Management Of Tibial Fractures Research Articles

Functional Outcome Of Delayed Anterolateral Plating For Tibial Pilon Fractures

BACKGROUND & OBJECTIVES: The Management of Tibial pilon fractures have always been perplexing. Our study was planned to evaluate functional outcome of delayed anterolateral plating for tibial pilon fractures by assessing the range of motion of ankle along with pain and affection in the activities of daily living. MATERIALS AND METHODS: A prospective observational study was done for 45 patients with tibial pilon fracture, for whom delayed anterolateral plating was done in Orthopaedics department of Government medical college, Thiruvananthapuram. The study was conducted at 6 months of follow up after surgery is done. Data collected using a structured proforma. The evaluation of results is based on scoring system given by kaikkonen ankle score RESULTS: Functional outcome was assessed at 6th month follow up using kaikkonen ankle score. The mean age of the patients was 38.53(19-72) and among them 52.78% had right side affected. 37.78% had excellent functional outcome and 51.11% had good functional outcome at the end of 6 months. Best functional outcome was obtained in Ruedi Allgower type 1 fractures. Wound related infections were noted in 6.7% cases who had significantly poor functional outcome CONCLUSION: Hence delayed anterolateral plating greatly improves the functional outcome in patients with tibial pilon fractures and allows for earlier mobilization and prevents complications like malunion.

Perioperative Management of Tibial Spine Fractures in Pediatric Patients: A Delphi Study to Identify Principles of Treatment.

The Delphi technique is a structured, iterative group survey method utilized to reach a consensus among experts in a field regarding topics with evidence-based equipoise. Currently, there are few studies at the highest levels of evidence published on the perioperative tibial spine management, making it an ideal subject to utilize expert opinion to reach consensus decision. The purpose of this study was to utilize a Delphi-method survey to achieve consensus statements regarding the perioperative management of tibial spine fractures. Before study initiation, 3 rounds of surveys were agreed upon, maintaining the traditional Delphi principles. Consensus was defined as 75% agreement or disagreement on a Likert scale. An anonymous survey consisting of 50 statements describing the management of tibial spine fractures preoperative and postoperative in varying scenarios was distributed to a group of 44 pediatric sports medicine orthopaedic surgeons utilizing an electronic survey software system. Of 44 surgeons invited to participate, 24 responded to round 1, 28 responded to round 2, and 25 responded to round 3. Consensus was achieved for the following: use of x-ray to determine initial treatment; casting for a minimum of 3 weeks for nonoperative management, but <3 weeks if treated with surgical fixation; advanced imaging to avoid missing concomitant injury; the necessity of physical therapy, but not continuous passive motion (CPM); and for arthroscopic surgical intervention. It was also agreed that functional testing is important in return-to-play (RTP) decision-making, though the specific timelines and clearance criteria could not be agreed upon. There were statements that displayed continued disagreement, including the role of aspiration, preoperative range of motion management, and the timing of surgical scheduling. Utilizing a Delphi methodology with experienced surgeons on tibial spine treatment, consensus in the management of tibial spine fracture was achieved for definitive management strategies. Further study will be important to optimize our management of this youthful population with tibial spine fractures.

Comparative clinical efficacy of “Figure-8” Banding and double-row anchor suture-bridge fixation in arthroscopic management of tibial intercondylar eminence avulsion fractures

ObjectiveThe objective of this study is to assess and compare the clinical efficacy of “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures.MethodA retrospective analysis was conducted on the medical records of 42 patients who underwent arthroscopic surgery for tibial intercondylar eminence fractures at our institution from June 2017 to June 2022. This cohort included 20 cases treated with “Figure-8” banding and 22 cases managed using double-row anchor suture-bridge fixation. Comparative assessments were made regarding operative duration, duration of fracture consolidation, postoperative knee joint range of motion, joint stability as assessed by the Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) functional score for both treatment groups.ResultsThe mean follow-up duration was 13.8 months. The analysis indicated that the double-row anchor suture-bridge group had a significantly longer operative duration compared to the “Figure-8” banding group (p < 0.05). Postoperative computed tomography (CT) scans confirmed successful reduction in both groups, with fracture consolidation achieved within an average of three months. Both groups showed significant improvements in postoperative knee range of motion, joint stability, and functional scores compared to preoperative measurements (p < 0.05). During the initial two-month post-surgery, the double-row anchor suture-bridge group demonstrated superior knee joint range of motion and functional scores compared to the “Figure-8” banding group (p < 0.05); however, these differences were not statistically significant beyond three months post-surgery (p > 0.05). By the one-year postoperative mark, joint stability outcomes were comparable between the two treatment groups (p > 0.05).ConclusionBoth “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures can achieve precise reduction and stable fixation. In addition, the figure-8 suture group has the characteristics of shorter surgery time and less cost. Notably, early postoperative knee function appears to be superior with double-row anchor suture-bridge fixation compared to “Figure-8” banding.

