Functional Outcome of various modalities of management of Distal Tibial Fractures

Arivazhagan, E S (2007) Functional Outcome of various modalities of management of Distal Tibial Fractures. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Distal tibial fractures remain a challenge to orthopaedic surgeons. They usually occur as a result of high energy trauma in young patients, but in the elderly they can result from a simple fall. In the elderly, the problem is compounded by poor bone-stock, their limited ability to partially weight bear and co-morbid conditions. The main challenges: 1.The compromised skin and soft tissue envelope as in open fractures lead to a high incidence of complications following open reduction and internal fixation. 2. In the metaphysis, fixation is less rigid and early loosening is a frequent event as the cancellous bone is open and ‘cell- like’ and therefore ill equipped to support a screw thread. 3. Comminuted fracture patterns, which create difficulty in achieving rigid fixation since the purchase in trabecular bone is less than optimal to permit weight bearing or even start early joint mobilization.These conditions that restrict mobility lead to decubitus ulcers, deep vein thrombosis, joint stiffness and secondary osteoarthritis. 4. These high energy fractures may be associated with extremely damaged soft tissue envelope, as well as comminuted metaphyseal region and articular surface making anatomical reduction difficult. AIM OF THE STUDY: To analyze and individualize the choice of fixation in the management of distal tibial fractures. MATERIALS AND METHODS: The present study deals with the analysis of out come of various modalities of treatment of distal tibial fractures depending on the type of fracture, location of the fracture and the status of the soft tissue envelope. The Study was conducted in Government Royapettah Hospital, Kilpauk Medical College between 2004 – 2006. Patients admitted with distal tibial fractures with or without intra articular extension and those having closed or open injuries were considered for this study. All patients having distal third tibial fractures were admitted and evaluated for co-morbid conditions. Routine investigations are done for anesthetic fitness and also to rule out systemic illness. Associated medical conditions were treated by corresponding specialists. The patients were maintained in POP and calcaneal pin traction in the case of compound fractures. Patients with compound fractures were treated with broad spectrum antibiotics. The time of surgery varied from 5 days to 25 days. There were 10 open injuries, of which there were 6 – Grade1; 3 – Grade 2 and 1-grade 3 open injuries. Those 5 patients who were not willing to undergo surgical procedures were treated conservatively by applying POP after 3 weeks of pin traction and check x-ray. RESULTS: The outcome of treatment of distal tibial fractures, is most affected by the severity of injury, management of the fracture and occurrence of certain complications. There are no uniformly accepted criteria for rating results. A number of factors are important for assessing results of tibial shaft fractures. Most reports omit one (or) more of them. For example Anderson et al., used only shortening and angulation to classify results of treatment into categories of excellent, good, fair, and poor. He rejected range of motion of the ankle joint as a criteria. However Horne and Colleagues with Hutching found ankle motion was a major determinant of functions. CONCLUSION: A short series of results of various modalities of management of distal tibial fractures were analyzed and the overall results including quality of reduction, functional recovery and the presence or absence of complications have led to us to individualise the option of treatment according to the status of the soft tissue, fracture location; fracture pattern and articular involvement. We are aware of the fact that the number of patients and duration of study may not give us the liberty to conclusively arrive at a protocol and might need a more elaborate study for standardization of the different methods available for the management of fractures of distal tibia.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional outcome ; various modalities ; management ; Distal Tibial Fractures.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 17:44
Last Modified: 17 Sep 2017 14:09

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