Outcome Of Distal Tibia Fractures Research Articles

A Dilemma in the Management of Distal Tibia Fractures Solved by Minimally Invasive Percutaneous Plate Osteosynthesis Technique: A Prospective Study.

Introduction Managing distal tibia fractures is challenging for trauma surgeons because of their peculiar anatomy with less soft tissue coverage and poor blood supply. There are various treatment options for distal tibia fractures such as open reduction and plating, minimally invasive percutaneous plate osteosynthesis, and intramedullary interlocking nailing. Open reduction and internal fixation can lead to excessive soft tissue dissection and devascularization of fracture fragments. We conducted a study on the functional outcome of distal tibia fractures treated by biological fixation with minimally invasive percutaneous plate osteosynthesis. Methods A total of 23 patients with distal one-third tibia fractures, fulfilling the inclusion criteria, who were treated at St. John's Medical College Hospital with minimally invasive percutaneous plate osteosynthesis between November 2020 and November 2022 were studied using the American Orthopaedic Foot & Ankle Society (AOFAS) score at six weeks, three months, and six months postoperative follow-up. Results This study included 17 males and six females. The mean age of the study participants was 43.78 years, with most of the participants being in the age group between 51 and 60 years (29.2%, n = 7). All the study participants were employed. The mean operative time was two hours and 10 minutes. The mean duration for the radiological union was 22 weeks. The mean AOFAS score at six months was 92.43 + 5.696. There was only one case of superficial infection, which was treated with intravenous antibiotics. There were no cases of malunion/nonunion. Conclusion Minimally invasive percutaneous plate osteosynthesis is an effective treatment for distal tibia fractures avoiding most of the complications such as wound dehiscence and malunion/nonunion involved in conventional open reduction and internal fixation with plating. Therefore, we recommend this technique for all distal tibia fractures.

Functional and radiological outcome of distal tibia fractures managed with expert tibia nail: a prospective clinical study

Leg bone fractures come at the top because it is actively involved in locomotive system with distal tibia fractures having second highest incidence due to its subcutaneous location with very less muscle mass around it. Such fractures are mostly comminuted fractures with extensive soft tissue injuries. These are the fractures which extend within approximately 4 cm. from the tibial plafond. As these fractures occur in proximity of weight bearing surface of ankle joint, a slight maladjustment may lead to permanent disability. Non operative treatment/ open reduction and internal fixation with medial or anterolateral plating of these fractures is associated with multiple post-operative complications like infection, wound dehiscence and non-union. Operative treatment allows proper length and anatomical alignment of the limb, early mobilization and hence excellent final results. The present study of 25 cases was done to evaluate the clinical and radiological functional outcome of extra-articular AO type A simple and compound (Gustilo type I and type II) fractures of distal tibia managed with expert tibial nail and complications (post-operative) if any of patients of either sex, same demographic profile admitted through emergency in a tertiary institute of Punjab. Clinico-radiologically results were assessed using Johner and Wruh’s criteria. Authors got excellent results in 88%, good to fair in 08% of the cases. Expert tibia nail provides good mechanical and rotational stability due to multiple, multidirectional distal locking options available in distal tibia fractures.

Functional outcomes of distal tibia fractures treated using the minimally invasive percutaneous plate osteosynthesis technique with a locking compression plate

Background: Distal metaphyseal tibia fractures are difficult to treat owing to their limited blood supply, subcutaneous location, and inadequate soft tissue blanket. Minimally invasive percutaneous plate Osteosynthesis (MIPPO) using a locking compression plate (LCP) is a widely used surgical treatment. It is beneficial for the management of distal tibia fractures. This study aimed to assess the functional outcomes of distal tibia fractures treated with the MIPPO technique with an LCP. Methods: The investigators have conducted this prospective study with thirty patients who presented with distal tibia fractures over 8 months. All patients fulfilling the inclusion criteria and exclusion criteria took part in the study. All the patients were surgically managed by the MIPPO technique with LCP under spinal or general anesthesia. The functional and radiological outcomes were evaluated with the American Orthopedic Foot & Ankle Society (AOFAS) scale. Results: A sizable number of the patients were aged 40–60 years, with a mean age of 49.8 years. Most participants were male (66.67%). The mean duration of surgery was 72.60 ± 5.35minutes. The mean length of hospital stay was 7.22 ± 1.45 days.

