Anterolateral or Posteromedial Plate-Assisted Intramedullary Nailing for Fixation of Proximal Third Tibia Fractures: A Biomechanical Study / 医用生物力学

Objective To study the stability of plate-assisted intramedullary nailing for fixing proximal third tibiafractures, compare and observe biomechanical characteristics of anterolateral or posteromedial plate-assisted intramedullary nailing after fixation of proximal third tibia fractures. Methods Eight artificial tibia of 4th-generation sawbones were divided into two groups based on location of the assisted plate, namely, anterolateral plate group and posteromedial plate group, with 4 specimens in each group. Each two locking bolts were fixed to theintramedullary nail proximally and distally, and each three bicortical screws were fixed to the plate proximally and distally. The specimens were osteotomized with a 10-mm defect which located 0. 5 cm to the proximal locking bolt of intramedullary nail or 5-6 cm distally to the knee joint line, in order to simulate an AO/ OTA 41-A2 type proximal third tibia fracture after fixation of intramedullary nail. After osteotomy was finished, axial compression test, three point bending test, cyclic loading and overstress test were conducted by mechanical testing machine. The results of axial stiffness and three-point stiffness between two groups were compared and analyzed. Results Axial compression test showed that the average axial stiffness in posteromedial plate group was lower than that in anterolateral plate group, but no significantly statistical differences were found between the two groups. Three point bending test showed that the average bending stiffness in posteromedial plate group was significantly higher than that in anterolateral plate group when stimulating either varus stress (plate located at pressure side of the fracture, t = 3. 679, P<0. 05) or valgus stress (plate located at tension side of the fracture, t = 8. 975, P<0. 05). Conclusions Plate-assisted intramedullary nailing for fixation of proximal third tibia fractures can minimize the angulation malalignment, improve the stability of nailed proximal tibial fragment and allow the early weight bearing. Both anterolateral and posteromedial plate-assisted intramedullary nail can provide satisfactory axial stability for proximal third tibia fractures, while posteromedial plate-assisted intramedullary nail shows better bending stability than anterolateral plate in countering varus or valgus stress deformity. This study provides an essential basis for clinical decision making about plate-assisted intramedullary nailing for fixing proximal third tibia fractures.

A prospective study on use of Ilizarov external fixator for open fractures of Tibia

Introduction: Open fractures are more commonly seen in tibia as compared to other bones because of subcutaneous location and the tenuous soft tissue cover. There has been rise in open tibia fractures with increased road traffic accidents. Management of open tibial fracture remains controversial. Ilizarov external fixator is a better option for the treatment of these fractures. This study was conducted to evaluate the clinical outcome of open tibial fractures managed with an Ilizarov external fixator. Material & Methods: Twelve patients among those who presented to the emergency department with Type II, Type IIIA and Type IIIB Gustilo-Anderson type open tibial fracture were enrolled. All these cases were treated by Ilizarov external fixator and appropriate wound management. Active movements were started at the earliest after the surgery. Partial weight bearing with support was started from the second day after the surgery. Results: Mean age of the study subjects was 37.66 ± 8.77 years. Half of the patients had Type IIIB GustiloAnderson type fractures. The mean duration of fracture union was 7.1 months. Pin tract infection of the wires was the more common among complications. Excellent to good outcome was seen in 90% of study subjects. Conclusion: Ilizarov external fixator gives stable fixation of the open tibial fractures and allows better wound care. It also helps in early ambulation and rehabilitation of these patients.

Surgical Management of Distal Tibia Fracture: Towards An Outcome-based Treatment Algorithm