Salvage of a comminuted proximal tibial polymicrobial infected non-union with antibiotic loaded bio-composite and intramedullary nailing: a case report

Background. Management of open proximal metaphyseal fractures poses a significant challenge and is fraught with complications. These injuries are severe, often accompanied by extensive soft tissue and vascular damage, leading to high risks of infection and long-term disability. Case presentation. A 72-year-old male was severely injured in a road traffic accident. Plain X-rays and CT angiogram identified a comminuted proximal tibial fracture with transection of the popliteal artery and vein. Initial emergency treatment included fasciotomies, external fixation, and vascular primary repair. On the 12th day of admission, the patient underwent open reduction and internal fixation (ORIF) with dual plate fixation using a two incision technique. A plastic surgeon performed skin grafting, harvested from the patient’s thigh, to allow closure of his fasciotomy wounds immediately following ORIF. Four weeks post-operatively, the patient developed a wound breakdown over the lateral fasciotomy site, exposing the metal plates with a small defect developing on the medial fasciotomy wound in tandem. The patient’s course was further complicated by persistent polymicrobial infections. Over 6 months of antibiotic regimes, operative intervention was ultimately required. All of the infected metal implants were removed, the non-union sites were aggressively debrided. The tibial canal was reamed to prepare for a tibial nailing. An antibiotic loaded bio-composite was then inserted through the non-union sites into the canal followed by an intramedullary nail. A blocking screw was used to address the procurvatum deformity in the sagittal plane. The patient currently shows signs of recovery, mobilizing over short distances, weight-bearing with assistive aids and with healing wounds and early signs of callus formation on recent CT scans and plain X-rays. Conclusions. The management of complex tibial fractures with vascular involvement demands an aggressive multidisciplinary approach and continuous adaptability in treatment plans to address the evolving challenges of such severe injuries. This case exemplifies the utility of injectable antibiotic-loaded bio-composites in a limb-salvage setting and their ability to provide high doses of local antibiotics to an infection site which, in conjunction with appropriate stable fixation and systemic antibiotics, can aid in eradicating and treating fracture-related infections.

TIBIAL DIAPHYSEAL FRACTURE, PANORAMIC REVISION

Introduction: Tibial fractures are quite common injuries. Since the tibia has a subcutaneous location, it is more likely to show exposed fractures. Exposed fractures of the tibial diaphysis are serious injuries that can result in significant long-term disability if not managed correctly. Objective: to detail current information related to tibial diaphysis fractures, etiology, epidemiology, anamnesis, physical examination, assessment, treatment, differential diagnosis, prognosis and complications. Methodology: a total of 29 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 17 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: tibia fractures, osteosynthesis, tibia fracture, intramedullary nails, leg trauma, exposed fractures. Results: tibial diaphysis fractures present an incidence of 16.9 per 100,000 individuals per year, being more common in the male sex, with 21.5 per 100,000 individuals per year, compared to 12.3 per 100,000 in the female sex. The most common triggers in males of tibial diaphysis fractures are motor vehicle accident injuries and sports. Conclusions: It is important to recognize the management of tibial fractures since they have a relatively high incidence. It is not uncommon to encounter an exposed tibial diaphysis fracture, so it is essential to identify, as well as perform damage control and appropriate management. The individual should undergo a complete examination and it may be necessary to implement the trauma life support protocol. In this type of fracture it is crucial to assess the neurovascular situation. In addition, complementary examinations should be requested to allow the best diagnosis, classification and treatment of the injuries. The treatment of tibia diaphysis fractures will depend on the specific situation and the patient's condition; however, external fixators are usually used for damage control and later intramedullary nails are used. Tibial diaphysis fractures may be accompanied by compartment syndrome and other complications. KEY WORDS: trauma, fractures, tibia, treatment.

Management of Femoral and Tibial Shaft Fractures in Chronic Spinal Cord Injury Patients.

