Distal Tibial Fracture Managed by Circular External Fixation: Clinical and Functional Outcomes
DOI:
https://doi.org/10.61919/jhrr.v4i3.1348Keywords:
Distal Tibial Fracture, Circular External Fixation, Ilizarov TechniqueAbstract
Background: Distal tibial fractures, often resulting from high-energy trauma, pose significant challenges in orthopedic management due to their complexity and associated soft tissue injuries. Circular external fixation, particularly the Ilizarov technique, has emerged as a treatment option that offers the potential for enhanced fracture stability and preservation of soft tissue integrity.
Objective: To evaluate the functional and clinical outcomes of distal tibial fractures managed by circular external fixation using the Ilizarov technique.
Methods: This prospective study was conducted from September 2023 to May 2024 at the Department of Orthopedics, Hayatabad Medical Complex, Peshawar. Sixty patients aged 18 years or older with distal tibial fractures were included. Patients with diabetes, pregnancy, or age over 60 years were excluded. The fractures were treated using the Ilizarov fixator technique by an experienced surgeon. Postoperative assessments included functional outcomes using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria and pain evaluation using the Visual Analog Scale (VAS). Radiographic assessments were performed to evaluate malunion and nonunion. Data were analyzed using SPSS version 25, with descriptive statistics summarizing demographic data and paired t-tests used for comparing preoperative and postoperative pain scores, with significance set at p < 0.05.
Results: The mean age of the patients was 41.10 ± 12.74 years, with a mean BMI of 25.07 ± 1.88 kg/m². Males constituted 76.7% of the cohort. The majority of injuries were due to road accidents (51.7%). Functional outcomes showed that 63.3% of patients had excellent results, 18.3% had good outcomes, 15.0% had fair outcomes, and 3.3% had poor outcomes. A significant reduction in pain was observed, with the mean VAS score decreasing from 7.47 ± 0.999 preoperatively to 2.47 ± 0.982 postoperatively (p = 0.0001). Complications were minimal, with 13.3% experiencing infections, 1.7% malunion, and 3.3% nonunion.
Conclusion: Circular external fixation using the Ilizarov technique for distal tibial fractures led to favorable clinical and functional outcomes, with significant pain reduction and minimal complications. This technique should be considered a viable option for managing complex distal tibial fractures, particularly in cases requiring soft tissue preservation.
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Vaienti E, Schiavi P, Ceccarelli F, Pogliacomi F. Treatment of Distal Tibial Fractures: Prospective Comparative Study Evaluating Two Surgical Procedures With Investigation for Predictive Factors of Unfavourable Outcome. Int Orthop. 2019;43(17):201-7.
Court-Brown CM, Caesar B. Epidemiology of Adult Fractures: A Review. Injury. 2006;37(8):691-7.
Stenroos A, Puhakka J, Jalkanen J, Laaksonen T, Kivisaari R, Kosola J, Nietosvaara Y. Risk of Premature Physeal Closure in Fractures of Distal Tibia. J Pediatr Orthop B. 2021;30(1):25-31.
Saad BN, Yingling JM, Liporace FA, Yoon RS. Pilon Fractures: Challenges and Solutions. Orthop Res Rev. 2019;15(7):149-57.
Zyskowski M, Wurm M, Greve F, Pesch S, von Matthey F, Pflüger P, Crönlein M, Biberthaler P, Kirchhoff C. Is Early Full Weight Bearing Safe Following Locking Plate ORIF of Distal Fibula Fractures? BMC Musculoskelet Disord. 2021;22(1):1-10.
Lovisetti G, Vulcano E, Bettella L, Cook R, Sala F, Muelle JD, Talamonti T. Circular External Fixation as an Alternative Method of Stabilization for Extra-Articular Tibia Fractures in the Elderly. J Limb Lengthen Reconstr. 2021;7(1):1-7.
Oguzkaya S, Misir A, Kizkapan TB, Eken G, Ozcamdalli M, Basilgan S. A Comparison of Clinical, Radiological, and Quality-of-Life Outcomes of Double-Plate Internal and Ilizarov External Fixations for Schatzker Type 5 and 6 Tibia Plateau Fractures. Eur J Trauma Emerg Surg. 2022;48(3):1087-95.
Zelle BA, Dang KH, Ornell SS. High-Energy Tibial Pilon Fractures: An Instructional Review. Int Orthop. 2019;43(8):1939-50.
Hui T, Wang J, Yu Y, Dong H, Lin W. External Fixator Versus Ilizarov External Fixator for Pediatric Tibial Shaft Fractures: A Retrospective Comparative Study. Injury. 2024;55(2):111-6.
Marwan Y, Turner J, Senan R, Muir R, Barron E, Hadland Y, Moulder E, Sharma H. Circular External Fixation for Revision of Failed Tibia Internal Fixation. Eur J Orthop Surg Traumatol. 2024;34(1):353-61.
Molepo M, Barnard AC, Birkholtz F, Viljoen S. Functional Outcomes of the Failed Plate Fixation in Distal Tibial Fractures. Eur J Orthop Surg Traumatol. 2018;28(8):1617-24.
Dickson DR, Moulder E, Hadland Y, et al. Grade 3 Open Tibial Shaft Fractures Treated With a Circular Frame, Functional Outcome and Systematic Review of Literature. Injury. 2015;46(4):751-8.
Webb LX, Bosse MJ, Castillo RC, et al. Analysis of Surgeon-Controlled Variables in the Treatment of Limb-Threatening Type-III Open Tibial Diaphyseal Fractures. J Bone Joint Surg Am. 2007;89(5):923-8.
Court-Brown CM, Wheelwright EF, Christie J, et al. External Fixation for Type III Open Tibial Fractures. J Bone Joint Surg Br. 1990;72(5):801-4.
Hassan SMT, Saud AM, Khan AGS, Ali R, Zeb SA, Raza T, et al. Clinical and Functional Outcomes in Patients With Distal Tibial Fracture Treated by Circular External Fixation. Biol Clin Sci Res J. 2024;34(1):899-906.
Bakhsh K, Atiq-Ur-Rehman, Zimri FK, Mohammad E, Ahmed W, Saaiq M. Presentation and Management Outcome of Tibial Infected Non-Union With Ilizarov Technique. Pak J Med Sci. 2019;35(1):136-40.
Giannoudis VP, Ewins E, Taylor DM, Foster P, Harwood P. Clinical and functional outcomes in patients with distal tibial fracture treated by circular external fixation: a retrospective cohort study. Strategies in Trauma and Limb Reconstruction. 2021 May;16(2):86.
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