Functional outcome of medial distal tibial locking compression plate fixation in distal tibial fractures: A prospective study

INTRODUCTION: Fractures of the distal tibia can be challenging to treat because of limited soft tissue, the subcutaneous location and poor vascularity. Fractures of distal tibia remain a controversial subject despite advances in both nonoperative and operative care. The goal in expect care is to realign the fracture, realign limb length and early functional recovery. Fractures of distal tibia remains one of the most challenging for treatment because of high complication rates both from initial injury and also from treatment. All these fractures are severe injuries. They are increased in frequency because of higher incidences of Road Traffic Accidents. Accounts to 1% of all lower extremity fractures, 10% of tibial fractures and bilateral in 0-8% and compartment syndrome in 0-5%. AIM: To Study and analyze the functional outcome of Distal Tibial fractures Treated by Medial Distal Tibial Locking Compression Plate in our Institute of Orthopaedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital Chennai over a period of May 2011 to November 2012. MATERIALS AND METHODS: This prospective study analyses the functional outcome of Medial distal tibial LCP for treatment of distal tibial fracture depending on the type of fracture and to find out their prognosis. The study included patients who were treated in Rajiv Gandhi Government General Hospital with Medial distal tibial Locking compression plate for distal tibial fractures. The period of study was from may2011 to December 2012 with a total duration of 20 months. In this period patients admitted for distal tibial fractures with or without intra-articular extension were considered for this study. The mean duration from hospital admission to definitive surgery was around 10 days to 14days in cases of closed fractures. Inclusion Criteria • Patients willing to participate in this study. • Skeletally mature patients. • Ruedi and Allgower type – I, II, III fractures. • Only closed fractures. • Minimum follow up of 6 months. Exclusion Criteria - • Age less than 16 years and above 60. • Compound fractures. • Associated calcaneum fractures and talus fractures. • Severely mangled extremity. • Associated spinal and abdominal injuries. The total number of patients in this study was 30. RESULTS: Distal tibial fractures though amenable to open reduction and internal fixation carries a high risk of complication and a potential for redo surgery. The outcome of an injury is best judged by how much it affects the patients, deformity, impairment or loss of function. Ovoida and Beals considered “an excellent result to be pain free patient who has returned to all activities without limp”. A number of factors affect the outcome of distal tibial fractures. The single most important factor is the severity of the initial injury, which is indicated primarily by the amount of damage to the plafond and the impaction, comminution and the displacement of the fragments and the extent to which soft tissue damage have occured. Another is the extent to which reduction was achieved and also the postoperative complications. CONCLUSION: A short series of result of our study were analyzed and the overall results have encouraged us in preferring the surgical management of distal tibial fractures over conservative methods. Distal tibial fractures are to be internally fixed either within 24 hrs of the injury before the edema sets in or a delay of 8 to 12 days for the edema to settle down and the wrinkle sign appears. Respect the soft tissues: do not operate too early or through compromised skin, instead wait till the soft tissues is amenable for surgery. Restoration of the articular surface and reestablishing its relationship to the tibial shaft is the primary goal of treatment. Good functional result depends on reasonable anatomic reduction of the articular surface either by direct or indirect methods