@#Introduction: Distal tibia fractures are frequently associated with an extensive soft tissue injury which then leads to a higher risk of complications such as infection, non-union and eventually poor overall outcome. The purpose of this study is to measure the outcome of distal tibia fractures treated with internal fixation, external fixator or Ilizarov external fixator(IEF). We aim to propose an algorithm for management of distal tibia fractures by evaluating the treatment options, outcomes and risk factors present. Material and Methods: This study is a cross-sectional study of all distal tibia fractures treated surgically in Tengku Ampuan Rahimah Hospital, Klang from 1st January 2016 till 30th June 2018. Patient records were reviewed to analyse the outcomes of surgical treatment and risk factors associated with it. Results: Ninety-one patients were included with a mean age of 41.5 years (SD = 16.4). Thirty-nine cases (42.9%) were open fractures. Thirty-eight patients (41.8%) were treated with internal fixation, 27 patients (29.7%) were treated with IEF and 26 patients (28.6%) were treated with an external fixator. Among open fractures cases, no significant finding can be concluded when comparing each surgical option and its outcome, although one option was seen better than the other in a particular outcome. Initial skeletal traction or temporary spanning external fixator in close fractures reduced the risk of mal-alignment (p value=0.001). Internal fixation is seen superior to IEF and external fixator in close fractures in term of articular surface reduction (p value = 0.043) and risk of mal-alignment (p value = 0.007). Conclusion: There is no single method of fixation that is ideal for all pilon fractures and suitable for all patients. This proposed algorithm can help surgeons in deciding treatment strategies in the challenging management of distal tibia fractures to reduce associated complications.

Comparative study of the efficacy of gentamicin-coated intramedullary interlocking nail versus regular intramedullary interlocking nail in Gustilo type I and II open tibia fractures / 中华创伤杂志(英文版)

PURPOSE@#Open tibia fracture is prone to infection, consequently causing significant morbidity and increasing the hospital stay, occupational loss and onset of chronic osteomyelitis. Intramedullary nailing is one choice for treating tibia shaft fractures. To improve the delivery of antibiotics at the tissue-implant interface, many methods have been proposed as a part of prophylaxis against infection. This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking (IMIL) nail in the prevention of infection in Gustilo type I and II open tibia fractures and to compare the results with regular intramedullary nail.@*METHODS@#The study included 28 patients with open tibia fractures (Gustilo type 1 or type 2); of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing. Randomization was done by alternate allocation of the patients. Follow-up was done postoperatively (day 1), 1 week, 6 weeks, and 6 months for bone union, erythrocyte sedimentation rate (ESR), hemoglobin and C-reactive protein (CRP). Statistical significance was tested using unpaired t-test. A p value less than 0.05 was considered significant.@*RESULTS@#There were 4 cases of infection in controls (regular IMIL nail) and no infection among patients treated with gentamicin-coated nail during the follow up (X = 4.66, p = 0.031). At 6 months postoperatively, CRP (p = 0.031), ESR (p = 0.046) and hemoglobin level (p = 0.016) showed significant difference between two groups. The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up (p = 0.016).@*CONCLUSION@#Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo type I and II open tibia fractures.

Imaging characteristics of irreducible tibial shaft fractures and their clinical significance / 中华创伤骨科杂志

Objective To propose a concept of irreducible tibial shaft fractures and to discuss their imaging characteristics and clinical significance.Methods A retrospective study was performed in 21 patients with tibial shaft fracture who had received intraoperative intramedullary nailing after limited open reduction at Department of Orthopaedics,The Second Affiliated Hospital to Anhui Medical University from November 2013 to June 2018.They were 14 males and 7 females,aged from 21 to 66 years (average,34.9 years).There were 15 left and 6 right sides.Firstly,closed reduction was performed followed by traction,folding and rotation,but repeated attempts failed to achieve smooth reduction or insertion of guide wire.Next,local limited open reduction had to be performed for intramedullary nailing.The X-ray and CT images of the tibial fractures were collected to analyze their imaging characteristics.The imaging manifestations were characterized into 4 types:single-segment type with intact fibula,multiple-segment type,interlocking type where the distal and proximal ends interlock commonly seen in short spiral and short oblique fractures,and incarceration type where the fracture interspace is blocked by a bone fragment.The therapeutic efficacy was evaluated at the final follow-up by knee scores of The Hospital for Special Surgery (HSS) and Kofoed ankle scores.Results Of the 21 patients,2 were single-segment type,4 multiple-segment type,13 interlocking type and 2 incarceration type.They were followed up for 7 to 50 months (average,22.7 months).The fractures united after 5 to 16 months (average,7.3 months).Postoperative knee pain was observed in 3 cases and delayed fracture union in 2.Osteomyelitis,superficial wound infection,implant breakage or malunion occurred in none of the patients.The therapeutic efficacy evaluated at the final follow-up by HSS knee scores and Kofoed ankle scores revealed 15 excellent,4 good and 2 fair cases,yielding an excellent to good rate of 90.5％.Conclusion The concept of irreducible tibial shaft fractures may lead to preoperative awareness on the part of the surgeons so that ineffective repeated reductions can be spared and the damage to the blood supply to the fracture ends and the operation time can be reduced.