A prospective study on functional outcome of distal tibia fracture treated with minimally invasive technique using locking compression plate

Background and Aim: Distal third tibia fractures accounts for about 7-9% of all lower extremity fractures. The treatment of distal tibia fractures is challenging, because of limited soft tissue coverage and poor vascularity. In the present study our aim is to assess the clinical and functional outcome of distal third tibia fractures treated by Minimally invasive percutaneous plate osteosynthesis. Materials and Methods: A total of 40 patients with distal tibia fracture was treated in this study from December 2018 to January 2020. TWS Scoring system was used to evaluated the functional outcome. Results: Majority of the study population (21, 52.5%) were belonging to the excellent outcome category, followed by good category among (14, 35.0%). Discussion: MIPPO technique offers biological advantage by preserving periosteal blood supply and it provides good stability to fracture site. Complication rate is less compared to other procedure.

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.

Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

BackgroundThis study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches.MethodsA retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements.ResultsA total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P > 0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P < 0.05).ConclusionsIn the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.

Outcome and complications of distal tibia fractures treated with intramedullary nails versus minimally invasive plate osteosynthesis and the role of fibula fixation.

Distal tibia fractures have been managed conservatively as well surgically. A large number of implants have been used for surgical management of these fractures. No treatment method or implant has been proven to be superior to others. In this prospective comparative study, the complications and outcome of distal tibia fractures managed with intramedullary nails and minimally invasive plate osteosynthesis has been compared. Further, the role of fibula fixation in these fractures has been evaluated. One hundred and fifty-four patients of distal tibia fractures with concomitant fibula fractures were randomized into 4 treatment groups based on predetermined inclusion criteria. Functional outcome in these groups was compared based on AOFAS score at 1year. Intra-operative, post-operative parameters as well as radiological alignment, complications and the need for reoperation were also compared in these groups. The functional outcome in all four treatment groups was similar. The duration of surgery and radiation exposure was higher with minimally invasive plate osteosynthesis. There was no improvement in outcome with plating of fibula. However, fixation of fibula improved the rotational alignment in distal tibia fractures. Although there is no difference in outcome of distal tibia fractures with either nailing or minimally invasive plating, nailing is recommended for closed displaced extraarticular fractures. Fixation of fibula should not be done routinely but should be reserved only for a few specific fracture patterns.

Outcome of distal tibia fractures: A prospective study of 25 patients

Outcome of distal tibia fractures: A prospective study of 25 patients

Radiographic and clinical outcomes of distal tibia fractures (3-12 cm proximal to the plafond): Comparison of two intramedullary nailing.

There are various distal locking options for the repair of tibia distal diametaphyseal fractures with intramedullary nails. There is no consensus about the superiority of any of these distal locking options. In our study, comparing nails with distal bolt locking screw (DSBLS) and conventional nails; we aimed to compare the clinical and radiological results of intramedullary nail models in fixing tibial distal diametaphyseal fractures. In our orthopedics and traumatology department, 117 tibial distal diametaphyseal fractures of 116 patients treated with intramedullary nails between August 2007 and May 2015 were retrospectively evaluated. Forty-six tibial distal diametaphyseal fractures of 45 patients who came to regular visits to outpatient clinic controls and who had a minimum follow-up of 18 months and whose fracture distance was between 3 and 12 cm were included in the study. The average follow-up period of the study group consisting of 28 males and 17 females with an average age of 44 (16-76 years) which was 48 months (18-100 months). The group using the DSBLS locking intramedullary nail was considered the first group and the group using the conventional distal locking intramedullary nail was considered the second group. Radiological union times, coronal, sagittal, and axial plan angulations and malunion presence were com-pared between the two groups. In addition, the two groups were compared clinically with length of time spent on weight-bearing and return to work, Olerud-Molander ankle score, and American Orthopedic Foot and Ankle Society Score scores. We found that the first group was superior in terms of length of time spent on partial and full weight-bearing between the two groups (p=0.00031 and p=0.00007). In addition, the union time of the first group was shorter (p=0.0149). Other radiological or clinical results did not differ significantly between the two groups. In addition, no significant correlation was found between the distance of the fracture from the tibial plate and its angulation. In cases with malunion alone, the fracture line was more distal than those without malunion (p=0.0411). Newly developed DSBLS intramedullary nails give as good results as conventional nails in tibia distal diametaphyseal fractures. Due to its ability to loading bone early and have a shorter union time, DSBLS can be safely preferred in distal diametaphyseal fractures and reduce complications from immobilization.

