REHABILITATION OF PATIENT WITH TIBIA-FIBULA FRACTURE

An orthopedic surgeon may find compound fractures of tibia-fibula challenging to treat. The degree of joint motion and the adequacy of reduction are the two factors that determine whether or not these fractures can be treated successfully. In many patients, open surgical treatment of comminuted tibial pilon fractures is associated with significant complications. Indirect reduction and stabilization of fractures using a circular external fixator can be a useful way of achieving adequate joint restoration, and it uses closed reduction principles to realign disturbed bones and joint structures. In this report, we describe about the effects of early rehabilitation compound grade IIIB fracture tibia, fibula of right side. The patient co-operation and motivation to return to daily functional activities also prove to very crucial for the rehabilitation process. The defect in bone is usually a result of high velocity trauma or a sudden impact. In present case open reduction and external fixation for distal one-third of tibia and fibula on right side was carried out followed by the rehabilitation protocol. Outcome measure used to check for the pain was NPRS. The patient morale and goal-oriented rehabilitation protocol progressed him to return to his functional activities.

Use of a circular fixator construct to facilitate closed reduction and percutaneous stabilization of a distal femoral physeal fracture in a dog

Background: Fractures of the distal femoral physis are the most common physeal fracture sustained by skeletally immature dogs. Reduction and stabilization of these fractures can sometimes be achieved through closed reduction, primarily in fractures that are nominally displaced. Circular external fixator constructs have been used to assist in indirect, closed reduction of fractures at other anatomic locations in dogs and this report describes application of this method to reduce a displaced Salter-Harris type II fracture of the distal femur in a 1-year-old dog. Case Description: A 1-year-old female spayed Akita was referred for treatment of a Salter-Harris type II fracture of the right distal femur. The epiphyseal segment was laterally and slightly caudally displaced. Multiple attempts to manually reduce the fracture during surgery were unsuccessful, so a two-ring circular external fixator construct was applied to facilitate distraction and reduction. The construct was applied by placing a medial-to-lateral Kirschner wire in both the mid-femoral diaphysis and in the distal femoral epiphysis. Distraction of the construct provided sufficient separation of the fracture segments to facilitate near anatomic reduction. The fracture was stabilized with two percutaneously placed Steinmann pins placed in Rush fashion. Radiographic union was confirmed 5 weeks after surgery. The dog was not lame and was bearing more weight on the right pelvic limb, as assessed using force plate analysis, 9 months following surgery. Goniometric measurements of stifle range of motion and thigh muscle circumference were similar between the pelvic limbs. Conclusion: Application of a two-ring circular construct would appear to be useful to facilitate closed reduction and percutaneous stabilization of distal femoral physeal fractures.

Effectiveness of circular external fixator in periprosthetic fractures around the knee

Background: The incidence of periprosthetic fractures after total joint arthroplasty (TJA) is rising due to an increasing number of TJAs performed annually and the growing elderly population. In many elderly patients with periprosthetic fractures, the bone strength is lowered due to the deterioration of bone quality and a decrease in bone quantity; rigid fixation of the fracture is difficult. It is a challenging operation for orthopedic surgeons. The usefulness of circular external fixation for periprosthetic fractures has been reported in several case studies. The aim of this study was to investigate the rate of union and complications associated with circular external fixation in periprosthetic fractures around the knee. Methods: We included 19 patients with periprosthetic femur and tibial fractures who underwent osteosynthesis using a circular external fixator and had at least 2 years of follow-up. All patients had comorbidities and high risks associated with anesthesia. Tourniquets were not used in any of the patients. There were no cases in which the skin incision was placed, and the closed reduction technique was used in all cases. Results: A 100% union rate was achieved with no serious complications. All fractures healed after a mean time of 14.3±5.2 weeks (range, 8-38 weeks). The walking ability was the same level as before the injury in 13 cases. Discussion: There are many comorbidities associated with periprosthetic fractures in elderly patients. Double-plate or revision surgery were largely invasive and had high risks associated with anesthesia. Circular external fixation is a feasible and effective treatment option because it provides stable fixation, prompt postoperative mobilization, and has no major complications, especially in elderly patients who are treated for periprosthetic fractures Conclusion: Circular external fixation is a safe and reliable method for periprosthetic fractures around the knee in elderly patients. Level of evidence: Level IV, retrospective case series