Management Of Distal Tibial Fractures Research Articles

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.

Outcome of minimally invasive plate osteosynthesis (MIPO) for distal tibial fractures

Background: Distal tibial fractures, also known as Pilon fractures constitute about 5 to 10 percent of the tibial fractures. These fractures are difficult to manage. MIPO (Minimal invasive plating osteosynthesis) technique is indicated for fractures with minimal articular comminution and the fractures where soft tissue envelops is minimally damaged. It works on Biological Fixation Principle, in which blood supply to the fracture fragments is maximally preserved. Aim: The purpose of this retrospective study is to evaluate the outcome of MIPO for distal tibial fracture.Design: This is a single center retrospective study conducted between 2016 and 2019 in a Tertiary Care Hospital (Medical College Hospital). Method: 19 patients of distal tibial fracture operated with MIPO technique using pre-contoured metaphyseal LCP (locking compression plate) were analyzed retrospectively. Fractures were classified as per AO system and patients were followed and scored according to TEENY and WISS clinical scoring criteria.Result: Among 19 patients operated, there were 14 males and 5 females with a mean age of 41.32years (ranging from26-66yrs). 16 patients sustained extra-articular fractures (type A), 02 partial-articular fractures (type-B) and 01 total-articular fracture (type C). High energy trauma (road traffic accident) predominated causing 13 fractures. Average trauma surgery interval was 10 days (02-16 days). Patients were followed, minimum for 01 year (range 1 -4 years). Surgical wound breakdown with implant exposure was seen in 01 case. Based on Teeny and Wises clinical rating system, all except one patient had an ‘Excellent’/good outcome.Conclusion: MIPO is an effective and safe technique for the management of distal tibial fractures without intra-articular comminution and minimum soft tissue damage. It preserves bone biology by maintaining balance between revascularization and mechanical perfection. Further studies with longer follow-up and large sample size are warranted.

Evaluation of operative management of distal tibia fractures by plating

Introduction: Tibia is the most common long bone to get involved in injuries because of almost subcutaneous position, very less cover of soft tissue and surrounding muscle mass. Despite advancement in surgical methods distal tibia fractures remains a therapeutic challenge and associated with a high complication rate. Aim: This study was aimed to evaluate the results of operative fixation of distal tibia fracture by plating in relation to union (clinical and radiological) and functional outcome. Material and methods: This study was conducted on 20 patients who were treated with operative fixation with plating and followed up over a minimum period of 6 months for complication and functional outcomes. Final evaluation for the grading of result was done according to Johner and Wruhs criteria. Results: The average time to attain radiological union was 19.78±2.39 weeks In our study 2 patients showed union at 16-17 weeks, 6 patients at 18-19 weeks, 5 patients at 20-21 weeks, 4 patients at 22-23 weeks, 2 patients at ≥24 weeks. In study 12 (60%) patients had no pain, 5 (25%) had occasional pain, 3 (15%) had moderate pain, no patients have severe pain. Incidence of Complications was 3 (15%) patients had ankle movement restriction; 1(5%) had non-union and 1(5%) had superficial skin infection. At final evaluation 11 (55%) patients showed excellent results, 6(30%) showed good, 2 (10%) showed fair, 1 (5%) had poor result. Conclusion: As this technique provides effective stabilization, good union and early mobilization with adequate ankle mobility, is recommended for better outcomes.

Comparison between outcome of various modalities of management of distal tibia fractures

Introduction: Fractures of distal tibia are usually due to high velocity injuries with extensive damage to the soft tissue. The best modality of method of management for distal tibial fracture is one that achieves a good reduction and stability and minimizes soft tissue compromise as well as devascularization of the bony fragments. The aim of our study is to compare, analyse and individualize the best modality of treatment for management of distal tibial fractures. Materials and Methods: This study of 30 patients of distal tibial fractures, was conducted at Dr. D.Y. Patil Medical College and Research Center, Pimpri, Pune, from September 2018 - August 2020. Required consents from all the patients and ethical committee clearance was taken before conducting the study. Necessary data was collected from all the patients during their hospital stay and regular follow-up was recorded. Results: Patients treated with Intra-Medullary Nail had mean AOFAS (American Orthopaedic Foot and Ankle Society) score of 75.2, while patients treated with External Fixator and MIPO (Minimally Invasive Percutaneous Osteosynthesis) had mean AOFAS(American Orthopaedic Foot and Ankle Society) score 71.5 and 87.1 respectively. Conclusion: In our study, we have analysed overall results including functional recovery, radiological assessment in terms of malalignment and complications related to different modalities of treatment of distal tibial fractures. Keywords: Distal tibia, MIPO, AOFAS, Trauma.