To compare outcomes and complications between non-operative and operative management of femur and tibia fractures in patients with paraplegia or quadriplegia from chronic spinal cord injury (SCI). Design: Retrospective cohort study. Three Level-1 Trauma centers. All adult patients with paraplegia or quadriplegia due to a chronic SCI with operative or nonoperative treatment of a femoral or tibial shaft fracture from 01/01/2009 through 12/31/2019 were included. Outcomes collected included range of motion, pain, return to baseline activity, extent of malunion and treatment complications (infection, pressure ulcers, nonunion, DVT/PE, stroke, amputation, death). Comparison between operative and nonoperative treatment were made for each outcome. Fifty-nine patients with acute lower extremity fracture in the setting of chronic SCI fulfilled inclusion criteria with a median age of 46 years in the operative group and 47 years in the non-operative group. Twelve patients (70.6%) in the nonoperative group were male with 32 (76.2%) male patients in the operative group. Forty-six patients (78%) presented as low energy trauma. Differences were seen between operative and non-operative management for pressure ulcers (19% vs 52.9%, p=0.009) and mean VAS pain score at first follow-up (1.19 vs 3.3, p=0.03). No difference was seen for rates of infection, nonunion, DVT/PE, stroke, amputation, death, return to baseline activity, and range of motion. Tibial and femoral shaft fractures commonly resulted from low energy mechanisms in patients with chronic SCI. Operative treatment seemed to decrease morbidity in these patients via lowered rates of pressure ulcers and decreased pain compared to non-operative management. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Classification and management of tibial tubercle avulsion fractures in children.

Fractures of the tibial tubercle are an uncommon injury, constituting 0.4-2.7% of all epiphyseal injuries. They occur in the adolescent age group, often during sports such as basketball and football. They are often classified using the modified Ogden classification. Understanding the anatomy and pathophysiology is essential in the management of these fractures, to predict complications and counsel patients and families on care. Tibial tubercle fractures generally have favourable overall outcomes when the correct treatment modality is chosen, with a high rate of union and a 98% return to preinjury activities. This article provides a guide for doctors on the classification and management of these injuries, to ensure that appropriate treatment is given according to current literature and best practice.

Classification and management of tibial tubercle avulsion fractures in children

Abstract Fractures of the tibial tubercle are an uncommon injury, constituting 0.4–2.7% of all epiphyseal injuries. They occur in the adolescent age group, often during sports such as basketball and football. They are often classified using the modified Ogden classification. Understanding the anatomy and pathophysiology is essential in the management of these fractures, to predict complications and counsel patients and families on care. Tibial tubercle fractures generally have favourable overall outcomes when the correct treatment modality is chosen, with a high rate of union and a 98% return to preinjury activities. This article provides a guide for doctors on the classification and management of these injuries, to ensure that appropriate treatment is given according to current literature and best practice.

Surgical management of combined osteoarthritis knee and proximal tibial stress fracture via long tibial stem total knee arthroplasty: assessment of medium-term results

Background The combined osteoarthritis knee and proximal tibial stress fracture is an uncommon condition that increases the complexity of the management for both. No common consensus among surgeons regarding management guidelines. We assessed the medium-term results (minimum 5 years) of using long tibial stem total knee arthroplasty (TKA) to restore limb alignment, achieve fracture union, and resurface the arthritic joint in a single procedure. Methods Total of 23 patients with combined osteoarthritis knee and proximal tibial stress fracture were enrolled in this study. Of those 23 patients, 18 were females and five were males. All patients were managed surgically by TKA (PCL sacrificing) with a long tibial stem (straight or with offset). Assessments of union and tibiofemoral alignment were carried out using radiographs. Clinically, patients were evaluated by assessment of knee range of motion, knee society score (KSS), and knee injury and OA outcome score. Results The average follow-up period was 6.5 ± 2.3 years (range from 5 to 9 years) all fractures united in 3–8 months (average 3.2 months), and mean range of motion improved from 89°±8° to 119°±6°, mean knee society score improved from 32 ± 8 to 87 ± 5, mean knee injury osteoarthritis outcome score improved from 27 ± 6 preoperatively to 79 ± 5 after a minimum of 5 years follow-up. no complications (instability, infection, or patella mal-tracking) were reported, although 1 case had a femoral intraoperative condyle fracture which was fixed by screws with no effect on the outcome. Conclusion The use of a long tibial stem TKA is an effective and reproducible single surgical procedure in the management of combined osteoarthritis knee and proximal tibial stress fracture. Satisfactory clinical scores and radiological outcomes were achieved and proper limb alignment was restored obviating the need for further fixation or grafting.

