ABSTRACT
PURPOSE OF THE STUDY: This study was a retrospective analysis of 39 proximal metaphyseal tibial fractures treated by Orthofix fixator in two trauma departments. MATERIAL AND METHOD: There were 28 men and 10 women with a mean age of 49.5 years. 13 pedestrians were stroked by a car and 18 had a traffic accident on a motorcycle. In 27 cases, the fracture was open with following Cauchoix grading: 15 types 2, 6 types 1 and 6 types 3. All fractures were partially or totally included in the proximal epiphyseal square of the AO system. 14 fractures were metaphyseal, 13 diaphyso-metaphyseal and 12 had an articular irradiation. All external fixations were performed using the Orthofix device, with image intensification. A partial weight bearing was allowed for 2.4 months as an average and full weight bearing at mean 3.7 months. 7 skin grafts, 2 micro surgical (latissimus dorsi) and 2 local flaps were necessary. RESULTS: In 3 patients this technique failed. 3 patients had an autologous bone graft at the metaphyseal and 2 at the diaphyseal fracture site. 30 patients healed without other procedure after an average delay of 5.5 months. During the healing and weight bearing time, 6 frontal deformities appeared and 5 flexion contractures were not reoperated. With a minimum follow up of one year (mean 3 years) 22 fractures had no deformity, 8 had a valgus deformity (5 degrees to 10 degrees) and 3 a varus deformity (6 to 17 degrees). For the 25 patients with an isolated proximal tibial fracture, 11 (44%) had an excellent functional result (no pain, full range knee motion, normal daily activity); 12 (48%) had a good result (episodic pain, minimally knee discomfort, flexion limitation). DISCUSSION: Orthofix fixator appear to be a good solution for comminuted fractures. These fractures have anatomical and epidemiological particularities. AO classification system is not useful; a new one is proposed. External fixator must be placed meticulously after closed fracture reduction.
Subject(s)
External Fixators , Tibial Fractures/surgery , Accidents, Traffic , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Fracture Fixation/methods , Humans , Male , Middle Aged , Prognosis , Pseudarthrosis/etiology , Range of Motion, Articular , Retrospective Studies , Tibial Fractures/classification , Tibial Fractures/etiologyABSTRACT
UNLABELLED: Hindfoot stabilization can be obtained by an isolated talonavicular arthrodesis as well as a triple arthrodesis. MATERIAL: There were 27 cases of unstable neurological foot, 13 cases of Rhumatoid foot, 7 cases of flat feet and 3 cases of post-trauma arthritis of the talonavicular joint. The procedure was, in all cases, a talonavicular arthrodesis, associated in some cases to a lengthening of the Achilles tendon, tendon transfer and forefoot correction. METHOD: 50 cases were reviewed with a mean follow-up of 40 months. RESULTS: There were 18 per cent cases of non-union. This could be explained by 2 technical errors: bad cartilagenous resection of the surfaces and unstable bone fixation. No subtalar mobility was noted in all cases. Only one case had a midtarsal mobility associated to a non-union. 39 feet had a normal heel axation. In most cases functional improvement was significant with a painless gait. DISCUSSION: Hindfoot stabilization can be obtained by an isolated talonavicular arthrodesis. Non-union could be avoided by a better surgical technique and a cast immobilization of 2 and a half months. The pre-operative deformities should be reduced manually, because isolated fixed valgus and varus can not be corrected by an isolated talonavicular arthrodesis. In conclusion, the indications are: An early valgus deformity of the hindfoot in rhumatoid arthritis. The aim is to avoid a fixed valgus deformity. Neurological induced equino varus deformities specially after stroke and other reducible neurological deformities. Flat foot due to posterior tibialis insufficiency. Isolated arthritis of the talonavicular joint.