Outcome of various modalities of management of distal tibia fracture

Background: Distal tibial fractures represent less than 7% of all tibial fractures. The present study was conducted to compare outcome of various modalities of management of distal tibia fractures. Materials & Methods: 45 distal tibia fracture patients of both genders were divided equally into 3 groups of 15 each. Group I patients were treated with intra-medullary nail, group II patients treated with external fixator and group III patients with MIPO (Minimally Invasive Percutaneous Osteosynthesis). The American Orthopaedic Foot and Ankle Society score was recorded. Gustilo Anderson (GA) type of fractures and complications were recorded. Results: GA type 1 was seen in 10, 2 in 8, 3A in 7 and no GA type in 20 patients. AO classification A1 was present in 5, A2 in 6, A3 in 15, B1 in 8, C1 in 5, C2 in 5 and C3 in 3 patients. The mean AOFAS score was 74.2 in group I, 70.5 in group II and 89.2 in group III. Complications were non- union seen in 1, 2 and 3, ankle stiffness in 2, 2 and 1, wound discharge in 0, 1 and 1, vagus deformity in 3, 2 and 0 and valgus deformity in 1, 3 and 2 in group I, II and III respectively. The difference was significant (P

A prospective study on functional outcome of distal tibial fracture fixation with locking compression plate using minimally invasive percutaneous osteosynthesis technique

Introduction: Treatment of distal tibia fractures is challenging because of its subcutaneous location, poor vascularity and limited soft tissue envelope. Various modalities of surgical treatment such as Intramedullary nailing, Open reduction and internal fixation with conventional plate osteosynthesis and external fixation have reported good functional outcome but had high complication rate. The newer technique of distal tibia fracture fixation with Minimally invasive plate osteosynthesis (MIPO) using Locking compressing Plates (LCP) has emerged as an alternative treatment option because it involves less soft tissue handling, minimal periosteal stripping resulting in low infection rate, faster healing and it respects biology of distal tibia and also provides biomechanically stable construct.Aim: To assess the functional role of locking compression plates in treatment of distal tibial fractures using minimally invasive percutaneous osteosynthesis technique.Materials and Methods: In this study, 30 patients with distal 1/3rd tibia extra articular fractures (AO type 43A1, 43A2, 43A3) with or without associated fibula fractures were treated with LCPs using MIPO technique. The present prospective study was conducted in Department of Orthopaedics, Geetanjali medical college and hospital, Udaipur between January 2019- May 2020.Results: All fractures had excellent clinical and functional outcome, the fractures were stabilized by LCP using MIPO technique with an average operative time of 48.16 minutes. The age of the patients ranged from 20 to 76 years with the fracture being most common in the 3rd and 4th decade. Out of 30 patients, 21 (70%) patients were males and 9 (30%) patients were females showing male preponderance. Functional outcome evaluation was done using American Orthopaedic Foot and Ankle Society (AOFAS) score. At the end of this study, 21 (70%) patients had excellent outcome, 08 (26.66%) had good results, 01 (3.33%) had fair outcome and no patient had poor functional outcome. None of the cases had implant failure or any significant deformity.Conclusion: The present study shows that MIPO technique using LCP proves to be most effective and safer technique in the management of distal tibial fractures with or without intra-articular comminution by providing good fracture healing, enabling rapid functional recovery and avoiding major complications.

Study on Surgical Management of Distal Tibial Fractures by Locking Compression Plates (LCP)

Introduction: Fractures of the distal tibia are one of the most commonly fractures encountered in orthopaedic practice accounting for 7-10% of all tibial fractures. They represent a significant challenge to most of the surgeons. Most common method of management is by internal fixation using locking compression plate. Aim: To evaluate the effectiveness, functional results and complications following internal fixation of distal tibia fractures by locking compression plates (LCP). Materials and methods: In this study, 20 patients of distal tibia fractures treated surgically following internal fixation by LCP plating, studied between January 2019 to March 2020 in department of orthopaedics, Prathima Institute of Medical Sciences, Nagnoor, Karimnagar, and Telangana. All cases treated surgically by LCP plating using standard surgical technique and postoperative protocol. Results: High energy trauma (RTA) accounted for 80% of cases. Surgeries were performed within one week average. Radiological union seen in 16 weeks (range 14-18 weeks) average. weight bearing started from 12 weeks (Range 10- 14weeks). Ankle stiffness noted in 5% of cases. There were 4 cases of superficial infections, 2 patients with deep infection got treated with antibiotics and debridement. Functional results done according to Olerud and molander scoring system. 70% of patients achieved excellent to good results, 30% patients shows fair to poor results. Conclusion: Locking compression plate has better functional outcome, has the advantage of rigid fixation even in osteoporotic fractures and better angular stability.