How Effective is Fibula Pro Tibia Plating in Treatment of Distal Tibial Fractures: A Pilot Study.

Despite recent advances, management of distal tibial fractures is challenging, with high rate of complications. Fibula pro tibia plating technique fixes fibula and tibia together, via laterally placed fibular plate without disturbing the tibial soft tissue sleeve. We contemplated this pilot study to assess effectiveness of fibula pro tibia plating in management of distal tibia fibula fractures. A total of 30 patients with distal tibia fibula fractures with fracture line extending within 5cm from tibial plafond were managed with fibula pro tibia plating, with or without minimal articular fixation. Outcome evaluation was done by union, union time, alignment and functional outcome as assessed by AOFAS score. Mean age in the series was 39.4 years with male to female ratio of 3:2. Mean duration of surgery, blood loss and C arm exposure were 79 minutes (range 52 to 98min), 80ml (range 62 to 102ml) and 48 shoots (range 36 to 81 shoots), respectively. All fractures united in mean union time of 10.2 weeks (range 9 to 14 weeks) with acceptable alignment in all the patients except one. Mean AOFAS score was 86.3 (range 70 to 93) with 29 patients having good to excellent outcome. One patient had varus malunion and in one case infection was seen. Fibula pro tibia plating can be successfully used to manage complex distal tibia fractures which leaves the soft tissue and periosteal sleeve undisturbed, thus avoiding wound related problems and leading to early union.

THE ACUTE MANAGEMENT OF PILON FRACTURES (ENFORCE) STUDY: A TRAINEE-LED NATIONAL COLLABORATIVE EVALUATION OF PRACTICE

IntroductionTibial Pilon fractures are potentially limb threatening, yet standards of care are lacking from BOFAS and the BOA. The mantra of “span, scan, plan” describes staged management with external fixation to allow soft tissue resuscitation, followed by a planning CT-scan. Our aim was to evaluate how Tibial Pilon fractures are acutely managed.MethodsENFORCE was a multi-centre retrospective observational study of the acute management of partial and complete articular Tibial Pilon fractures over a three-year period. Mechanism, imaging, fracture classification, time to fracture reduction and cast, and soft tissue damage control details were determined.Results656 patients (670 fractures) across 27 centres were reported. AO fracture classifications were: partial articular (n=294) and complete articular (n=376). Initial diagnostic imaging mobilities were: plain radiographs (n=602) and CT-scan (n=54), with all but 38 cases having a planning CT-scan. 526 fractures had a cast applied in the Emergency Department (91 before radiological diagnosis), with the times taken to obtain post cast imaging being: mean 2.7 hours, median 2.3 hours, range 28 mins – 14 hours). 35% (102/294) of partial articular and 57% (216/376) of complete articular (length unstable) fractures had an external fixator applied, all of which underwent a planning CT-scan. Definitive management consisted of: open reduction internal fixation (n=495), fine wire frame (n=86), spanning external fixator (n=25), intramedullary nail (n=25), other (n=18).ConclusionThe management of Tibial Pilon fractures is variable, with prolonged delays in obtaining post cast reduction radiographs, and just over half of length unstable complete articular fractures being managed with the gold standard “span, scan, plan” staged soft tissue resuscitation. A BOFAS endorsed BOAST (British Orthopaedic Association Standard for Trauma) for Tibial Pilon fractures is suggested for standardisation of the acute management of these potentially limb threatening injuries, together with setting them apart from more straightforward ankle fractures.

Intramedullary nailing at different distal tibial fracture levels: A biomechanical study.

