Open Fractures Of Distal Tibia Research Articles

Comparative analysis of external locking plate and combined frame external fixator for open distal tibial fractures: a comprehensive assessment of clinical outcomes and financial implications

BackgroundOpen distal tibial fractures pose significant challenges regarding treatment options and patient outcomes. This retrospective single-centre study aimed to compare the stability, clinical outcomes, complications, and financial implications of two surgical interventions, namely the external locking plate and the combined frame external fixator, to manage open distal tibial fractures.MethodsForty-four patients with distal open tibial (metaphyseal extraarticular) fractures treated between 2020 and 2022 were selected and formed into two main groups, Group A and Group B. Group A (19 patients) are patients that underwent treatment using the external locking plate technique, while Group B (25 patients) received the combined frame external fixator approach. Age, gender, inpatient stay, re-operation rates, complications, functional recovery (measured by the Johner-Wrush score), pain ratings (measured by the Visual Analogue Scale [VAS]), and cost analyses were evaluated for each group. Statistical analyses using SPSS were conducted to compare the outcomes between the two groups.ResultsThe research found significant variations in clinical outcomes, complications, and cost consequences between Group A and Group B. Group A had fewer hospitalisation periods (23.687.74) than Group B (33.5619.47). Re-operation rates were also considerably lower in Group A (26.3%) than in Group B (48%), owing to a greater prevalence of pin-tract infections and subsequent pin loosening in the combination frame external fixator group. The estimated cost of both techniques was recorded and analysed with the locking average of 26,619.69 ± 9,602.352 and the combined frame average of 39,095.64 ± 20,070.077.ConclusionThis study suggests that although the two approaches effectively manage open distal tibia fractures, the locking compression plate approach (Group A) has an advantage in treating open distal tibia fractures. Shorter hospitalisation times, reduced re-operation rates, and fewer complications will benefit patients, healthcare systems, and budget allocation. Group A's functional recovery results demonstrate the locking plate technique's ability to improve recovery and patient quality of life. According to the cost analysis, the locking plate technique's economic viability and cost-effectiveness may optimise healthcare resources for open distal tibia fractures. These findings might improve patient outcomes and inform evidence-based orthopaedic surgery.

Comparative Outcome of Hybrid External Fixator Versus Primary Ilizarov Fixator in the Treatment of Open Distal Tibia Extra-Articular Fractures.

Because one-third of the tibia is subcutaneous throughout most of its length and its location, it is more prone to open fractures. Open distal tibia fractures are mostly due to RTA and sports injuries. The goal of treatment is to obtain a healed, well-aligned fracture; pain-free weight-bearing; and functional range of motion of the knee and ankle. 33 patients of the 18-60-year age group with open distal tibia extra-articular fractures (without vascular injury), less than 3weeks old trauma were included in the prospective study for 1year period (1st June 2019 to 31st May 2020). 17 cases were treated with the Hybrid external fixator (HEF) and 16 cases were treated with the Ilizarov fixator (IF). Significantly (P < 0.05), the mean duration of surgery was less in the HEF group (67.6min), faster union of open type-II fractures in the HEF group (16.4weeks), and also a higher AOFAS score at 6months in open type-II fractures in the HEF group (84.4). There were two cases of equinus deformity in the IF group and one case of valgus deformity in the HEF group. HEF and IF are both equally effective in the treatment of open distal tibia extra-articular fractures with the advantage of stable fracture fixation, early weight-bearing, preserving soft tissue, minimal periosteal stripping, and providing one-staged definitive intervention. However, HEF is preferred over IF in terms of less operating time, faster union, and a better functional outcome with minimal complications.

Outcome of hybrid external fixator in the treatment of open distal tibia fractures

Distal tibia fractures are very common in day-to-day practise. Because one-third of the tibia is subcutaneous throughout most of its length and its location, it is more prone to open fractures.Distal tibia fractures (mostly due to RTA, sports injuries) include extra-articular fracture of the metaphysis and intra-articular pilon fractures. Treatment depends on the closeness to the tibial plafond, displacement of the fracture, comminution, and injury to the soft tissue envelope.The goal of treatment is to obtain a healed, well-aligned fracture; pain-free weight-bearing; and functional range of motion of the knee and ankle. 17 patients of the 18–60-year age group with open distal tibia fractures (without vascular injury) of less than 3 weeks old of trauma were included in the prospective study of 1 year period (1 June 2019 to 31 May 2020). All cases were treated with the Hybrid external fixator (HEF).The mean duration of surgery was 67.6 minutes. All fractures united with a mean time of 16.5 weeks. The mean AOFAS score at 6 months was 84.59. A good-excellent functional outcome was seen in 88.25% of the cases. There was 1 case of valgus deformity and 4 cases of pin-tract infections. HEF is effective in the treatment of open distal tibia fractures as it provides stable fracture fixation, early joint motion, and weight-bearing with minimal complications without jeopardizing the status of soft tissue condition.