Treatment outcomes of distal tibia fractures among adult patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Background: The treatment of distal tibia fractures remains challenging since they are prone to higher rates of complications. Treatment options are expanding and although their indications, advantages and disadvantages have been discussed in literature, controversy still exists over the clinical efficacy and cost-effectiveness of each option. This has led to different orthopaedic surgeons employing different operative treatment options based on their experience, preference and patient characteristics. Objective: This study sought to describe the patients’ characteristics and treatment of distal tibia fractures at MTRH and compare the outcome results of the various treatment options. Design: A prospective observational study design was used. Adult patients with distal tibia fractures admitted during the study period were included through consecutive sampling. Methods: A total of 76 patients were followed up. Data including injury aetiology, fracture types and classification, treatment and complications were collected. Functional outcome was assessed using Olerud and Molander Ankle Score (OMAS) at 6 months after treatment. Data was collected between October 2015 and March 2017 using a structured questionnaire and analyzed using STATA version 13 at 95% confidence level. Chi square test was used to determine the significance of associations between categorical variables. Results: The median age was 40.0 (30.0, 52.0) years, with a male-to-female ratio of 1.7:1. Most common causes of injury were RTA in 37 patients and falls in 29 patients. There were 48 closed and 28 open injuries. According to Arbeitsgemeinschaftfur Osteosynthesefragen (AO)/ Orthopaedic Trauma Association (OTA) classification, there were 40 (52.6%) type A, 28 (36.8%) type B and 8 (10.6%) type C fractures. Twenty-five (32.9%) patients were treated non-operatively, 28 (36.8%) patients underwent internal fixation with plating and 23 (30.3%) patients were treated using external fixation method. Non-operative treatment was mostly used for closed injuries (80%) whereas majority of open fractures (82%) were treated operatively ( P =0.033). Complications occurred in 48 (57.8%) patients, including 30 (62.5%) wound infections, 21 (43.7%) malunions and 3 (6%) chronic osteomyelitis. Infections were significantly higher among external fixation treated patients ( P =0.002). At final follow up the functional outcome using OMAS was excellent in 11(14.5%) patients, good in 28 (36.8%), fair in 17 (22.4%) and poor in 20 (26.3%) patients. OMAS scores were significantly high in patients treated with plating and low in patients with comminuted fractures, complications and open injuries ( P <0.001). Conclusion: Distal tibia fractures mostly occurred in young males. Road traffic accidents and falls were the commonest causes. Treatment by plate fixation resulted in significantly higher functional outcome scores and lower rate of complications compared to non-operative treatment. Recommendation: Distal tibia fractures should be treated operatively by plate fixation to improve treatment outcomes. Keywords: Distal tibia fracture, OMAS, Treatment outcome

Functional outcome of distal tibia fracture treated with locking compression plate using minimally invasive percutaneous plate osteosynthesis technique (MIPPO): A prospective study

Introduction: Treating distal tibia fracture is a greater challenge for surgeons to manage even today. The difficulty is due to its poor blood supply and limited soft tissue envelope. Various techniques are now available for the treatment of tibia fractures. The occurrence of implant failure, skin necrosis, infection and malunion are high in case of distal tibia fractures. Aims/Objective: Our aimed was to analyze the functional outcome of distal tibia fractures treated by MIPPO Technique using the American Orthopedic Foot and Ankle Society Score. Method: A total of 20 patients of a closed distal Tibia fracture were studied by us with a MIPO with LCP Technique in Department of Orthopedics at DYP Medical College and hospital Kolhapur during the period from June 2017 and June 2019 and were prospectively followed for average duration of 16 months (6-24 months). Results: In our study the mean age of patients was 43 out of which 65% was male and 35% was female. Functional outcome was measured using the AOFAS score and mean AOFAS score was 84.45 at the end of 6 months. Under our study out of 20 patients 4 had excellent outcome, 14 had good result, 2 had acceptable result on basis of AOFAS score. Conclusion: MIPPO is an effective method of treatment for distal tibia fractures because it offers a Bio-logical advantage by preserving periosteal blood supply and combine with C-arm guidance helps in indirect reduction of distal tibia fracture in restoring length an alignment, thus reducing the chances of malunion and deformities. It helps in early mobilization of ankle movement and reduces the ankle stiffness thus improving clinical and functional outcome.

