Fibula fixation in the treatment of tibial pilon fractures – Is it really necessary?

Hong, Choon Chiet; Tan, Si Heng Sharon; Saha, Soura; Pearce, Christopher J.

doi:10.1016/j.fas.2021.12.007

Cited by 12 publications

(6 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rouhani and coworkers found no difference in the outcome after tibial pilon fractures with compared to without fixation of the distal fibula in their retrospective study at two-year follow-up ( 53 ). These findings are further supported by multiple other authors ( 59 , 60 ). However, most studies are of retrospective character.…”

Section: Important Aspects Of Operative Treatmentsupporting

confidence: 88%

Treatment strategies for complex ankle fractures—current developments summarized in a narrative review

Mair,

Pflüger,

Hanschen

et al. 2023

Ann Transl Med

View full text Add to dashboard Cite

Background and Objective Ankle fractures occur frequently in patients throughout all ages. Due to the many pitfalls associated with their treatment, complex ankle and especially tibial pilon fractures remain a challenge for surgeons. As there is still need for improvement in treating complex ankle fractures and treatment options are steadily increasing this review aims to summarize current practice and aims to highlight current developments by reviewing the literature. Methods We conducted a thorough search of PubMed database in December 2022 to identify relevant articles on complex ankle and tibial pilon fractures. Articles in English and German were included in this study. Key Contents and Findings Complication rates, especially wound infection are still high, emphasizing the need for careful preoperative planning. Soft tissue management is crucial to reduce complication rates and will often dictate the treatment plan utilized. Open reduction and internal fixation (ORIF) remains the treatment of choice. Nevertheless, in select cases alternative methods such as external fixation, tibiotalocalcaneal nailing or conservative treatment need to be considered as well. Furthermore, additional treatment options such as arthroscopically assisted surgery might help to improve functional outcome after complex ankle fractures. The incidence of complex ankle fractures in geriatric patients keeps rising with our aging population. This group of patients demands particular care and further high-quality studies are needed to warrant best results. Conclusions However, more randomized controlled trials are need in order to enhance evidence of newly developed treatment options.

show abstract

Section: Important Aspects Of Operative Treatmentsupporting

confidence: 88%

Treatment strategies for complex ankle fractures—current developments summarized in a narrative review

Mair,

Pflüger,

Hanschen

et al. 2023

Ann Transl Med

View full text Add to dashboard Cite

show abstract

“…In the presence of significant comminution or when there is difficulty in obtaining reduction of the distal tibia, reduction and fixation of the fibula may be used as a gauge to determine appropriate length and rotation and hence is thought to improve alignment and rotation. However, there is no clear consensus on the role of fibula fixation in distal tibia fractures with conflicting studies demonstrating improved rotational alignment 19 and varus/valgus alignment 20 to having no differences in mechanical complications 21 . In our series, while the mean rotational deformity was less for the MIPO fibula group, this could have been due to surgeons opting to perform MIPO fixation of the fibula if they were confident of obtaining good reduction of the tibia fracture without using the fibula fixation as a guide.…”

Section: Discussionmentioning

confidence: 99%

Lower Limb Malrotation following Minimally Invasive Plating in Distal Tibia Fractures

WMQ,

JW,

MJJR

et al. 2024

Malays Orthop J

View full text Add to dashboard Cite

Introduction Minimally invasive percutaneousosteosynthesis (MIPO) plating techniques havedemonstrated good outcomes in the treatment of distal tibia fractures. Early arthritis and functional impairment mayoccur if length and rotation are not restored. This study aims to determine the incidence and severity of tibia malrotation following MIPO plating of isolated unilateral distal tibia fractures, defined as torsional difference of greater than 10° as compared to the contralateral limb and whether the degree of malrotation affects functional outcomes scores. Materials and methods This was a level 2 prospective cohort study. All patients with fractures of the distal tibia who underwent surgical fixation with the exclusion ofpatients with polytrauma, neurovascular injuries or pre-existing disabilities were recruited. Patients underwent MIPO plating followed by a post-operative ComputedTomography (CT) scan of bilateral lower limbs. AOFAS ankle-hindfoot score was recorded at six months and one year follow-up. Results A total of 24 patients (28 to 83 years old) were recruited. Nineteen patients obtained CT scans. Nine of the 19 patients (47.3%) had tibia malrotation. The mean tibia malrotation angle was 10.3° (0° - 45°). The average AOFAS scores was 82.4 and 84.3 at 6 months and 1 year follow-up. Degree of CT malrotation was not significantly associated with AOFAS scores at 6 month (spearman rho -0.386) and 1 year (spearman rho -0.343). Conclusions Tibia malrotation following MIPO plating of distal tibia fractures is common, with an incidence of 47.3% and an average malrotation angle of 10.3°. The degree of malrotation does not appear to have significant mid-term functional impact on the patient.

show abstract

“…In 2021, a study of 76 patients by Hong C. C. et al noted that patients without fibula fixation have more wound complications (44% vs. 25.9%, p = 0.108). A larger sample size may lead to statistically significant conclusions [ 41 ]. We believe that, with a large sample size cohort study, the necessity of internal fixation of fibular fractures will be reconsidered.…”

Section: Discussionmentioning

confidence: 99%

Early Reduction of the Posterior Column: A Surgical Technique in AO/OTA C3 Tibial Pilon Fractures

Gao

Zhu

Guo

et al. 2023

JPM

View full text Add to dashboard Cite

Staged treatment for pilon fractures is widely accepted. It remains to be discussed how to reduce and fix posterior column fractures while avoiding clinical complications. We provided a staged treatment protocol with detailed surgical techniques for closed AO Foundation/Orthopaedic Trauma Association (AO/OTA) C3 tibial pilon fractures with fibular fractures. In the first stage, the internal fixation of the fibula and distal tibial posterior column is accompanied by an external fixator. After swelling, the medial and anterior columns were fixed via the posteromedial approach in the second stage. We advocate early reduction and fixation of the posterior column and lateral column. The right timing of surgery can ensure well-reduced articular surface and alignment while minimizing soft tissue complications.

show abstract

Fibula fixation in the treatment of tibial pilon fractures – Is it really necessary?

Cited by 12 publications

References 15 publications

Treatment strategies for complex ankle fractures—current developments summarized in a narrative review

Treatment strategies for complex ankle fractures—current developments summarized in a narrative review

Lower Limb Malrotation following Minimally Invasive Plating in Distal Tibia Fractures

Early Reduction of the Posterior Column: A Surgical Technique in AO/OTA C3 Tibial Pilon Fractures

Contact Info

Product

Resources

About