Management of Periarticular Distal Tibia Fractures with Minimal Internal Fixation and Ankle-spanning External Fixation
Purpose: Fractures of the 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 handling soft tissue injuries around the ankle. We have treated these fractures with extern...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Jaypee Brothers Medical Publisher
2025-07-01
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| Series: | Journal of Orthopedics and Joint Surgery |
| Subjects: | |
| Online Access: | https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1218 |
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| Summary: | Purpose: Fractures of the 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 handling soft tissue injuries around the ankle. We have treated these fractures with external fixation with limited internal fixation. This minimally invasive nature of the surgery can avoid catastrophic wound complications such as dehiscence, implant exposure, and infection.
Materials and methods: Thirty-seven patients with distal tibial fractures (AO type 43A1–5, A2–5, A3–6, B1–6, B2–5, B3–5, C1–5) were treated with the technique of ankle-spanning external fixation. Thirty-one patients had closed injuries and six patients had open injuries. Lag screws or K-wires were used for limited internal fixation. The fibula was stabilized in all cases.
Results: The mean follow-up was 24 months. Of the 37 patients included, all but one fracture united with an average healing time of 14 weeks. Ankle pain and motion were graded according to Karlsson–Peterson ankle scoring system. Thirteen of them had excellent, 21 had good results, two had fair results, and one patient had poor results. Five pin tract infections occurred. One patient had nonunion of tibia, for which later bone grafting and plating were performed, which united subsequently. Two patients had ankle arthritis for which later ankle fusion was done.
Conclusion: Distal tibial fractures are complex injuries in terms of the management of bony and soft tissue components. Ankle-spanning external fixator with limited internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function. Another main advantage of this type of fixation is that we can use this method as a definitive option for all types of open fractures. |
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| ISSN: | 2582-7863 |