The Usefulness of Blocking Screw in Intramedullary Nail of Distal Tibial Metaphyseal Fracture / 대한정형외과학회잡지

PURPOSE: To evaluate the usefulness of blocking screws in distal tibial metaphyseal fractures treated with intramedullary nailing. MATERIALS AND METHODS: A total of 18 patients with distal tibial metaphyseal fractures, who underwent intramedullary nailing treatment with blocking screws between January 2012 and December 2014 and had a minimum follow-up of 1 year, were retrospectively reviewed for analysis. There were 7 patients with open fracture and 4 patients with intra-articular fracture. The location of the blocking screws was previously determined according to the fracture pattern. Moreover, the preoperative and postoperative angular alignment was measured. Patients received regular postoperative radiographic check-up, and the time-to-bone union and the incidence of nonunion were recorded. The clinical outcome was evaluated using the modified functional Kalstrom-Olerud score. RESULTS: All fractures healed completely without nonunion at an average of 17.7 weeks. The mean coronal/sagittal alignment improved from 6.4/4.8 degrees preoperatively to 2.5/1.9 degrees postoperatively. The alignment was maintained until complete union. There were 3 cases of anterior knee pain but no complications related to the blocking screw and wound infection. Using a modified functional Karlstrom-Olerud score, the outcome was considered good to excellent in 83.4% of the patient cohort. CONCLUSION: We conclude that the blocking screws may help the maintenance of reduction and alignment in distal tibial metaphyseal fractures treated with intramedullary nailing.

Treatment of Distal Tibia Fracture using MIPPO Technique with Locking Compression Plate: Comparative Study of the Intraarticular Fracture and Extraarticular Fracture / 대한족부족관절학회지

PURPOSE: To evaluate the efficiency of the minimally invasive percutaneous plate osteosynthesis (MIPPO) with locking compression plate (LCP) for distal tibial metaphyseal intra-articular fracture compared with extra-articular fracture. MATERIALS AND METHODS: From February 2006 to June 2008, 21 patients with distal tibia metaphyseal intra-articular fracture and 20 patients with extra-articular fracture were treated operatively by MIPPO technique with LCP and followed for at least one year. In the group with intra-articular fracture, mean age was 48.85 years old and a mean follow-up was 15 months. In the other group with extra-articular fracture, mean age was 52.35 years old and a mean follow-up was 14.5 months. The type of fracture was evaluated using the AO/OTA classification and open-fractures were according to the Gustilo-And gron classification. Radiologic evaluation with fracture healing and tibial alignment, clinical evaluation with Olerud and Molander ankle score and restriction of motion were done for treatment. RESULTS: According to AO/OTA classification, There were 21 type A, 15 type B, 5 type C. Average union time of the intra-articular fracture (type B, C) was 18.7 weeks. Average union time of the extra-articular fracture (type A) was 17.1 weeks. All fractures were healed without malunion. There were no difference of mean restriction angle between intra-articular fracture (ankle dorsiflexion was 3.57 degree, plantar-flexion was 5.95 degree) and extra-articular fracture (ankle dorsiflexion was 3 degree, plantar-flexion was 3.75 degree). There were no difference of Olerud and Molander ankle score between them as a mean score of intra-articular and extra-articular was 89.25, 91.25 each other. As a complication, there were 3 case of skin necrosis, 8 case of discomfortable skin tenting by plate and 1 superficial infection, but could be healed by conservative care. CONCLUSION: MIPPO technique, combined articular reduction, with LCP of distal tibial metaphyseal fracture was a good method with high functional recovery.

Lateral Plate Fixation of Distal Tibial Metaphyseal Fracture Using Minimally Invasive Plate Osteosynthesis Technique

PURPOSE: To evaluate the efficiency of lateral plate fixation using minimally invasive plate osteosynthesis (MIPO) technique as a treatment of distal tibial metaphyseal fracture. MATERIALS AND METHODS: Among the patient who were treated from March, 2002 to September, 2004, the cases of twenty patients with distal tibial metaphyseal fracture treated by lateral plate fixation using MIPO technique who were able to be followed up for at least one-year period were reviewed in this study. According to AO/OTA classification, five were type A1, twelve cases were type A2 and other three cases were type A3, and among them two cases were open fracture type I according to the Gustillo-Anderson classification. Radiologic studies and clinical assessment described by Daniel et al and complication following the treatment were evaluated. RESULTS: At a mean of 16.4 weeks (range 11 to 23), all fractures united without secondary procedures. According to clinical assessment, all cases had good and excellent result, and there were no complications. CONCLUSION: The lateral plate fixation using MIPO technique of distal tibial metaphyseal fracture is an efficient method of treatment with high functional recovery rate which minimize soft tissue damage, decreases the risk of infection and incidence of nonunion at the same time as the classic MIPO technique does, and it is a useful alternative method when there is a anteromedial soft tissue damage.

Minimally Invasive Plate Osteosynthesis for Distal Tibial Metaphyseal Fracture

PURPOSE: To retrospectively reviewed the outcomes and advantages of minimally invasive plate osteosynthesis (MIPO) technique as a new treatment of distal tibial metaphyseal fracture. MATERIALS AND METHODS: Nineteen distal tibial metaphyseal fractures were treated by MIPO technique and evaluated radiologically and functionally. A mean age was 46 years old (range 20~69 years) and a mean follow-up was 15 months (range 6~37 months). Sixteen fractures were not extended into ankle joint (AO/OTA type A1;4, A2;8, A3;4) and three fractures were extended into ankle joint (AO/OTA type C1;2, C2;1). Two cases were open fractures (type I;1, type III-A;1) according to the Gustilo-Anderson classification. RESULT: At a mean of 18 weeks (range 12 to 24), all fractures united without secondary procedures. A mean score was 94.2 point by Baird ankle scoring system. There were no complications including shortening over 1 cm, mal-alignment over 5 degrees, deep infection, or implant failure. CONCLUSION: MIPO technique of distal tibial metaphyseal fracture is a worthwhile method with good unions and functional recovery.