Fractures of distal tibia indirect screws fixation of Tibia through fibular plate

ABSTRACT

Distal tibial fractures are becoming more and more common because of increased incidence of high velocity injuries. Outcome of such fractures is generally not satisfactory when associated with soft tissue injuries especially at the anteromedial aspect. Mechanism of injury varied between low and high energy injury, the aim of this work is assessment of treatment of a group of fracture distal tibia. Fifteen patients were assessed during the period of 2003 - 2005. All patients were classified as AO type A. All patients had anteromedial soft tissue injuries [e.g. severe abrasion, contused wound, swelling, ecchymosis and blisters]. Mode of treatment was wound debridement and open reduction and internal fixation of the fibula with pre- contoured plate and screws. Under fluoroscopic control, closed reduction of tibial fractures and indirect fixation by long transverse screws extended to the proximal and distal fragments of tibia through the fibular plate. All cases were done on the same day of injury. Of 15 patients, 12 fractures united with congruent ankle joint with average healing time [12-15 weeks], two patients had mild varus deformity and one had posterior sagging. Of all 15 patients no infection, no metal failure and no delayed union or non union were detected. Early ankle mobilization and non weight bearing started on the 2[nd] day of surgery. Full weight bearing was allowed only after bone consolidation of tibial and fibular fractures and not before removal of the long transverse tibial screws and its changing with short screws to fibula only. Limited internal screw fixation of the tibia through the fibular plate provides good alignment, articular congruence and avoids complications associated with other treatment options