Surgical Management of Distal Tibia Fracture: Towards An Outcome-based Treatment Algorithm
https://doi.org/10.5704/MOJ.2011.010
- Author:
Rushdi I
1
;
Che-Ahmad A
1
;
Abdul-Ghani KAH
2
;
Mohd-Rus R
3
Author Information
1. Department of Orthopaedics, International Islamic University Malaysia, Kuantan, Malaysia
2. Department of Orthopaedics, Tengku Ampuan Rahimah Hospital, Kuantan, Malaysia
3. Department of Community Medicine, International Islamic University Malaysia, Kuantan, Malaysia
- Publication Type:Journal Article
- Keywords:
distal tibia fracture, tibia pilon fracture, tibial plafond fracture, Ilizarov external fixator, internal fixation
- From:Malaysian Orthopaedic Journal
2020;14(No.3):57-65
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Distal tibia fractures are frequently associated
with an extensive soft tissue injury which then leads to a
higher risk of complications such as infection, non-union and
eventually poor overall outcome. The purpose of this study is
to measure the outcome of distal tibia fractures treated with
internal fixation, external fixator or Ilizarov external
fixator(IEF). We aim to propose an algorithm for
management of distal tibia fractures by evaluating the
treatment options, outcomes and risk factors present.
Material and Methods: This study is a cross-sectional study
of all distal tibia fractures treated surgically in Tengku
Ampuan Rahimah Hospital, Klang from 1st January 2016 till
30th June 2018. Patient records were reviewed to analyse the
outcomes of surgical treatment and risk factors associated
with it.
Results: Ninety-one patients were included with a mean age
of 41.5 years (SD = 16.4). Thirty-nine cases (42.9%) were
open fractures. Thirty-eight patients (41.8%) were treated
with internal fixation, 27 patients (29.7%) were treated with
IEF and 26 patients (28.6%) were treated with an external
fixator. Among open fractures cases, no significant finding
can be concluded when comparing each surgical option and
its outcome, although one option was seen better than the
other in a particular outcome. Initial skeletal traction or
temporary spanning external fixator in close fractures
reduced the risk of mal-alignment (p value=0.001). Internal
fixation is seen superior to IEF and external fixator in close
fractures in term of articular surface reduction (p value =
0.043) and risk of mal-alignment (p value = 0.007).
Conclusion: There is no single method of fixation that is
ideal for all pilon fractures and suitable for all patients. This
proposed algorithm can help surgeons in deciding treatment
strategies in the challenging management of distal tibia
fractures to reduce associated complications.
- Full text:16.2020my1111.pdf