“A prospective study of minimally invasive percutaneous plate osteosynthesis using LCP for surgical management of distal tibia fracture”

Background: Management of distal tibia fracture is challenging because of wound infections and poor wound healing due to precarious blood supply. Various methods of surgical treatment had been tried, such as closed intramedullary nailing, open reduction and internal fixation with conventional plate osteosynthesis and external fixation however most of them have a high complication rate than a good functional outcome. The newer technique of distal tibia fractures fixation using MIPPO involves less soft tissue handling and minimal periosteal stripping resulting in a lower infection rate and faster healing. Materials and Methods: In this study, 25 patients with distal tibia extra articular fractures and intra articular fractures with or without associated fibula fractures were treated with MIPPO using medial LCP. The present study was conducted in the department of Orthopaedics at a tertiary care hospital and followed up for a period of 2 years. Results: The mean follow up period ranged from 6 weeks to 2 years. All the fractures were united at an average of 16 weeks and mean AOFAS score at the end of 1 year was 85.64. There were two superficial wound infections which were treated with oral antibiotics and there was one deep infection and another with persistent ankle pain. Conclusion: Minimally invasive percutaneous plate osteosynthesis is a reliable method of fixation not only extra articular, but also intra articular fractures of distal tibia. MIPPO technique for the distal tibia fractures offers a biological advantage by preserving the blood supply and decreases chances of delayed or non-union. Patients treated by MIPPO technique have a much lesser rate of deep infection and excellent radiological union. MIPPO technique helps in initiating early mobilization and reduces the risk of ankle stiffness.

Management of distal tibia fractures with MIPPO

Management of distal tibia fractures with MIPPO

A review of minimally invasive technique using locking compression plate for fractures involving distal tibia

Distal tibia fractures are one of commonest lower extremity fracture. The treatment is quite challenging, since it has poor vascularity and limited soft tissue coverings. There are various treatment modalities for the management of distal tibia fractures. Minimally Invasive techniques using locking compression plate has emerged as a popular treatment option because of its respect towards the biology of distal tibia, maintenance of fracture haematoma and providing a biomechanically stable fixation. It also has an advantage of early mobilization and minimal complications with a relatively higher rates on union. In this review article, we will evaluate the effectiveness of minimally invasive techniques for fractures involving distal Tibia.

Surgical Management of Distal Tibia Fracture: Towards An Outcome-based Treatment Algorithm.

Introduction:Distal tibia fractures are frequently associated with an extensive soft tissue injury which then leads to a higher risk of complications such as infection, non-union and eventually poor overall outcome. The purpose of this study is to measure the outcome of distal tibia fractures treated with internal fixation, external fixator or Ilizarov external fixator(IEF). We aim to propose an algorithm for management of distal tibia fractures by evaluating the treatment options, outcomes and risk factors present.Material and Methods:This study is a cross-sectional study of all distal tibia fractures treated surgically in Tengku Ampuan Rahimah Hospital, Klang from 1st January 2016 till 30th June 2018. Patient records were reviewed to analyse the outcomes of surgical treatment and risk factors associated with it.Results:Ninety-one patients were included with a mean age of 41.5 years (SD = 16.4). Thirty-nine cases (42.9%) were open fractures. Thirty-eight patients (41.8%) were treated with internal fixation, 27 patients (29.7%) were treated with IEF and 26 patients (28.6%) were treated with an external fixator. Among open fractures cases, no significant finding can be concluded when comparing each surgical option and its outcome, although one option was seen better than the other in a particular outcome. Initial skeletal traction or temporary spanning external fixator in close fractures reduced the risk of mal-alignment (p value=0.001). Internal fixation is seen superior to IEF and external fixator in close fractures in term of articular surface reduction (p value = 0.043) and risk of mal-alignment (p value = 0.007).Conclusion:There is no single method of fixation that is ideal for all pilon fractures and suitable for all patients. This proposed algorithm can help surgeons in deciding treatment strategies in the challenging management of distal tibia fractures to reduce associated complications.

