Abstract
Background: Distal one-third tibial fractures with or without articular involvement can be difficult to manage. Variety of treatment methods have been suggested for these injuries, including conservative treatment, external fixation with or without limited internal fixation, intramedullary nailing, plate fixation (medial or anterolateral) and more recently minimally invasive plate osteosynthesis (MIPO). All of these techniques have advantages and disadvantages. None of these techniques can be considered the “gold standard” for these injuries.
Objective: The objective of this prospective study was to evaluate the results of anterolateral plating of these fractures.
Result: We studied the outcome of 30 consecutive patients with closed distal tibial fractures using anterolateral plating. We followed patients for one year. All the fractures united. The average to union was 17.2 weeks One patient had limb length shortening of more than one cm (1.5 cm). Two patients developed superficial wound infection and one patient developed deep infection. Three patients had ankle stiffness and three had painless palpable implant. The average AO Foot and Ankle score was 84. 2 in our study.
Conclusion: We concluded distal one-third tibial fractures with or without articular involvement can be treated with anterolateral tibial plate.
Keywords: Anterolateral, Distal, Fracture, Plating, Tibia.
References
- Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P, Mainard D, Vix N, Dehoux E. Distal tibia fractures: management and complications of 101 cases. Int Orthop. 2010 Apr;34(4):583-8.
- Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M. Treatment of distal tibia fractures without articular involvement: a systemic review of 1125 fractures. J Orthop. Trauma. 2006 Jan,20(1):76-9.
- Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D. Tibial pilon fractures : A review of incidence, diagnosis, treatment, and complications. Acta Orthop. Belg. 2011;77:432-40.
- Ronga M, Longo UG, Maffulli N. Minimally Invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat. Res. 2010;468:975-82.
- Maffulli N, Toms AD, McMurtie A, Oliva F. Percutaneous plating of distal tibial fractures. International Orthopaedics (SICOT). 2004;28:159-62.
- Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate ostheosynthesis in distal tibia fractures. International Orthopaedics (SICOT). 2008;32:697-703.
- Shrestha D, Acharya BM, Shrestha PM. Minimally invasive plate osteosynthesis with locking compression plate for distal diametaphyseal tibia fracture. Kathmandu Univ Med J (KUMJ). 2011 Apr-Jun;9(34):62-8.
- Vallier HA, Cureton BA, Patterson BM. Factors influencing functional outcomes after distal tibia shaft fractures. J Orthop Trauma. 2012 March;26(3):178-83.
- Janssen KW, Biert J, Kampen AV. Treatment of distal tibial fractures: plate verusu nail. International Orthopaedics (SICOT). 2007;31:709714.
- Li Y, Liu L, Tang X, Pei F, Wang G, Fang Y, Zhang H, Crook N. Comparision of low multidirectional locked nailing and plating in the treatment of distal metadiaphysel fractures. Int Orthop. 2012 jul;37(7):1457-62.
- Ehlinger M, Adam P, Gabrion A, Jeunet L, Dujardin F, Asencio G, Sofcot. Distal quarter leg fractures fixation: The intramedullary nailing alone option. Orthopaedics & Traumatology: Surgery & Research. 2010;95:674-82.
- Paraschou S, Bekir H, Anastasopoulos H, Papapanos A, Alexopoulos J, Karanikolas J, Karanikolas, Roussis N. Evaluation of interlocking intramedullary nailing in distal tibial fractures and nonunions. Acta Orthop Traumatol Turc. 2009;43(6):472-77.
- Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomized trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010 Jul;92(7):984-8.
- Borelli J Jr et al: Extra osseus blood supply of the tibia and the effects of different plating techniques : a human cadaveric study, J Orthop Trauma16(10):691-695.
- Mario Ronga et al: Minimally invasive locked plating of distal tibial fractures is safe and effective Clin Orthop and Relat Res(2010) 468:975-982.
- Bahari S, Lenehan B, Khan H, McElwain JP (2007) Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg 73:635–640.
- Histane Niki et al: Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders: development of standard rating system, J Orthop Sci (2005)10:457-465.
- Hon g Goa MD et al: Fractures of distal tibia treated with polyaxial locking plating, Clin Orthop and Relat Res 2009;467:831-837.
- Nicola Maffulli. Andrew D. Toms et al: Percutaneous plating of distal tibial fractures, International Orthopedics 2004;28:159-162. of distal metaphyseal tibial fractures, Journal of Bone and Joint Surgery Am 2005;87:1213-1221
- Sirkin MS. Plting of tibial pilon fractures. Am J Orthop. 2007;36(12 suppl):13-7
- Hooper GJ, keddell RG, Penny ID. Conservative management or closed nailing for tibial shaft fractures. J Bone Joint Surg Br. 1991;73-B:83-5.
- Vallier HA, Cureton BA, Patterson BM. Factors influencing functional outcomes after distal tibia shaft fractures. J Orthop Trauma. 2012 March;26(3):178-83.
- Paraschou S, Bekir H, Anastasopoulos H, Papapanos A, Alexopoulos J, Karanikolas J, Karanikolas, Roussis N. Evaluation of interlocking intramedullary nailing in distal tibial fractures and nonunions. Acta Orthop Traumatol Turc. 2009;43(6):472-77.
- Shon OJ, Aprk CH. Minimally invasive plate osteosynthesis of distal tibial fractures: a comparison of medial and lateral plating. J Orthop Sci. 2012 Sep;17(5):562-6.
- Yenna ZC, Bhadra AK, Ojike NI,. SjajullHameed A, Burden RL, Voor MJ, Roberts CS. Anterolateral and medial plate stiffness in distal tibial fracture model. Foot Ankle Int. 2011 Jun;32(6):630-7.
- Shantharam SS, Naeni F, Wilson EP. Single-incision technique for internal fixation of distal tibia and fibula fractures. Orthopedics. 2000 May;23(5):429-31.
- Lee YS, Chen SH, Lin JC, Chuang CR, Chen YO, Huang CR, Cheng CY. Surgical treatment of distal tibia fractures: A comparison of medial and lateral plating. Orthopedics. 2009 March;32(3):163.
- Manninen MJ, Lindahl J, Kankare J, Hirvensalo E. Lateral approach for fixation of the fractures of the distal tibia. Outcome of 20 patients. Technical note. Arch Orthop. Trauma Surg. 2007 Jul;127(5):349-53.
- Dickson KF, Montgomery S, Field J. High energy plafond fractures treated by a spanning external fixator initially and followed by a second stage open reduction internal fixation of the articular surfacepreliminary report. Injury. 2001 Dec;32(4):92-8.
Corresponding Author
Ajaz Ahmad Bhat
Medical Officer, Department of Health, J&K.
DOI: https://dx.doi.org/10.18535/jmscr/v7i12.118
