Treatment of High-energy Distal Tibia Intraarticular Fractures with Two-staged Delayed Minimal Invasive Plate Osteosynthesis

Hong-Moon Sohn; Jun-Young Lee; Sang-Ho Ha; Jae-Won You; Sang-Hong Lee; Kwang-Chul Lee

doi:10.12671/jkfs.2007.20.1.19

Journal List > J Korean Fract Soc > v.20(1) > 1037582

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Sohn, Lee, Ha, You, Lee, and Lee: Treatment of High-energy Distal Tibia Intraarticular Fractures with Two-staged Delayed Minimal Invasive Plate Osteosynthesis

Original Article

Journal of the Korean Fracture Society 2007; 20(1): 19-25.

Published online: 14 June 2016

DOI: https://doi.org/10.12671/jkfs.2007.20.1.19

Treatment of High-energy Distal Tibia Intraarticular Fractures with Two-staged Delayed Minimal Invasive Plate Osteosynthesis

Hong-Moon Sohn, M.D., Jun-Young Lee, M.D., Sang-Ho Ha, M.D., Jae-Won You, M.D., Sang-Hong Lee, M.D., Kwang-Chul Lee, M.D.

Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to: Jun-Young Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 588, Seosuk-dong, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, leejy88@chosun.ac.kr

Abstract

Purpose

To evaluate the short-term results of two-staged delayed minimal invasive plate osteosynthesis in high-energy intraarticular fractures of the distal tibia.

Materials and Methods

Thirteen patients, who underwent two-staged delayed minimal invasive plate osteosynthesis for intraarticular fractures of the distal tibia between January 2002 and July 2004, were followed for more than one year. The mean interval time between first stage and second stage of the procedures was 28.6 days (range, 14~34 days). By Ruedi-Allgower classification, there were two cases in type I, three cases in type II, and eight cases in type III. There were six cases in type B and seven cases in type C patients according to AO/OTA classification. Radiographs were graded by the criteria of Burwell and Charnley and ankle functions were graded by the criteria of Mast and Teipner. Union time and postoperative complications were also analysed.

Results

Average union time was 16.9 weeks (range, 14~20 weeks) in twelve of the thirteen fractures, but there was one fracture resulting in soft tissue complication and infected nonunion. At the latest follow-up, review of the radiographic results showed that ten cases of fractures (77%) achieved an anatomic reduction, two cases (15%) achieved fair reduction and one case (8%) achieved a poor reduction. And clinical functional assessment showed that nine cases (69%) were good results, three cases were (23%) fair results and one case (8%) was poor result.

Conclusion

Two-staged delayed minimal invasive plate osteosynthesis is an excellent option for the treatment of high-energy intraarticular fractures of the distal tibia.

Keywords: Tibia, Intraarticular fractures, Two-staged minimal invasive plate osteosynthesis

Figures and Tables

Fig. 1

Limited incision by anterolateral arthrotomy.

Fig. 2

The 57-year-old male had a traffic accident, and sustained a Rüedi-Allgöwer type III fracture (A~C) and Gustilo-Anderson type IIIA open pilon fracture of right ankle (D). The patient underwent open reduction and internal fixation about fibular shaft fracture, closed reduction and external fixation about pilon fracture (E). The definitive procedure was performed days later and postoperative radiographs after two-staged delayed minimal invasive plate osteosynthesis show anatomic reduction, good alignment and articular congruity (F). Radiographs at the latest follow-up show complete bony union and no complication was developed (G).

Table 1

Summary of the patients data

^*Rüedi-Allgöwer classification, ^†Interval time between first stage and second stage of the procedures, ^‡Radiographic criteria of reduction by Burwell and Charnley, ^§Function criteria by Mast and Teipner, ^∥Traffic accident.

References

1. Abelseth G, Buckley RE, Pineo GE, Hull R, Rose MS. Incidence of deep-vein thrombosis in patients with fractures of the lower extremity distal to the hip. J Orthop Trauma. 1996; 10:230–235.

2. Anglen JO. Early outcome of hybrid external fixation for fracture of the distal tibia. J Orthop Trauma. 1999; 13:92–97.

3. Anonymous . Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma. 1996; 10:1–154.

4. Barbieri R, Schenk R, Koval K, Aurori K, Aurori B. Hybrid external fixation in the treatment of tibial plafond fractures. Clin Orthop Relat Res. 1996; 332:16–22.

