Treatment Of Distal Tibial Fractures Research Articles

Comparative study between Interlocking Nail and Locked Plate in Distal Tibial Fractures Fixation

ABSTRACT Background: Distal tibial fractures accounts for approximately 37.8% of all tibial injuries affecting all ages. Treatment of distal tibial fractures in skeletally mature patients is challenging because of its unique anatomical characteristics of subcutaneous location with weak blood supply and proximity to the ankle joint. Objective: To compare the results of fixation of extra-articular distal tibial fractures in adults by ILN vs. distal tibial locked plate with MIPPO. Patients and methods: This study was done at Al-Azhar University Hospital, during the period of January 2020 to December 2020. 20 patients were recruited for this study to compare ILN vs. distal tibial locked plate with MIPPO technique in fixation of extra-articular distal tibial fractures. Patients were assessed clinically using Olerud and Molander score and radiologically at 6months. Results: Age range of the patients was 20-57yr. Most common mode of trauma was RTA. Associated fibula fracture was present in 9 (90%) of patients in both groups. Difference between 2 groups regarding demographic data, AO classification, operative time wasn't significant .No significant intraoperative complications were noted in both groups. The average time for union was 13.10 weeks (range, 12-16 weeks) in group 1 and 16.78 weeks (range, 12-24 weeks), Malunion was found in 20% of patients in group 1 and 10% of patients in group2. Conclusion: The overall results were comparable and most patients were satisfied with the results. These results indicate that both modalities of treatment deserve a place in treating distal Tibial fractures.

Comparative Study between Intra-medullary Nailing and Minimally Invasive Plate Osteosynthesis (MIPO) in Closed Distal Tibia Fracture in a District Hospital in Bangladesh

Introduction: Tibia fractures are the most common long bone fractures encountered by the orthopedic surgeons and distal tibia fractures have the second highest incidence of all tibia fractures after the middle third of tibia the distal tibial fractures are unique and are considered as most challenging fractures to treat due to its proximity to the ankle joint and its superficial nature. The objective of this study is to compare two osteosynthesis systems developed for surgical treatment of distal tibia fractures: the intramedullary nailing and the MIPO technique.
 Methods: The study was conducted between Jan 2018 to Dec 2019. 30 patients with extraarticular distal tibia fracture treated with intramedullary nailing and MIPO technique were reviewed retrospectively and clinical outcome was evaluated according to American Orthopaedic Foot and Ankle Score.
 Results: 15 patients were treated with intramedullary nail and 15 with MIPO technique. Fibular fixation was done in cases where fibular fracture was at or below the level of tibial fractures. We found no difference in terms of time for fracture union, mal-union, non-union, duration of surgery and amount of blood loss. But there was significant difference in terms of infection and duration of hospital stay. Also weight bearing was possible much earlier in intramedullary group as compared to the MIPO group.
 Conclusion: Thus we conclude that intramedullary nailing is better choice of implant in patients with extra- articular distal tibia fractures and helps in early weight bearing and ambulation of patient with fewer complications.
 J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 33-37

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.

Distal tibial fractures treated by minimally invasive percutaneous plate osteosynthesis

Objective: To analyse the functional and radiological outcomes of treating distal tibia fractures with minimally invasive percutaneous plate osteosynthesis.Methods: A prospective study was performed on Thirty adult patients who underwent locking compression plate using MIPPO technique for closed fracture of distal tibial in the Department of Orthopaedics from May 2017 to April 2018 and were followed for one year. The functional outcome was measured using AOFAS (American Orthopaedic Foot and Ankle Society score) and was then graded as excellent/ good/ fair and poor. Radiological outcomes assessed to look for cortical union by taking anteroposterior and lateral view x-ray of affected limb.Results: Majority of the patient were male (60%) belonging to the age group of 36 to 40 years (26%). AOFAS score depicts excellent result in the majority of the patients (70%). Duration of cortical union is less than 16 weeks in almost 50% of patients. Complication resulted in 22% of patients.Conclusion: minimally invasive percutaneous plate osteosynthesis technique for the treatment of distal tibia fracture provides good healing and excellent functional results in most of the patients with few complications.

