Functional outcome of comminuted upper metaphyseal tibial fracture treated with circular external fixators
Keywords:JESS, Hybrid, Ilizarov, Tibial metaphysis
Background: High speed motor vehicle accidents are on the rise over the past few years. These are responsible for most of the complex fractures of the tibial metaphysic. Proper treatment of these fractures is of paramount importance. The use of circular fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications.
Methods: This study was prospective and conducted over 22 patients diagnosed with upper comminuted metaphyseal tibial fracture treated with circular external fixator.
Results: In this series, all 22 patients (100%) were male. Fourteen cases (64%) involved the left tibia and eight (36%) fractures were on right. The mean patient age was 49.5 years (range 26-75). Road traffic collisions accounted for most of the injuries (n=14), while fall from bike (n=8). In this study, using knee society score evaluation, excellent results (KSS>80) were seen in 8 patients (36.36%), good results (KSS 70-79) were seen in 10 patients (45.45%), fair (KSS 60-69) in 4 patient (18.18%) and poor (KSS< 60) in 0 patient (0%). Complication seen was pin tract infection in 2 patients (9.9%), which was managed by regular pin site dressings. Another complication was non-union in 1 patient (4.54%). No other complication was encountered.
Conclusions: Circular external fixation is a promising modality for surgical treatment of comminuted upper metaphyseal tibial fractures. It allows satisfactory realignment of the fractured fragments and their stabilization, besides early mobilization of the joints and care of associated soft tissue injuries, without significant complications.
Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma. 2005;19(7):448-55.
Gupta A, Anjum R, Singh N, Hackla S. Outcome of distal both bone leg fractures fixed by intramedulary nail for fibula & MIPPO in tibia. Arch Bone Jt Surg. 2015;3(2):119.
Bucholz RW, Court-Brown CM, Heckman JD, Tournetta PMD. Rockwood and Green’s Textbook of orthopaedic fractures in adults. 7th ed. USA: Wolters Kluwer; 2003.
Young M, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994;23(2):149.
Yilmaz E, Belhan O, Karakurt L, Arslan N, Serin E. Mechanical performance of hybrid Ilizarov external fixator in comparison with Ilizarov circular external fixator. CliniC Biomech. 2003;18(6):518-22.
Fleming B, Paley D, Kristiansen T, Pope M. A biomechanical analysis of the Ilizarov external fixator. Clinic Orthop Rel Researc. 1989;241:95-105.
Babis GC, Evangelopoulos DS, Kontovazenitis P, Nikolopoulos K, Soucacos PN. High energy tibial plateau fractures treated with hybrid external fixation. J Orthop Surg Resear. 2011;6(1):35.
Zeman J, Matejka J. Use of a hybrid external fixator for treatment of tibial fractures. Acta Chir Orthop Traumatol. 2005;72(6):337.
Zahid M, Sherwani MKA, Siddiqui YS, Abbas M, Asif N, Bin A. The role of the Jess (Joshi’s External Stabilization System) fixator in the management of tibial plateau fractures which are associated with severe soft tissue injuris. J Clinic Diagn Researc. 2010;4:3356-61.
Hall JA, Beuerlein MJ, McKee MD. Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures: surgical technique. J Bone Joint Surg Am. 2009;91:74-88.
Subasi M, Kapukaya A, Arslan H, Ozkul E, Cebesoy O. Outcome of open comminuted tibial plateau fractures treated using an external fixator. J Orthop Sci. 2007;12(4):347-53.
Babis GC, Evangelopoulos DS, Kontovazenitis P, Nikolopoulos K, SoucacosPN. High energy tibial plateau fractures treated with hybrid external fixation.J Orthop Surg Res. 2011;6:35-41.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clinic Orthop Relat Res. 1989;(248):13-4.
Kim PH, Leopold SS. Gustilo-Anderson Classification. Clin Orhtop Relat. 2012;470(11):3270-4.
Ruffolo MR, Gettys FK, Montijo HE, Seymour RB, Karunakar MA. Complications of high-energy bicondylartibial plateau fractures treated with dual plating through 2 incisions. J Orthop Trauma. 2015;29(2):85-90.
Jiang R, Luo CF, Wang MC, Yang TY, Zeng BF. Acomparative study of lessinvasive stabilization system (LISS) fixation and two-incision double plating forthe treatment of bicondylartibial plateau fractures. Knee. 2008;15(2):139-43.
Canadian Orthopaedic Trauma Society. Open reduction and internal fixation compared with circular fixator application for bicondylartibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am. 2006;88(12):2613-23.
Hall JA, Beuerlein MJ, McKee MD. Open reduction and internal fixation compared with circular fixator application for bicondylartibial plateau fractures. Surgical technique. J Bone Joint Surg Am. 2009;91:74-88.
Aggarwal AK, Nagi ON. Hybrid external fixation in periarticular tibial fractures. Good final outcome in 56 patients. Acta Orthop Belg. 2006;72(4):434-40.
Gupta SV, Sunil G. Management of tibial metaphyseal fractures by hybrid external fixator. Open J Orthop. 2014;4(3):84-9.
Kataria H, Sharma N, Kanojia RK. Small wire external fixation for high-energy tibial plateau fractures. J Orthop Surg. 2007;15(2):137-43.
Watson JT, Coufal C. Treatment of complex lateral plateau fractures using Ilizarov techniques. Clinic Orthop Rel Res. 1998;353:97-106.