Outcome of minimal invasive plate osteosynthesis in distal tibia fractures

Osman Çiloğlu; Fırat Seyfettinoğlu; Hakan Çiçek; Ahmet Yılmaz; Fatma Feride Görgülü; Ümit Tuhanioğlu; Hasan Ulaş Oğur

doi:10.17826/cutf.290352

TR EN

Distal tibia kırıklarında minimal invasiv plak osteosentez sonuçları

Öz

Amaç: Bu çalışmanın amacı distal tibia kırığı nedeniyle minimal invaziv yöntem ve biyolojik fiksasyon prensipleri ile plak kullanarak osteosentez uyguladığımız olgularda klinik, radyolojik sonuç ve komplikasyonların değerlendirilmesidir.

Gereç ve Yöntem: Bu çalışmada distal tibia kırığı nedeniyle minimal invaziv yöntem ve biyolojik fiksasyon prensipleri ile ameliyat olan 58 hasta (35 erkek, 23 bayan, ortalama yaş 32) ortalama 28 aylık takibleri sonucunda değerlendirildi. Hastaların kırıkları AO/OTA sınıflamasına göre değerlendirildi. Buna göre 16 hastada A1 (%27.6), 13 hastada A2 (%22.4), 14 hastada B1 (%24.1), 11 hastada B2 (%19), 4 hastada ise C1 (%6.9) tipi kırık mevcuttu. Tüm hastalarda kırıkların kaynama sonuçları, aktiviteye dönüşleri, ayak bileği hareket açıklıkları, enfeksiyon ve komplikasyonlar Johner ve Wruhs kriterlerine göre değerlendirildi.

Bulgular: Hastalarda kırıkların ortalama kaynama süresi 13 hafta (11-24 arası) idi. Tüm olgularımızda kaynama elde edilirken bir hastada gecikmiş kaynama görüldü. Hiçbir olgumuzda enfeksiyon ve yara yeri problemi görülmedi. İki olguda kaynama sonrasında 5 derece varus deformitesi tespit edildi. Dört olgumuzda diğer ayağa kıyasla 5 derece, 4 olguda ise 10 derece dorsifleksiyon kaybı görüldü. Sonuç olarak Johner ve Wruhs değerlendirme kriterlerine göre 48 hasta mükemmel (%82.75), 10 hasta (%17.25) iyi olarak değerlendirildi.

Sonuç: Yumuşak doku azlığı, zayıf vaskülarizasyon gibi nedenlerden dolayı komplikasyonla karşılaşma oranının yüksek olduğu distal tibia kırıklarında, minimal invaziv yöntem ve biyolojik plaklama prensipleri ile başarılı sonuçlar alınabilmektedir.

r.

Anahtar Kelimeler

Distal Tibia Kırığı,Biyolojik fiksasyon,Minimal invaziv cerrahi

Outcome of minimal invasive plate osteosynthesis in distal tibia fractures

Abstract

Purpose: The aim of this study was to evaluate clinical, radiological and complication results in cases of osteosynthesis using plate by minimally invasive methods and biologic fixation principles due to distal tibia fracture.

Materials and Methods: In this study, 58 patients (35 males, 23 females, mean age 32 ) who underwent surgery by minimally invasive method and biologic fixation principles due to distal tibial fracture were included. Patients were followed for an average of 28 months . Fractures were classified according to AO/OTA classification. 16 patients were classified as A1 (27.6%), 13 patients classified as A2 (22.4%), 14 patients classified as B1 (24.1%), 11 patients classified as B2 (19%) and 4 patients were classified as C1 (%6.9) according to AO classification. All patients fractures, union results, return to activity, ankle range of motion, infection and complication were evaluated according to the criteria of Johner and Wruhs.

Results: Mean union time of fractures was 13 weeks (11-24). In all our cases, union was achieved. Delayed union was observed in only one patient. There was no infection or wound problem in any of our cases. In four cases, dorsiflexion loss was seen at 5 degrees compared to the other foot and 10 degrees at 4 other cases. 48 patients were evaluated excellent (82.75%) and 10 patients (17.25%) were evaluated good according to Johner and Wruhs evaluation criteria.

Conclusion: Successful clinical and radiologic results can be obtained by using the minimally invasive methods and biological fixation principles in distal tibia fractures which has high complication rates due to soft tissue weakness and weak vascularization.

