Lower Limb Malrotation following Minimally Invasive Plating in Distal Tibia Fractures

Introduction: Minimally invasive percutaneous osteosynthesis (MIPO) plating techniques have demonstrated good outcomes in the treatment of distal tibia fractures. Early arthritis and functional impairment may occur 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 of patients with polytrauma, neurovascular injuries or pre-existing disabilities were recruited. Patients underwent MIPO plating followed by a post-operative Computed Tomography (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

Lumbosacral Plexopathy in Pelvic Injury – A Cause of Hip Instability in Acetabular Fractures: A Report of Two Cases

Lumbosacral plexopathy is a rare clinical entity that results in potentially severe neurological deficit. The clinical presentation of lumbosacral plexopathy includes motor and sensory deficits. However to the best of our knowledge, hip instability secondary to lumbosacral plexopathy has not been reported in current literature. We report two cases of pelvic injury in which recurrent hip subluxation occurred following fixation of acetabular fractures. We attribute this to inadequate hip muscle tension from the associated lumbosacral plexopathy. In patients with acetabular fractures, this may lead to debilitating hip joint instability. In an already traumatized hip joint, this instability has a poor prognosis and can lead to degenerative changes with the eventual need for hip replacement