Intramedullary nail versus plate in osteosynthesis of distal tibial shaft fractures in adults / 中华创伤骨科杂志

Objective To compare the efficacy between intramedullary nail and plate in the internal fixation for distal tibial shaft fractures in adults.Methods A retrospective analysis was conducted of the 49 patients with distal tibial shaft fracture who had been treated by internal fixation with intramedullary nail or plate at Department of Orthopaedics,The First People's Hospital of Neijiang from September 2014 to September 2018.They were 26 males and 23 females,aged from 19 to 71 years (average,42.3 years).According to the AO/ ASIF classification,there were 34 cases of type 43A1 and 15 cases of type 43A2.There were 7 open and 42 closed fractures.Of them,23 received intramedullary nailing and 26 steel plating.The 2 groups were compared in terms of intraoperative blood loss,operation time,hospitalization time,fracture healing time,The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score,infection and fracturemalunion.Results The 2 groups were comparable because there were no significant differences in the preoperative general data between them(P ＞ 0.05).The intraoperative blood loss in the intramedullary nail group (160.3 mL ± 15.2 mL) was significantly greater than that in the plate group (110.5 mL ± 13.4 mL) (P ＜ 0.05).There were no significant differences between the 2 groups in operation time,hospitalization time,fracture healing time or AOFAS ankle-hindfoot scores at the final follow-up (P ＞ 0.05).There were no significant differences between the 2 groups either in the rates of malunion,infection or internal fixation failure (P ＞ 0.05).Five cases in the intramedullary nail group reported painful discomfort in the front of the knee joint while 7 cases in the plate group postoperative discomfort due to plate protrusion.Conclusions Both intramedullary nail and plate are effective treatments of adult distal tibial fracture.However,in order to minimize the risk of infection,intraoperative maneuvers should be as careful and gentle as possible,repeated violence be avoided and soft tissues be carefully protected.

Therapeutic effect of Peter-Williams intramedullary nail in children with tibia fracture due to osteogenesis imperfecta / 中华实用儿科临床杂志

Objective To study the method and therapeutic effect of Peter-Williams intramedullary nail in children with tibia fracture due to osteogenesis imperfecta.Methods A total of 30 children of tibia fracture due to osteogenesis imperfecta,including 17 males and 13 females in Department of the Third Orthopaedics and Osteogenesis Imperfecta Center,Tianjin Wuqing District People's Hospital from June 2015 to January 2017,were operated on the shaft of tibia with Peter-Williams intramedullary nail.Twelve cases were left tibia fracture,13 cases were right tibia fracture,and 5 cases were bilateral tibia fracture.Twenty of 35 tibias were accompanied with no tibial deformity,and 15 of 35 tibias were accompanied with different degrees of anterior arch bowing deformity.The movement and life self-care ability were evaluated according to Functional independence measure (WeeFIM) evaluation form.Results All of the children were followed up for an average of 18 months(ranging from 10 to 26 months).The average operating time was 1.2 hours(0.75-2.50 hours).The average bleeding was 60 mL(30-100 mL).The average bone healing time was 10 weeks (8-16 weeks).Patients began to exercise on bed after removing plaster,and to walk after X-ray showing bone healing.Parents of all children were satisfied with surgical operation,and the WeeFIM score was improved by (60.76 ± 15.57) scores (64-85 scores) preoperatively to (82.00 ± 7.50) scores (75-91 scores) postoperatively.There was a statistically significant difference in scores before and after the treatment(t =2.765,P =0.003).There was no infection,osteomyelitis,nerve damage,or vascular damage.Conclusions Therapy of Peter-Williams intramedullary nail in children with tibia fracture due to osteogenesis imperfect is advantaged.It causes less blood,less damage,with no intruding joint,correcting deformity and improving lower limb functions and life quality.