Outcome of distal tibia fractures managed with locking compression plate using MIPPO technique

Introduction: Treatment of distal tibial fracture with or without intra-articular involvement is challenging, for reasons like poor healing due to precarious blood supply. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But none of them have good functional outcome but had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To study the functional and radiological outcome of distal tibial fractures managed with MIPPO (minimally invasive percutaneous plate osteosynthesis), using locking plates and to look for complications in MIPPO. Materials and Methods: In this study, 55 patients with distal third tibial extra articular Metaphyseo-diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at a tertiary care hospital, between September 2014 to September 2018, followed up for a period of 1 year.Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 4.27 days post- trauma, with an average operative time of 76.5 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 19.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 88.5 % cases. Conclusion: From this study, it is concluded that Minimally invasive percutaneous plate osteosynthesis technique (MIPPO), using locking plate is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.

Prospective study of the surgical management of distal tibia extra-articular metaphyseal tibial fractures managed with CRIF with IMIL tip locking nails: A study of 20 patients

Background: Distal tibia extra articular metaphyseal tibial fractures are difficult to manage because of the hour glass shape of the distal tibia poses a difficulty to achieve fixation with intramedullary nails. For the past decade, nailing and plating for fracture reduction has been successful in treating fractures of lower extremity especially distal tibia. Objectives: To prospectively study the functional and radiological outcome of distal tibia fractures managed by CRIF with IM tip locking nails.Materials and Methods: Patients with fractures of distal tibia extra articular metaphyseal tibial fractures managed with CRIF with IMIL tip locking nails were followed up prospectively till fracture union. Their functional and radiological outcome was assessed by using IOWA knee and ankle scoring index.Conclusion: All fractures united well. No infections were seen. Distal tibia fractures can be managed well with CRIF with IM tip locking tibial nails. 6 patients developed a coronal plane deformity of

Functional outcome of distal tibia fractures managed with anatomical locking plates

Functional outcome of distal tibia fractures managed with anatomical locking plates

A prospective study on functional outcome of distal tibia fractures treated with minimally invasive percutaneous plate osteosynthesis

Distal tibial fractures are very commonly encountered by orthopaedic surgeons. Fractures of distal tibia are among the most perplexing injuries. Distal tibial fractures are difficult to manage due to its poor blood supply and limited soft tissue. Soft tissue injury component is a major concern among these fractures and may result in serious complications and disability [1]. High energy motor vehicle accidents are the common cause [2]. 0.7% is the incidence of distal tibia fractures and it accounts to about 10-13% of all tibial fractures [3]. The aim of this study was to evaluate the functional outcome and to study major complications in KIM’s hospital. Materials and Methods: A prospective study which was carried out from October 2015 to September 2017 in Karnataka Institute of Medical Sciences, Hubbali, and Karnataka State, India. In this study period, cases of distal tibial fractures were treated by open reduction and internal fixation using MIPPO. All patients with age >18 years, closed fractures without intra-articular extension and Gustillo type 1 fractures were included. Pathological fractures and grade 2 and above were excluded. Results: In our series of 18 cases, there were 14 men and 4 women, with average age of 40.3 years. Sixteen (88.8%) cases were admitted due to RTA and with slight predominance of left side. All fractures healed with good functional outcome. Mean union time was 22.6 weeks. 14 cases showed good ankle function outcome and 3 showed fair ankle function outcome according to Merchant and Dietz criteria. There was 1 case of superficial infection, treated successfully with antibiotics. Conclusion: The strategy of biological osteosynthesis with a bridge plating is less invasive, with fewer soft tissue impingement and improved cosmoses and convenient for removal.

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.

Limited Open Reduction and Percutaneous Plate Osteosynthesis - Alternative Option to Minimally Invasive Plate Osteosynthesis in Management of Distal Tibia Fractures

The management of distal tibia fracture is challenging because of the limited soft tissue coverage and poor vascularity around the bone in that area. Minimally invasive percutaneous plate osteosynthesis is a novel technique in this regard but needs fluoroscopy. In unavailability of fluoroscopy or its technical malfunction, limited open reduction percutaneous plate osteosynthesis becomes useful. The aim of this study is to compare the outcomes of distal tibia fractures treated by LORPPO and MIPPO techniques in terms of duration of hospital stay, full weight bearing, union time and complications. Twenty-two cases of closed distal tibia fractures without articular involvement or comminution operated at Koshi Zonal Hospital, Nepal from March 2014 to May 2016 were included in this study. Total 11cases of which were treated by MIPPO whereas other 11 cases were treated by LORPPO. MIPPO technique was done only when the fluoroscopy was available. In MIPPO, the average age of the patients were 43.72 (range 23-65) years, hospital stay mean duration 8.45 (range 6-12) days, full weight-bearing walking was started in 11.27 (range 9-15) weeks and average radiological union time was 21.25 (range 18-28) weeks. In LORPPO, the mean age was 46.36 (range 25-70)years, hospital stay mean 11.81 (range 10-15) days, full weight bearing walking mean 10.63 (range 9-15) weeks and average radiological union time was 23.0 (range 19-27) weeks. The outcomes are comparatively similar for both the techniques. LORPPO could be an alternative to MIPPO in the management of distal tibia fractures.