Distal tibial fractures remains a significant challenge in orthopedic trauma surgery. As the fracture level approaches the joint, alternative fixation options instead of intramedullary nailing (IMN) come to the fore. The present study aimed to assess the biomechanical stability of IMN at different distal tibial fracture levels and the number of locking screws required. Using a total of 21 sawbone models, 3 different tibial fracture levels (3, 4.5, and 6 cm proximally to the talocrural joint) were created and the fractures were fixed using 2, 3, or 4 distal locking screws. A single compression force at a speed of 30 mm/min with a maximum force of 800 Newton and a cyclic compression force of 60 cycles at a speed of 60 mm/min was applied to all tibia models. The applied weight and displacements from the fracture lines were recorded and evaluated. There was no statistically significant difference in fixation with 2 distal locking screws in groups 1, 2, and 3 (single test P =.9689) (cyclic test P =.8050). Therefore, if 2 distal screws are used, the fracture level does not affect the strength of fixation. In fractures located 6 cm proximal to the talocrural joint, all 4 holes of the nail can be used to insert screws, which provides a stronger fixation. When 2 screws are used, a statistically weaker fixation is obtained than with 3 or 4 screws. However, there is no significant difference between using 3 or 4 screws. Our findings support the use of IMN with 2 distal locking screws as a viable option for the management of distal tibial fractures. We found that it provides sufficient fixation regardless of the fracture level, suggesting that there is no need to choose an alternative fixation technique due to concerns of inadequate fixation as the fracture line moves distally. In cases where more stable fixation is desired, an additional locking screw can be used, but the potential increase in procedure and fluoroscopy time should be considered.

Exchange Nailing vs Plate over Nail and Graft in the Management of Non-United Proximal Tibial Fractures after Interlocking Nail Fixation in Proximal Tibial Fractures

Exchange Nailing vs Plate over Nail and Graft in the Management of Non-United Proximal Tibial Fractures after Interlocking Nail Fixation in Proximal Tibial Fractures

Primary Arthrodesis with Retrograde Hindfoot Nail for Elderly Patients with Tibia Pilon Fractures and Psychiatric Illness.

Management of tibial pilon fracture in elderly patients with psychiatric illness remains challenging for orthopedic doctors because of patients' poor bone quality and inability for self-care. This study aimed to ascertain the viability and reliability of primary arthrodesis by using retrograde hindfoot nail for these difficult cases. We retrospectively reviewed eight elderly consecutive patients (age older than 65 years) with tibial pilon fractures and psychiatric illness from January of 2012 to December of 2019 in our institute. Primary tibiotalocalcaneal arthrodesis with retrograde hindfoot nail was used as a definitive procedure. The bone union time, wound complication rate, ankle alignment, necessity for narcotic agents, and ambulation status were evaluated. The average length of follow-up was 22.25 months (range, 15-36 months). Additional bone grafting surgery was performed for one patient because of fusion-site nonunion 6 months postoperatively. Another patient required debridement and removal of posterior calcaneal screw because of implant prominence and local infection. Osseous union with angular deformity less than 10° was achieved in all patients finally. The average bone union time was 6.6 months (range, 4-12 months). In terms of walking ability, six patients were capable of outdoor ambulation (classes 2 and 3). Two patients required oral pain medication at the final visit. The current study involved only a small number of patients, and two of the eight cases encountered undesired complications (one local infection and one bone nonunion); however, we believe that our method may serve as a valuable alternative for the treatment of tibial pilon fractures in elderly patients with psychiatric illness, considering the specificity of this fragile population.

The Clinical Application of Double Taylor Spatial Frame in Segmental Tibial Fracture.

Multi-planar external fixation has been used for the management of segmental tibial fractures with severe soft tissue injuries. However, fewer specialized studies have been reported. The primary aim of this study was to describe our experience of treating fractures of this type using the Taylor Spatial Frame and Ilizarov external fixation methods. We retrospectively analyzed 33 patients with segmental tibial fracture treated at our institution between January 2016 and December 2020. The patients were divided into double Taylor Spatial Frame (D-TSF) and Ilizarov groups based on the external fixation structure. Baseline demographic data included sex, age, injury side and cause, open or closed fracture, time from injury to surgery, complications, and external frame removal and fracture healing time. The hip-knee-ankle angle (HKA) was measured from preoperative, immediate postoperative, and final follow-up full-length X-rays of bilateral lower limbs. We determined the degree of deviation in the HKA by calculating the difference between the measured angle and the ideal value of 180°; the absolute value was used to assess recovery of the lower limb force line. At the final follow-up, Johner-Wruhs tibial fracture outcome criteria (J-W TFOC) were used to classify the postoperative function of the affected limb as excellent, good, moderate, or poor. Count data were analyzed with the chi-square test or Fisher's exact test; the Mann-Whitney U test was used for rank data. No statistically significant differences were observed between the two groups in terms of sex, age, side of injury, cause of injury, closed or open fracture, or time between injury and surgery, which indicates that the groups were comparable (p > 0.05). A statistically significant difference was observed in external frame removal and fracture healing time between the D-TSF and Ilizarov groups (36.24 ± 8.34 vs 45.42 ± 10.21 weeks, p = 0.009; 33.33 ± 8.21 vs 42.00 ± 9.78 weeks, p = 0.011). The Johner-Wruhs criteria were used to assess the function of the affected limb, the D-TSF group performed better in correcting the lower limb force line than the Ilizarov group. A statistically significant difference in terms of excellent ratings was observed between the two groups (18/2/1/0 vs 5/5/1/1, p = 0.010). Postoperative follow-up X-rays demonstrated a significant improvement in the HKA in both groups immediately after surgery and at the final follow-up compared to the angle before surgery. At the final follow-up, a statistically significant difference was observed in the degree of deviation in the HKA between the two groups (1.58° ± 0.84° vs 2.37° ± 1.00°, p = 0.023). The D-TSF treatment is associated with minimal secondary damage to soft tissue, a straightforward and minimally invasive procedure, multiplanar stable fracture fixation, and optimization of fracture alignment and lower limb force lines, therefore, it is highly effective therapeutic option for segmental tibial fracture.

