A comparative analysis between methods of open reduction and closed reduction in internal fixation of proximal tibia fractures

Vinoth, S (2016) A comparative analysis between methods of open reduction and closed reduction in internal fixation of proximal tibia fractures. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Fractures of the tibial plateau result from high energy trauma. Knee is the major weight bearing joint of the body. Fractures of the tibial plateau change the knee kinematics alter joint stability and cause joint incongruity. Fracture reduction for fixation can be done by 2 methods viz., direct (open)and indirect (closed) technique. With indirect reduction fracture fixation can be done by minimally invasive method which is more biological since there is minimal soft tissue handling and fracture site is not surgically exposed. AIM: To evaluate the functional and radiological outcome of proximal tibia fractures treated with internal fixation by methods of open reduction and closed reduction. MATERIALS AND METHODS: Twenty patients with a mean age of 33.4 years, with type 5 or type 6 Schatzker tibial plateau fracture were chosen. 10 patients internal fixation by direct or open method where fracture site is exposed and fragments are reduced under direct vision. 10 other patients indirect or closed method using fracture table traction by ligamentotaxis principle under image intensifier guidance. Here internal fixation was done by minimally invasive method without exposing the fracture site. In both groups internal fixation was done with lateral column Locking compression plate and screws. The functional outcome was assessed using Knee Scoring System by Hospital for Special Surgery and radiological union by monthly X rays. RESULT: In open reduction group the average range of knee movement was 0-86, time for fracture union was 18.8 weeks, Knee score was 70.8. In closed reduction group the average range of knee movement was 0-115, time for fracture union was 12.8 weeks, Knee score was 83.9 . Complications like knee stiffness, infection and knee pain occurred in open reduction group. The mean follow up was 9.2 months. CONCLUSION: The functional outcome assessed using Knee Scoring System shows better functional outcome with closed reduction group in the aspects of pain, range of knee movements, functions like standing, walking and climbing stairs and knee stability. There is early fracture union and less complications leading to early rehabilitation and early return to function. In high energy type 5, type 6 Schatzker tibial plateau fractures closed reduction and locking plate fixation gives better result than open reduction.

Item Type: Thesis (Masters)
Uncontrolled Keywords: comparative analysis ; methods of open reduction ; closed reduction ; internal fixation ; proximal tibia fractures.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 14:35
Last Modified: 16 Sep 2017 14:35
URI: http://repository-tnmgrmu.ac.in/id/eprint/3192

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