Surgical management of distal tibia fracture: towards an outcome-based treatment algorithm

Isnin, Rushdi and Che Ahmad, Aminudin and Abdul Ghani, Kamarul Haq and Mohd Rus, Razman (2020) Surgical management of distal tibia fracture: towards an outcome-based treatment algorithm. Malaysian Orthopaedic Journal, 14 (3). pp. 57-65. ISSN 1985-2533 E-ISSN 2232-111X

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Abstract

Introduction: Distal tibia fractures are frequently associated with an extensive soft tissue injury which then leads to a higher risk of complications such as infection, non-union and eventually poor overall outcome. The purpose of this study is to measure the outcome of distal tibia fractures treated with internal fixation, external fixator or Ilizarov external fixator(IEF). We aim to propose an algorithm for management of distal tibia fractures by evaluating the treatment options, outcomes and risk factors present. Material and Methods: This study is a cross-sectional study of all distal tibia fractures treated surgically in Tengku Ampuan Rahimah Hospital, Klang from 1st January 2016 till 30th June 2018. Patient records were reviewed to analyse the outcomes of surgical treatment and risk factors associated with it. distal tibia fracture, tibia pilon fracture, tibial plafond fracture, Ilizarov external fixator, internal fixation Results: Ninety-one patients were included with a mean age of 41.5 years (SD = 16.4). Thirty-nine cases (42.9%) were open fractures. Thirty-eight patients (41.8%) were treated with internal fixation, 27 patients (29.7%) were treated with IEF and 26 patients (28.6%) were treated with an external fixator. Among open fractures cases, no significant finding can be concluded when comparing each surgical option and its outcome, although one option was seen better than the other in a particular outcome. Initial skeletal traction or temporary spanning external fixator in close fractures reduced the risk of mal-alignment (p value=0.001). Internal fixation is seen superior to IEF and external fixator in close fractures in term of articular surface reduction (p value = 0.043) and risk of mal-alignment (p value = 0.007). Conclusion: There is no single method of fixation that is ideal for all pilon fractures and suitable for all patients. This proposed algorithm can help surgeons in deciding treatment strategies in the challenging management of distal tibia fractures to reduce associated complications.

Item Type:	Article (Journal)
Additional Information:	3516/85865
Uncontrolled Keywords:	distal tibia fracture, tibia pilon fracture, Ilizarov external fixator, internal fixation
Subjects:	R Medicine > RD Surgery > RD701 Orthopedics
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Community Medicine (Effective: 1st January 2011) Kulliyyah of Medicine > Department of Department of Orthopaedics, Traumatology & Rehabilitation
Depositing User:	Assoc Prof Dr Aminudin Che Ahmad
Date Deposited:	08 Dec 2020 14:35
Last Modified:	08 Dec 2020 14:35
URI:	http://irep.iium.edu.my/id/eprint/85865

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