THE BIGGER, THE BETTER? TWO-RING CIRCULAR FRAMES AND DURATION OF TREATMENT IN THE MANAGEMENT OF TIBIAL FRACTURES: A RETROSPECTIVE COHORT STUDY

IntroductionFrame configuration for the management of complex tibial fractures is highly variable and is dependent not only on fracture pattern and soft tissue condition but also surgeon preference. The optimal number of rings to use when designing a frame remains uncertain. Traditionally, larger, stiffer constructs with multiple rings per segment were thought to offer optimal conditions for bone healing, however, the concept of reverse dynamisation questions this approach.Materials &amp; MethodsWe compared clinical outcomes in 302 consecutive patients with tibial fractures treated in our unit with either a two-ring circular frame or a three-or-more-ring (3+) frame. The primary outcome measure was time spent in frame. Secondary outcomes were the incidence of malunion and the need for further surgical procedures to achieve bone union. The groups were evenly matched for age, co-morbidities, energy of injury mechanism, fracture classification, post-treatment alignment and presence of an open fracture.ResultsThe mean time in frame was 168 days for the 2-ring group and 200 days for the 3+ rings group (p=0.003). No significant difference was found in the rate of malunion (p=0.428) or the requirement for secondary surgical intervention to achieve union (p=0.363). No significant difference in time in frame was found between individual surgeons.ConclusionsThis study finds that 2-ring frame constructs are a reliable option associated with significantly shorter duration of treatment and no increase in rates of adverse outcomes compared with larger, more complex frame configurations. Although this study cannot identify the underlying cause of the difference in treatment time between frame designs, it is possible that differences in mechanical stability lead to a more favourable strain environment for fracture healing in the 2-ring group.

Bone union and mobility outcomes for reconstructed open tibial fractures: a plastic surgical experience from a major trauma center.

The goal in open tibial fracture management is to achieve a united tibia in an extremity that allows pain free mobilization. The objective of this study was to assess factors that lead to this functional outcome in lower limb reconstruction, from a plastic surgical perspective. The Plastic and Reconstructive Surgery lower limb database at a tertiary trauma hospital was searched for open tibial injuries from February 2015 to March 2020. The nature and severity of injury, timing and details of all operations including reconstructions were collected prospectively. Mobility including gait aids, pain, and complications were retrospectively collected. Union was assessed in two ways, depending on fracture location. Metaphyseal and diaphyseal tibial fractures were provided mRUST scores (union defined as RUST > 13) and epiphyseal tibial fractures were categorically classified as "united" or "non-union" by two independent radiologists. During the five-year study period there were 148 open leg injuries in the database. Twenty-one patients underwent a primary amputation due to severity of their initial injury. One hundred patients underwent primary limb salvage. Sixty-one patients in the limb salvage group achieved primary tibial union with a mean follow-up time of 19.4 months post injury. Twenty-three additional patients were confirmed to subsequently unite. Patient who achieved union were more likely to mobilise without gait aids. In this study definitive external fixation and soft tissue infection were both associated with higher rates of non-union. Longer times to soft tissue reconstruction was not associated with an increase in acute soft tissue complications. More importantly bone union, pain and mobility did not decline. After undertaking a primary limb salvage pathway for 100 patients, the ultimate tibial fracture union rate was 84% and the confirmed ambulation rate was 96%.