Union Following Biological and Rigid Fixations of Distal Tibia Extra-articular Fractures.

Distal tibia fractures are among the most common bony injuries, with a significant rate of nonunion and delayed union. There are multiple methods for the management of distal tibia fractures. Among the plating methods, there are bridge plating and compression plating techniques. There is still a lack of evidence about whether one method has a higher rate of union than the other. The present study aimed to assess the union rate of extra-articular distal tibia fractures using biological fixation with bridge plating and rigid fixation with compression plating. This retrospective analysis was performed on 41 adult patients with distal tibia fractures. The subjects were divided into two groups based on the fixation method, namely bridge plating and compression plating. Baseline characteristics, fracture characteristics, and union status were analyzed and compared in this study. Baseline and fracture characteristics were similar between the groups. Only higher translation in any planes was noted in the bridge plating group (2.80±3.04 mm; P<0.001). As for union status, the rates of the union during 3 months and delayed/no union were similar between the two groups (P=0.18). During a 6-month follow-up, 92% and 93.8% of the patients achieved union in the bridge plating and compression plating groups, respectively. Rates of delayed union and nonunion are similar regarding extra-articular distal tibia fractures treated with either bridge plating or compression plating.

A clinical study: management of distal tibial fractures with minimally invasive plating osteosynthesis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Distal tibial fractures of bone poses major challenge to the trauma orthopaedic surgeons as this bone is subcutaneous associated with soft tissue injuries and precarious blood supply. Distal tibial fractures require accurate reduction, perfect articular restoration with stable fixation with minimal stripping of soft tissues, thereby preserving the blood supply. Minimally invasive osteosynthesis using locking plates has emerged as viable option of fixing such fractures due to poor results associated with open plating which leads to extensive soft tissues stripping and subsequently poor blood supply.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 27 patients with closed distal tibial fractures with or without articular involvement without vascular compromise were treated with LCP fixation using MIPO technique studied from June 2017 to December 2018.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All fractures in our series united well at the end of 5 months with mean time to clinical and radiological union was 17 weeks. There was no case of implant failure while 2 patients had varus angulation. Very few soft tissue complications with excellent functional outcome were seen.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We concluded that distal tibial fractures can be effectively managed with LCP using MIPPO technique with excellent functional outcome and avoiding the complications associated with other treatment methods. &lt;/p&gt;

A comparative non-randomized study between locking compression plate and intramedullary nail-in the management of distal tibial fractures

37.8% of tibia fractures occur in the distal tibial region. Due to the poor soft tissue envelope and precarious blood supply in the distal tibial region, there is a very high incidence of complications like non-union, delayed union and wound dehiscence, with increased secondary procedure rate especially after implant failure. Literature review shows that there is no optimal treatment (implant) for the management of these fractures. Nailing provides lesser chances of wound dehiscence but fails in providing adequate stability. Compression plating provides increased complication due to bulky implants causing wound dehiscence. Some of it is offset by locking compression plate. Hence we decided to study which implant would be ideal to treat these fractures with the best functional outcome and low incidence of complications.This was a prospective study of 72 patients who had unilateral, displaced fracture of distal tibia. 41 patients where managed with intra-medullary interlocking nailing and 31 patients were managed with locking compression plate osteosynthesis.The incidence of complications was found to be higher in nailing when compared to that of plating. 2 of patients developed non-union in nailing. 4 of patients developed implant failure and required secondary procedures in nailing group when compared to 1in LCP group which was attributable to poor biomechanical construct.25 age matched pairs of patients were selected from each group and were assessed with the help of modified Klemm and Borner scoring system. Based on this scoring system the results were analyzed for the study group. Patients in the locking compression plate osteosynthesis group yielded scores that were significantly higher than the nailing group and were found to be statistically significant with a p value of < 0.05. 76% had excellent results, 16% had good results and 4% had fair results in the plating group when compared to 24% excellent results, 40% good results, 20% fair results and 16% poor results in the nailing group.The results of current study show statistically advantageous for locking compression plate osteosynthesis when compared to close intramedullary interlocking nailing for distal third of tibia fractures. With decreased incidence of complications &secondary procedure in LCP group. Particularly in MIPPO with LCP group did much better as no secondary procedures were required. A multicentric study with large population is necessary to confirm this.

