Fracturas metafisarias de tibia distal: analisis comparativo de los resultados obtenidos mediante placa bloqueada y clavo intramedular / Metaphysary fractures of the distal tibia: Comparative analysis of the results obtained by means of a blocked plate and intramedular nail

Introducción Las fracturas del tercio distal de tibia son en su mayoría consecuencia de un traumatismo de alta energía con importante afectación de partes blandas siendo mas frecuentes en varones. Este tipo de fracturas se diferencian de la fractura articular de pilón tibial en su mecanismo de lesión, manejo y pronóstico. El objetivo del presente estudio fue analizar y comparar los resultados obtenidos en el tratamiento de las fracturas de tercio distal de tibia sin extensión articular mediante placa bloqueada y clavo intramedular. Material y métodos: Realizamos un estudio retrospectivo en el que se incluyeron todos los pacientes con diagnostico «fractura de tercio distal de tibia» segmento 43A según la clasificación propuesta por «Trauma Orthopedic Association» intervenidos entre enero del 2015 y mayo del 2019. Obtuvimos 24 pacientes intervenidos mediante clavo intramedular y 29 mediante placa bloqueada. Resultados: La muestra incluyó 53 pacientes (36 varones y 17 mujeres) con una media de edad de 51 años (rango: 15-77 años). El tiempo de seguimiento medio fue de 6 meses (3-30 meses). No se hallaron diferencias significativas en el tiempo de consolidación de la fractura, aunque el inicio de la deambulación con carga fue mas temprano en el grupo clavo. Discusión: En la actualidad no existe consenso acerca del manejo terapeútico de las fracturas distales de tibia sin extensión articular. Conclusiones: Dados los resultados obtenidos consideramos que tanto la osteosíntesis con clavo intramedular como con placa bloqueada son opciones válidas en el tratamiento de las fracturas del tercio distal de tibia.(AU)

Introduction: Fractures of the distal third of the tibia are mostly the consequence of high-energy trauma with significant soft tissue involvement, being more frequent in men.These types of fractures differ from the tibial pilon joint fracture in their mechanism of injury, management and prognosis. The objective of the present study was to analyze and compare the results obtained in the treatment of fractures of the distal third of the tibia without joint extension using a locked plate and intramedullary nail. Material and methods: We carried out a retrospective study with patients diagnosed of “distal third tibia fracture” segment 43A according to the classification proposed by the “Trauma Orthopedic Association” who were intervened between January 2015 and May 2019 were included. We obtained 24 patients intervened with a nail intramedullary and 29 using a blocked plate. Results: The study included 53 patients, 36 men and 17 women with a mean age of 51 years (range: 15-77 years). The mean follow-up time was 6 months (3–30 months). No significant differences were found in the time to fracture healing, although the beginning with load walking was earlier in the nail group. Discussion: Currently there is no consensus on the therapeutic management of distal tibia fractures without joint extension. Conclusions: After analyzing the results, we consider that both intramedullary nail osteosynthesis and a locked plate are valid options in the treatment of fractures of the distal third of the tibia.(AU)

Metaphysary fractures of the distal tibia: Comparative analysis of the results obtained by means of a blocked plate and intramedular nail / Fracturas metafisarias de tibia distal: Análisis comparativo de los resultados obtenidos mediante placa bloqueada y clavo intramedular

Introduction: Fractures of the distal third of the tibia are mostly the consequence of high-energy trauma with significant soft tissue involvement, being more frequent in men.These types of fractures differ from the tibial pilon joint fracture in their mechanism of injury, management and prognosis. The objective of the present study was to analyze and compare the results obtained in the treatment of fractures of the distal third of the tibia without joint extension using a locked plate and intramedullary nail. Material and methods: We carried out a retrospective study with patients diagnosed of “distal third tibia fracture” segment 43A according to the classification proposed by the “Trauma Orthopedic Association” who were intervened between January 2015 and May 2019 were included. We obtained 24 patients intervened with a nail intramedullary and 29 using a blocked plate. Results: The study included 53 patients, 36 men and 17 women with a mean age of 51 years (range: 15-77 years). The mean follow-up time was 6 months (3–30 months). No significant differences were found in the time to fracture healing, although the beginning with load walking was earlier in the nail group. Discussion: Currently there is no consensus on the therapeutic management of distal tibia fractures without joint extension. Conclusions: After analyzing the results, we consider that both intramedullary nail osteosynthesis and a locked plate are valid options in the treatment of fractures of the distal third of the tibia.(AU)

