Title: Minimally Invasive Plating of High-Energy Metaphyseal Distal Tibia Fractures
Authors: Cory Collinge, MD, Mark Kuper, DO, Kirk Larson, RNFA, and Robert Protzman, MD
Source: Journal of Orthopedic Trauma, April 2007 20(6): 355-361.
PODIATRIC RELEVANCE:
Treatment of metaphyseal injuries of the distal tibia include open plating, external fixation, and intramedullary nailing. This study evaluated clinical results and outcomes of high energy metaphyseal distal tibia fractures with minimal or no intraarticular involvement.
METHODS:
A retrospective analysis of consecutive case series was used to evaluate the treatment of 26 patients with high energy metaphyseal distal tibia fractures. Patients were followed for 36 months on average. A minimally invasive plating technique was used to stabilize and align fractures. Revision surgeries were performed if the fractures took more than three months to heal. Clinical and radiographic results were assessed at a minimum of 1 year. Clinical outcomes were assessed at final follow up using American Orthopedic foot and ankle surgeons ankle hindfoot instrument Olerud and Molander’s ankle score, and a Short Form-36.
RESULTS:
Out of 26 patients, 11 had an intraarticular extension. On average, 8 days after the injury the fracture was plated. Nineteen patients had a temporary external fixator applied for an average of 12 days. In 92% of the fractures the fibula was fixed before the tibia to maintain length and provide indirect reduction.
Two patients had late failure of fixation. All 26 fractures healed with an average healing time of 35 weeks. Nine patients required secondary surgeries done on average at 22 weeks after initial treatment. These healed on an average of 67 weeks, using iliac crest autograft and intramedullary nails to achieve full union.
The only patient or injury variable that influenced functional outcomes was the occurrence of a secondary surgery. It was associated with poorer function only on the AOFAS grading system. Associated lower-extremity fracture, other injuries, intraarticular extension, bone loss, open fracture, or the time to union were not associated with poorer function.
COMMENTS:
Minimally invasive treatment of high-energy metaphyseal injuries of the distal tibia provided anatomical alignment and decreased soft tissue problems. This technique was shown to have good patient outcomes. However, several patients still required secondary procedures to achieve ultimate union. Special considerations should be made for patients with high grade open fractures, comminuted fractures, and bone loss to decrease their risk of complications.
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Disclaimer:
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