RETROSPECTIVE STUDY EVALUATING THE RESULTS OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) IN MANAGEMENT OF DISTAL TIBIAL FRACTURES

Background Minimally Invasive Plate Osteosynthesis is widely accepted as a good option for treatment of fractures of distal tibia as it preserves the fracture biology leading to improved outcomes. Questions/purposes the study aimed to find out the efficacy of MIPO in treatment of extra-articular fractures of distal tibia. Methods 30 patients with fractures of distal tibia treated with MIPO were retrospectively reviewed. Mean age was 40.3 years. There were 21 males and 9 females, 24 patients had closed fractures and 6 patients had open fractures. Patients were followed up clinically and radiologically for 1 year and AOFAS score for ankle and hind foot was used to assess the functional outcome. Results 23(67.7%) patients had a peaceful fracture healing, 5 patients (16.7%) showed delayed healing and non-union occurred in 2 patients (6.6%). 4 patients (13.3%) had wound infection and 3 patients (10%) had a plate irritation problems. The average AOFAS score was 83.3. Conclusions MIPO technique is an effective option in treatment of distal tibia fractures with good functional outcomes but its complications raise the need for good preoperative planning to avoid the complications as much as possible

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.

Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis.

Background and Aims:To evaluate evidence on the superiority of plate fixation over intramedullary nail fixation in the treatment of distal tibial fractures regarding functional outcomes and complication rates.Material and Methods:Cochrane Controlled Trials Register, Medline, Embase, CINAHL, Scopus, and Web of Science databases were searched in December 2019. The risk of systematic bias was assessed according to the Cochrane Collaboration’s domain-based evaluation framework.Results:The search resulted in 514 records, the final sample included 10 randomized controlled trials (782 patients). There were statistically significant differences in operating time (−11.2, 95% confidence interval: −16.3 to −6.1 min), time to partial weight bearing (−0.96, 95% confidence interval: −1.8 to −0.1 weeks), time to full weight bearing (−2.2, 95% confidence interval: −4.32 to −0.01 weeks), the rates of deep infections (risk ratio = 0.37, 95% confidence interval: 0.19 to 0.69), and the rates of soft-tissue complications (risk ratio = 0.52, 95% confidence interval: 0.33 to 0.82) favoring intramedullary nail. Intraoperative blood loss (127.2, 95% confidence interval: 34.7 to 219.7 mL) and postoperative knee pain and stiffness (relative risk = 5.6, 95% confidence interval: 1.4–22.6) showed significant differences favoring plate fixation. When combining all complication rates, the difference was risk ratio = 0.77 (95% confidence interval: 0.63 to 0.95) favoring intramedullary nail. No significant differences in radiation time, length of incision, length of hospital stay, time to return to work, time to union, the rates of healing complications or secondary procedures, ankle pain or stiffness, or functional scores were found.Conclusion:This meta-analysis suggests that intramedullary nail might be slightly superior in reducing postoperative complications and result in slightly faster healing when compared to plate fixation.

Minimally invasive internal fixation of distal tibia fractures with a nonconventional implant:

Fractures of the distal end of the tibia without joint involvement are usually the result of high-energy trauma. Local anatomic conditions lead to high rates of infection, delayed consolidation, and exposure of fixation hardware. In this setting, minimally invasive techniques are indicated to mitigate the complications of surgical treatment. The aim of this study is to present an alternative for the surgical treatment of distal tibia fractures using a minimally invasive technique and a nonconventional implant. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Fixation of distal tibia fracture through plating, nailing, and nailing with Poller screws: A comparative biomechanical-based experimental and numerical investigation.

