para-patellar approachfor nailing of distal tibiaextra-articular fracturesenhances reduction, simplifies nail insertion,reduces both fluoroscopy and operative time, minimizes anterior knee pain and improves knee functional outcomes at six months follow-up.

Comparative Study Between Intramedullary Nail and Minimally Invasive Plate Osteosynthesis in Tibial Shaft Fracture

Background: Casting, open plate fixation, minimally invasive plate osteosynthesis, intramedullary nailing, and external fixation are some treatment options for tibial fractures. The aim of treatment is anatomical alignment with sufficient stability to permit early motion. The least invasive and most popular techniques are intramedullary nailing, external fixation, and minimally invasive plate osteosynthesis. Aim of Study: To compare the clinical and functional outcome between Intramedullary nailing and external fixation and minimally invasive plate osteosynthesis in treating tibial shaft fracture. Patients and Methods: A randomized clinical trial study was conducted at Al-Yarmouk Teaching Hospital and other private hospitals in Baghdad, Iraq, during a period of 17 months from September 2020 to January 2022, including a period of one year for follow-up. Patients were selected according to certain inclusion criteria and divided into two groups, each with 20 patients. IMN was treated by intramedullary nailing, and the MIPO group was treated by minimally invasive plate osteosynthesis. Patients were followed up radiologically and clinically using the JETTS Lower Extremity Trauma Scale score. Result: The difference was significant (P&lt; 0.05) regarding partial and full weight bearing, union time, and return to work. Ankle stiffness, implant irritation, and knee pain revealed significant differences. Conclusion: Intramedullary nailing and external fixation and minimally invasive plate osteosynthesis are effective methods for the treatment of extra-articular tibial shaft fracture. They provided rigid fixation, preventing major complications and good functional and anatomical outcomes.

Plating as a reduction aid prior to intramedullary nailing of tibia fractures: a systematic review and meta-analysis.

The purpose of this meta-analysis is to analyse the literature on plate-assisted reduction during intramedullary nailing of tibial shaft fractures and to compare the rates of infection and nonunion. The databases Medline, Embase, and Web of Science were searched from inception to February 2022 for literature comparing plate-assisted reduction during intramedullary nailing of extra-articular tibia fractures to standard, closed means of reduction. Data were extracted and pooled in a random effects meta-analysis for the primary outcomes of nonunion and infection risk. Five comparative studies were identified including 520 total patients, of which 151 underwent tibial nailing with the use of plate-assisted reduction with an average follow-up time of 17.9months. Approximately two-thirds of patients retained the plate used to assist reduction during intramedullary nailing (102 of 151). Pooled analysis of the infection rates found no significant difference with plate-assisted intramedullary nailing (Risk Ratio [RR] 0.90, 95% CI 0.49-1.65, p = 0.72), and for nonunion rates, there was also no significant difference with plate-assisted intramedullary nailing (Risk Ratio [RR] 0.80, 95% CI 0.40-1.60, p = 0.53). Plate-assisted reduction during intramedullary nailing of tibia shaft fractures was not associated with an increased risk for nonunion or infection, and can be safely applied as an adjunct for reduction in challenging fracture patterns, without the need for later removal. However, evidence is quite limited and further investigation into the use of provisional plating as a technique is needed as its use in intramedullary nailing continues to expand.

A Comparison of the Outcomes Between Suprapatellar and Infrapatellar Approaches of Intramedullary Interlock Nailing in Patients With Extra-Articular Tibial Fractures.

Background and objective Intramedullary nailing can be considered the current gold standard for the treatment of diaphyseal tibial fractures. Nailing ensures good fracture stability, protection against malalignment, and quick mobilization. The suprapatellar (SP) approach of tibial nailing in the semi-extended position has recently been recommended as a safe and effective surgical technique; it has been gaining significant attention in the orthopedic literature, with fewer complications and reoperations. The approach has been shown to facilitate a reduction in fractures around the knee jointin the semi-extended position, and the extended position of the lower leg allows for easier fluoroscopic imaging. In this study, we aimed to compare the outcomes between SP and infrapatellar (IP) approaches of intramedullary nailingin patients with extra-articular tibial fractures. Method A randomized control trial was conducted over a period of 1.5 years at our tertiary care hospital after obtaining approval from its institutional ethics committee. A total of 60 patients with extra-articular tibial fractures were included in the study, with 30 patients each in the SP nailing groupand the IP nailing group, based on randomized sampling and with the help of radiological exposure in SP and IP nailing as per a previous study. The groups were then compared in terms of KUJALA patellofemoral knee score, operative time, radiation exposure, and time of union. Results When comparing both groups, those treated with the SP approach had better outcomes, including reduced radiation exposure, less pain, decreased operative time, better KUJALA patellofemoral knee score, and faster union. Conclusion Based on our findings of the comparison between SP and IP nailing approaches of extra-articular tibial fractures,the former leads to better and safer outcomes than the latter.

