Osteosynthesis of Distal Tibial Fractures Using Anterolateral Distal Tibia Locking Compression Plate

Original Article Journal of Bone and Joint Diseases| Jan-April 2019 |34(1):10-15 © 2019 by Journal of Bone and Joint Diseases | Available on www.jbjdonline.com | is is an Open Access article distributed under the terms of the Creative Commons A ribution Non-Commercial License (h p://c reativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Tibia is the most commonly fractured long bone. Its subcutaneous location makes it vulnerable to frequent injury [1]. ey are approximately 3 times more frequent in males than in females and the average age of patients is about 37 years [2, 3]. With increasing number of vehicles on the roads in India, complex trauma cases caused by road traffic accidents have increased progressively directly increasing the incidence of tibia fractures [4]. Tibial pilon fractures are fractures involving distal tibial articular surface and mostly are result of high-energy trauma with associated so tissue injuries. ese fractures represent a challenge for the treating orthopedic surgeon [5]. Although multiple treatment approaches and protocols have been described, there is no consensus regarding the optimal treatment of these challenging injuries. Conservative treatment of these fractures quite o en results in a number of complications including malunion, non-union, and ankle stiffness [6, 7, 8]. ese fractures are generally not suitable for intramedullary nailing despite certain studies indicating satisfactory results in some of these fractures [9, 10, 11]. External xation can be used either as a temporary or de nitive method of treatment, especially in fractures with severe so tissue injury [9, 12, 13, 14, 15], but malunion and delayed union continue to be the main problems with this method of xation [16, 17]. Conventional plate osteosynthesis with open reduction can further devitalize the fragments and lead to higher incidence of non-union, infection, and implant failure [18, 19]. Historically, an anteromedial approach has been used for the management of tibial pilon fractures, one of the major disadvantages of this approach is the risk of wound breakdown over the subcutaneous tibia border with the Introduction: e management of distal tibia fractures has been a great challenge to orthopedic surgeons due to so tissue damage, extensive comminution, intra-articular extension, and lack of vascularity. Conservative treatment of these fractures quite o en results in a number of complications including malunion, non-union, and ankle stiffness. ese fractures are generally not suitable for intramedullary nailing despite certain studies indicating satisfactory results in some of these fractures. External xation can be used either as a temporary or de nitive method of treatment, especially in fractures with severe so tissue injury, but malunion and delayed union continue to be the main problems with this method of xation. Some studies show signi cant good results in distal tibial fracture xed with anterolateral distal tibial locking compression plate (LCP) using anterolateral approach. Materials and Methods: In this study, 36 patients were treated using anterolateral distal tibia LCP plate between January 2017 and August 2018. e functional outcome was measured by Teeny and Wiss clinical assessment criteria. Results: Of the 36 patients in the study, 29 were male and seven were female. e mean age was 37.86 years with standard deviation ± 9.54. e majority of cases were AO Type B (50%). In majority of cases (77.13%), complete union was achieved by 16–20 weeks. ree patients had immediate complication in the form of infection and one patient had wound dehiscence. Early complication includes deep infection in four patients, of which two progressed to wound dehiscence. One patient develops non-union and two develop malunion, one patient had infection, one united in valgus, and one had non-union. e mean functional score was 78.16 ± 10.02 with one excellent outcome, six good, 24 fair, and ve poor outcomes. Conclusion: Anterolateral plating in the distal end tibial fractures using anterolateral approach is safe, easy, and effective and has fair functional outcome with less complication. Keyword: Osteosynthesis, Anterolateral Approach, Distal Tibia Dinesh Kumar1, Jasveer Singh1, Rajeev Kumar1, Harish Kumar1, Manish Raj1, Ankit Mi al1 Osteosynthesis of Distal Tibial Fractures using Anterolateral Distal Tibia Locking Compression Plate 1Department of Orthopaedics, U ar Pradesh University Of Medical Sciences, Saifai, Etawah, U ar Pradesh, India Address of Correspondence: Dr. Jasveer Singh, Department of Orthopaedics, U ar Pradesh University Of Medical Sciences, Saifai, Etawah, U ar Pradesh, India E-mail: singhkgmc@gmail.com Dr. Dinesh Kumar Dr. Jasveer Singh Dr. Rajeev Kumar Dr. Ankit Mi al Dr. Harish Kumar Dr. Manish Raj Journal of Bone and Joint Diseases Volume 34 Issue 1 JanApr 2019 Page 10-15 10| | | | | Kumar D et al www.jbjdonline.com potential need for ap coverage. In addition, this approach limits the visualization of the lateral Chaput fragment. Recently, the anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures [20]. Some study found that this approach offers the bene t of improved so tissue coverage and the potential for a lower rate of wound healing complications by avoiding an incision placement over the subcutaneous border of the tibia. erefore, this present study has been chosen to evaluate the functional outcome and clinical results while treating distal tibial fractures using anterolateral locking compression plate (LCP) [21]. Materials and Methods e study was prospective, interventional, and hospital based. All the cases which satis ed the inclusion criteria were included in the study. Duration of study was for 18 months from January 2017 to August 2018 and a total of 36 cases were studied. Inclusion criteria were adults (>18 years of age), both sexes, and closed and compound Grade I fractures and exclusion criteria include compound Grade II and III fractures, fractures with neurovascular complications, chronic moribund conditions, pathological fractures, and patients not willing to participate in the study. Patients were evaluated for functional outcome and fracture union according to standard protocol. Patients were followed up periodically and detailed observation was recorded using pro forma. e results were analyzed by statistical methods using Student’s t-test, Chi-square test, and Fisher’s exact test and compared with other studies in literature. Results is study was conducted at the department of orthopedics, at tertiary care hospital from January 2017 to August 2018. e study comprised 36 patients, which included 29 males and seven females. All patients were followed up for minimum 6 months duration. e maximum follow-up was of the rst patient who was 13 months. e functional assessment was done using Teeny and Wiss [22] clinical assessment criteria, and nal results were graded as excellent, good, fair, and poor based on these criteria. Of the 36 patients studied, 13.9% of patients were between 25 and 30 years, 52.8% of patients were between 31 and 40 years, 19.4% were between 41 and 50 years, and 13.9% of patients were between 51 and 60 years. Mean age was 37.86 years with standard deviation (SD) of ± 9.54. During our study, we used the Orthopaedic Trauma Association (OTA) fracture classi cation and we observed three fracture pa erns in our cases. Of the 36 patients, 27.77% of patients (Table 1) had OTA 43 A-type fractures, 50.00% of patients had OTA 43 B-type fractures, and 22.22% of patients had OTA 43 A3-type fractures. During this study, interval between injury and surgery was recorded. Of 36 patients, 16.66% of patients (Table 2) were operated between 5 and 7 days, 47.22% of patients were operated between 8 and 10 days, and 36.11% of patients were operated >10 days a er surgery. Of 36 patients, fracture united in 14–15 weeks in 14.28% of patients (Table 3) in 16–17 weeks in 42.85% of patients, in 18–20 weeks in 34.28% of patients, and in >20 weeks in 8.57% of patients. Non-union occurred in one patient. In our study, functional OTA fracture classification Frequency (%)