Fixation Of Compound Fractures Of Distal Tibia Using A Delta External Fixator As A Definite Modality Of Treatment With Or Without Fibular Plating/ Limited Internal Fixation With K- Wires.

Abstract

Introduction : The goal was to evaluate the results of fixation of compound fractures of distal tibia using a delta external fixator and to analyse the results vis-à-vis functional outcome, soft tissue healing and fracture union. Compound fractures of distal tibia produce a challenge to manage, especially when associated with significant soft-tissue injury. Although a variety of options are available to treat these fractures, timing of definitive surgery is crucial with respect to the condition of the soft tissues. Despite the advances that have been made in managing these fractures, new developments in the field continue to lead to better outcomes. Ankle spanning external fixation has become the initial treatment of choice for complex tibial pilon fractures [1].Material: Between 2006 and 2010, 25 patients, three lost in follow up, net 22 (17 men and five women) with compound tibial fractures were treated with delta external fixator using a two staged protocol at the Department of Orthopaedics and Traumatology ,government medical college jammu. The average age of the patients was 35.5 years. The fractures, evaluated by the AO classification, included 14 AO43A2, 5 AO43C1, 1 AO43B3, 1 AO43C2,1 AO43C3.There were 5 type I, 9 type II, 6 type IIIa, 2 type IIIb open fractures according to the Gustilo-Anderson Classification [2]. In 13 patients the fracture was associated with multiple traumas and in 12 it was a single injury. The injury was due to a high-velocity motor vehicle accident in 18 and a fall in three patients. Method: All the patients were treated by debridement followed by Ankle spanning Delta external fixator, with or without fibular plating/ Kwire fixation of articular elements.All the patients were assessed clinically and radiographically for an average follow-up of 7.5 months using American Orthopaedic Foot and Ankle Society score (AOFAS). RESULTS: The evaluation, based on clinical and radiographic findings and subjective complaints of the patients, was made with the use of the American Orthopaedic Foot and Ankle Society score (AOFAS). 22 patients were followed up, three failed to turn up. AOFAS scoring: excellent in 81% (18/22).Average hospital stay: 28.6 days .Non union: one case, delayed union: two case.Mean time to union 5.5 months (3-16 months). Conclusion: Delta type of external fixator is a safe and useful modality in compound tibial fractures as definitive modality, however caution is advocated as cohort is short.