The Result of Using an Additional Mini-Locking Plate for Tibial Pilon Fractures

PURPOSE: We evaluated the usefulness of an additional, 2.7 mm mini-locking plate for tibial pilon fractures. MATERIALS AND METHODS: We studied 21 patients (14 males and 7 females), who were treated with a 2.7 mm mini-locking plate via the anterolateral approach for tibial pilon fractures between September 2012 and April 2014. The mean age was 43.85 years, and the mean follow-up period was 16.6 months. The radiologic outcomes were graded by the Burwell and Charnley modified system and clinical outcomes were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score. RESULTS: The mean union period was 14.3 weeks. At the final follow-up, radiologic results showed 16 excellent results, 4 fair results, and 1 poor result. The average VAS was 3.4 points; the average AOFAS score was 81.8 points. During the follow-up period, there were three cases of posttraumatic osteoarthritis and one case of superficial skin infection. CONCLUSION: Additional anterolateral, 2.7 mm mini-locking plate may be a good treatment method to manage tibial pilon fractures.

Usefulness of Computed Tomography on Distal Tibia Intra-Articular Fracture Associated with Spiral Tibia Shaft Fracture

PURPOSE: The purpose of this study is to evaluate the usefulness of computed tomography (CT) for spiral tibia shaft fracture by analyzing associated distal tibia intra-articular fractures diagnosed by CT only which met the indication of surgical fixation and were fixed. MATERIALS AND METHODS: Ninety-five spiral tibia shaft fractures with preoperative ankle plain radiographs and CT were analyzed retrospectively. The incidence and type of associated distal tibia articular fractures were evaluated by reviewing ankle plain radiography and CT. The number of fractures diagnosed by CT that correspond with the indication of fixation and that were actually fixed were analyzed. RESULTS: Among 95 spiral tibia shaft fractures, 62 cases (65.3%) were associated with distal tibia intra-articular fracture. There were 37 cases of posterior malleolar fracture, 5 cases of avulsion fracture of the distal anterior tibiofibular ligament, 5 cases of medial malleolar fracture, and 15 cases of complex fracture. Among 52 posterior malleolar fractures including complex fracture, 20 cases were diagnosed by ankle plain radiograph. Of these 20 cases, 16 posterior malleolar fractures (80.0%) met the indication of surgical fixation, and 14 cases were actually fixed with a screw. Among 32 posterior malleolar fractures diagnosed by CT only, 26 cases (81.3%) met the indication of surgical fixation and 18 cases (56.3%) were fixed by screw. CONCLUSION: Approximately 50% of associated fractures were diagnosed by CT only and more than 80% of associated posterior malleolar fractures met the indication of surgical fixation and among these fractures, 18 cases (56.3%) were actually fixed by screw. This result suggests that CT is useful in diagnosis and treatment of distal tibia intra-articular fracture associated with spiral tibia shaft fracture.

A clinical comparative study of tibia fracture treated by intrmedullary nail using limited incision or close reduction / 西安交通大学学报(医学版)

Objective To discuss the clinical therapeutic effect of tibia fracture treated by intramedullary nail using limited incision or close reduction.Methods We treated 54 tibia transverse fracture cases,93 oblique fracture cases, 7 1 fragmental fracture cases by intramedullary nail using open with limited incision or close reduction.We then compared operation time,X-ray time,hospital stay duration,infection rate,nonunion rate, and postoperative function restoration between patients with different fractures.Results There was no different operation time in transverse fracture group,but longer for close reduction in oblique fracture group and for open reduction in fragmental fracture group.X-ray time did not differ for open or close reduction in transverse fracture group.Long X-ray time was used in close reduction in oblique and fragmental fracture groups.There was no significant difference in nonunion rate for open and close reduction in both transverse and fragmental fracture groups.The oblique fracture nonuinon rate was higher in close reduction group than in open reduction group.No difference was found in infection rate or function recovery whether for open or close reduction in all types of fractures.Conclusion Different therapy methods should be determined by different fracture types.Open reduction with minimal incision should be used for oblique fracture cases and fragmental fracture cases with reduction difficulty.

