We classified the distal tibia fractures according to the AO/OTA classification as type 43 (metaphyseal) with distinction of type A fractures (extra-articular), type B (partial articular) and type C (total articular) (Table 1). High-energy injury occurred in 74 cases (42 road traffic accidents and 32 falls from height) and low-energy traumatism in 27 cases (twisting injuries). Thus we obtained a group of 101 consecutive fractures (100 patients). Four subjects were lost at final follow-up and 95% of patients were reviewed for clinical and radiological evaluation. The study group included 35 women and 69 men with an average age of 44 years (range, 15–86 years). This retrospective and multicentre study concerned 104 patients with 105 distal tibia fractures from 2002 to 2004 in six general hospitals in northeast France. The purpose of this paper was to study the functional and radiographic outcomes after distal tibia fractures, to evaluate complications and to determine predictive factors of poor results. ĭespite progress of surgical procedures, outcomes are not always excellent and complications affect 20–50% of patients. All of these techniques have advantages and disadvantages and there is no consensus concerning the management of these fractures. Many osteosynthesis techniques can be used for these fractures such as traditional open reduction and internal fixation (ORIF), external fixation with or without limited internal fixation, intramedullary nailing or, more recently, minimally invasive plate osteosynthesis (MIPO). The goal of orthopaedic surgeons is to restore the tibial anatomy, to fix the epi-metaphyseal block with the diaphysis and to avoid complications. Management of distal tibia fractures, with or without articular involvement, is a therapeutic challenge. For other cases, we recommend ORIF with early mobilisation. We believe that external fixation must be reserved for trauma with severe skin injury, as a temporary solution in a two-staged protocol. Predictive factors of poor results were fracture severity, complications, malunion and the use of external fixation. The average functional score was 76 points (range, 30–100 points), and complications occurred in 30 patients. Outcome parameters included occurrence of complications, radiographic analysis, evaluation of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and measures of the ankle range of motion. Internal fixation, external fixation, limited internal fixation (K-wires or screws), intramedullary nailing and conservative treatment were used. One hundred patients (101 fractures) were reviewed with an average follow-up of 19 months (range, 12–46). Between 20, 104 patients were admitted for 105 distal tibia fractures. In this retrospective and multicentre study we attempted to detail complications and outcomes of this type of injury in order to determine predictive factors of poor results. All rights reserved.Distal tibia fractures are complex injuries with a high complication rate. For this reason, we recommend fibular fixation in all 42 distal fractures when both fractures lie on the same plane and the tibial fracture is relatively stabilised.ĭistal shaft leg fractures Fibular osteosynthesis Union rate.Ĭopyright © 2013 Elsevier Ltd. This study showed a higher non-union rate when the fracture of the tibia and fibula were at the same level, the tibia was fixed with a bridging plate and the fibula left untouched. None of the parameters considered (open injury, AO classification, device used and level of the fibular fracture relative to the tibial) were shown to have an influence on the development of a non-union. Other parameters examined were the union rate of the two groups correlated to the fracture pattern and position of the fibular fracture the demographic data, such as age and gender the presence of an open fracture, and the type of tibial fixation device used (nail or plate). The fibular fracture was classified according to the AO and related to the level of the tibial fracture. Patients were divided into two groups according to whether or not the fibula was fixed: Group I (n=26) comprised patients who had their fibula fixed while Group II (n=34) comprised patients who did not. The aim of the current paper is to explain the role of stabilisation of the fibula in 42 AO fractures, correlating the rates of healing and non-union between patients with and without fibula fixation.Ī total of 60 patients with 42 AO (distal) shaft fracture of the tibia with associated fracture of the fibula were selected. Some studies indicate the need for fibular stabilisation in 43 AO fractures, but few studies consider the role of the fibula in 42 AO fractures. The role of stabilisation of the fibula in distal two-bone fractures of the leg is controversial.
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