5. Baumgaertel F, Buhl M, Rahn BA. Fracture healing in biological plate osteosynthesis. Injury. 1998; 29:Suppl 3. C3–C6.

6. Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001; 15:153–160.

7. Bone L, Stegemann P, McNamara K, Seibel R. External fixation of severely comminuted and open tibial pilon fractures. Clin Orthop Relat Res. 1993; 292:101–107.

8. Bone LB. Fractures of the tibial plafond. The pilon fracture. Orthop Clin North Am. 1987; 18:95–104.

9. Burwell HN, Charnley AD. The treatment of displaced fractures of the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br. 1965; 47:634–660.

10. Chang SA, Ahn HS, Byun YS, Kim JH, Bang HH, Kwon DY. Minimally invasive plate osteosynthesis in unstable fractures of the distal tibia. J Korean Fract Soc. 2005; 18:155–159.

11. Dillin L, Slabaugh P. Delayed wound healing, infection, and nonunion following open reduction and internal fixation of tibial plafond fractures. J Trauma. 1986; 26:1116–1119.

12. Francois J, Vandeputte G, Verheyden F, Nelen G. Percutaneous plate fixation of fractures of the distal tibia. Acta Orthop Belg. 2004; 70:148–154.

13. French B, Tornetta P 3rd. Hybrid external fixation of tibial pilon fractures. Foot Ankle Clin. 2000; 5:853–871.

14. Giordano CP, Koval KJ. Treatment of fracture blisters: a prospective study of 53 cases. J Orthop Trauma. 1995; 9:171–176.

15. Kilian O, Bundner MS, Horas U, Heiss C, Schnettler R. Long-term results in the surgical treatment of pilon tibial fractures. A retrospective study. Chirurg. 2002; 73:65–72.

16. Mast J. Pilon fractures of the distal tibia: a test of surgical judgement. In : Tscherne H, Schatzker J, editors. Major fractures of the pilon, the Talus, and the Calcaneus. 1st ed. Heidelberg: Springer-Verlag;1993. p. 7–27.

17. Mast JW. Reduction techniques in fractures of the distal tibial articular surface. Techn Orthop. 1987; 2:29–36.

18. Mast JW, Spiegel PG, Pappas JN. Fractures of the tibial pilon. Clin Orthop Relat Res. 1988; 230:68–82.

19. McNamara MG, Heckman JD, Corley FG. Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS). J Orthop Trauma. 1994; 8:81–87.

20. Moot JW. Preoperative planning in the surgical correction of tibial nonunions and malunious. Clin Orthop Relat Res. 1983; 178:26–30.

21. Ovadia DN, Beals RK. Fractures of the tibial plafond. J Bone Joint Surg Am. 1986; 68:543–551.

22. Park KC, Park YS. Minimally invasive plate osteosynthesis for distal tibial metaphyseal fracture. J Korean Fract Soc. 2005; 18:264–268.

23. Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma. 1999; 13:85–91.

24. Rommens PM, Claes P, De Boodt P, Stappaerts KH, Broos PL. Therapeutic procedure and long-term results in tibial pilon fracture in relation to primary soft tissue damage. Unfallchirurg. 1994; 97:39–46.

25. Ruedi TP, Allgower M. The operative treatment of intraarticular fractures of the lower end of the tibia. Clin Orthop Relat Res. 1979; 138:105–110.

26. Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 1999; 13:78–84.

27. Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res. 1993; 292:108–117.

28. Tornetta P 3rd, Weiner L, Bergman M, et al. Pilon fractures: treatment with combined internal and external fixation. J Orthop Trauma. 1993; 7:489–496.

29. Tscherne H, Gotzen L. External articular transfixation of joint injuries with severe soft tissue damage. In : Tscherne H, Gotzen L, editors. Fractures with soft-tissue injuries. 1st ed. Berlin: Springer-Verlag;1984. p. 103–117.

30. Varela CD, Vaughan TK, Carr JB, Slemmons BK. Fracture blister: clinical and pathological aspects. J Orthop Trauma. 1993; 7:417–427.

31. Wagner M. General principles for the clinical use of the LCP. Injury. 2003; 34:B31–B42.

TOOLS

Similar articles