MANAGEMENT OF DISTAL METAPHYSEAL FRACTURES OF TIBIA USING HYBRID EXTERNAL FIXATOR
Journal of Evidence Based Medicine and Healthcare
AIMS AND OBJECTIVES: Distal tibial fractures represent a significant challenge to orthopaedicians. The low energy fractures get dramatic results with open reduction and internal fixation. But high energy fractures have a high amount of complications due to soft tissue coverage, skin necrosis, infections and also the usually comminuted nature of the fractures. Conservative treatment by cast application leads to prolonged immobilization, ankle and knee stiffness affecting quality of life of the
... ty of life of the patient. The Hybrid External Fixator combines the advantages of the monolateral pin fixators and the circular Ilizarov wire fixators. The tensioned wires provide improved fixation in the small distal cancellous fragment, as they have rapid and straight forward application, reduced surgical time and is minimally invasive. It is adjustable, hence reduction can be easily attained after frame assembly. With rigid fixation it also allows immediate mobilization of the knee and ankle joints and early weight bearing. Aim of this present study is to study and establish the results and functional outcome in surgical treatment of distal metaphyseal fractures of Tibia using a Hybrid External Fixator. MATRIALS AND METHODS: 25 patients with distal tibial metaphyseal fractures were studied from June 2010 to July 2012 in department of Orthopaedics, Government General Hospital, Kurnool and followed up for a period of 6-10 months. Ovadia and Beals 1 scoring system of objective and subjective evaluation was used in this study to assess the results. RESULTS: All the fractures consolidated with average of 13 weeks. All the studied fractures resulted in good union. Three of the 5 compound fractures and 2 of the 20 simple fractures developed pin tract infections. Twelve patients had ankle stiffness from 20-90% of total ankle movement. Two cases had a malunion with an anterior angulation of 5 degrees but had a good ankle function. At 6 months, results were based on objective and subjective parameters by Ovadia and Beals. 1 12 (48%) patients had excellent outcome 7 (28%) had good, 5 (20%) had fair and 1 (4%) patient had a poor outcome. Subjective parameters showed 21 (74%) good to excellent results and 4 (16%) patients with fair results. CONCLUSION: Hybrid external fixator is simple, rapid and straightforward application, reduces surgical time, minimally invasive and adjustable. It has negligible complications and resulted in excellent results for this type of fractures.