Comparative study of functional outcome of distal one-third shaft tibia fractures treated with tip locking tibia nailing versus precontoured anatomical locking plate

Background: The distal 1/3rd shaft tibia extra-articular fractures are treated with both tip locking intra-medullary nailing (TLIMN) and precontoured anatomical locking plates (PCALP). The aim of this study was to compare the results of TLIMN and PCALP in distal tibia fractures and to determine dominant strategies. The complications and functional outcome in both groups were compared. Methods: Forty patients with distal 1/3rd shaft tibia were randomly assigned to TLIMN (group 1) and PCALP group (group 2). The functional outcomes were evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score. Complications like infection, delayed union, non-union, malunion, hardware prominence and secondary interventions were compared. Results: The average union time was 15.05±3.33 weeks in group 1 and 13.4±2.46 weeks in group 2 (p=0.045). The mean AOFAS score at 1 year follow up was 89.8±6.13 in group 1 and 89.1±6.15 in group 2 (p=0.262). Five patients in group 1 and one in group 2 had mal-alignment. Deep infection was present in one and superficial infection was present in two cases in group 2. Four patients in group 1 developed anterior knee pain and five patients in group 2 had hardware prominence. Conclusions: We conclude that tip locking intra-medullary nail is a reliable and satisfactory method for treatment of fractures of distal 1/3rd shaft tibia AO type 42A, 42B and 42C fractures with good functional outcomes and high union rates with comparatively low complications. Prevalence of malunion was higher in TLIMN group and hardware prominence was more prevalent in PCALP group. Implant removal are more in PCALP group mostly due to implant irritation.

To Study the Functional Outcome of Proximal Tibia extra-articular Fractures Treated with Lcp

To Study the Functional Outcome of Proximal Tibia extra-articular Fractures Treated with Lcp

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.

STUDY OF CLINICAL AND RADIOLOGICAL OUTCOME OF EXTRA-ARTICULAR PROXIMAL TIBIA FRACTURE TREATED WITH MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) TECHNIQUE

Background: Proximal extra articular tibia fractures management is challenging to surgeon because of its complex fracture pattern and anatomic location. Our aim of this study is to assess the functional, clinical, radiological outcome of MIPO in extra articular proximal tibia fractures. Materials and methods: Prospective study of 43 closed extra articular proximal tibia fracture patients. Study was done in between July 2017 to September 2019 at tertiary care centre in India. The mean age was 32.5 years (range 31-65). Primary bony union was achieved average ofResults: 16.32 weeks (range 14 to 24 weeks). According to modied Rasmussen's criteria 23 patients (53.48%) had excellent outcome, 12 patients (27.90%) had good outcome and 8 patients (18.60%) had fair outcome. mean knee range of motion is 124.23° (Range 10-150°). Complication includes Infection rate (9.3%) and varus malunion (18.60%). Minimally invasive plate ostosyntesis technique offers biological advantagesConclusion: with minimal complication. It fullls the demands of fast implantation, soft tissue protection and high biomechanical stability

A prospective comparative study of functional outcome of distal extra articular tibia fracture fixed with intramedullary nail versus locking compression plate

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Distal&lt;strong&gt; &lt;/strong&gt;tibia fractures are one of the most common long bone fractures and their management presents with a series of problems due to the soft tissue surroundings and even more at risk due to their proximity to ankle joint. In our paper we showed functional outcome of distal extra articular tibia fracture while comparing its management between intramedullary nailing and locking compression plate.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;There were 40 patients from November 2019 to November 2020 with distal extra articular tibia fracture. Patients were divided into 2 groups, first group included 20 patients managed with intramedullary nail and the second group included 20 patients managed with locking compression plate. Patients were followed preoperatively, intraoperatively and postoperatively for functional outcome and assessed clinically using AOFAS score and radiologically using X-ray.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of the 40 cases treated in this manner, all cases were available for the follow up for a period of 1 year. Overall results by 1 year follow up showed excellent in 7 cases (35%) good in 13 cases (65%) in nailing group and in plating group showed excellent in 4 cases (20%), good in 12 cases (60%), fair in 3 cases (15%) and poor in 1 case (5%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;All fractures united well. Complications were encountered in 4 patients, 2 patients had superficial wound infections,1 patient had deep infection and another had persistent ankle pain in plating group and 2 patients had superficial wound infection in nailing group. No cases showed malunion or nonunion in both plating as well as nailing group.&lt;/p&gt;

