Selvaraj, P (2010) Management of extra-articular distal tibial fractures with combined external fixation and limited internal fixation: A prospective study. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Distal tibial fractures are among the most challenging of orthopaedic problems. Distal tibia have been treated by a variety of methods, including plaster immobilization, traction, lag screw fixation, open reduction and internal fixation with plates, and external fixation with or without limited internal fixation. Distal tibial metaphyseal fractures are often caused by high-energy axial compressive, direct bending or low-energy rotational forces. These fractures represent less than 7% of all tibial fractures and less than 10% of all lower extremity fractures. Specifically, metaphyseal fractures of the distal tibia comprise 15% of all fractures of the distal third of the tibia. This injury commonly occurs in males 35–40 years of age and is the result of motor vehicle accidents, falls from heights or twisting injuries. But no age is exempted from sustaining this type of injury. More recently, staged protocols have been advocated consisting of temporary external fixation spanning the ankle joint, followed by open reduction and internal fixation with plates and screws after the condition of the soft tissues has improved, usually 2 to 3 weeks after injury. Primary arthrodesis has been performed in selected severe open fractures with extensive articular comminution and talar injury. The surgeon's preference and experience should play a role in preoperative decision making. AIM OF THE STUDY: Aim of this prospective study is to evaluate the clinical outcome of extraarticular distal tibial fractures treated with external fixation combined with or without limited internal fixation. MATERIALS AND METHODS: This is a prospective study of 20 extra-articular distal tibial fractures that were operatively treated at the Department of Orthopaedic Surgery, Government Royapettah Hospital, Kilpauk Medical College between August 2007 to December 2009. Inclusion criteria: • Extra-articular distal tibial fractures (Type A fractures of AO/OTA classification system) with fibular fractures, closed injuries and all grades of open injuries. • Age above 20 years. Exclusion criteria: • All intra-articular fractures (Type B & C of AO/OTA classification system) • Severe osteoporosis, • Inadequate follow-up, • Open physis. All of the patients were in age group of 24-64 years with mean age of 38 years. Road traffic accidents were found to be the commonest mode of trauma. Right limb was involved more often (60%) than the left. RESULTS: Patients returned for follow-up visits at least every three months for the first year and every six months thereafter. The duration of follow-up was ranging from 5 to 24 months. A clinical score was derived with use of a questionnaire with which the patient evaluated pain and the functional outcome. Postoperative radiographs were evaluated for the adequacy of the reduction amount of callous formation. CONCLUSION: External fixation with or without limited internal fixation is an alternative option for the management of extra-articular distal tibial fractures. • Union rate is comparable with open reduction and plate osteosynthesis. • Wound complications are much less compared with open reduction and plate osteosynthesis. • Instruments and implants are cheap. • Operative procedure is simple. • Ankle stiffness is prevented by ankle sparing external fixator, early mobilization and proper rehabilitation protocol.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Management of extra-articular distal tibial fractures ; combined external fixation ; limited internal fixation ; prospective study. |
| Subjects: | MEDICAL > Orthopaedics |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Sep 2017 18:27 |
| Last Modified: | 17 Sep 2017 17:16 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2984 |
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