Management Of Distal Tibial Fractures Research Articles

Plate-Assisted Intramedullary Nailing of Distal Tibia Fractures.

The combination of plate and intramedullary nailing has been established as the treatment of proximal tibial fractures. Nevertheless, at the distal end of the tibia, the application of the plate-assisted intramedullary nailing is rarely applied as a therapeutic technique. This technical note demonstrates the use of the reduction plating technique for nail insertion as the management of distal tibia fractures.

Comparative Study of the Management of Distal Tibia Fractures by Nailing Versus Plating

Comparative Study of the Management of Distal Tibia Fractures by Nailing Versus Plating

Anatomical pre-contoured plates in management of distal tibia fracture: a prospective study

Background: Distal tibial fractures are complex injuries with high complication rate. Management of such fractures are often complicated by soft tissue injuries. Precarious vascularity around distal tibia also results in high non-union rates. This study aims to study and analyse the outcome of distal tibia fracture managed by anatomical contoured plate. Methods: In this prospective observational study, we attempted to assess the functional and radiological outcome of distal tibia fracture managed by with distal tibia fracture with average follow up of 24 weeks. ORIF/MIPO with plating was done for fracture distal tibia with anatomical precontoured plates. Results: Patients were evaluated using AOFAS and measure of ankle range of motion. Average functional score was 88 with complications in 3 patients. Conclusions: We believe precontoured plates provide for better biological fixation than conventional plates.

MIPO Technicque for Management of Distal Tibia Fractures Using LCPPrecontoured (3.5mm & 4.5mm) - A study Done in 250 Bedded General Hospital, Tangail

Fractures of the distal tibia are unique in that the bone is subcutaneous with poor muscular coverage. Theconsequence of its decreased vascularity leads to complications like delayed bone union, wound complications suchas dehiscence and infection. These fractures can be managed with various techniques. Open reduction and internalfixation by plating, have been used with varying results. In current orthopedic practice, minimally invasivepercutaneous plating osteosynthesis (MIPO) and interlocking nailing are the preferred techniques for fractures of thedistal third tibia. In our study, twenty adult patients with closed fractures of distal tibia were treated with LCP usingMIPO technique & were followed for a period of one year (January 2014 to December 2014). Average age of patientsstudied was 40.5 years (18-55) with majority being high energy trauma (65% vs. 35%). Mean duration for surgeryfrom day of identification to go for surgery was 4-7 days. Results were evaluated clinically and radiologically. In 18cases (90%) fractures united & 2 cases (10%) had delayed union. All fractures were united by 20 weeks. Superficialskin infection was found in 2 cases, Valgus mal-alignment in 2 cases &1 case had ankle stiffness. Finally resultsshowed:10 cases (50%) had excellent outcome, 4 cases (20%) had good outcome, 4 cases (20%) had fair outcome,and 2 cases (10%) had poor outcome.
 Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):09-13

Anterolateral and Medial Locking Compression Plates for the Management of Distal Tibial Fractures: A Comparative Prospective Study.

Open/close reduction (OR/CR) and internal fixation (IF) of displaced fractures of distal tibia with either a medial or anterolateral plate is a commonly performed procedure. Anterolateral plating avoids an incision along the medial subcutaneous border of tibia and has been shown to have reduced risk of wound complications. The aim of our study was to determine the functional outcome of these fractures treated with anterolateral and medial distal tibial locking compression plates. This was a prospective study that included 60 patients with distal tibial fractures (close or grade I open injury)divided into two groups with 30 patients in each where one group was treated with OR/CR and IF using an anterolateral distal tibial locking plate (Group A) and the other using a medial distal tibial locking plate (Group B). The duration of surgery and intraoperative blood loss and time to union were recorded for all the patients. Functional evaluation was done at one year in terms of pain, function and alignment using theAmerican Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and complications, if any, were noted. Both the groups were comparable in terms of age, gender, time of presentation, AO classification and presence of wound. The mean duration of surgery as well as the intraoperative blood loss were more in the anterolateral plate group than in the medial plate group, but the difference was statistically insignificant. Ten patients (33%) with medial plates had symptomatic hardware and 7 (23.3%) underwent removal while only 3 (10%) patients in the anterolateral plate group had similar complaints and none had to undergo removal. Two patients with anterolateral plate and one with medial plate had malunion. The mean time to fracture union as well as the rate of infection was less and the functional outcome at one year was better in the group treated with anterolateral plates as compared to the one with medial plates, but the difference again was not statistically significant for all the parameters. With reduced risk of soft tissue complications and by obviating the need for implant removal, anterolateral plates can prove to be a better alternative to the medial plates especially in elderly patients in the management of these fractures.