Ilizarov technique for one-stage treatment of infected tibia defect with soft tissue defect / 重庆医学

Objective To explore the application and the clinical curative effect of Ilizarov technique in infected tibia defect with soft tissue defect .Methods It was case series retrospective study .Fifteen patients (6 women ,9 men;age 23-54 ,average 38) with infected tibia defect combined soft tissue defect between March 2008 and March 2012 were treated with Ilizarov external fixa‐tion .The average length tibia defect was 7 .7 cm(3 .0 -21 .0 cm) ,The average area of soft tissue defect was 7 .5 cm2 (3 .6 -18 .4 cm2 ) .Ilizarov external fixation was applied in the operation .Results All 15 patients were followed up and the mean time was 16 .2 months (range ,8-36 months) .The average time of the bony healing was 12 .3 months (range ,7 -28 months) .The docking site was bony healing after rapid compression in 4 cases .The docking site was not bony healing in 2 cases .The docking site achieved bony healing by accordion technique in one case ,and bone grafting in the other case .The skin and hypodermis were embedded in the docking site in 9 cases .The skin and hypodermis were displaced in 3 cases ,and bone grafted at the same time in the other 6 cases . The soft tissue defect gradually become small and healed at last in the 14cases .One case with large soft tissue defect was cured by skin grafting .According to Paley′s evaluation criteria ,12 cases were excellent ,2 good ,1 moderate ,giving a good to excellent rate of 93 .3% .Conclusion Ilizarov technique is a safe and effective method to treat infected tibia defect with soft tissue defect which can completely debride infected lesions ,repair the soft tissue defect ,cure bone nonunion and restore the limb length .

Identification of peroneal nerve’ s safety zone and its clinical value in treatment of MIPPO for proximal tibia fracture / 局解手术学杂志

Objective To define the peroneal nerve’ s safety zone and study its clinical value in treatment of MIPPO for proximal tibia fracture. Methods The peroneal nerve’ s safety zone was defined according to dead body anatomy. Patients with proximal tibia fracture were divided into traditional therapy group ( control group) and peroneal nerve’ s safety zone therapy ( observation group) . The curative effects and complications were compared. Results The peroneal nerve’s safety zone of R1 was (45. 30 ± 1. 55) mm,R2 was (45. 61 ± 1. 40) mm,R3 was(45. 42 ± 1. 62) mm,angle A was(33 ± 2. 1)°,angle B was(97 ± 2. 3)°. The operating time,bleeding volume,hospitalization time and fracture time in observation group were significantly lower than those in the control group,but there was no siginificant difference in post-ther-apy infection,delayed healing and other complications. Conclusion The curative effects according to peroneal nerve’ s safety zone are better than traditional MIPPO in proximal tibia fracture.

The Treatment Results in Site of Tibia Fracture Treated with Interlocking Intramedullary Nail / 계명의대학술지

Intramedullary nailing is the treatment of choice for most diaphyseal fractures of the tibia. The purpose of this study is to evaluate the result of tibia fractures treated with interlocking intramedullary nail, according to different sites of fractures. From september 2004 to august 2012, 106 cases of tibia fracture with a minimum follow up until bony union were selected and analyzed retrospectively. The mean follow-up period of the patients was 24.5 months. The location of fractures were divided into three groups, proximal (n = 18), mid (n = 42), distal (n = 46). Delayed union, mal-alignment and additional operation were investigated. The number of angle change over 5 degrees in the coronal plane and 10 degrees in the sagittal plane were 7 cases in proximal, 7 cases in mid, and 12 cases in distal with statistic significance. And an additional operation was required in 6 patients in proximal fracture, 2 patients in mid fracture, and 7 patients in distal fracture during bony union. Conclusively, intramedullary nailing in proximal and distal tibia fracture showed higher delayed union rate and could result in excessive angle change due to mal-alignment. Therefore, proximal level or distal level tibia fractures need more accurate reduction of fracture than midshaft level would need more accurate reduction of fracture and observe bony union through regularly radiography examination.

