INTRODUCTION: Distal tibial fractures remain a challenge to orthopaedic surgeons.
They usually occur as a result of high energy trauma in young patients, but
in the elderly they can result from a simple fall. In the elderly, the problem
is compounded by poor bone-stock, their limited ability to partially weight
bear and co-morbid conditions.
The main challenges:
1.The compromised skin and soft tissue envelope as in open fractures
lead to a high incidence of complications following open reduction and
internal fixation.
2. In the metaphysis, fixation is less rigid and early loosening is a
frequent event as the cancellous bone is open and ‘cell- like’ and therefore ill
equipped to support a screw thread.
3. Comminuted fracture patterns, which create difficulty in achieving
rigid fixation since the purchase in trabecular bone is less than optimal to
permit weight bearing or even start early joint mobilization.These
conditions that restrict mobility lead to decubitus ulcers, deep vein
thrombosis, joint stiffness and secondary osteoarthritis.
4. These high energy fractures may be associated with extremely
damaged soft tissue envelope, as well as comminuted metaphyseal region
and articular surface making anatomical reduction difficult.
AIM OF THE STUDY:
To analyze and individualize the choice of fixation in the management of distal tibial fractures.
MATERIALS AND METHODS: The present study deals with the analysis of out come of various modalities of treatment of distal tibial fractures depending on the type of
fracture, location of the fracture and the status of the soft tissue envelope.
The Study was conducted in Government Royapettah Hospital,
Kilpauk Medical College between 2004 – 2006.
Patients admitted with distal tibial fractures with or without intra
articular extension and those having closed or open injuries were
considered for this study.
All patients having distal third tibial fractures were admitted and
evaluated for co-morbid conditions. Routine investigations are done for anesthetic fitness and also to rule
out systemic illness. Associated medical conditions were treated by
corresponding specialists.
The patients were maintained in POP and calcaneal pin traction in
the case of compound fractures.
Patients with compound fractures were treated with broad spectrum
antibiotics.
The time of surgery varied from 5 days to 25 days.
There were 10 open injuries, of which there were 6 – Grade1; 3 –
Grade 2 and 1-grade 3 open injuries.
Those 5 patients who were not willing to undergo surgical
procedures were treated conservatively by applying POP after 3 weeks of
pin traction and check x-ray.
RESULTS: The outcome of treatment of distal tibial fractures, is most affected by
the severity of injury, management of the fracture and occurrence of
certain complications.
There are no uniformly accepted criteria for rating results. A number
of factors are important for assessing results of tibial shaft fractures.
Most reports omit one (or) more of them.
For example Anderson et al., used only shortening and angulation to
classify results of treatment into categories of excellent, good, fair, and
poor. He rejected range of motion of the ankle joint as a criteria.
However Horne and Colleagues with Hutching found ankle motion
was a major determinant of functions.
CONCLUSION: A short series of results of various modalities of
management of distal tibial fractures were analyzed and the overall
results including quality of reduction, functional recovery and the
presence or absence of complications have led to us to individualise
the option of treatment according to the status of the soft tissue,
fracture location; fracture pattern and articular involvement.
We are aware of the fact that the number of patients and
duration of study may not give us the liberty to conclusively arrive at a
protocol and might need a more elaborate study for standardization of
the different methods available for the management of fractures of
distal tibia