Minimally Invasive Percutaneous Plate Osteosynthesis versus Interlocking Intramedullary Nail Fixation in Treating Extra-Articular Distal Tibial Fractures in Adults. A Systematic Review

Background IM nailing and MIPPO fixation remain viable options for management of distal tibia fractures. IM nailing provides superior operation time, union time, and time to full weight-bearing as well as a lower incidence of superficial and deep infection, but may provide inferior alignment and is associated with residual knee pain. MIPPO fixation provides superior alignment and avoids knee pain, but it has a higher rate of soft-tissue complications and hardware irritation. This review revealed that MIPPO has a higher risk of both superficial and deep infection among patients treated with MIPPO compared to IMN. In the MIPPO technique, 15% developed a superficial infection, compared to 7% after IMN, and 14% developed a deep infection, compared to 6.3% after IMN. Aim of the Work to provide a complete overview of the optimal surgical treatment of distal tibia fractures by evaluating and comparing the clinical and functional outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs Interlocking intramedullary nail (IMN) for treating extra-articular distal tibial fractures. Outcomes of interest include operation time, time to union, non-union, mal-union, infection, secondary operations, and functional outcomes (quality of life scores and ankle scores). Patients and Methods In terms of union complication, IMN has a higher incidence of malunion which occurred in 14.7% of the patients after IMN compared to 8.8% after MIPPO fixation. The incidence of non-union was similar in both treatment methods, it occurred in 3.5% of patients. In addition to union rate, the union time was significantly shorter after IMN fixation compared to the MIPPO technique especially in AO 43A fracture type and the closed fractures. The mean time for union was 18 weeks in IMN compared to 20 weeks in MIPPO. Results Nine studies including 813 patients reported on operation time with an overall weighted mean operation time of 74.1 minutes (range 56.4 – 124 minutes) in IMN and 85.4 minutes (range 51.4 – 124 minutes) in MIPPO. The operation time in the IMN was significantly shorter compared to MIPPO (WMD -11.24 minutes, 95% CI -15.44 to -7.05, P < 0.05) with significant moderate heterogeneity (I2 = 68%). Conclusion Based on this study, both MIPPO and IMN have similar therapeutic efficacy regarding the functional outcome and can be used safely in distal tibial extra-articular fractures. Although IMN is advantageous over MIPPO with a lower incidence of infection and implant irritation symptoms, shorter operation time, earlier weight-bearing, and earlier union, it leads to a higher rate of mal-union and anterior knee pain. Overall, choosing an implant based on the findings of this meta-analysis is difficult and should be done on a caseby-case basis. Patients who have a high risk for infection (due to high age, comorbidities, smoking, or severe soft tissue injury) should preferably be treated with a nail. MIPPO fixation may be more beneficial to young, active, and healthy patients who are less prone to infection because it reduces the risk of knee pain and mal-union.

