Treatment with Circular External Fixation of Bicondylar Tibial Fractures: Potential in Accurate Reduction and Efficacy on Functional Results

AbstractSurgical reconstruction of bicondylar tibial fractures with external fixation relies on indirect fracture reduction that could affect anatomical restoration. The aim of the present study is to evaluate the radiographic and clinical outcomes of tibial bicondylar fractures treated with circular external fixation. A total of 20 bicondylar fractures of the proximal tibia in 20 patients treated with circular external fixation were included in the study. Two fractures were open. Mean clinical and radiographic follow-up was 37.3 months after frame removal. Angular, translation, and length deformities were assessed on nonweight-bearing anteroposterior, lateral, and two 45 degrees oblique views. The medial proximal tibia (MPTA) and posterior proximal tibia angles (PPTA) were calculated in all cases. The condylar widening was calculated in relation to the width of the femoral condyles. Joint depressions or gaps of the articular surface were identified on the four views of the knee. The modified Hospital for Special Surgery (HSS) knee scoring system was used for clinical evaluation. The MPTA was good in 18 (90%) and fair in 2 patients (10%). The PPTA was good in 13 (65%), fair in 6 (30%), and poor in 1 patient (5%). The articular reduction was good in 12 (60%) and fair in 8 patients (40%). The condylar widening was good in 15 (75%) and fair in 5 patients (25%). Mechanical axis deviation was within the normal range in 11/12 patients (91.7%). All fractures consolidated. One deep infection was successfully treated with local debridement, the mean modified HSS knee score at the latest follow-up was 90.5 (range: 67–100). Articular reconstruction and tibia alignment based on radiographic evaluation in the present study, along with functional results compare favorably with those of external and internal fixation presented in the literature.

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Immediate Interlocking Nailing versus External Fixation Followed by Delayed Interlocking Nailing for Gustilo Type IIIB Open Tibial Fractures

Journal of Orthopaedic Surgery ◽

10.1177/230949900701500201 ◽

2007 ◽

Vol 15 (2) ◽

pp. 131-136 ◽

Cited By ~ 6

Author(s):

HJ Park ◽

M Uchino ◽

K Nakamura ◽

M Ueno ◽

Y Kojima ◽

...

Keyword(s):

Standard Deviation ◽

External Fixation ◽

Deep Infection ◽

Fracture Site ◽

Tibial Fractures ◽

Fracture Type ◽

Infection Rates ◽

Open Tibial Fractures ◽

Interlocking Nailing ◽

Type Iiib

Purpose. To compare immediate interlocking nailing with external fixation followed by delayed interlocking nailing, for Gustilo type IIIB open tibial fractures. Methods. 23 patients with Gustilo IIIB open tibial fractures were treated with either immediate unreamed interlocking nailing (n=9) or external fixation followed by delayed unreamed interlocking nailing (n=14). Patient age, sex ratio, fracture site, fracture type, and severity were similar in both groups. The time to union, deep infection rate, and nonunion rate in the 2 groups were compared. Results. In the immediate and delayed nailing groups, respective mean times to union were 21 (standard deviation [SD], 14) months and 14 (SD, 8) months; nonunion rates were 44% (4/9) and 36% (5/14), and deep infection rates were 22% (2/9) and 7% (1/14). All corresponding differences were not statistically significant. Conclusion. Prospective, randomised, multicentre studies are needed to assess whether there are significant differences between the 2 treatment methods.

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Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174557 ◽

2017 ◽

Vol 5 (10) ◽

pp. 4355

Author(s):

Siddharth Goel ◽

Abhay Elhence

Keyword(s):

Soft Tissue ◽

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Tibial Fractures ◽

Fixation Method ◽

Ankle Pain ◽

Distal Tibial Fractures ◽

Tract Infections

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

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Complex Articular Fractures of the Distal Radius: The Role of Closed Reduction and External Fixation

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408087092 ◽

2008 ◽

Vol 33 (3) ◽

pp. 305-310 ◽

Cited By ~ 11

Author(s):

A. BINI ◽

M. F. SURACE ◽

G. PILATO

Keyword(s):

Retrospective Study ◽

External Fixation ◽

Distal Radius ◽

Functional Results ◽

Ao Classification ◽

Radial Inclination ◽

Articular Fractures ◽

Acceptability Criteria

Twenty-two patients underwent surgery for 23 complex articular fractures of the distal radius of C.3 type, according to the AO classification. The surgical treatment consisted, in all cases, of a closed, or limited-open, reduction and external fixation. The functional and radiographic results were analysed at a mean follow-up of 40 months. This retrospective study confirms that satisfactory functional results where obtained in 12 out of the 15 wrists where all the intra and extra-articular parameters of the Fernandez’ criteria where respected. For those wrists where keeping with Fernandez’ criteria for intra-articular parameters and ulnar variance was not possible, four of eight had satisfactory results. As far as the acceptability criteria for radial inclination and dorsal tilt are concerned, the functional results seem to suggest that a little wider tolerance than proposed in the literature could be accepted.

