The Anterior T-Frame External Fixator for High-Energy Proximal Tibial Fractures

Background: Tibial plateau fractures constitute about 1% of all fractures and complex bicondylar fractures constitute 30% of all Tibial plateau fractures. Minimally Invasive Percutaneous Plate Osteosynthesis [MIPPO] is a method of biological fixation in which a plate is percutaneously inserted and fixed at a distance proximally and distally from the fracture site. By minimal exposure, this helps in the preservation of the essential fracture hematoma, minimal soft tissue dissection, avoidance of periosteal stripping and providing an adequate fixation. The objective of the study was to analyze the functional outcome of proximal Tibial fractures treated with MIPPO technique. The method of fixation shall be evaluated for the time period required for the patients to return to active work following surgery.Methods: In our study, all 18 patients with proximal Tibial fractures underwent definitive fixation by MIPPO technique. All our cases underwent initial stabilization as per the ATLS guidelines. Patients with closed Tibial plateau fractures associated with a tense haemarthrosis underwent aspiration of the joint under aseptic precautions. The limb was immobilized either in an above knee slab or through skeletal traction using a distal Tibial or calcaneal pin traction on a Bohler Braun splint until definitive fixation was carried out. In cases complicated with excessive swelling and blistering, definitive fixation was delayed until the swelling/ blistering subsided.Results: The post-operative results were designated as excellent, good, fair and poor according to pain, walking capacity, the range of motion and stability of the knee using Rasmussen’s grading system. In our study, the average functional knee score was 22.89. Rasmussen’s score does not consider articular congruity while assessing the functional outcome of the knee.Conclusions: MIPPO technique gives good to excellent results even in high energy Tibial condyle fractures [72.22% cases in our study]. Our patients were able to achieve a good functional range of movement, averaging 120 degrees. [Krettek et al – 124 degrees]. Those who were treated with early fixation and early mobilization were found to have a better functional outcome irrespective of the fracture type. No secondary bone grafting was required.

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The Ilizarov external fixator - a useful alternative for the treatment of proximal tibial fractures A prospective observational study of 30 consecutive patients

BMC Musculoskeletal Disorders ◽

10.1186/1471-2474-14-11 ◽

2013 ◽

Vol 14 (1) ◽

Cited By ~ 19

Author(s):

Telmo Ramos ◽

Carl Ekholm ◽

Bengt I Eriksson ◽

Jón Karlsson ◽

Lars Nistor

Keyword(s):

Observational Study ◽

External Fixator ◽

Prospective Observational Study ◽

Tibial Fractures ◽

Ilizarov External Fixator ◽

Proximal 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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Role of hybrid external fixator in proximal tibial fractures: A prospective analysis

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2017.v3.i1l.116 ◽

2017 ◽

Vol 3 (1l) ◽

pp. 810-813

Author(s):

Dr. MK Aseri ◽

Dr. Ankur Gupta ◽

Dr. Uukhtiyar Khilji

Keyword(s):

External Fixator ◽

Tibial Fractures ◽

Prospective Analysis ◽

Hybrid External Fixator ◽

Proximal Tibial Fractures

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TIBIAL PLATEAU FRACTURES

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.06.263 ◽

2018 ◽

Vol 25 (06) ◽

pp. 810-814

Author(s):

Saeed Ahmad ◽

Tariq Mahmood ◽

Muhammad Imran Haider

Keyword(s):

External Fixator ◽

Tibial Plateau ◽

Case Series ◽

High Energy ◽

Tibial Plateau Fractures ◽

Tibial Fractures ◽

Female Ratio ◽

Non Union ◽

Hybrid External Fixator ◽

Pin Track

Background: Tibial fractures is most common type of long bone fractures. Highspeed lifestyles with vehicles motorcycles as well as growing waves of violence, contributingincrease occurrence of tibial fractures. Tibial plateau fractures continues to be a challenge fororthopedic surgeon. Treatment of these fractures have been plagued by complications. Recentimprovements in the techniques and development of hybrid external fixator have revolutionizedthe treatment of such fractures. Objective: To evaluate the clinical outcomes of hybrid externalfixator in high energy Schatzkar V and VI tibial plateau fractures. Study Design: Descriptive,Case series. Period: 27 June 2013 to 26 June 2016. Setting: Nishtar Hospital, Multan. Materialand methods: A total of 125 patients with open and close tibial plateau fractures, 20 to 50 yearsof age of both genders were included in the study. Patients having history of pervious surgeryor intervention tibial plateau fractures, and h/o malignancy were excluded. All the patients wereoperated by a consultant orthopedic surgeon. Outcome was assessed at 16 weeks by serialradiological x-ray by formation of callus and noting any grade of pin track infection. Results; Ourstudy comprised of 125 patients having Schatzker V and Schatzker VI tibial plateau fractureswho met our inclusion criteria. Mean age of 38.925 ± 7.09 years. Majority of the patients 47(37.60%) were between 41 to 50 years of age. Mean duration since injury in our study was 13.18± 4.79 hours. Out of 125 patients, 102 (81.60%) were males and 23(18.40%) were females withmale to female ratio of 1.2:5.4. Fifty three (42.4%) patients presented with Schatzker V and 72(57.6%) had Schatzker VI type of tibial plateau fractures. In our study, non-union was seen in10cases (8.0%) and pin track infection was noted to be present in 19 (15.20%) patients. So, theacceptable outcome (achievement of union without non-union or pin track infection during 16weeks) was seen in 96(76.8%) patients. Conclusion: This study concluded that there is highrate of acceptable outcome (achievement of union without any non-union or pin track infectionduring 16 weeks) after hybrid external fixator of the open and closed fractures of tibial plateauamong the patients having schatzker-V and VI.