Outcomes of patients treated with minimally invasive plate osteosynthesis in the management of distal tibial fractures

Background: Distal tibial fractures are a common injury, often caused by high-energy trauma, and can result in significant morbidity. Traditional surgical management with open reduction internal fixation (ORIF) is associated with complications including infection and soft tissue injury. Minimally invasive plate osteosynthesis (MIPO) has emerged as a potential alternative, with advantages including less soft tissue injury and a faster return to function. The study aimed to evaluate the outcomes of MIPO for distal tibial fractures. Method: Sample size of 38 patients between 18-80 years of age with distal tibial fractures treated with MIPO was included. Patient demographics, fracture characteristics, surgical details and postop outcomes collected. Results: A total of 38 patients with distal tibia fractures with a mean age of 44.36 years were included in the study. The mean duration of hospital stay was 12.71 days, and the time required for a union was 18.61 weeks. The AOFAS score improved significantly from 3 to 6 months after surgery. However, 15 patients (34.88%) reported complications, with deep infection and skin necrosis being the most common. Out of 43 patients, 11 underwent culture and sensitivity testing, with no growth in 5 cases, and the remaining cases showed various bacterial infections. Seven patients underwent implant removal due to complications. Conclusions: The study provides valuable information about the use of MIPO in treating distal tibia fractures, as well as the risk of complications associated with this approach.

Tibia fractures managed with minimally invasive internal fixation: a case series of 20 cases

Distal tibia fractures are frequently associated with an extensive soft tissue injury, leading to a higher risk of complications such as skin complications, infection, non-union, and eventually poor overall outcome. This study aims to measure the outcome of open/closed distal tibia fractures treated with minimally invasive internal fixation. We aim to propose an algorithm for the management of distal tibia fractures by evaluating the treatment options, outcomes, and risk factors present. This study is a case series study of all distal tibia fractures treated surgically in Kamineni Academy of Medical Sciences, LB Nagar from 2018 to 2022. Patient records were reviewed to analyze the outcomes of surgical treatment and the risk factors associated with it.

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

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

Functional outcome of minimally invasive plate osteosynthesis using anatomical locking compression plate for distal tibia fractures: A prospective study

Background: Distal tibia fracture is a therapeutic challenge in modern orthopaedics. Due to fracture pattern, periarticular location, minimal soft tissue coverage, the surgical treatment is complex one. Various modality of surgical treatment such as closed intramedullary nailing, The newer technique of fixation of distal tibia fractures - minimally invasive percutaneous plate osteosynthesis involves less soft tissue handling and the minimal periosteal stripping resulting in low infection rate and faster healing.Materials and Methods: The prospective study was done at a tertiary care centre on 18 patients from June 2017 to June 2019. The functional outcome is evaluated by clinical and radiological (AP/LATERAL) aspects at 6th, 12th weeks, 3rd, 6th months and one year interval using Olerud-Molander Ankle Questionnaire/ Score (OMAS).Results: The results were excellent in 54%, good in 29% and fair in 17% of patients. The post-operative pain was minimal and the post-operative ankle function was very good.Conclusion: Minimally invasive plate osteosynthesis using LCP proves to be a safer technique in the management of distal tibial fractures without intra-articular comminution by providing good fracture healing, enabling rapid functional recovery and avoiding major skin complications.

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 & 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.

Translated article] Metaphysary fractures of the distal tibia: Comparative analysis of the results obtained by means of a blocked plate and intramedular nail

IntroductionFractures of the distal third of the tibia are mostly the consequence of high-energy trauma with significant soft tissue involvement, being more frequent in men.These types of fractures differ from the tibial pilon joint fracture in their mechanism of injury, management and prognosis.The objective of the present study was to analyse and compare the results obtained in the treatment of fractures of the distal third of the tibia without joint extension using a locked plate and intramedullary nail. Material and methodsWe carried out a retrospective study with patients diagnosed of “distal third tibia fracture” segment 43A according to the classification proposed by the “Trauma Orthopedic Association” who were intervened between January 2015 and May 2019 were included. We obtained 24 patients intervened with a nail intramedullary and 29 using a blocked plate. ResultsThe study included 53 patients, 36 men and 17 women with a mean age of 51 years (range: 15–77 years). The mean follow-up time was 6 months (3–30 months). No significant differences were found in the time to fracture healing, although the beginning with load walking was earlier in the nail group. DiscussionCurrently there is no consensus on the therapeutic management of distal tibia fractures without joint extension. ConclusionsAfter analyzing the results, we consider that both intramedullary nail osteosynthesis and a locked plate are valid options in the treatment of fractures of the distal third of the tibia.

