RESUMO
<p><b>PURPOSE</b>Tibial fracture is the most common long bone fracture. Distal third tibial fractures are challenging though open reduction and plating can result in anatomical reduction and rigid fixation. This paper aimed to evaluate and compare the results of medial and lateral locking compression plates for distal third tibial fractures.</p><p><b>METHODS</b>This prospective clinical study involved 36 patients with distal tibial fractures admitted in Department of Orthopaedics, Sawai Mansingh Medical College & Affiliated Hospital, Jaipur, India, from June 2011 to May 2012, including 29 closed fractures and 7 open fractures at the mean age of 38.9 years. Thirty-six patients were divided equally into two groups based on treatment method, including medial plating group (18 patients) and lateral plating group (18 patients). They were followed up for at least 5 months after discharge. The functional outcomes were evaluated using Tenny and Wiss clinical assessment criteria.</p><p><b>RESULTS</b>Malunion was found in 3 cases of medial plating group and in 1 case of lateral plating group. In the medial plating group, there were 5 cases of superficial infections, 1 deep infection, 1 nonunion and 3 wound dehiscence. In the lateral plating group, there was 1 case of superficial infections, 1 deep infection and 1 nonunion. In the lateral plating group, 4 patients reported feeling the plates and screws but none of them asked to remove the hardware. In the medial plating group, 9 patients reported symptomatic hardware problems and 7 asked to remove the hardware. The number of cases graded as excellent/good/fair was 1/8/7 in the medial plating group and 3/7/7 in the lateral plating group respectively. In the medial plating group, the final range of motion was 17.2° in ankle dorsiflexion and 30.7° in ankle plantar flexion. In the lateral plating group, the final range of motion was 19° in ankle dorsiflexion and 34.2° in ankle plantar flexion.</p><p><b>CONCLUSION</b>Lateral plating of distal tibia is safe and feasible, which can provide biological fixation and prevent the soft tissue complications associated with medial plating.</p>
RESUMO
Objective: to compare the short-term functional outcome between resection and reconstruction in Mason Type II and Type III radial head fractures using Broberg and Morrey score
Methods: a prospective cohort study was conducted in the Department of Orthopedic Surgery of SMS Medical College and attached Hospitals. A total of 29 patients [15 in resection group, 14 in reconstruction group] between the age group of 20-60 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. The functional outcome including the range of motion, extension lag and Broberg Morrey score were determined and compared between two groups
Results: the mean age of resection group was 44.5+/-6.6 years and mean age of reconstruction group was 37.1+/-6.2 years. The baseline characteristics . At 12-months follow-up, in Mason type II fracture, radial head reconstruction group with mean extension lag of 9.4+/-4.1 and mean Broberg Morrey score of 94.9+/-5.1 showed better results compared to radial head resection group with mean extension lag of 15.7+/-4.1 [p=0.022] and mean Broberg Morrey score of 88.3+/-5.1 [p=0.045] respectively. In Mason type III fractures, radial head resection with mean supination of 79.4+/-4.7, mean pronation of 74.4+/-4.1 and mean Broberg Morrey score of 89.8+/-6 showed better results when compared with radial head reconstruction group with mean supination of 64.2+/-4 [p<0.001], mean pronation of 59.2+/-8.4 [p=0.003] and mean Broberg Morrey score of 81.9+/-5 [p=0.031]
Conclusion: the procedure suggested in Mason type II, is reconstruction of radial head. In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with resection. We recommend radial head excision in Mason type III fractures where anatomical and stable fixation is not possible