A study of results of surgical management of distal tibia fractures treated by mippo tehnique with locking compression plate

Background and objectives: The surgical treatment of fractures according to AO principles has seen a change in the past decade, from anatomical reduction and rigid fixation to the current concept of Biological fixation, precise reduction being a goal only in intra-articular fractures. With the advent of internal fixators like PC-Fix and LISS (Less Invasive Stabilizing System) this was being achieved to some extent. The recent development of LCP has revolutionized the treatment by overcoming the few drawbacks of these internal fixators. The LCP is a screw plate system that offers the possibility of inserting conventional and locking head screws into the specially designed combination holes. We aimed to study the nature of fracture union in fractures treated with LCP by MIPO technique and to analyse any complications arising out of this technique. Methods: This is a retrospective study of 23 cases of distal tibia fracture (19 patients had associated fibula fracture) admitted in Southern Headquarter Railway Hospital, Chennai, between March 2006 and November 2009. Cases were taken according to inclusion and exclusion criteria. We treated all patients with LCP by MIPO technique. Results: We followed up all the patients and the duration ranged from 13 weeks to 38 weeks (mean 18.9 weeks). All fractures eventually united including 2 which had delayed union. Rest of the 21 fractures united at a mean of 20 weeks. We had totally 6 complications which included superficial infection (1), deep infection (2), iatrogenic fracture (1) and delayed union (2). We had no case of any purely implant related complications like screw loosening, screw breakage, plate failure. Interpretation and conclusion: The patient sample approximately reflected the regular trauma patients encountered at our set up. Fractures treated with MIPO, healed rapidly by secondary fracture union and hence achieving strong bony union across the facture site. With the LCP system the biological fixation of fractures was easier than the conventional plates. The anchorage of locking head screws even in osteoporotic bone was excellent. We also confirmed its proven efficacy in the treatment of difficult fracture situations, where in other implants have limited application. Fresh conclusions cannot be drawn as sample size is not sufficient.

Acute management of complex tibial pilon fractures (AO/OTA 43-C)

Background In pilon fracture management, careful soft tissue handling is as relevant as the treatment of the bony injury itself. It is crucial to spare the extraosseous vessels during surgery as best as possible. Minimally invasive plate osteosynthesis has attracted great interest in the management of distal tibia fractures and can be used as an alternative to staged approach. Patients and methods From January 2009 to December 2013, 32 pilon fractures (AO/OTA 43-C) in 30 patients were treated by acute minimally invasive plate osteosynthesis with distal tibia anatomical locked plates within an average 1.3 days of injury. The mean follow-up time was 30.8 months (24–48 months). Immediate postoperative reduction was assessed, and rating of the symptoms and functional abilities of each patient was done according to American Orthopaedic Foot and Ankle Society ankle-hind foot score. Results Satisfactory immediate postoperative radiograph articular reduction was achieved in 90.9% (n=29) ankles. There is no statistically significant difference (P>0.05) between immediate postoperative reduction and reduction at the final follow-up. Bony union was achieved in all cases after an average of 4.6 months (3–8 months). The mean American Orthopaedic Foot and Ankle Society ankle-hind foot score at final follow-up was 79. Excellent clinical result was achieved in 21 (65.6%) ankles, good in nine (28.1%) ankles, and poor in two (6.3%) ankles. Complications include one deep infection and two ankle arthrodesis. Conclusions Acute minimally invasive approach combined with locking plates for the treatment of complex pilon fractures decreases complications associated with disruption of the soft tissue envelope and associated osseous complications and allows quicker return to function. Level of evidence: Level IV, case series.