AO external fixator for definitive treatment of an open distal tibia fracture during the COVID-19 pandemic

BackgroundThe accepted gold standard for primary treatment of long bone open fractures consists of aggressive debridement, irrigation and temporary external fixation. Removal of the external fixator followed by definite internal fixation is recommended within the first two weeks after the injury to obtain a more stable fixation, alleviate rehabilitation and to avoid pin infection. Materials & MethodsHere, we report a case of a Gustilo IIIB open tibia fracture with extended soft tissue degloving of the distal tibia. Following removal of the AO external fixator, plate fixation and soft tissue coverage with a free flap, implant loosening occurred warranting a return to external fixation. The patient did not return for follow-up due to a prolonged COVID-19-quarantine and no further treatment was installed. Results & ConclusionsThe patient returned after 6 months with the fractures and soft tissues fully healed. In specific situations, the external fixator may be used as a definitive form of treatment.

External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study

BackgroundTo compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula.MethodsFrom January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n = 35), plate-screw (group B, n = 30) and Kirschner wire (group C, n = 26). The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups.ResultsFour patients were lost to follow-up, and 87 patients were followed up for 5–35 months (average, 14.2 months). The operation time of group C (114.92 ± 36.09 min) was shorter than that of group A (142.27 ± 47.05 min) and group B (184.00 ± 48.56 min) (P < 0.05). There was no difference in intraoperative blood loss among the three groups (P > 0.05). The surgical and implants costs in group C (5.24 ± 1.21, thousand dollars) is lower than that in group A (6.48 ± 1.11, thousand dollars) and group B (9.37 ± 2.16, thousand dollars) (P < 0.05). The fracture healing time of group C (5.67 ± 1.42 months) was significantly less than that of group A (6.90 ± 1.33 months) and group B (6.70 ± 1.12 months) (P < 0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P < 0.05). The wound infection and needle-tract infection did not differ among the three groups (P > 0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P > 0.05).ConclusionCompared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.

Are Open Distal Tibia Fractures More Severe Injuries Than Open Tibial Shaft Fractures in Children

Purpose: The purpose of this study was to compare a cohort of pediatric open distal tibia fractures to open tibial shaft fractures in regards to injury severity, method of fixation, and outcomes. Methods This is a retrospective review of 39 open distal tibia fractures (group D) with a mean age of 8.4years and 55 open tibia shaft fractures (group S) with a mean age of 8.6years, treated from Jan 2007-May 2017 at a single level 1 pediatric trauma center. Mann …

Management of compound fractures of distal tibia and fibula by JESS (Joshis external stabilizing system)

Introduction: Study is to evaluate the outcome of fixation of compound fractures of distal tibia by JESS fixator and to analyse the soft tissue healing and fracture union, functional outcome. Different modalities of treatments are available for this fractures, timing of surgery plays a vital role in the management of this compound fractures of distal Tibia with condition of the soft tissues. Although the severity of these injuries, complexities of a variety of treatment methods, and limitations of management having been well documented in the literature, excellent long-term results of treatment continue to elude patients sustaining these fractures. The open fractures of distal tibia are very common, and which adds complexity to distal tibial fracture treatment and union. So this study is a prospectively evaluating the results of compound fractures of distal tibia (AO 43-A) that is extra articular fractures managed using JESS fixator. Material and Methods: Patients with distal tibia fracture with compound injury are selected for the study. Study conducted in Gulbarga institute of medical science (GIMS) department of orthopaedics Kalaburgi, Karnataka from January 2017 to December 2018. Total 12 patients selected with the criteria and treated with jess and followed up for 12 months. Antibiotic prophylaxis with injection given preoperatively and continued till 5th postoperative day. Regular dressing and knee and ankle passive and active mobilization started from day one. And non-weight bearing till three weeks and gradual weight bearing after 3 weeks. On an average patient discharged on 15th postoperative day, then regular followed-up. Check x-ray done first postoperative day. Another x ray done before jess removal that is on 6-8 week postoperative. Patient followed up closely and the functional outcome, ankle range of motion assessed. Results: The evaluation, based on clinical and radiographic findings and subjective complaints of the patients, was made with the use of the American Orthopaedic Foot and Ankle Society score (AOFAS). 12 patients were followed up. AOFAS scoring: excellent in 83% (10). Average hospital stay: 15 days. Non union in one case and infection in one case. Conclusion: JESS fixator is a safe and useful modality in compound tibial fractures as definitive modality, however caution is advocated as cohort is short.