Functional Outcome of Various Modalities of Management of Distal Tibial Fractures

Functional Outcome of Various Modalities of Management of Distal Tibial Fractures

Functional Outcome of Various Modalities of Management of Distal Tibial Fractures

Functional Outcome of Various Modalities of Management of Distal Tibial Fractures

Fracturas metafisarias de tibia distal: analisis comparativo de los resultados obtenidos mediante placa bloqueada y clavo intramedular

IntroductionFractures of the distal third of the tibia are mostly the consequence of high-energy trauma with significant soft tissue involvement, being more frequent in men.These types of fractures differ from the tibial pilon joint fracture in their mechanism of injury, management and prognosis.The objective of the present study was to analyze and compare the results obtained in the treatment of fractures of the distal third of the tibia without joint extension using a locked plate and intramedullary nail. Material and methodsWe carried out a retrospective study with patients diagnosed of “distal third tibia fracture” segment 43A according to the classification proposed by the “Trauma Orthopedic Association” who were intervened between January 2015 and May 2019 were included. We obtained 24 patients intervened with a nail intramedullary and 29 using a blocked plate. ResultsThe study included 53 patients, 36 men and 17 women with a mean age of 51 years (range: 15-77 years). The mean follow-up time was 6 months (3–30 months). No significant differences were found in the time to fracture healing, although the beginning with load walking was earlier in the nail group. DiscussionCurrently there is no consensus on the therapeutic management of distal tibia fractures without joint extension. ConclusionsAfter analyzing the results, we consider that both intramedullary nail osteosynthesis and a locked plate are valid options in the treatment of fractures of the distal third of the tibia.

FUNCTIONAL OUTCOME OF PRE-CONTOURED MEDIAL LOCKING COMPRESSION PLATE USING MIPO (MINIMaAL INVASIVEPLATING OSTEOSYNTHESIS) TECHNIQUE IN TREATMENT OF DISTAL TIBIAL FRACTURES

Introduction:- The management of distal tibial fractures remains challenging due to subcutaneous location of larger portion of tibia,paucity of soft tissue coverage and precarious blood supply of distal leg.Conservative management may be complicated by loss of reduction and subsequent malunion. MIPO (Minimal invasive plating osteosynthesis) has evolved as a newer concept to treat distal tibial fractures. It works on Biological fixation principle which assists physiological process of bone healing wisely with minimal operative intervention. Methods:- Prospective follow up study carried out at J.L.N. Medical College Ajmer from 1 Jan 2017 to 30 June 2018. 30 patients with distal tibial fractures were included and operated with pre-contoured medial locking compression plate using MIPO technique. Fractures were classified as per AO system and patients were followed and scored according to TEENY and WISS scoring criteria. Results:- Functional results according to TEENY and WISS scoring criteria was found excellent in 9 (30%), good in 16(53.33%), Fair in 3(10%) and poor in 2 (6.66%) patients. Poor outcome occurs due to development of complications Conclusion:-Internal fixation of distal tibial fractures with pre-contoured medial locking compression plate using MIPO technique is effective and safe and provides more stable construct with anatomical reduction.

Outcomes after primary ankle arthrodesis in recent fractures of the distal end of the tibia in the elderly: a systematic review.