Outcome of Distal Tibia Fractures Treated with Minimally Invasive Percutaneous Plate Osteosynthesis

Outcome of Distal Tibia Fractures Treated with Minimally Invasive Percutaneous Plate Osteosynthesis

Mid-Term Results of Minimally Invasive Plate Osteosynthesis and Circular External Fixation in the Treatment of Complex Distal Tibia Fractures.

The treatment of pilon tibia fractures is challenging. Anatomical reduction of the joint surface is essential. Excessive soft-tissue dissection may interfere with the blood supply and can result in nonunion. We sought to compare the outcomes of distal tibia fractures treated with medial locking plates versus circular external fixators. We retrospectively evaluated 41 consecutive patients with closed pilon tibia fractures treated with either minimally invasive locking plate osteosynthesis (n = 21) or external fixation (EF) (n = 20). According to the Ruedi and Allgower classification, 23 fractures were type B and 18 were type C. Soft-tissue injury was evaluated according to the Oestern and Tscherne classification. Time to fracture union, complications, and functional outcomes were assessed annually for 3 years with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score. Mean ± SD values in the plate group were as follows: age, 42.4 ± 14 years; union time, 19.4 ± 2.89 weeks (range, 12-26 weeks); and AOFAS ankle scores, 86.4 ± 2.06, 79.5 ± 1.03, and 77.9 ± 0.80 at 1, 2, and 3 years, respectively. Four patients in the plate group needed secondary bone grafting during follow-up. In the EF group (mean ± SD age, 40.7 ± 12.3 years), all of the patients achieved union without secondary bone grafting at a mean ± SD of 22.1 ± 1.7 weeks (range, 18-24 weeks). In the EF group, mean ± SD AOFAS ankle scores were 86.6 ± 1.69, 82.1 ± 0.77, and 79.7 ± 1.06 at 1, 2, and 3 years, respectively. There were no major complications. However, there were soft-tissue infections over the medial malleolus in five patients in the plate group and grade 1-2 pin-tract infections in 13 patients and grade 3 pin-tract infections in one patient in the EF group. Post-traumatic arthritis was detected in eight plate group patients and seven EF group patients. Minimally invasive plating and circular EF methods have favorable union rates with fewer complications.

Percutaneous osteosynthesis in tibial pilon fractures. Does the surgical technique determine the final result?

ObjectiveTo analyze the outcomes of distal tibia fractures with or without extension into the ankle joint, treated by percutaneous cannulated screws or locking plates. Materials and methodsA retrospective study was conducted on 107 patients treated between 2001 and 2012. Inclusion criteria: fractures 43-A and 43-C1 and C2 according to the AO/OTA system, treated with percutaneous osteosynthesis by locking plate or two cannulated screws in X-letter setting. A total of 33 patients were evaluated: 16 tibial fractures were performed with locking plate (G1) and 17 with cannulated screws (G2). Mean time to surgery was 8.31 days (0–14) in G1, and 2 days (0–7) in G2. The mean follow-up was 72 months (12–132). Mean time to healing: 17.08 weeks (8–48) in G1, and 14.56 weeks (8–24) in G2. The results were evaluated according to the AOFAS scale, with plain X-rays, and complications during follow-up. ResultsThe mean evaluation according to the AOFAS score was 78.62 in G1 (22–93), and 90.63 in G2 (70–100), and this was statistically significant. In G1, 61.4% (8) of the results were excellent or good, while in G2 it was 76% (13). There were no axial deformity cases or shortenings. There were four superficial infections and one broken device recorded in G1. DiscussionThe percutaneous cannulated screw fixation is a suitable alternative for the management of fractures without significant joint involvement, and seems to offer better functional results than plates. The shortest time from injury to intervention in this group improves the progress of the soft tissues, and can improve the final result.