The goal of this study was to investigate two commonly used methods of fixation of distal metaphyseal tibia fractures, plating and nailing as well as the less frequently employed nailing with Poller screws, from a biomechanical perspective. Despite numerous studies, the best method to repair fractures of tibia the remains up for of debate. This study includes an in vitro experimental phase on human cadaveric tibias followed by a finite element analysis. In the experimental phase, under partial weight-bearing axial loading, the axial stiffness of the bone-implant construct and interfragmentary movements for each of the fixation methods, bone-plate, bone-nail, and bone-nail-Poller screw, were measured and compared with each other. Shear interfragmentary movement and stress distribution in the bone-implant construct for the three mentioned fixation methods were also determined from FE models and compared with each other. Results of in vitro experiments, i.e., the exertion of axial loading on the tibia-plate, tibia-nail, and tibia-nail-Poller screw, showed that utilization of tibia-nail and tibia-nail-Poller screw led to a stiffer bone-implant construct, and consequently, lower interfragmentary movement, compared to the tibia-plate construct (p values for tibia-nail and tibia-nail-Poller screw, and for both axial stiffness and interfragmentary movement, compared to those of tibia-plate construct, were less than 0.05). Numerical analyses showed that nailing produced less undesirable shear interfragmentary movement, compared to the plating, and application of a Poller screw decreased the shear movements, compared to tibia-nail. Furthermore, using the finite element analysis, maximum von Mises stress of adding a screw in tibia-nail, tibia-plate, and tibia-nail-Poller screw, was found to be: 51.5, 78.6, and 60.5 MPa, respectively. The results of this study suggested that from a biomechanical standpoint, nailing both with and without a Poller screw is superior to plating for the treatment of distal tibia fractures.

Posterolateral plating is a safe alternative for the treatment of distal tibial fractures

IntroductionWe assessed the outcome and safety of posterior plating of distal tibial fractures. MethodsWe conducted a retrospective case series at a Level I trauma center. Seventy-four consecutive patients with distal tibial fractures treated with anatomically contoured 3.5-mm T-shaped locking compression plate using a posterolateral approach from January 2008 through April 2018 were included in the study. The mean patient age was 48 years (range, 18−87 years). Fifty-nine percent of the patients were male patients, 47% of the fractures were open fractures; and 27% of the patients had multiple traumatic injuries. Eleven fractures were AO/OTA type 42, 22 were type 43A, and 41 were type 43C. Sixty-two (84%) patients were treated with initial spanning external fixation (median time, 23 days) and staged open reduction and internal fixation. The main outcome measure was unplanned reoperation to address implant failure, nonunion, deep surgical site infection, or symptomatic implant. ResultsOverall risk of unplanned reoperation was 15% (11 of 74 patients, 95% confidence interval, 9%–25%). Four (5%) reoperations were for nonunion, three (4%) were for surgical site infection, two (3%) were for infected nonunion, and two (3%) were for implant prominence. Loss of alignment >10 degrees occurred in one patient who underwent unplanned reoperation for nonunion. No plate breakage occurred. Median time to reoperation was 221 days (range, 22–436 days). Only one other complication was noted: wound dehiscence associated with the posterolateral approach, which was treated with irrigation and débridement and a 6-week regimen of oral antibiotics. ConclusionsUse of a posterolateral approach with a pre-contoured locking compression T-plate for the treatment of distal tibial fractures led to reasonable outcomes with an acceptable risk of unplanned reoperation, even with a high proportion of open fractures commonly staged with external fixation.

A comparative study of extra-articular distal tibia fractures managed by intramedullary nailing vs locking plate

Introduction: Distal tibial fractures are common long bone fractures that occur mainly due to a high velocity trauma. These are difficult to treat because of its subcutaneous location and poor blood supply. Many studies have been published on modalities of treatment of distal tibia fractures. Available options are Intramedullary nails, locking plates and external fixators. The aim of our study was to compare intramedullary interlocking (IMIL) nailing and locking plate (LP) for the treatment of these fractures. Materials and methods: This is a prospective study consisting data of 20 patients with distal tibial fractures operated for IMIL nailing and LP. Patients were followed up for radiological and clinical outcome using The American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: The functional outcome was assessed by AOFAS score. Overall 10 patients obtained an excellent result (50%) and 8 obtained a good result (40%) and 2 obtained fair result (10%). IMIL nailing shows lower rate of delayed wound healing and superficial infection and plating may avoid malunion and knee pain. Discussion: The study suggests superiority of IMIL nailing over LP in terms of less rates of infections, early rate of union, early weight bearing. Whereas LP is better in anatomical and fixed reductions of the fracture and less knee pain. Hence the modality of treatment should be based on the patient’s injury pattern, surgeon’s expertise and clinical condition.