Management of distal tibia fractures in the elderly is complex. The results of conservative treatments may be disappointing and primary ankle arthrodesis is now regularly offered as an alternative. In this study, we aimed to review the outcomes of primary ankle arthrodesis for distal tibia fracture in the elderly. We conducted a systematic review of the literature, from the Cochrane, MEDLINE, and Embase databases, on studies published in English and in French between 1950 and 2020. Only studies reporting the clinical results, the function, or the complications of primary ankle arthrodesis after ankle fracture in the elderly were included. We included nine studies. The total number of patients was 229: 21% of them (50/229) sustained open fractures and 41% (95/229) had three or more comorbidities. All the patients underwent a tibio-talo-calcaneal arthrodesis with a retrograde transplantar intramedullary nailing (TIMN): short nail in 52% (151/229) and long nail in 48% (78/229) of the cases. At a mean follow-up comprised between six and 21months, 94.5% of patients (190/201) achieved bone union, 87% (123/140) recovered an ankle range of motion close to their pre-operative status, 19% (40/211) had a complication, and 11.3% (24/211) required a revision. The use of a short nail resulted in a higher rate of peri-implant complication (2%) as well as a higher rate of revision (12.4%). Primary ankle arthrodesis in recent fractures of the distal end of the tibia in the elderly frequently results in satisfactory results. The use of a long nail may be associated with a lower rate of implant specific complications.

Management of distal tibial fractures by Ilizarov fixator with or without minimal internal fixation

Management of distal tibial fractures by Ilizarov fixator with or without minimal internal fixation

Lateral distal tibial locking compression plate fixation through single lateral incision technique is biologically superior and mechanically equivalent alternative to medial plate fixation for lower third tibia-fibula fractures

<p><strong>Background:</strong> A number of surgical options for management of distal tibia fractures makes scenario confusing and available techniques are associated with complications. Recently lateral plating of tibia has shown good promise. To compare results between medial and lateral distal tibial locking compression plate for treatment of distal third tibia fractures</p><p><strong>Methods:</strong> Prospective clinical study was carried out among 24 patients presenting with distal third tibia fractures. Patients were randomized into two groups of 12 each. One group was allocated into medial distal tibial LCP and second group was allocated into lateral distal tibial LCP. In first group, approach taken was medial or anteromedial while in second group, approach taken was lateral. Follow up was done for six months after surgery.</p><p><strong>Results:</strong> There were 10 cases in medical group and eight cases in lateral group which had fracture due to road traffic accidents. All cases in medical group had concomitant fibula fracture while such cases were 10 in lateral group. One case in each group developed infection after surgery. There was one case of superficial skin dehiscence and one case of hardware problem in medial group compared to none in lateral group. Two cases from medial group required removal of implant compared to none from medial group.</p><p><strong>Conclusions:</strong> Lateral distal tibial LCP seems to provide biological advantage than medial distal tibial LCP without difference in biomechanical properties of implants. Single lateral incision technique is an ingenious, biologically sound, and cosmetically superior for fixation of both lower third tibia & fibula fractures together.</p>

A comparative study of functional and radiological outcome in the management of distal tibia fractures treated by intra medullary nailing and minimally invasive locking plate

Aim: To compare functional and radiological outcome in the management of distal tibia fractures treated by intra medullary nailing and minimally invasive locking plate. Material and Method: This perspective observational study was undertaken in the Department of Orthopaedic Surgery of SRMS-IMS, Bareilly for a period of 18 months from November 2019 to April 2021 among patients with DISTAL TIBIAL FRACTURE. According to the hospital record, 30 patients of similar condition were treated by intra medullary nailing or minimally invasive locking plate last year. The study participants were split into two groups: those who received intramedullary interlock nailing (Group 1) and those who received a minimally invasive locking plate (Group 2). All patients who underwent intramedullary nailing or minimally invasive plating were evaluated using the American Orthopaedics Foot and Ankle Society score. Results: Mean duration of surgery (in min) was 64.19±7.91 and 72.36±6.23 in group 1 and 2 respectively. After 6 months, excellent radiological union was revealed among 50% and 56.25% of the subjects in group 1 and 2 respectively. When AOFAS score was compared using chi square test among group 1 and group 2 at 3 and 6 months, it was found to be statistically insignificant as p>0.05 in our study. Conclusion: Intramedullary nailing in distal tibial fractures allows for early mobilisation and is a simpler, less expensive and less complication-prone procedure. In cases where the fracture is very close to the ankle mortise and is associated with a greater rate of wound complications, plating is preferred.