Introducción Las fracturas del tercio distal de tibia son en su mayoría consecuencia de un traumatismo de alta energía con importante afectación de partes blandas siendo mas frecuentes en varones. Este tipo de fracturas se diferencian de la fractura articular de pilón tibial en su mecanismo de lesión, manejo y pronóstico. El objetivo del presente estudio fue analizar y comparar los resultados obtenidos en el tratamiento de las fracturas de tercio distal de tibia sin extensión articular mediante placa bloqueada y clavo intramedular. Material y métodos: Realizamos un estudio retrospectivo en el que se incluyeron todos los pacientes con diagnostico «fractura de tercio distal de tibia» segmento 43A según la clasificación propuesta por «Trauma Orthopedic Association» intervenidos entre enero del 2015 y mayo del 2019. Obtuvimos 24 pacientes intervenidos mediante clavo intramedular y 29 mediante placa bloqueada. Resultados: La muestra incluyó 53 pacientes (36 varones y 17 mujeres) con una media de edad de 51 años (rango: 15-77 años). El tiempo de seguimiento medio fue de 6 meses (3-30 meses). No se hallaron diferencias significativas en el tiempo de consolidación de la fractura, aunque el inicio de la deambulación con carga fue mas temprano en el grupo clavo. Discusión: En la actualidad no existe consenso acerca del manejo terapeútico de las fracturas distales de tibia sin extensión articular. Conclusiones: Dados los resultados obtenidos consideramos que tanto la osteosíntesis con clavo intramedular como con placa bloqueada son opciones válidas en el tratamiento de las fracturas del tercio distal de tibia.(AU)

Metaphysary fractures of the distal tibia: Comparative analysis of the results obtained by means of a blocked plate and intramedular nail. / Fracturas metafisarias de tibia distal: analisis comparativo de los resultados obtenidos mediante placa bloqueada y clavo intramedular.

INTRODUCTION: Fractures of the distal third of the tibia are mostly the consequence of high-energy trauma with significant soft tissue involvement, being more frequent in men. These types of fractures differ from the tibial pilon joint fracture in their mechanism of injury, management and prognosis. The objective of the present study was to analyze and compare the results obtained in the treatment of fractures of the distal third of the tibia without joint extension using a locked plate and intramedullary nail. MATERIAL AND METHODS: We carried out a retrospective study with patients diagnosed of "distal third tibia fracture" segment 43A according to the classification proposed by the "Trauma Orthopedic Association" who were intervened between January 2015 and May 2019 were included. We obtained 24 patients intervened with a nail intramedullary and 29 using a blocked plate. RESULTS: The study included 53 patients, 36 men and 17 women with a mean age of 51 years (range: 15-77 years). The mean follow-up time was 6 months (3-30 months). No significant differences were found in the time to fracture healing, although the beginning with load walking was earlier in the nail group. DISCUSSION: Currently there is no consensus on the therapeutic management of distal tibia fractures without joint extension. CONCLUSIONS: After analyzing the results, we consider that both intramedullary nail osteosynthesis and a locked plate are valid options in the treatment of fractures of the distal third of the tibia.

Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures. / Tratamiento de las fracturas intraarticulares de calcáneo mediante placa de reconstrucción. Resultados y complicaciones de 86 fracturas.

OBJECTIVE: To evaluate the results of surgical treatment of intraarticular calcaneal fractures, and also to analyze the variables that influence the final clinical and radiological outcomes as well as the complications. MATERIAL AND METHODS: We retrospectively analyzed 86 intraarticular calcaneal fractures in 78 patients, who underwent surgery with an extended lateral approach and reconstruction plate. The mean age was 48 years (16-74 years) and the mean follow-up was 4.6 years (9-99 months); 54 patients (69.2%) suffered falls from less than 3m in height or banal injuries and 24 patients (30.8%) falls from more than 3m in height or high energy-accidents. According to the Sanders classification we operated 12 (15%) typeII, 54 (62.8%) typeIII and 20 (23.2%) typeIV fractures. RESULTS: The postoperative mean AOFAS score was 73.9 points, with good or excellent results in 57% of the patients. Twelve cases (14%) suffered surgical wound complications and 11 (12.8%) required subtalar arthrodesis. Significantly better results were obtained in the patients younger than 30 years old, patients that fell from less than 3m in height and patients with Sanders fractures types II and III compared to typeIV, which were associated with higher rate of subtalar arthrodesis. CONCLUSIONS: We consider that open reduction and internal fixation of intraarticular fractures of the calcaneus with reconstruction plate is a valid treatment alternative. Given the complications described and the secondary subtalar arthrodesis rate, we recommend a meticulous technique carried out by experienced surgeons.