Abstract
Tibial fractures with compromised soft tissue envelop May lead to significant complications and optimal management of these injuries is still controversial. The use of a locking plate as an external fixator appears to be an attractive option because it not only minimizes injury to soft tissue, but also overcome some of the disadvantages of standard external fixators. The purpose of this study is to evaluate the results of external fixation using the locking plates in tibial fractures. In this study prospectively evaluated 17 patients (13 males and 4 females] with an age of 40.7 years who presented with fresh tibial fractures. According to Gustilio classification, grade IIIB injury in cases, grade IIIA in 2 cases, grade II injuries in 6 cases and 7 cases had closed injuries with skin blebs. Locking plates were used to fix these fractures which were placed on the anteromedial aspect of tibia as an external fixator. The mean follow up period was 10 months. In all patients the plate was left in place till 6 weeks after full healing was obtained clinically and radigraphically. All fractures healed in a mean period of 19 weeks. There was one case on non union which subsequently healed with skin grafting. There was no case of infection or any failure of hard ware. The skin sees to tolerate the screws well and even seems to tolerate the screws well and even seems to adhere to the screw. At the latest follow up at a 12month period, all the patients were fully recovered weight bearing with a well healed tibia and good range of motion of knee and ankle. It is believed that the supra-cutaneous locking plate technique is an effective procedure for treatment of tibial fractures in patients who need a long period of external fixation, ankle sparing stable fixation with good reduction is achieved immediately. Soft tissue reconstruction where ever is necessary, lead to union of all fractures with good action.
Keywords: Tibia, Fracture, Locking plates, Fixator, Clinical outcome.
References
- Mills WJ, Nork SE, Open reduction and internal fixation of high energy tibia plateau fractures. Orthop Clin North Am 2002;33(ix)”177-98.
- Perry CR, Evans LG, Rice S, Fogarty J, Burdge RE. A new surgical approach to fractures of the lateral tibial plteau. J Bone Joint Surg Am 1984;66:1236-40.
- Sirkin M, Sanders R, Dipasquale T et al. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 1999 13(2):78-84.
- Tejwani NC, Achan P (2004) staged management of high energy proximal tibia fractures. Bull Hosp jt Dis 62(1-2):62-66.
- Marsh JL, Bonar S, Nepola JV et al. Use of an articulated fixator for fractures of the tibial plafond. J Bone Surg (Am), 1995;77:1498-509.77(5):661-673.
- Watson JT, Moed BR, Karges DE, Cramer KE (2000). Pilon fractures. Treatment protocol based on severity of soft tissue injury. Clin Orthop Relat Res 375:78-90.
- Ma CH, Wu CH, Yu SW, Yen CY, Tu YK (2010). Staged and internal less invasive e stabilization system plating for open proximal tibial fractures. Injury 41(2): 1990-196.
- Ma CH, Yu SW, Yen CY, Tu YK,Yen CY, Wu CH (2010). Staged external and internal locked plating for open distal tibial fractures. Acta Orthop 81(3):382-386.
- Ma CH, Tu YK, Yeh SC, Yang SC, Wu CH (2011) Using external and internal locking plates in a two stage protocol for treatment of segmental tibial fractures. J Trauma 71(3):624-619.
- K Venkatesh Gupta, Shyam Prasad Parimala. supracutaneous locking compression plate for grade I & II Compound fracture distal tibia- A case series. Open journal of orthopedics, 2013, vol.02(02),pp.106-109.
- Hansmann C: Eine neue moglichkeit der Fixierung derf Fragmente bei komplizierten Frakturen. Verh. Dtsch. Ges. Chir., 158,1886.
- Tulner S A 1, Strackee SD, Kloen P. Metaphyseal locking compression plate as an external fixator for the distal tibia. Int Orthop. 2012. Sep;36(9):1923-7.
- Zhang JI, Ebraheim N2, Li M1, He X1, Liu J1, Yu Y1. External fixation using femoral less invasive stabilization system plate in tibial proximal metaphyseal fracture. Clin Orthop Surg. 2015 Mar: 7(1):8-14.
- He X, Zhang J, Li M, Yu Y, Zhu L. Treatment of segmental tibial fractures with supracutaneous plating. Orthopedics. 2014: Aug;37(8):e712-6.
- Colin YL Woon, Merng-Koon Wong, Tet-Sen Howe. LCP external fixation- External application of an internal fixator: two cases and a review of the literature. J Orthop Surg Res 2010:5;19.
- Ziran BH, Smith WR, Anglen JO, Tornetta P III: External fixation: How to make it work. J Bone Joint Surg Am 2007,89:1619-32.
- Ma CH1, Wu CH, Tu YK, Lin TS. Metaphyseal locking plate as a definitive external fixator for treating open tibial fractures –clinical outcome and a finite element study. Injury 2013. Aug;44(8):1097-101.
- He X1, Zhu L2, Zhang J2, Li M2, Yu Y2. Curative efficacies of mini-invasive percutaneous osteosynthesis versus supercutaneous plating of distal tibial fractures.(article in Chinese language). Zhinghua Yi Xue Za Zhi. 2014 Dec 30;94(48): 3826-30.
Corresponding Author
Dr Sreedhar Rakasi
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile No: 9949043225
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.195