Knee injuries associated with extraarticular tibial fractures and their impact on the clinical outcome of the patients: a prospective arthroscopic study

Background: Associated injuries in tibial shaft fractures are not investigated often, and their impact on patient outcome is not clear. In this study, associated knee injuries in tibial shaft fractures were arthroscopically investigated, and their impact on the outcomes of patients were evaluated. Methods: In a prospective study, 57 patients with closed tibial shaft fractures and without concomitant fibular fractures were included. Motor-vehicle accident was the most frequent mechanism of the injury. The fractures were treated with reamed and locked titanium intramedullary tibial nailing. The functional outcome was evaluated using the International Knee Documentation Committee score and compared between the patients with and without an ipsilateral associated injury. Results: The mean age of the patients was 33.2±13.2 years. The mean follow-up duration was 10.2±3.1 mo. In 35 patients (61.4%), at least one associated knee injury was detected. Chondral damage was the most frequent arthroscopic finding (n=23, 40.4%). The anterior cruciate ligament (ACL) injury was the second most frequent injury (n=7, 12.3%). No intervention was performed for chondral lesions and ACL tears. Meniscal injuries were detected in three (5.3%) patients only. The mean International Knee Documentation Committee score was 95.9±2.2 in patients with and 96.2±2.1 in patients without an arthroscopic finding (P=0.38). The severity of comminution was not correlated with the incidence of arthroscopic findings (r=0.089, P=0.45). Conclusions: Ipsilateral injuries are frequent in tibial shaft fractures. However, they do not seem to affect the functional outcome of patients, at least in short-term follow-up. Level of Evidence: Level III.

Minimally-Invasive Plate or Intramedullar Nail in the Management of Distal Extra-Articular Tibial Fracture, What Is Better?

Objective: The aim of this study was to compare the clinical and functional outcomes of patients with distal tibia extraarticular fractures treated with Intramedullary nailing (IMN) or Minimally invasive plate osteosynthesis (MIPO). Materials and Methods: This retrospective study included 47 patients treated with IMN and 41 patients with MIPO. Clinical and radiographic results were evaluated at last follow-up. Anterior knee pain, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score and Lysholm knee scoring scale were used as clinical measurement. Results: Although the union time and operation time were significantly higher in the IMN group compared to the MIPO group (p&amp;lt;0.001), the full weight bearing time and the hospital time were higher in the MIPO group (p&amp;lt;0.001). There were no statistical differences between wound problem, malposition, infection and grafting rates in both groups (p&amp;gt;0.05). Although the AOFAS score was statistically higher in the IMN group (p=0.031), the Lysholm knee score was higher in the MIPO group (p&amp;lt;0.001). Conclusion: While MIPO is advantageous with low union time, low operating time and no damage to the knee joint, IMN allows earlier full weight bearing, lower hospitalization and has better ankle functional results. Keywords:

Наружный чрескостный остеосинтез при лечении внесуставных переломов костей голени: показания, осложнения, результаты применения

Введение. Выбор оптимальной методики остеосинтеза внесуставных переломов большеберцовой кости продолжает обсуждаться в научной литературе. При открытых переломах, высокоэнергетической травме, повреждениях мягких тканей, особенно в нижней трети голени, нередко используется метод наружной фиксации. Отказ от более широкого его применения объясняется опасениями воспалительных осложнений и неудобствами для больного. Цель исследования: анализ опыта применения наружного чрес­костного остеосинтеза при внесуставных переломах костей голени и обоснование показаний к его использованию. Материалы и методы. Проведен ретроспективный анализ лечения 67 пострадавших с внесуставными переломами большеберцовой кости методом наружного остеосинтеза. Изучены осложнения и результаты лечения. Проанализированы показания к применению, при которых преимущества метода превосходят неудобства, связанные с наличием внешнего модуля. Результаты. Несросшиеся переломы отмечены у 4 (5,9 %) пострадавших, воспалительные осложнения — у 2 (2,9 %), контрактуры голеностопного сустава — у 4 (5,9 %). Хороший результат отмечен у 55 (80,9 %) пострадавших, удовлетворительный — у 8 (11,1 %), неудовлетворительный — у 5 (7,3 %). Пациенты в период лечения сохраняли мобильность, возможность самообслуживания, осуществляли осевую нагрузку и движения в суставах. Анализ показаний к применению наружного остеосинтеза показал, что при некоторых ситуациях (переломы, сопровождающиеся травматическими или трофическими нарушениями со стороны мягких тканей; переломы большеберцовой кости типа С, двойные (тройные) переломы; перелом костей голени как компонент политравмы; внесуставные переломы костей обеих голеней; лечение несросшихся переломов и дефектов костей) преимущества, которые обеспечивает применение внешней фиксации, превышают неудобства, связанные с наличием наружной конструкции. Выводы. Таким образом, наружный чрескостный остеосинтез является эффективным методом лечения внесуставных переломов костей голени. Опасения, связанные с высокой частотой воспалительных осложнений и неудобствами пребывания в аппарате, при использовании современных конструкций являются преувеличенными. Условием эффективного применения метода является использование конструкций, предусматривающих возможность осевой нагрузки и движений в суставах, этапного воздействия на костные фрагменты, строгое соблюдение технологии вмешательства.

