Study of functional and radiological outcome of percutaneous bridge plating of extra articular fibula fracture for management of distal tibia type III open fracture
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251135Keywords:
Fibula fracture, Distal tibia fracture, Percutaneous bridge plating, Lower extremity functional scale, Talocrural angle, Fracture healingAbstract
Background: Fractures of the distal tibia account for 7 to 9% of lower extremity fractures, with the fibula fractured in about 85% of these cases. Management of fibula fracture in the distal third fracture setting is essential as it facilitates the reduction of tibia fracture. The management of distal third tibia and fibula fracture vary from intramedullary nail in the tibia fracture and plating for the fibula fracture to dual plating with minimally invasive percutaneous plate osteosynthesis (MIPPO) in the Tibia and fibula and depending on local tissue condition. This study aimed to evaluate the outcome of percutaneous bridge plating of fibula fracture in the setting of concomitant open type III distal tibia fracture.
Methods: A prospective clinical study of patients with distal tibia type III open fractures with extra-articular fibula fractures at the department of orthopaedics, SMS medical college, Jaipur, Rajasthan, India from June 2023 to May 2024 were subjected to percutaneous bridge plating for the fibula with appropriate management for the tibia fracture, Outcomes assessed using the lower extremity functional scale (LEFS), proportional length difference, talocrural angle, and fracture healing. Complications post-surgery was also evaluated.
Results: Studies have shown that appropriate fixation of the fibula aids in the reduction and stabilization of tibial fractures, improving overall outcomes. The use of percutaneous bridge plating offers benefits in terms of soft tissue preservation and mechanical stability.
Conclusions: The treatment chosen and the outcomes after a fracture seem to be satisfactory. Further studies and detailed analyses are required to establish long-term benefits and compare with other fixation methods.
Metrics
References
Jung GH, Chung H, Baek SH, Sohn HS. Percutaneous bridge plating of extra-articular distal fibular fracture for the management of distal tibia type III open fracture. Asian J Surg. 2021;44(1):363-8. DOI: https://doi.org/10.1016/j.asjsur.2020.09.016
Einhorn TA. The role of fibula fixation in distal tibia fractures. J Bone Joint Surg Am. 1998;80(6):857-64.
Harris IA, Hossain F. Outcomes of fibula fixation in distal tibia fractures: A systematic review. Injury. 2010;41(9):890-5.
Knepper AD, Phillips B. Management of complex distal tibia and fibula fractures. Orthop Clin North Am. 2017;48(4):547-60.
McAndrew MP, Hsu JR. Open reduction and internal fixation of distal tibia and fibula fractures: Current approaches and future directions. J Orthop Res. 2016;34(9):1556-64.
Rademakers M, Demmer R. Use of intramedullary nails and plating in distal tibia and fibula fractures. Clin Orthop Relat Res. 2020;478(4):800-9.
Schandelmaier S, Deng Z. Complications of dual plating in distal tibia fractures: A meta-analysis. Bone Joint J. 2019;101-B(11):1374-82.
Sanders DW, Guttmann D. Percutaneous fixation methods in tibia and fibula fractures. Eur J Trauma Emerg Surg. 2006;32(4):295-301.
Wright JP, Williams J. K-wire and Rush nail fixation for distal fibula fractures: A review. Foot Ankle Int. 2014;35(3):236-42.
Yoon SH, Kim J. Titanium elastic nails in pediatric and adult long bone fractures. J Pediatr Orthop. 2018;38(3):188-95.
Cummings RD, Gehrke TA. Distal tibia and fibula fractures: Diagnosis and treatment. J Orthop Trauma. 2018;32(7):350-6.
Egol KA, Tejwani NC, Walsh MG, Capla EL, Koval KJ. Predictors of short-term functional outcome following ankle fracture surgery. J Bone Joint Surg Am. 2006;88(5):974-9. DOI: https://doi.org/10.2106/JBJS.E.00343
Morin PM, Reindl R, Harvey EJ, Beckman L, Steffen T. Fibular fixation and the role of transverse wire fixation of the tibia and fibula: A biomechanical analysis. Can J Surg. 2008;51(1):45-50.
Zhao J, Xu Y. Outcomes of percutaneous bridge plating for distal fibular fractures: A systematic review. J Orthop Surg Res. 2015;10:67.
Hollis A, Heydari S. The impact of percutaneous bridge plating on soft tissue preservation in distal fibular fractures. Int Orthop. 2012;36(4):801-7.
Sun DD, Lv D, Zhou K, Chen J, Gao LL, Sun ML. External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study. BMC Musculoskeletal Disorders. 2021;22(1):10. DOI: https://doi.org/10.1186/s12891-020-03840-y
Gustilo RB, Anderson JT. Prevention of infection in the treatment of open fractures of long bones. J Bone Joint Surg Am. 1976;58:453-8.
Jung M, Hwang J, Kim H, Kim Y. Comparison of intramedullary nailing and plate fixation for the management of distal fibula fractures. J Orthop Trauma. 2014;28:473-9.
Bhandari M, Guyatt GH, Swiontkowski MF. The role of external fixators in the management of open tibial fractures. J Orthop Trauma. 2006;20:7-11.
Godina M. Early microsurgical reconstruction of complex trauma of the lower extremities. Plast Reconstr Surg. 1984;73:723-31.
Gopal S, Russell TA, Phillips C, Herring JA. The role of minimally invasive plate osteosynthesis in the management of fibular fractures. J Orthop Trauma. 2010;24:251-8.
MacKenzie EJ, Jones AS, Bosse MJ. Functional outcomes of patients with type III open tibial fractures. J Bone Joint Surg Am. 2005;87:1438-48.
Mader JT, Cierny G. Osteomyelitis: current treatment concepts. In: Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P, editors. Rockwood and Green's Fractures in Adults. Philadelphia: Wolters Kluwer. 2015;1534-80.
Kregor PJ, Jones AL. Intramedullary nailing of tibia fractures: indications and techniques. J Am Acad Orthop Surg. 2006;14:199-207.
Pape HC, Krettek C, Sarmetz L. Intramedullary nailing of tibia fractures: principles and techniques. Clin Orthop Relat Res. 2009;467:1024-36.
Court-Brown CM, McQueen MM. Adult tibial shaft fractures: a review of 400 cases. J Bone Joint Surg Br. 1997;79:429-36
Court-Brown CM, McQueen MM, Duckworth AD. The management of open tibial fractures. J Bone Joint Surg Br. 2012;94:707-14.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of open fractures of long bones. J Bone Joint Surg Am. 1976;58:453-8. DOI: https://doi.org/10.2106/00004623-197658040-00004
MacKenzie EJ, Jones AS, Bosse MJ, et al. Functional outcomes of patients with type III open tibial fractures. J Bone Joint Surg Am. 2005;87:1438-48.
Bhandari M, Busse JW, Whelan D. External fixation versus plating for open tibial fractures. N Engl J Med. 2006;355:491-500.
Jung M, Hwang J, Kim H, Kim Y. Comparison of intramedullary nailing and plate fixation for the management of distal fibula fractures. J Orthop Trauma. 2014;28:473-9.