The Masquelet technique in the treatment of a non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss: A case report

The treatment of open distal tibia fractures remains challenging, particularly when the fracture involves severe soft tissue damage and segmental bone loss.We present the case of a 33-year-old woman who sustained an open distal tibia fracture type 43-A3.3, with segmental bone loss, and a closed bifocal fibular fracture.The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture underwent an intramedullary nailing on day six post-trauma, while the segmental bone loss was refilled with a temporary cement spacer, in order to create a biologic chamber, according to the technique by Masquelet et al.At three months post-trauma, the temporary cement spacer was removed and the bone loss was filled with an autologous bone graft obtained with the Reaming Irrigation Aspiration (RIA) system. The fracture successfully healed at 13 months post-trauma.Masquelet technique, in association with the RIA system, represents a valid strategy in the treatment of non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss.

Fratture esposte metaepifisarie distali di tibia

The meta-epiphyseal fractures of the distal tibia commonly called tibial pilon fractures seem to have one based frequency, about 1% of all lower limb fractures. They are mostly high-energy fractures that determine burst fractures with comminution and exposure of the fragments. Muller’s AO classification divides them into three types: A (extra-articular), $B$ (partial articular), and $C$ (articular complete). Gustilo’s classification divided fractures into three types, depending on the degree of exposure of the bone. The treatment of meta-epiphyseal open fractures of distal tibia provides for an initial time of debridement of the affected tissue and then a stabilization with external fixators, which may be permanent or followed by a second internal osteosynthesis.

Ustilago echinata: Infection in a Mixed Martial Artist Following an Open Fracture

Ustilago, a common fungal parasite of grains, is infrequently isolated as a pathogen in humans. We describe a case of Ustilago echinata infection following an open distal tibia fracture, review the current literature of this genus as a cause of invasive fungal infection in humans, and discuss management issues.

Treatment of an open distal tibia fracture with segmental bone loss in combination with a closed proximal tibia fracture: a case report

The treatment of open distal tibia fractures remains challenging, particularly when the fracture is infected and involves segmental bone loss. We report the case of a 38-year-old man who sustained an open distal tibiofibular fracture with segmental bone loss and a closed proximal tibial fracture. The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture was infected, and the skin was covered after the wound became culture negative. The tibia was then internally transported with a ring external fixator; the closed fracture of the proximal tibia served as the corticotomy for internal transport without conventional corticotomy. After 5cm internal transport, the docking site of the distal tibia was fixed with a locking plate and autogenous cancellous bone graft. Bone graft was also used to the distal tibiofibular space to achieve distal tibiofibular synostosis. We describe one treatment option for an infected open fracture of the distal tibia with segmental bone loss that is accompanied by a closed fracture of the proximal tibia. This method can treat two fractures simultaneously.

Staged Protocol in Treatment of Open Distal Tibia Fracture: Using Lateral MIPO

BackgroundTo evaluate the radiological, clinical results in patients with open distal tibia factures, who were treated with a staged treatment protocol using the lateral minimally invasive plate osteosynthesis (MIPO) technique.MethodsFrom January 2007 to June 2009, 10 patients with open distal tibia fractures (Gustilo-Anderson classification II, 3; IIIA, 1; IIIB, 6) were treated using a staged treatment protocol. The initial debridement and application of an external fixator were performed within 24 hours and the mean interval from injury to definitive surgical treatment was 15 days (range, 6 to 52 days). Eight weeks later, an additional bone graft was performed in 3 patients. The follow-up duration was more than 1 year.ResultsThe mean fracture healing time was 21 weeks (range, 17 to 28 weeks), and the average Iowa ankle rating score was 84.5 points. At the last follow-up, there was no non-union, angular deformity > 5°, shortening > 10 mm or infection. In 10 patients, 2 patients had a superficial wound infection, and another 2 patients showed limitation of ankle joint motion.ConclusionsThis staged treatment protocol using a lateral MIPO technique is a useful alternative method for achieving high functional recovery with good healing and low complication rates in patients with an open distal tibia fracture.

Free Fibula Transfer in the Treatment of Difficult Distal Tibia Fractures

Management of the high-grade open distal tibia fracture remains problematic. The authors reviewed the charts of 14 cases of distal tibia and tibial plafond fractures reconstructed with a free fibula transfer. Six cases involved a plafond defect, and the fibula was used to arthrodese the tibio-talar joint. Seven cases included a skin paddle. Three of the four patients with osteomyelitis cleared their infection. Twelve patients went on to osseous union, and two were ultimately treated with amputation. Patients who went on to union had an average of 1.1 subsequent procedures, began full weightbearing in an average of 5.8 months, and were weightbearing without any assistive devices by an average of 8.5 months. There was no significant correlation between the time to full weightbearing and either the presence of infection or the length of the original defect. In this series, 86 percent success was obtained when a free fibula transfer was used either to bridge a tibial non-union or to promote arthrodesis of the tibio-talar joint.