Minimally Invasive Plate Osteosynthesis with Conventional Compression Plate for Diaphyseal Tibia Fracture

The diaphyseal tibia fracture is best treated with intramedullary nail but in some cases where the nail is not applicable, plate fixation will be the next option of fixation. The extensile anterior approach is normally used for conventional compression plate fixation in tibia shaft fractures. The extensive surgical dissection may devitalizes the bony fragments and interfere with the fracture union as well as soft tissue healing. Minimally Invasive Plate Osteosynthesis (MIPO) provides good preservation of blood supply and fracture hematoma at the fracture site thus promotes biological bone healing. The use of indirect reduction techniques and small skin incisions to introduce the plate is technically demanding and requires fluoroscopy exposures throughout the surgery, being some of its drawbacks. We recommend MIPO for conventional compression plate fixation in tibial shaft fractures in view of the reduced surgical trauma to the surrounding soft tissue and good functional outcome.

Autologous bone-marrow stem-cell transplantation for nonunion of tibia fracture / 局解手术学杂志

Objective To investigate the effect of the percutaneous autologous bone marrow stem cell transplantation for the treatment of nonunion of tibial fracture. Methods From 2007 to 2011,the data of 11 patients with tibial nonunion who received autologous bone marrow stem cell transplantation was analyzed retrospectively. Taking bone marrow,examine,isolation,cultivation and expansion marrow mesenchymal stem cells( MSCs) ,and then marrow needle was inserted into the site of the nonunion under the X-ray,the MSCs were injected into the site of nonunion. Compression bandage was applied after operation. X-rays following-up were reviewed. Results All 11 patients were followed up from 4~27 months,with average of 13 months,X-ray showed:fracture healed well,no adverse events happen. Conclusion Satisfactory out-come can be obtained by percutaneous autologous bone marrow stem cell transplantation in treatment of tibial nonunion. Clinical application value is high,especially to patients who had suffered from severe skin and soft tissue injury with keloids healed.

Tratamiento de la fractura de tibia mediante fijación externa: presentación de dos casos / Fracture treatment by mean of external fixation: presentation of two cases

Se presentaron dos casos que tuvieron fractura de tibia, a quienes se les colocaron fijadores externos bipolares RALCA, lo que brinda mayor estabilidad. En el primer caso, que fue una niña de 9 años politraumatizada con gran cantidad de traumas graves que permitió continuar las curas sin peligro de movilidad del foco de fractura, evitó abrir el foco de fractura y, por consiguiente, aumentar el sangramiento y el ulterior empeoramiento dentro de la gravedad del caso. En el segundo, permitió la movilización precoz del miembro inferior izquierdo y evitó la inmovilización con yeso prolongada. Se obtuvieron resultados satisfactorios en ambos casos, llegando a la conclusión de que la aplicación de esta técnica es sumamente útil, y evita operaciones demoradas que afecten el estado general del paciente.

We presented two cases who had tibia fracture, to whom we put bipolar external fixers RALCA, giving more stability. In the first case, a girl aged 9 years, politraumatized with a great quantity of serious trauma, it allowed to continue the treatment and healing without the danger of mobility in the fracture focus, avoiding the fracture focus opening and, therefore, the increase of bleeding and the farther worsening in the case seriousness. In the second case it allowed the precocious mobilization of the lower left limb and avoided the long immobilization with a cast. We obtained satisfactory results in both cases, arriving to the conclusion that this technical application is extremely utile and avoids delayed operations affecting the general status of the patient.

Analysis of the Result Treated with Locking Compression Plate-Distal Tibia and Zimmer Periarticular Locking Plate in Distal Tibia Fracture

PURPOSE: To evaluate the clinical and radiological results of minimally invasive plate, osteosynthesis, using either a locking compression plate-distal tibia (LCP-DT) or Zimmer periarticular locking plate (ZPLP) for distal tibia fractures. MATERIALS AND METHODS: Fifty one patients (51 cases), who underwent minimally invasive osteosynthesis using locking compression plate for distal tibia fractures between October 2008 and August 2011, were followed for more than six months. Eighteen patients were treated with LCP-DT and 33 patients with ZPLP. Time to bony union and anatomic alignment were evaluated radiologically. Clinically, American Orthopedic Foot & Ankle Society ankle-hindfoot scales (AOFAS score) and range of ankle motion were assessed and compared between two groups. RESULTS: All patients achieved bony union at an average of 18 weeks on LCP-DT group and 16weeks on ZPLP group. The average American Orthopedic Foot & Ankle Society ankle-hindfoot scales was 83.3 points on the LCP-DT group, 84.6 points on the ZPLP group, and range of ankle motion averaged at 45 degrees, 48 degrees, respectively. CONCLUSION: Both types of locking compression plates were effective when performing minimally invasive osteosynthesis for distal tibia fractures.