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Risk factors for deep infection in secondary intramedullary nailing after external fixation for open tibial fractures

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70094-4 ◽

2007 ◽

Vol 2007 ◽

pp. 91-92

Author(s):

M.F. Swiontkowski

Keyword(s):

Risk Factors ◽

External Fixation ◽

Intramedullary Nailing ◽

Deep Infection ◽

Tibial Fractures ◽

Open Tibial Fractures

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A Prospective Observational Study on Efficacy of Ilizarov External Fixation in Infected Non-Union Tibial Fractures

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/181 ◽

2021 ◽

Vol 8 (15) ◽

pp. 932-938

Author(s):

Avinash Gundavarapu ◽

Vishal Singh ◽

Prashant Kumar Mishra ◽

Santhosh Kumar M

Keyword(s):

External Fixation ◽

External Fixator ◽

Functional Results ◽

High Energy ◽

Tibial Fractures ◽

Bony Union ◽

Ilizarov External Fixator ◽

Non Union ◽

Ring Fixator ◽

Study Results

BACKGROUND Open fractures and fractures caused by high-energy trauma are likely to get infected and result in non-union. Infected non-union of long bones is a problem in developing countries like India. Ilizarov external fixator was employed to correct all the complications associated with non-union such as bone gap, infection, shortening, and deformities. Stable fixation, corticotomy and bone transport was employed to reduce or eliminate infection at the same time achieving bone union and correction of limb length discrepancy. Our study assesses the efficacy and safety of Ilizarov external fixation in patients with infected non-union tibial fractures. METHODS A series of 30 patients with infected non-union of tibia were treated with Ilizarov external fixation in Yashoda super speciality hospital and regularly followed-up between May 2014 and April 2016 (2 years). Bony and functional results were estimated and correlated with existing studies. RESULTS Out of thirty patients treated, bony results were excellent in 17 patients, good in 8 patients, fair in 4 patients and poor in 1 patient. Functional results were excellent in 17 patients, good in 5 patients, fair in 5 patients, and poor in 3 patients. Average duration of the fixator period was 8.1 months (min - 3 months, max - 14 months). Average length of regenerate was 3.64 cm (min - 2 cm, max - 6 cm). Average lengthening index in the study was 2.09 months / cm. Our study in all 4 categories of Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria had approached Dror Paley’s Bony results and functional results. CONCLUSIONS In our study results have been encouraging in addressing all the complex problems by Ilizarov principle. Ilizarov external fixator system is the best device to treat infected non-union of tibia. Distal third of tibia is more prone for infection and non-union. Corticotomy or bone grafting is required for augmentation of the healing process. Almost all patients had varying degrees of oedema and pin track infections. Infection was controlled in all the cases and bony union was achieved, no patient had persistence of non-union and infection at the end of 2 years. KEYWORDS Ilizarov External Ring Fixator, Infected Non-Union, ASAMI Criteria, Bony Results, Functional Results, Bony Union

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Treatment of femoral and tibial fractures in puppies by elastic plate osteosynthesis

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0037-1616588 ◽

2007 ◽

Vol 20 (01) ◽

pp. 51-58 ◽

Cited By ~ 15

Author(s):

F. Meige ◽

A. Autefage ◽

S. Sarrau

Keyword(s):

Femoral Head ◽

Elastic Plate ◽

Plate Osteosynthesis ◽

Functional Results ◽

Tibial Fractures ◽

Plate Bending ◽

Diaphyseal Fracture ◽

Clinical Consequences ◽

Diaphyseal Fractures

SummarySeventeen puppies, two to four months old, with a femoral (n=12) or tibial (n=5) diaphyseal fracture were treated by elastic plate osteosynthesis with a Veterinary Cuttable Plate (VCP) or straight plate. In one case of femoral fracture treated with a VCP, plate bending due to an excessive elasticity of the implant was observed three days after the osteosynthesis and surgical revision was required. Two cases of femoral overgrowth and one case of slight femoral head and neck retroversion were identified during the radiographic follow-up but without any clinical consequences. Bone healing was obtained for all fractures four to eight weeks (5.64±0.88 weeks) after the surgical procedure, and functional results were excellent in all cases. Our study confirms that elastic plate osteosynthesis with either a VCP or straight plate can be used to treat femoral diaphyseal fractures in medium and large breed puppies less than four months old, but that modification of implant elasticity or rigid osteosynthesis use is required when such puppies reach four months. The same technique can also be used successfully to treat tibial fractures in puppies younger than four months old.

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Distal Fibula Reconstruction in Primary Malignant Tumours

Current Oncology ◽

10.3390/curroncol28050299 ◽

2021 ◽

Vol 28 (5) ◽

pp. 3463-3473

Author(s):

Adyb Adrian Khal ◽

Riccardo Zucchini ◽

Claudio Giannini ◽

Andrea Sambri ◽

Davide Maria Donati ◽

...