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Tosic External Fixator in the Management of Proximal Tibial Fractures in Adults

Orthopedics ◽

10.3928/0147-7447-20010601-16 ◽

2001 ◽

Vol 24 (6) ◽

pp. 581-584

Author(s):

Aleksandar Tosic ◽

Nabil A Ebraheim ◽

Iman Abou Chakra ◽

Khaled Emara

Keyword(s):

External Fixator ◽

Tibial Fractures ◽

Proximal Tibial Fractures

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Functional and clinical outcome of MIPPO anterolateral plating for proximal tibia fracture both proximal one third and coronal intrarticular fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214178 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1127

Author(s):

Dinesh Kumar Meena ◽

Raghvendra Choubisa ◽

Johney Juneja ◽

Anamendra Sharma

Keyword(s):

Road Traffic ◽

Intraoperative Complications ◽

High Energy ◽

Fracture Site ◽

Tibial Fractures ◽

Age Group ◽

Secondary Fracture ◽

Intraarticular Fractures ◽

Proximal Tibial Fractures ◽

Rapid Healing

Background: The proximal tibial fractures are one of the commonest intraarticular fractures. Generally these injuries fall into two broad categories, high energy fractures and low energy fractures. The tibial plateau fractures are mostly due to high velocity road traffic accidents and fall from height, where fractures result from direct axial compression, usually with a valgus (more common) or varus moment and indirect shear forces.Methods: This is a prospective study and includes operations by MIPPO technique that were undertaken between January 2020 till June 2021 in RNT government hospital; Udaipur. The total number of cases studied were 25 with the youngest being 25 years old and oldest 70 years old. Intraoperative complications were noted. Functional outcome was assessed using Modified Rasmussen’s Criteria.Results: Patients with fracture in our study occurred between the age of 25 to 70 years with maximum incidence involving the productive age group of 21-30 years (90%). Majority of the patients was males- 90%.Conclusions: From the minimally invasive percutaneous plate osteosynthesis of proximal tibial fracture there is an increase in the complexity of proximal tibial fractures with increasing road traffic accident. As most of the patients sustained these fractures belong to physically highly active and productive age group, they need optimal treatment to get back to their previous work capacity and avoid long term complications like osteoarthritis. We treated all fractures in our study with MIPPO technique and found rapid healing by secondary fracture union and hence achieving strong bone union across the fracture site due to inherent benefits of less tissue damage and minimal disturbance of fracture site biology. We operated 20 proximal tibial fractures with MIPPO technique and observed rapid healing and good functional recovery.

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A prospective study to analyse the outcome of locking compression plating by minimally invasive percutaneous plate osteosynthesis technique in proximal tibial fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20181798 ◽

2018 ◽

Vol 4 (3) ◽

pp. 442

Author(s):

Anjaneyulu Reddy D. ◽

Krishna Redy P.

Keyword(s):

Minimally Invasive ◽

Functional Outcome ◽

Plate Osteosynthesis ◽

High Energy ◽

Tibial Fractures ◽

Articular Fractures ◽

Tibial Condyle ◽

Proximal Tibial Fractures ◽

Compression Plating ◽

Osteosynthesis Technique

Background: The proximal tibial fractures are one of the commonest intra articular fractures majority are of high energy fractures. We did the study to measure the outcome of locking compression plating by minimally invasive percutaeneous plate osteosynthesis technique in proximal tibial fractures.Methods: Study comprises 20 cases of proximal tibial fractures, which have been managed by MIPPO technique during the period December 2014 to August 2016.Results: The sex distribution in our study was 18 males and 2 females with 30 to 57 years age. The most common mode of injury in this study was road traffic accident. Type V Schatzker tibial plateau fractures were the commonest in 8 patients. 70% of our patients had excellent and good results in the functional outcome. In our study the average functional knee score was 22.40. The average range of movement achieved was 120 degrees. The average time taken for fracture healing was 16.52 weeks. In conclusion, MIPPO technique gives good to excellent results even in high energy tibial condyle fractures (70% cases in our study). Those who were treated with early fixation and early mobilization were found to have a better functional outcome irrespective of the fracture type. No secondary bone grafting was required.Conclusions: The study reports that MIPPO technique is an effective method of treating proximal tibial fractures due to its overall good functional outcome.

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Application of Intelligent Computer Information Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

10.2196/preprints.21455 ◽

2020 ◽

Author(s):

Hongfeng Sheng ◽

Weixing Xu ◽

Bin Xu ◽

Hongpu Song ◽

Di Lu ◽

...

Keyword(s):

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Tissue Injury ◽

Plate Fixation ◽

Soft Tissue Injury ◽

Three Dimensional ◽

High Energy ◽

Tibial Fractures ◽

Intelligent Computer

BACKGROUND Background: With the development of social economy, severe and complex tibial fractures caused by high-energy injuries such as traffic accidents have gradually increased. At present, the commonly used methods for the treatment of tibial fractures include plate fixation, intramedullary nail fixation, and external fixation. Most of these fractures are open wounds with severe soft tissue injury and wound contamination, and some even have bone defects, which makes the previous internal fixation treatment difficult. OBJECTIVE Objective: This study was aimed to explore Intelligent Computer Information Assisted Taylor Three-dimensional External Fixation for the treatment of tibiofibular fractures. METHODS Methods: 70 patients were collected and divided into Taylor three-dimensional external fixation (TSF) group (28 patients with severe tibial fractures treated with TSF) and the internal fixation group (42 patients with severe complicated tibiofibular fractures treated by internal fixation). After the treatment, the follow-up evaluation of Intelligent Computer Information Assisted Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. RESULTS Results: The results showed that Intelligent Computer Information Assisted Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. CONCLUSIONS Conclusions: Intelligent Computer Information Assisted Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures which is worthy of clinical promotion. CLINICALTRIAL

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