Techniques for the Surgical Treatment of Distal Tibia Fractures

Richard, Raveesh D.; Kubiak, Erik N.; Horwitz, Daniel S.

doi:10.1016/j.ocl.2014.04.001

Cited by 56 publications

(47 citation statements)

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“…These fractures are most often high energy fractures resulting from axial and rotational force on distal tibia. [1][2][3][4] There are multiple studies in the literature comparing various modalities of treatment for distal tibial fractures. The various treatment options include plating, Nailing, AO external fixation, Ilizarov fixation to conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Giving more importance to anatomical reduction and ignoring often injured soft tissues has led to poor outcomes and high complication rates. [1][2][3][4] Multiple methods of treatment are available for managing these fractures. Although multiple options are described to treat these fractures, there is no consensus on the best method of treatment.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of distal tibia fractures: plating versus intramedullary nailing

2016

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Background: Distal tibia shaft fractures pose significant challenge to treating surgeons. Giving more importance to anatomical reduction and ignoring often injured soft tissues has led to poor outcomes and high complication rates. Although multiple options are described to treat these fractures, there is no consensus on the best method of treatment. We hereby want to study the results of distal tibia fractures treated by expert tibia nailing and distal tibia plating.Methods: This study was undertaken in patients who were operated in between January 2012 to March 2015 at M S Ramaiah Teaching Hospital, which is a tertiary care hospital in Bangalore. Study included 52 patients with distal tibia fracture treated by surgery. All the fractures were closed distal diaphyseal fractures without articular involvement. Thirty two patients underwent expert tibia nailing whereas 20 patients were treated with open reduction and internal fixation with locking plates. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year.Results: Fifty two patients included in study and they were divided into two groups as nailing group and plating group. Plating group included 20 patients whereas nailing group included 32 patients. The mode of injury was road traffic injury in 32 cases , followed by self-fall in 17 cases and sports related injury in 3 cases. Distal tibia fracture was associated with in 29 patients (87%) of nailing group whereas in 17 patients (80) of plating group. Average distance of fracture from pilon was 6 cm in nailing group and 3cm in plating group. The average duration of surgery in nailing was group was 88 minutes (range, 65-130 minutes) whereas average duration of surgery in plating group was group was 92 minutes (range, 70-130 minutes). The average time for union was 16 weeks for nailing group and for plating group it was 18 weeks. Conclusions: Both intramedullary nailing and plating are the optimal methods of treatment. Plating is preferred in cases where fracture is close to pilon whereas intramedullary nailing is preferred for fractures away from tibial pilon. There is no significant difference between union and complication rates.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of distal tibia fractures: plating versus intramedullary nailing

2016

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“…Screening should be done for factors including smoking, diabetes mellitus, peripheral vascular disease, malnutrition, osteoporosis, peripheral neuropathy and excessive alcohol intake. Such factors are associated with an increased risk of infection and fracture non-union and can ultimately affect surgical management (Richard et al, 2014).…”

Section: Primary Management In the Emergency Departmentmentioning

confidence: 99%

Textbook of Plastic and Reconstructive Surgery

Butler¹,

Ghali²,

Kalaskar³

2016

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A CIP catalogue record for this book is available from The British Library.This book is published under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International license (CC BY-NC-ND 4.0). This license allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licenses are available at http://creativecommons.org/ licenses/by/4.0The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. The user is advised to always check the product information and clinical procedures with the most up-to-date published product information and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or misuse or misapplication of material in this work.ISBN: 978-1-910634-37-0 (Hbk.) ISBN: 978-1-910634-38-7 (Pbk.) ISBN: 978-1-910634-39-4 (PDF) ISBN: 978-1-910634-40-0 (epub) ISBN: 978-1-910634-41-7 (mobi)

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“…Open reduction and internal fixation [ORIF] with plates and screws achieves stability, allows joint mobilization but does not allow early weight bearing which as a stimulus is a must for early union [5] . Minimally invasive percutaneous plate osteosynthesis [MIPPO], shows high rate of healing and low rate of soft-tissue complications [6,7] . Close intramedullary nailing [IMN ] preserves extra osseous blood supply, doesn't disturb fracture haematoma and maintains the integrity of soft tissue envelope, allows early weight bearing [2] , but it compromises the intramedullary blood supply and in open fractures increases the risk of infection [8,9,10] .…”

Section: Introductionmentioning

confidence: 99%

“…Close intramedullary nailing [IMN ] preserves extra osseous blood supply, doesn't disturb fracture haematoma and maintains the integrity of soft tissue envelope, allows early weight bearing [2] , but it compromises the intramedullary blood supply and in open fractures increases the risk of infection [8,9,10] . IMN has been recommended in management of closed fractures and Gustilo I and II tibial shaft fractures [11,10,12,13,14,6] . Few reports have described uniplanar and biplanar external fixator in treatment of close tibial shaft fractures.…”

Section: Introductionmentioning

confidence: 99%

Role of Ilizarov ring fixator in definitive management of tibia shaft fractures: A prospective observational study of 50 cases

Dwivedi¹,

Rathva²,

Patel³

2017

Int. J. Orthop. Sci.

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Introduction: Tibia shaft fractures can be treated with various modes, each having its merits and demerits. The aim of our study was to analyze clinical outcome of Ilizarov technique in patients with tibia shaft fracture. Method: 50 patients with isolated tibia shaft fracture treated with Ilizarov external fixator were followed prospectively for one year. Depending upon the level of fracture 4 or 5 rings were used. Weight bearing as per patient pain tolerance was allowed within 24 to 48 hours. The decision of frame removal was taken based on Ramos criteria. The function was evaluated based on Johner and Wruh's criteria. Results: According to Johner and Wruh's criteria, 34 patients had excellent, 12 patients had good and 4 patients had fair results. No poor results were noted. There was no case of re-operation and re-fracture. Pin-site infections were seen in 14% cases but there were no deep infections. Conclusion: Ilizarov technique can be used as an early definitive management in tibia shaft fractures with excellent clinical outcome.

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Techniques for the Surgical Treatment of Distal Tibia Fractures

Cited by 56 publications

References 55 publications

Treatment of distal tibia fractures: plating versus intramedullary nailing

Treatment of distal tibia fractures: plating versus intramedullary nailing

Textbook of Plastic and Reconstructive Surgery

Role of Ilizarov ring fixator in definitive management of tibia shaft fractures: A prospective observational study of 50 cases

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