Immediate weightbearing after intramedullary fixation of extra-articular distal tibial fractures reduces the nonunion rate compared with traditional weight-bearing protocol: A cohort study.

To investigate whether immediate weightbearing after intramedullary fixation of extra-articular distal tibial fractures could avoid secondary replacement. We prospectively included 167 patients receiving intramedullary nailing in treatment of distal tibial fractures. All these patients were encouraged to bear weight as tolerated postoperatively. One hundred and fifty-five patients who did not bear weight immediately after surgery were retrospectively included as historical control. The mean immediate lateral and anterior DTA were 88.9±3.9 and 85.2±3.5° for historical control and 88.7±3.6 and 84.9±3.8° for immediate weight bearing group (lateral DTA: P=0.715; anterior DTA: P=0.734). The mean final lateral and anterior DTA were 88.1±3.3 and 84.1±4.3° for historical control and 87.9±5.0 and 84.5±5.1° for the immediate weightbearing group (lateral DTA: P=0.857; anterior DTA: P=0.788). Strikingly, the immediate weightbearing resulted in accelerated healing (3.5±1.2 versus 4.9±1.3 months, P=0.023) and decreased nonunion rate (2.4% versus 7.1%, P=0.027). The rates of infection and soft-tissue necrosis were similar between the two groups. Immediate weightbearing after IMN fixation of extra-articular distal tibial fractures led to a similar change in alignment compared with our historical control without immediate weightbearing. Immediate weightbearing appears to be safe for most patients and might be able to accelerate fracture healing and decrease nonunion rate.

Functional and radiological outcome of surgical treatment of distal tibial fracture by minimally invasive percutaneous plate osteosynthesis technique

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Minimally invasive percutaneous plate osteosynthesis (MIPPO) is an established technique for fixation of fractures of the distal third tibia. Aim of our study was to manage extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications &amp;amp; efficacy of the procedure reviewed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; From June 2018 to June 2019,25 patients of closed distal tibial fractures were operated by MIPPO technique with a distal tibial anatomical locking plate having 4.5 out of 5 proximal and 3.5 out of 4 distal screw holes. The follow up duration was for 1 year.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean fracture healing time was 17 weeks (range 16 to 32 weeks) and average The American orthopedic foot and ankle score was 88.2 out of a total possible 100 points. At last follow up, superficial infection occurred in 3 patients, deep infection in 1 patient, ankle stiffness in 1 patient, limb length discrepancy &amp;lt;1 cm in 1 patient and malunion in 2 patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; MIPPO technique provides good bone healing and decreases incidence of non-union and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminute fractures.&lt;/p&gt;

The impact of lag screw in the healing time of distal tibia fractures treated with minimally invasive plate osteosynthesis: A randomized clinical trial

BackgroundIn recent years, Minimally Invasive Plate Osteosynthesis (MIPO) has been gaining popularity in the treatment of distal tibia fractures, because it is a minimally invasive surgical procedure, thus it limits the soft-tissues damage. This prospective randomized study aims to assess the impact of lag screw in the healing time of distal tibia fractures treated with MIPO technique, in a six-month follow-up. MethodsPatients between 20 and 70 years of age with distal tibial fracture, type 43-A according to AO/OTA classification system were included. All the patients were randomized into two groups, to receive MIPO without lag screw (Group-A) or MIPO with percutaneous lag screw (Group-B). Patients were followed clinically and radiographically at 3, 6, 12 and 24 weeks postoperatively. The main outcome measure was the time needed to achieve the painless full weight-bearing (FWB) after surgery. Unpaired t-test after ANOVA (analysis of variance) was performed to assess AOFAS score differences between the 2 groups at each follow-up. Pearson correlation test also was performed. The tests were two-tailed with a confidence level of 5%. Results42 patients (24 male and 18 female, mean age 49.54 years old, range 25–80) were recruited. A significant shorter mean time until painless FWB (p = 0.016) was observed in Group-B (11.22 ± 3.06 weeks) compared with Group-A (13.48 ± 2.42 weeks) (Table 2). The mean AOFAS score was comparable in patients treated with (Group-B) and without lag screw (Group-A) at all follow-ups. ConclusionsThis prospective randomized clinical study has shown that the use of lag screw in distal tibia fractures treated with MIPO technique speeds the fracture healing, thus shortening the time needed to achieve FWB.