Comparative Study of Intramedullary Interlocking Nailing and Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibia Extra-Articular Fractures

Management of distal tibial extra-articular fractures presents a significant challenge in orthopedic practice due to their complex anatomical features and variable fracture patterns. Surgical intervention plays a crucial role in achieving stable fixation and optimal functional outcomes. This study aimed to compare the effectiveness between minimally invasive percutaneous plate osteosynthesis and intramedullary nailing for the management of distal tibial extra-articular fractures. This was a prospective observational study that was conducted in the Department of Orthopedics, Bangabandhu Sheikh Mujib Medical College, Hospital (BSMMCH), Faridpur, Bangladesh from January 2021 to December 2022. Total 24 patients having a fracture of the distal third of the tibia were enrolled in this study as the study subjects. Total patients were divided into two groups. In group A, 12 patients underwent minimally invasive percutaneous plate osteosynthesis (MIPPO) and in group B, 12 patients underwent intramedullary nailing (IMN). A random selection method was used in sample selection. According to Olerud Molander’s score, Excellent, Good and Fair results were found in 50%, 50%, and 0% of the group A patients respectively. On the other hand, those results were found in 42%, 50% and 8% of group B patients respectively. Although both minimally invasive percutaneous plate osteosynthesis and intramedullary nailing procedures are effective in managing distal tibial extra-articular fractures, considering excellent union rate, low blood loss and remarkable Olerud Molander’s score, MIPPO may be considered as the better option. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(2):92-96.

Ambulatory surgical management of most displaced tibial tubercle fractures in children is safe and efficient.

The purpose of this study is to compare the outcome of patients with displaced tibial tubercle fractures treated surgically who spent one or more nights in the hospital after surgery with that of patients treated in an ambulatory setting with no perioperative hospitalization. We hypothesized that tibial tubercle fractures have a low rate of complications and that most patients do well without an overnight hospital stay for observation. We retrospectively reviewed all pediatric tibial tubercle fractures treated operatively by a single surgeon over a 13.5-year period. Fractures treated in an inpatient setting, defined as at least one night of overnight hospitalization postoperatively, were compared with fractures treated in an ambulatory setting with no perioperative hospitalization. Seventy-one fractures in 70 patients were analyzed. All fractures were treated with open reduction and internal fixation with unicortical screws. Thirty-five fractures (49.3%) were fixed in an ambulatory setting, while 36 (50.7%) were inpatient. There were no significant differences between inpatient demographics (age, gender, body mass index, fracture type). Average operative time was significantly longer in the inpatient group compared with the ambulatory group (97.8 min versus 58.8 min, p < 0.001). There was no significant difference in the incidence of complications between inpatient and ambulatory groups (25.0% versus 11.4%, p = 0.22). No cases of compartment syndrome were noted. Ambulatory surgical treatment of select tibial tubercle fractures with same-day discharge is safe and efficient. Not all patients with surgically treated tibial tubercle fractures need to stay overnight in the hospital.

Comparison between Exercise Program-Foot Orthoses Treatment and Exercise Program Alone after Pilon Fracture Surgery: Study Protocol for a Randomized Controlled Trial.

The management of tibial pilon fractures is challenging and often leads to complications and limitations in ankle function. The study aims to investigate myotonometric parameters and muscle strength of ankle muscles, as well as gait pattern and balance among patients following surgical treatment of pilon fractures. The randomized controlled study will analyze the differences between the patients who will follow a 3-month physical exercise program and will wear customized foot orthoses (i.e., customized orthotic arch support insoles) versus patients who will attend only the physical exercise program. For each group, at least 21 patients will be required. The assessment involves four different testing procedures: myotonometry (anterior tibialis, medial and lateral gastrocnemius, and longus peroneus assessed using MyotonPRO), muscle strength testing (ankle dorsiflexors, plantar flexors, and peroneal muscles assessed using MicroFET2 dynamometer), analysis of gait parameters (using Scheinworks treadmill), and double-leg and single-leg balance tests (using K-Force plate). After 3 months, the assessments will record which of the two treatments (physical exercise program with or without wearing customized foot orthoses) has better outcomes in regaining ankle muscle properties and tone, as well as the restoration of gait and balance.