Study on Functional outcome of lower third tibial including distal 1/3 and distal ¼ fracture fixation with medial anatomical locking compression plate

Vikas, Gupta (2015) Study on Functional outcome of lower third tibial including distal 1/3 and distal ¼ fracture fixation with medial anatomical locking compression plate. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Fracture of lower third of tibia including distal 1/3 and distal ¼ are primarily located within distal tibia in a square shape wide region, fracture in pattern with comminution extension or non comminution. Treatment in age group 30 to 60 years of these fractures is very difficult and problematic. The various factors that affect the end result outcome are as following: 1. Fracture pattern and type, 2. Trauma to soft tissue associated with fracture, 3. The modality and method of fracture management and calibre of reduction. Forces which are responsible for lower third fractures of tibia bone. 1. Axial compression forces with high grade and high velocity, 2. Torsion and bending due to direct trauma forces 3. Low energy rotation forces. Minimal invasive method for locking compression plate may be advantageous in that it causes less soft tissue injuries and preserves the vascularization of the fracture site. Indications for minimally invasive plate osteo-synthesis of lower third fractures include widely separated tibial plafond, comminuted lower third tibial fracture, and fracture which are far away for proper fixation with intramedullary nails. AIMS AND OBJECTIVE: Therefore this study included use of locking compression plate for distal tibial fracture by both open and minimal invasive method to assess the, 1. Rate of union, any deformation in ankle, leg length differences and gait, arc of motion of ankle, return to previous daily and sports, routine activities, infections and other consequences associated with distal tibial plates and to compare the results achieved by other researches to evaluate whether these plates are suitable devices for operative treatment of lower 1/3 tibial fractures. 2. To assess the arc of motion ankle, any deformation in ankle, walking habits and gait analysis ,rate of fracture union, return to previous routine and sports activities in case of lower third tibia locking plate used for distal 1/4 tibial fractures. 3. To describe any complications in treating lower third tibial fracture with LCP both open and minimal method. 4. To evaluate the function outcome of lower third tibial fracture fixation with LCP. METHODS OF TREATMENT: CLOSED TREATMENT WITHOUT REDUCTION - This method of fracture management is indicated only for undisplaced or mildly displaced A type fractures or type C1 fractures. First without reduction ankle should put on below above knee slab and followed by cast conversion in next setting.. This method of treatment is strictly contraindicated in fracture of metaphyseal region with articular involvement because it requires prolonged immobilization in cast which cause ankle stiffness and restriction of range of motion and in future secondary osteoarthritis. OBSERVATION AND RESULTS: Primary aim of treatment of fracture is sound clinical and radiological union with no functional disability or residual deformity. In this series a total of 20 patients have been studied. All the cases were fixed using locking compression plate. The study period was from January. 2013 to July 2014. CONCLUSION: In the present study, 20 patients with fractures of the distal third and fourth tibia had undergone reduction and internal fixation with distal tibia locking plating through open and MIPO technique. This technique has resulted in the effective stabilization of these fractures. It does provide adequate stability and allows early motion. The distal tibia locking plating through open and MIPO technique not only helps in achieving reduction in difficult situations, but also in rapid union, because it facilitates preservation of the blood supply to the fragment and anatomical reduction of the fracture. The greatest advantage of reduction and internal fixation with distal tibial locking plate is that anatomical reduction is achieved and fracture hematoma is not disturbed much. It is also effective in extra articular fractures occurring within 5cm of the joint because, intramedullary nails often do not provide enough stability and external fixators usually applied for primary stabilization and until soft tissue edema get subsided and delays the return to work with fixators. It is a simple, rapid and straight forward procedure which has a reduced surgical time in both extra articular fractures and intra articular fractures due to newer anatomically contoured locking compression plates for the distal fourth tibial fractures. Although, a larger sample of patients and longer follow up are required to fully evaluate this method of treatment, we strongly encourage its consideration in the treatment of such complex fractures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional outcome ; lower third tibial ; distal 1/3 ; distal ¼ fracture fixation ; medial anatomical locking compression plate
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 25 Sep 2017 01:36
Last Modified: 25 Sep 2017 01:36

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