Keyword(s):

Case Series ◽

Functional Results ◽

Deep Infection ◽

Malignant Tumours ◽

Distal Fibula ◽

Vascularized Fibula ◽

Long Time ◽

The Mean ◽

Ankle Biomechanics

(1) Background: Restoration of ankle biomechanics after distal fibula (DF) resection in bone sarcomas can be performed with different techniques. We report the functional and oncological outcomes of a case series; (2) Methods: Ten patients (5 females and 5 males) with a mean age of 27 years (range 10–71) were retrospectively evaluated. Following the resection, different techniques were used to reconstruct the ankle: tibiotalar arthrodesis, residual lateral malleolus fixed to the tibia, non-vascularized or rotational vascularized fibula transposition and intercalary allograft. All complications were recorded, and the functional outcomes were evaluated; (3) Results: The mean follow-up time was 54 months (range, 13–116). Six patients were free of disease while four patients died of disease. All patients had a stable ankle and bone union, which was achieved after a mean of 9.4 months (range 3–20). The mean MSTS Score was 26.7 (range 21–30). Chronic ankle pain and peroneal external nerve palsy were observed. Patients underwent additional surgeries for deep infection and for equinus ankle deformity. No local recurrence was observed. Metastasis occurred in four patients after a mean of 14.7 months (range 2–34); (4) Conclusions: After DF resection, the restoration of ankle biomechanics gives acceptable functional results, but a larger series of patients with long-time follow-up are required to confirm the durability of the reconstruction.

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Solving the enigma of posterolateral tibial plateau fractures, the clue protocol

Acta Orthopaedica Belgica ◽

10.52628/87.1.16 ◽

2021 ◽

Vol 87 (1) ◽

pp. 125-136

Author(s):

Radwan G Metwaly ◽

Zeiad M Zakaria ◽

Mohamed A Elgebeily ◽

Hany El Zahlawy

Keyword(s):

Tibial Plateau ◽

Soft Tissue Injuries ◽

Common Peroneal Nerve ◽

Functional Results ◽

Deep Infection ◽

Tibial Plateau Fractures ◽

Academic Center ◽

Peroneal Nerve Injury ◽

Arthroscopically Assisted

The study aim is to evaluate functional and radio- logical outcomes following a suggested protocol based on the four-column classification for management of posterolateral column tibial plateau fractures. A prospective cohort study was performed in level I academic center on 42 patients with mean age of 36 years (22-59). Eleven patients had isolated posterolateral column fractures whereas 31 patients had associated columns fractures. According to the suggested protocol, all cases of isolated posterolateral column fracture started treatment via arthroscopic evaluation of soft tissue injuries (menisci and liga- ments), arthroscopically assisted reduction and inter- nal fixation by rafting screws followed by ORIF if plating was needed. If associated with other columns fractures, columns were fixed sequentially in an anti-clockwise direction starting from anteromedial column. Average follow up was 26 months. Mean time to union was 16.3 (12-22) weeks. No radiological evidence of loss of coronal or sagittal alignment was detected at final follow up. Five patients had an average depression of 5 millimeters that did not need further intervention at this short-term follow up. Mean KOOS was 81 (72- 88). The average knee range of motion was (0° - 127°). One patient had temporary common peroneal nerve injury, one patient had deep infection and two had superficial wound infection. implementing the suggested protocol gives good to excellent radiological and functional results as regard posterolateral tibial plateau fracture. A larger study group with longer follow up is needed.

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Therapeutic ultrasound as an aid in tibial fracture management in a dog

Vlaams Diergeneeskundig Tijdschrift ◽

10.21825/vdt.v86i1.16301 ◽

2017 ◽

Vol 86 (1) ◽

pp. 29-34

Author(s):

J. Heremans ◽

E. De Bakker ◽

B. Van Ryssen ◽

Y. Samoy

Keyword(s):

Hind Limb ◽

Tibial Fracture ◽

Proximal Tibia ◽

Cruciate Ligament ◽

Radiographic Evaluation ◽

Cranial Cruciate Ligament ◽

Ligament Rupture ◽

Fracture Management ◽

Cranial Cruciate Ligament Rupture

A six-year-old, male, neutered Bernese mountain dog was presented with acute left hind limb lameness. Based on the symptoms, orthopedic examination and radiographic evaluation, a cranial cruciate ligament rupture was diagnosed. Surgical treatment with TTA Rapid was performed with good result. At two weeks postoperatively, the dog developed a fracture of the proximal tibia, due to excessive activity. Conservative treatment consisting of a splint and rest was advised. Physiotherapeutic ultrasonography and exercises were started to stimulate bone healing. After eight sessions, the dog was clinically much better, and radiographs showed a good evolution with a clear callus. Follow-up controls confirmed the progressive evolution.

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