Joshi’s external stabilization system in the management of distal tibial and fibular fractures with associated soft tissue injury in children

Shivanand C. Mayi, Sachin Shah, Sadashiv R. Jidgekar, Arunkumar Kulkarni


Background: Injuries around ankle and distal third of tibial shaft are among common paediatric bone trauma.  Some of these cases are associated with soft tissue injury over the lower third of leg or around the ankle joint as tibia is subcutaneous on the anteromedial aspect. This study was conducted to know the outcome of these injuries with minimal invasive external fixation.

Methods: Eleven patients in the age group of 4-14 years were included in this study. All patients had closed fracture of distal third tibial shaft or injury of distal tibial physis with associated soft tissue injury. Joshi’s external stabilization system was used to retain the reduction of fracture and appropriate wound care was taken. JESS was removed after radiological signs of fracture union.

Results: Patients were followed up for mean period of 8.9 month. After JESS fixation healing of wound occurred at an average of 12.45 day and external fixator was removed at 6-8 weeks period. Three patients had grade 1 pin tract infection which was controlled by local dressing. No patient had stiffness of ankle at the time of JESS removal.  No limb length discrepancy was seen in any of the patients in this study at their final follow up.

Conclusions: JESS gives good results in fractures of distal tibial with associated soft tissue injury. It helps in better management of wound and fracture stabilization.



Distal tibial fracture, Epiphysis, Soft tissue injury, External stabilization

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