A comparative study of low multidirectional locked nailing and locking compression plating in management of distal tibia fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Ideal management for distal tibial meta-diaphyseal fracture remains controversial, due to lack of adequate evidences about implants and multiple treatment modalities. Most commonly these fractures were dealt with either locking compression plate (LCP) or by multi directional intra-medullary nail (IMIL). Aim is to compare these two implants, to understand the mechanism and find out the ideal implant for the management of distal tibia fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study is prospective and comparative done at the associated hospitals of KMC Mangalore, spanning a period of around 2 years (October 2014 to July 2016). All patients presented with distal tibial meta-diaphyseal fractures were included in the study. Patients were treated with either low multi directional IMIL nail or by LCP and followed up for a minimum period of 6 months. Outcome measures included Olerud Molander Ankle Score (OMAS), wound issues, union of the fracture and patient mobility.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 50 consecutive patients (mean age 40 years) were included in the study, divided equally into 2 groups. Group-A treated with multi directional IMIL nail and group-B with MIPPO plating. Mean functional OMAS score for nailing is 91 and for plating is 88. All fractures treated with nailing united within 6 months and 4% patient treated by plating goes mal union and 4% infected.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; For distal tibial fracture management, intra-medullary nailing proved reliable surgical option with regards to the OMAS score, fracture union and less infection rates.&lt;/p&gt;

Interlocking nail for management of distal tibia fracture: our experience at tertiary center of Bihar

Introduction: Tibia is the most commonly fractured bone amongst all long bones of the body due to its position and lack of soft tissue protection. Treating tibia distal 1/3rd fracture is still a greater challenge because Most of the distal third tibia is subcutaneous and has precarious blood supply. Fractures of the distal third tibia have comminution at the fracture site and have associated significant soft tissue injury. Generally, associated with ecchymosis, blebs, swellings, wounds, etc. All these factors contribute to delayed union, non-union, and malunion. The present study is about the ability to maintain a mechanically stable reduction in the distal third tibia with intramedullary nail, when lower 4cm of tibia not fractured. If associated with fibula fracture (in lower 10 cm), it fixed to give stability to syndesmosis and stability to same-level tibia fracture. Materials and methods: all patients of distal tibia fracture fulfilling the inclusion criteria from July 2011 to July 2017, were operated and followed up at every 4 weeks, till sign of union seen. Results: 72 patients (male 40, female 32) with Mean age of was 35.2 years (20–50 yrs), Fracture union was seen radiologically within 12 to 20 weeks, depending on fracture geometry. Conclusion: We found that results of fractures of distal third tibia not extending into lower 4 cm of tibia treated with interlock nailing were found satisfactory. Careful planning and placement of nail at the center of a wide metaphysis in the anteroposterior and lateral is necessary to avoid varus, valgus, and antero-posterior tilt. Polar screw or temporary K-wire during surgery was found to be helpful. Same-level fibula fracture fixation with a plate or k-wire is effective for stability of reduction.

Outcome of distal tibia fractures treated with tibial linterlocking nail and minimal invasive plating: A prospective study

Introduction: The best modality of management of distal tibial fractures (extra articular) remains controversial and challenging. Various studies have shown varying results with different modalities of treatment, however our study is to compare functional and radiological outcomes between patients treated with tip locking nail and compression plate using MIPP0 Technique. The mechanism of injury and the prognosis of these fractures are different from pilon fractures, but their proximity to the ankle makes the surgical treatment more complicated than the tibial midshaft fractures. Material and methods: A total of 120 patients between the age of 25-50 years were treated randomly with nailing (Group A) and percutaneous plating (Group B) between the year May 2014- March 2017. At one year follow up, outcome was analysed based on union rate, operating time, complications (Infections, Nonunion, delayed union, malunion) and functional score by AOFAS (American orthopedic foot and ankle score). 53 patients included in group A and 55 patients in group B. 12 patients did not follow up. Result: Out of 108 patients randomly, average operating time in nailing is 44.21 mins and plating is 40.14 mins. 1 patient in group B developed superficial infection which healed well on long term follow up. In 30 patients, fibula fracture was first fixed using 3.5mm one third tubular plate and cortical screws due to ankle joint/syndesmotic instability. Mean radiological union time in nailing group was 20.1 weeks. (18-22 weeks) and plating group was 17.5 weeks (16-18 weeks). 4 cases in nailing developed malunion with angulation less than 5 degree which was acceptable and 2 cases developed varus deformity with angulation more than 5 degree. No cases of implant failure was noted. No evidence of nonunion was noted in both groups. Functional outcomes based on AOFAS score was IM nailing 90.8 and 96.2 for plating which was statistically significant between the 2 groups. In addition to pain which was included in AOFAS score 10 patients treated with IM nailing had anterior knee pain. Conclusion: Based on the above study, we concluded that treating distal tibia fractures (extraarticular) with locking compression plate using MIPPO technique is superior than tip locking nail as there is better anatomical reduction/alignment leading to quicker radiological union and better functional outcome according to AOFAS.