Evaluation of Minimally Invasive Percutaneous Plate Osteosynthesis in Treatment of Distal Tibial Fractures

Background: Distal tibial fractures are usually the result of high-energy axial compression and rotation forces. They are usually associated with severe soft tissue compromise. The limited soft tissue, subcutaneous location and poor vascularity make these fractures very challenging. Objectives: The aim of the current work was to evaluate clinically and radiologically the results of the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique in fixation of distal tibial fractures. Patients and methods: This prospective study included a total of 18 cases of type A distal tibial fractures treated by locked distal tibial plate, attending at ZAGAZIG University Hospitals. The fractures were classified using the method of AO classification. This study was conducted between February 2018 and April 2019. Results: A comprehensive sample will be taken including cases that need minimally invasive percutaneous plate osteosynthesis in treatment of distal tibial fractures, 3 cases / month, sample equal 18 / 6 months who have traumatic fracture distal tibia on Orthopedic Surgery Department, Zagazig University Hospitals. Conclusion: MIPO is simple, safe and effective method of treatment for diaphyseal & metaphyseal fractures. It does not require direct visualization of the fracture at the cost of extensive soft tissue dissection. We are confident in suggesting this alternative approach of plating. MIPPO through the deltoid-pectoralis approach seems superior to conventional ORIF through the deltoid-pectoralis approach in the treatment of PHF in elderly patients in terms of Constant-Murley score, NEER score, intraoperative blood loss, length of operation and SF36 score.

Treatment of distal tibial fractures with minimally invasive plate osteosynthesis

Treatment of distal tibial fractures with minimally invasive plate osteosynthesis

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

Open reduction and internal fixation treatment of distal tibia fracture with Wise lock plate followed by two year follow up

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Distal tibial fractures are high energy injuries with high complication rate. The objective of this study was to reduce the postoperative complications of distal tibial fracture by using indigenously manufactured implants (plates and screws).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective study of 10 patients (6 patients had 43-B1 fracture, 4 patients had 43-B2 fracture) with two year follow up period followed by physical exercises after one month of the surgery. The fractures were treated with 3.5 mm Wise lock medial distal tibia plate. X-ray was used to check the union, non-union. Functional outcomes were assessed with visual analog scale (VAS) score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; X-ray was showing good results. Average VAS score was 1.5 (90%) 9 patients and 2.5 (10%) in 1 patient. At the end of the first year VAS score is 2 for one patient with 9 others having 1 and at the end of the second year the VAS score is 0 for 9 patients and 1 for one patient.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Treatment of distal tibial fracture with 3.5 mm Wise lock medial distal tibia plate shows good outcomes with less complications.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Fixation of Distal Tibial Fractures by Intramedullary Nail with Multidirectional Distal Locking Screws

AbstractBackground: Fractures of the distal tibia involve the diaphyseo-metaphyseal area of the bone, and may be either extra-articular or intrarticular. Several methods have been described for the treatment of these fractures, including casting, external and internal fixation.Aim of Study: The aim of the work was to evaluate the results of fixation of distal tibial fractures by intramedullary nail with multidirectional distal locking screws (Expert tibial nail).Methods: This study included 21 patients with distal tibial fractures treated between October 2017 and October 2018 (including follow-up period) at Tanta University Hospital with intramedullary nail with multidirectional distal locking screws (Expert tibial nail). Clinical and radiological data were analyzed.Results: According to Tenny & Wiss scoring systems for distal tibial fractures the clinical results were graded as excellent in six patients (28.6%), good in nine patients (38.1 %), fair in four patients (19%) & poor in two patients (9.5%).The excellent and good results were considered as satisfactory results while the unsatisfactory included the fair and the poor results. Thus, satisfactory results were found in 15 patients (71.43%), and the unsatisfactory results were found in six patients (28.57%).Conclusion: Treatment of distal tibial fractures using intramedullary nail with multidirectional distal locking screws (Expert nail) is a safe and accepted method alternative to conventional nail and plating technique. It provides additional biomechanical stability than the conventional nails and plate osteosynthesis.

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.