Study of surgical and functional outcome in the management of proximal tibial fracture with circular wire-based external fixation

Abstract

Background: The principle of treatment in proximal tibial fracture includes soft tissue care, restoring articular surface congruity and reduction of anatomical alignment enabling early joint mobility. Aim: Assessing surgical, and functional outcomes by evaluating pain, range of motion (ROM) and muscle power in circular wire-based external fixation procedure in proximal tibial fractures with complications. Objectives: Documenting clinical observations, preoperative, and postoperative symptoms in the study population with time for bony union and complications. Materials and Methods: Thirty patients aged 18–70 years with proximal tibial fractures excluding polytrauma and pathological fracture cases were included in the prospective observational study. Surgery and post-operative follow-up were done at 6, 12, 24 weeks and 6 months. Functional assessment is done by the knee society score system. Removal of fixator followed evidence of clinical and radiological union with advice for full weight bearing. Results: Road traffic accident was a major injury, right laterality more than left. The type of tibial fractures was 41A2, A3 and C3. Eighty per cent of patients had no persistent residual pain after fracture union; 80% showed normal relative to age walking capacity, and 95% showed normal to <10° lack of extension. Fourteen patients had ROM of 125° and 120° in ten. Twenty-six patients showed normal stability in extension and 20° flexion. Twenty-five patients showed excellent knee scores, 24 showed excellent functional scores; four showed good knee scores and five showed good functional scores. Post-operative complications included pin-tract infection in four patients followed by delayed and non-union in one patient each. Conclusion: Circular wire-based external fixation in the proximal tibial fracture is an effective method of treatment even with moderate soft-tissue injury showing excellent to good functional outcome.