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was the prospective comparative study of 50 patients with distal third tibia fractures divided into two groups. First group of patients were treated with MIPPO technique while second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, non-union, superficial and deep infection between the two groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Average time taken by patients for full weight bearing in group A was 17.6 weeks as compared to 16.7 weeks in group B. All patients were able to bear weight prior to complete union of fracture. By the process of weight bearing, we believed that it would promote secondary bone healing. On taking X-rays during follow up of included patients starting of radiological union was observed carefully by looking for bridging callus, haziness of fracture line. Appearance of callus was taken average time of 12.5 weeks in group A and 12.1 weeks in group B.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.&lt;/p&gt;

Comparative study: Interlock nailing versus plating for extra articular distal tibial fractures

Background: Distal 1/3rd tibia is the second most common fracture location in tibia, diaphysis being the first. Subcutaneous location, poor blood supply and less soft tissue cover make it prone for infections and thus are challenging for orthopaedists. There are many options available for management but still there are insufficient evidences on the best surgical intervention. Materials and Method: We conducted the study of total 60 patients of distal 1/3rd extra articular tibial fractures during the period of October 2018 to April 2020 in the Department of Orthopaedics in tertiary care hospital. Patients fulfilling inclusion and exclusion criteria were the study participants. After obtaining consents, patients were divided in nailing and plating groups. Radiological outcomes and clinical outcomes using lysholm knee score and kaikkonen ankle score system were assessed at 1 month, 3 months, 6 months and 1 year intervals. Results: A total of 60 patients (30 in each group) participated. The mean age of participants were 40.4 and 43.06 years for nailing and plating respectively and there was no significant difference between numbers of male and female. The duration of surgery for intramedullary nail was significantly less compared to plating. The lysholm knee score was significantly higher in plating group and kaikkonen ankle score was higher in nailing group. Anterior knee pain was more frequent after nailing. Exposed implant was found only in the plating group. Conclusion: The study found that the duration of surgery as well as the time taken for union was significantly less for nailing group and complications were also less in the nailing group with reduced morbidity. So we prefer intramedullary interlocking nailing in treatment of extra articular distal tibia fractures.

Study of clinical and radiological outcome of extra-articular proximal tibia fracture treated with minimally invasive plate osteosynthesis (MIPO) technique

Background: The management of proximal extra-articular tibia fractures is challenging to a surgeon because of its complex fracture pattern and anatomical location. The aim of our study is to assess the functional, clinical and radiological outcome of MIPO in extra articular proximal tibia fractures. Materials and Methods: This is a prospective study of 43 closed extra articular proximal tibia fracture patients. The study was done in between July 2017 to September 2019 at a tertiary care centre in India. Results: The mean age was 32.5 years (range 31-65). The primary bony union was achieved by an average of 16.32 weeks (range 14 to 24 weeks). According to the Modified Rasmussen’s criteria, 23 patients (53.48%) had excellent outcome, 12 patients (27.90%) had good outcome and 8 patients (18.60%) had fair outcome. The mean range of motion of the knee is 124.23° (Range 10-150°). The complications include Infection (9.3%) and varus malunion (18.60%). Conclusion: Minimally invasive percutaneous plate osteosynthesis technique offers biological advantage with minimal complication and fulfils the demands of fast implantation, soft tissue protection and high biomechanical stability.