Surgical Treatment of Distal Tibia Fractures / 대한족부족관절학회지

Distal tibia fractures were mainly caused by high energy trauma and the lower legs were enveloped in poor soft tissue. Therefore, there are many open fractures and concomitant soft tissue injuries in distal tibia fractures. For the restoration of ankle function, the surgical treatment was performed in distal tibia fractures. However, it is difficult to treat the distal tibia fracture surgically. There are many complications in distal tibia fracture due to highly comminuted fracture and poor soft tissue condition. There are many surgical methods for distal tibia fractures, such as, external fixator, intramedulary nailling, open reduction & internal fixation, and minimally invasive plate osteosynthesis. We reviewed the surgical treatments of distal tibia fractures.

Clinical Outcomes of Combinations of Locking Compression Plate Fixation through Minimally Invasive Precutaneous Plate Osteosynthesis and Interfragmentary Screw Fixation in Distal Tibia Fracture / 대한족부족관절학회지

PURPOSE: To analyze the outcome of distal tibia fracture treated with the Distal Tibia LCP with combination of interfragmentary screw. MATERIALS AND METHODS: Between January 2008 and March 2012, data of 34 patients with fracture of distal tibia treated with the Distal Tibia LCP with or without combination of interfragmentary screws were reviewed. There were 17 males and 17 females with an average age of 51.8 years (range, 18~77 years). Radiographic union time and time from surgery until ability to full weight bearing were measured and compared. Callus index was measured as quotient of callus thickness and diameter of corticalis both in AP and sagittal direction. RESULTS: 12 fractures were treated with interfragmentary screws and 22 fractures were treated with bridging plate alone. In interfragmentary fixation group, time to full weight bearing was 14 weeks versus 15.75 weeks without screw. Callus index at bearing was not significantly lesser in patients with screw compated with those without, but callus index difference at posterative 4weeks was sigficant. Radiologic union time was 11.3 weeks in interfragmentary fixation group and 12.58 weeks without screw. CONCLUSION: The osteosynthesis with the Distal tibia LCP with combination of interfragmentary screw seems to be more stable in postoperative 4weeks than Distal tibia LCP alone, expecting to earlier ROM exercise and rehabilitation.

Clinical Outcomes of Locking Compression Plate Fixation through Minimally Invasive Percutaneous Plate Osteosynthesis in the Treatment of Distal Tibia Fracture

PURPOSE: To analyze the clinical results of operative treatment of distal tibia fracture with locking compression plate fixation through a minimally invasive percutaneous plate osteosynthesis technique. MATERIALS AND METHODS: The subjects were 46 patients (conventional open surgery: 22 patients, minimally invasive percutaneous plate osteosynthesis: 24 patients) with fracture of the distal tibia who were treated with plating between November 2006 and June 2010. The time of bony union, complications, range of motion, and clinical functional outcome (according to American Orthopedic Foot and Ankle Society, AOFAS) were investigated. RESULTS: In the minimally invasive percutaneous plate osteosynthesis group, the average union time was 14.3 weeks, postoperative range of motion was an average of 55.2, average AOFAS was 96.9, and incidence of complications was 20.8%. In the open surgery group, the average union time was 18.9 weeks, postoperative range of motion was an average of 49.1, average AOFAS was 83.8, and incidence of complications was 32.6%. There were statistically significant differences (p<0.05). CONCLUSION: Surgical treatment with locking compression plate fixation through the minimally invasive percutaneous plate osteosynthesis technique showed favorable results regarding its union time, postoperative functional outcome, and incidence of complications. The locking compression plate fixation through minimally invasive percutaneous plate osteosynthesis technique can be an effective treatment option.