Analysis of functional outcome of anterolateral plating in tibial pilon fractures

Thirumurugan, A (2014) Analysis of functional outcome of anterolateral plating in tibial pilon fractures. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Tibial pilon fractures account for 1% to 10% of all lower extremity injuries. The difficulty in managing these injuries is primarily due to the precarious vasculature around the ankle. Subcutaneous location of tibia adds to the difficulty. It encompasses a spectrum of skeletal injury ranging from low energy injury due to simple falls to high energy explosive injury due to road traffic accidents and fall from height. Fibula is fractured in 85% of the tibial pilon injuries. Fixation of fibula fracture is crucial to the reduction of pilon fracture. Complication rates were higher in the high energy explosive fracture pattern. Medial plating using LCP on the subcutaneous medial border of distal tibia resulted in a significant rate of wound dehiscence and deep infection. Plating on the lateral surface of tibial plafond is a new entity and the anterolateral approach is gaining popularity for the fixation of tibial pilon fractures. MATERIALS AND METHODS: This retrospective and prospective study analyzes the functional outcome of Anterolateral distal tibia LCP for treatment of distal tibia fracture. The period of study was from June 2013 to December 2013 with a total duration of 7 months. In our study 30 cases with a minimum follow up of 4 months and maximum of 12 months with an average of 9 months was carried out. Fibula fixation is performed initially to restore length and achieve indirect reduction of tibia fracture using posterolateral approach. Anterolateral approach to ankle was used to fix tibia. Anterolateral locking compression plates are placed through the interval between the anterior and lateral compartments of leg. All cases were assessed postoperatively using the Kaikkonen clinical ankle score and Teeny wiss radiological score. RESULTS: 27 fractures united with a mean duration of 12 to 24 weeks. In our study we were able to achieve anatomic reduction in 32% (7 cases) of the patients. Good reduction was achieved in 50% (11 cases) of the patients. Fair reduction was achieved in 18% (4 cases). There was no case of poor fracture reduction in our study according to Teeny Wiss Score. In our study we had excellent functional outcome in about 30% of cases, good functional outcome in 50% of cases fair and poor outcome 10% of cases each based on Kaikkonen Clinical Ankle Score. In our study the complication we met were 6 cases (20%) of wound dehiscence and superficial infection which healed by secondary intention, 2 cases (7%) of flap necrosis, 3 cases(10%) of nonunion, extensor tendon exposed in 1 case (3%), implant failure in one of the three non union cases. In our study we had no deep infection (0%). CONCLUSION: Distal tibia fractures with high grade of soft tissue injury are to be internally fixed after a delay of 21 days for the edema to settle down and the wrinkle sign appears. The posterolateral incision to fibula provides a larger skin bridge between this incision and the tibial incision. A 7 cm skin bridge between two incisions is recommended to avoid wound complication. Restoration of the articular surface and reestablishing its relationship to the tibial shaft is the primary goal of treatment. Good functional result depends on reasonable anatomic reduction of the articular surface and meticulous soft tissue handling. From our study, 3.5mm Anterolateral Distal tibia Locking Compression Plating for tibial pilon fractures were found to be safe and effective. For AO type A fractures, can be fixed either using MIPPO or ORIF technique. For AO type C fractures Open reduction of the articular fragment is mandatory and then stabilize with locking compression plate for added up stability.

Item Type: Thesis (Masters)
Uncontrolled Keywords: dual incision technique, anterolateral approach for tibia, wound problems, skin bridge.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 09:43
Last Modified: 16 Sep 2017 09:43

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