A prospective study on surgical management of complex distal metaphyseal fracture of tibia with hybrid external fixation

Abstract

Background and Objectives: Fractures of 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. The difficulty in treating the fracture of tibial metaphysis is exemplified by orthopedists, who in the first half of 20th century, believed the injuries were so severe and operative repair was fraught with so many complications that the fracture was deemed not amenable for surgical reconstruction. Since there was no definitive protocol for the treatment of such fractures, the Hybrid External Fixator seemed suitable for such fractures as they combine the advantages of monolateral and circular fixation, Tensioned wires provide improved fixation in the peri-articular fragments. It allows early weight bearing and movement of the knee and ankle at all times. Methods: A Prospective study of 31 cases of surgically managed fractures of distal Tibia using Hybrid External fixation undertaken at Department of Orthopedics, J.J.M Medical College, Davangere from 1st June 2018 to 30th November 2021 who follow Inclusion and Exclusion criteria and followed up for a period of 6-24 months. Results: 6 patients were lost to follow up before removal of the fixator and were thus not included in the statistics. All the fractures consolidated at an average of 13 weeks and the fixators were removed. All the studied fractures resulted in good union. 2 of 4 compound fractures and 4 of the 10 simple fractures developed pin tract infections which were suppressed using antibiotics. 8 patients had stiffness of the ankle joint. This was probably due to the patient incompliance to the physiotherapy regimen. 2 cases had a malunion with an anterior angulation of 5 degrees but had a good ankle function. At 6 months, results were based on objective and subjective parameters by Ovadia and Beals. 9(36%) patients had excellent outcome, 12 (48%) had good,3(12%) had fair and 1(4%) patient had a poor outcome. Interpretation and Conclusion: Hybrid external fixator is simple, rapid and straightforward application, reduced surgical time, minimally invasive and adjustable. It has negligible complications and resulted in excellent results for this type of fractures.

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