Distal tibial treatment with multidirectional locked nailing and plating: An observational comparative study at Rajasthan based teaching hospital

Background: We Assessed patients with Functional recovery between two treatment modality intramedullary interlocking nail and locking plate fixation in the surgical management of extra-articular distal tibia fracture. In high energy distal tibial fractures younger age groups are involved due to road traffic accident and fall from height. Axial loading, compression and torsional forces are involved in the mechanism of injury. Distal tibial fractures are very commonly encountered by orthopaedic surgeons. Aims and Objectives: To study and compare clinical and radiological outcome in extra articular fractures of distal tibia treated by multidirectional interlocking intramedullary nails and anterolateral locking compression plates with reference to rate of healing, functional outcome and complications. Material and Methods: In this study 26 patients with distal tibia extra-articular fractures, AO type 43 A1, 43A 2,43A3 were randomly selected and 13 of them were operated with multidirectional interlocking nailing and remaining 13 with anterolateral locking compression plate. The patients were regularly followed up for a period of one year 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: About 42 to 52% complication rate was attributed in internal fixation device and extensive surgical procedure due to soft tissue injury. Therefore ankle spanning external fixation became popular to maintain the articular surface of tibia with minimal internal fixation. In multidirectional Interlocking intramedullary group average time for union was 4.5 months compared to 6.4 months in plating group which was significant (p value

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

PurposeTreatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods. MethodsThis was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0). ResultsAverage malunion (degrees) in the MIPPO group was 5 (3–7) ± 1.41 vs. 10.22 (8–14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001). ConclusionBoth procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

Comparison of the results of expert tibial nailing with results of distal tibial plating in patients with distal 1/3rd extraarticular tibial fractures

Background: The tibia constitutes one of two bones of the leg. Recently, minimally invasive percutaneous medial locked plating has been described in the literature with promising results. Expert Tibial Nail currently represents an effective approach to the treatment of complex extraarticular distal tibial fractures. Hence; the present study was undertaken for comparing the results of Expert Tibial nailing with results of Distal Tibial Plating in patients with Distal 1/3rd extraarticular Tibial Fractures. Materials & Methods: The study was conducted on 40 patients with extraarticular distal 1/3rd tibia fractures. All the patients were divided into two study groups randomly with 20 patients in each group as follows: Expert Tibial Nailing group, & Distal Tibial Plating group. All the patients underwent procedures according to their respective study groups. During the postoperative phase, static quadriceps exercises & toe movements, as tolerated were started from 1st postoperative day. Full weight-bearing was allowed after 10 to 12 weeks, depending on the radiographic signs of fracture healing. Patients were followed up for 6 months after operation and evaluated as per Johner and Wruss Criteria. Results: The mean age of the patients of the expert tibial nailing group and distal tibial plating group was 48.12 years and 49.71 years respectively.Mean operative time among the patients of the expert tibial nailing group was 83.15 minutes and was significantly lower in comparison to the patients of the distal tibial plating group (101.2 minutes). Mean intraoperative blood loss was compared between expert tibial nailing and distal tibial plating. Torniquet was used in all the cases. Mean intraoperative blood loss among the patients of the expert tibial nailing group was 51.6 ml and was significantly lower in comparison to the patients of the distal tibial plating group (89.1 ml). Mean postoperative weight-bearing time among the patients of expert tibial nailing was 8.95 weeks and was significantly lower in comparison to the patients of the distal tibial plating (14.35 weeks). Mean fracture union time among the patients of the expert tibial nailing group was 18.6 weeks and was significantly lower in comparison to the patients of the distal tibial plating group (25.84 weeks). Excellent results were obtained in 80 percent of the patients of the expert tibial nailing group and 55 percent of the patients of the distal tibial plating group respectively. Conclusion: The results of present study with expert tibial interlocking nailing are encouraging and demonstrate the benefits of new nailing system. Changes in the design of the nail for improved proximal and distal locking enable it to use in proximal and distal metaphyseal fractures of tibia.

Functional results of compound extra articular tibial pilon fractures managed with hybrid external fixator

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Distal tibia fractures are difficult to treat. It is often difficult to assess the potential risk of surgical complications because of the variations in the clinical findings. Less subcutaneous tissue, limited blood supply and no muscle insertions are the factors that tend to make the healing of the soft tissue more complex. Compounding presents a great challenge for the treating surgeon regarding the treatment options.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;A total of 23 patients were included in the study based on the inclusion and exclusion criteria and were managed by hybrid external fixator as definitive treatment. They were kept in follow up for at least 6 months and were assessed using Ovadia and Beal’s objective and subjective scoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All patients achieved fracture union with 82% patients reporting excellent to good functional outcome. Pin site infections and ankle stiffness were most common complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; A very good outcome is achieved in compound extra articular tibial pilon fractures with the hybrid fixator technique. Adequate stability is provided and hence early motion and ambulation can be started.&lt;/p&gt;