Open reduction and internal fixation treatment of distal tibia fracture with Wise lock plate followed by two year follow up

<p class="abstract"><strong>Background:</strong> Distal tibial fractures are high energy injuries with high complication rate. The objective of this study was to reduce the postoperative complications of distal tibial fracture by using indigenously manufactured implants (plates and screws).</p><p class="abstract"><strong>Methods:</strong> This was a prospective study of 10 patients (6 patients had 43-B1 fracture, 4 patients had 43-B2 fracture) with two year follow up period followed by physical exercises after one month of the surgery. The fractures were treated with 3.5 mm Wise lock medial distal tibia plate. X-ray was used to check the union, non-union. Functional outcomes were assessed with visual analog scale (VAS) score.<strong></strong></p><p class="abstract"><strong>Results:</strong> X-ray was showing good results. Average VAS score was 1.5 (90%) 9 patients and 2.5 (10%) in 1 patient. At the end of the first year VAS score is 2 for one patient with 9 others having 1 and at the end of the second year the VAS score is 0 for 9 patients and 1 for one patient.</p><p class="abstract"><strong>Conclusions:</strong> Treatment of distal tibial fracture with 3.5 mm Wise lock medial distal tibia plate shows good outcomes with less complications.</p><p> </p>

Hindfoot Alignment Changes after Internal Fixation of Distal Tibial Fracture: Comparing Radiological and Clinical Outcomes of Patients Treated with Standard Plating vs Intramedullary Nailing

Category: Trauma Introduction/Purpose: Until now, many papers Traditionally concerned for union of the fracture, changes of alignment, clinical symptoms and complication. However, there are no studies on changes in foot alignment, hid foot and related clinical changes. The Purpose of this study to evaluate clinical outcome and radiological outcome including hind foot alignment using Plate versus IM nail fixation of distal tibia fracture and to evaluate influence factors of hindfoot alignment alteration among the radiologic parameters. Methods: Overall, 92 patients with distal tibial metaphyseal fractures (AO-OTA 43-A1, 43-A2) with simple or no articular involvement treated from 2002 to 2013. Among them, 39 cases of intramedullary nailing and 53 cases of standard plate osteosynthesis were performed. Inclusion criteria were applied for patient group. Union rate and complication rate compared both group. Radiographic measurements were evaluated at a minimum of 1-year follow-up. Radiological parameters of hindfoot angulation and moment arm were measured at the Saltzman view, calcaneal pitch angle and Meary angle were measured at the lateral standing radiograph. Hindfoot alignment changes after surgery were compared between both groups using student T-test. Alignment changes after fracture site union were evaluated simple radiograph and computed radiograph; coronal plane angulation, saggital plane angulation and transverse plane rotation were measured. Correlation and regression were analyzed between fracture alignment parameters and hindfoot alignment Results: We studied 92 patients with distal tibia fractures treated with IMN (39 patients) and SP (53 patients). 37 patients in the IMN group and 47 in the IMN group met inclusion criteria. All patients ultimately healed, with the average time to union of 26 weeks in both the groups. Complications were similar between the two groups. Hindfoot alignment angle, calcaneal pitch and Mearly angles showed no difference between the groups. But moment arm was increased valgus in the IMN group. Angulation at fracture site on the coronal and hindfoot alignment changes were showed low significant relationship(R=0.38). But transverse rotation and hindfoot alignment changes were showed high significant relationship(R=0.79). And only transverse rotation has a strong correlation with hindfoot alignment changes after regression analysis. Conclusion: Similar union rate and complication were seen when treating nonarticular metaphyseal distal tibia fractures with SP compared with IMN. Angulation on coronal plane after internal fixation may a little affect to change hindfoot alignment due to compensation on the subtalar joint. However, rotation on the transverse plane has intactly influenced hindfoot alignment alteration. Therefore, regardless of the fixed method, the patients treated distal tibial fracture required close attention to changes in hindfoot alignment due to transverse rotation during surgery.