Keywords

Distal tibia fractures,Biological fixation method,Minimal invasive surgery

References

1. Aksekili MA, Celik I, Arslan AK, Kalkan T, Uğurlu M. The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures. Acta Orthop Traumatol Turc. 2012;46:161-7 .
2. Krettek C. Recent advances in the fixation of fractures of the long bones of the leg. European Instructional Course Lectures. 1999;4:1-11.
3. Arens S, Kraft C, Schlegel U, Printzen G, Perren SM, Hansis M. Susceptibility to local infection in biological internal fixation. Experimental study of open vs minimally invasive plate osteosynthesis in rabbits. Arch Orthop Trauma Surg. 1999;11:82-5.
4. Gerber C, Mast JW, Ganz R. Biological internal fixation of fractures. Arch Orthop Trauma Surg. 1990;109:295-303.
5. Dhal A, Singh SS. Biological fixation of subtrochanteric fractures by external fixation. Injury. .1996;27:723-31.
6. Bicimoglu A, Muratlı HH, Yagmurlu MF, Tabak AY. The results of plate fixation with the use of biological fixation principles and minimally invasive technique in femur fractures. Acta Orthop Traumatol Turc. 2001;36:129-35.
7. Muratlı HH, Can M, Bicimoğlu A. Kırık tespitinde güncel yaklaşım: internal atelleme. Totbid Dergisi. 2003;2:44-51.
8. Helfet DL, Shonnard PY, Levine D, Borrelli J Jr. Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury. 1997;28:42-8.
9. Farouk O, Krettek C. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury. 1997;28:7-12.
10. Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma. 2007;21:355-61.

11. Court-Brown CM. Fractures of the tibia and fibula. In Rockwood and Green’s Fractures in Adults. 5th ed. (Eds RW Bucholz, JD Heckman). Philadelphia, Lippincott Williams & Wilkins, 2011.
12. Orhun H, Bayhan IA. Treatment of adult tibial diaphysis fractures with reamed and locked intramedullary nailing. Acta Orthop Traumatol Turc. 2009;43:7-13.
13. Canale ST. Tibial shaft fractures. In Campbell’s Operative Orthopaedics, 10th ed. (Eds ST Canale, WC Campbell). Philadelphia, Mosby, 2011.
14. Bahari S, Lenehan B, Khan H, McElwain JP. Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg. 2007;73:63-5.
15. Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma. 2007;21:355-61.
16. Ağuş H, Kıranyaz Y, Mavi E, Reisoğlu A, Eryanılmaz G. Açık tibia kırıklarının erken biyolojik internal tesbitle tedavisi. Turkish Journal of Arthroplasty Arthroscopic Surgery. 2000;11:24-31.
17. Kayalı C, Ağuş H, Eren A, Özlük S. Açık tibia kırıkları nasıl tedavi edilmelidir? İntramedüller çivileme ve biyolojik plaklama arasında kıyaslamalı geriye dönük çalışma. Ulus Travma Cerrahi Derg. 2009;15:243-8.
18. Tong G, Bavonratavech S. AO Manual of Fracture Management Minimally Invasive Plate Osteosynthesis (MIPO) Davos, Thieme, 2007.
19. Stoffel K, Forster T, Stachowiak GW, Gachter A, Kuster MS. Oblique screws at the plate ends increases the fixation strenght in synthetic bone test medium. J Orthop Trauma. 2004;18:611-7.
20. Stoffel K, Dieter U Stachowiak G, Gächter A, Kuster MS. Biomechanical testing of the LCP - how can stability in locked internal fixators be controlled? Injury. 2003;34:11-9.
21. Oh CW, Kyung HS, Park IH, Kim PT, Ihn JC. Distal tibia metaphyseal fractures treated by percutaneous plate osteosynthesis. Clin Orthop. 2003;408:286–91.
22. Redfern DJ, Syed SU, Davies SJ. Fractures of the distal tibia. Injury. 2004;35:615-20.
23. Feng Q, Lu-wei X. Minimally invasive percutaneous plate osteosynthesis through fracture site approach for fracture of both tibia and fibula. Chin J Traumatol. 2007;10:242-5.
24. Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia. results in 20 patients. Injury. .2006;37:877-87.
25. Perren SM. Evolution of the internal fixation of long bone fractures. Bone Joint J. 2002;84;1093-10.
26. Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma. 2011;25:736-41.
27. Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing J Orthop Trauma. 2008;22:307-11.
28. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92:984-8.
29. Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma. 2010;24:24-9.
30. Bozkaya A, Gülabi D, Bekler Hİ, Çeçen GS, Bulut G, Sağlam F. Distal tibia meatafizer ve diyafizer kırıklarının biyolojik fiksasyonunun radyolojik ve klinik sonuçları. Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2014;25:46-52.

Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Fatma Feride Görgülü This is me

Ümit Tuhanioğlu

Hasan Ulaş Oğur This is me

Publication Date

September 30, 2017

Submission Date

January 4, 2017

Acceptance Date

February 23, 2017

Published in Issue

Year 2017 Volume: 42 Number: 3

DOI

https://doi.org/10.17826/cutf.290352

IZ

https://izlik.org/JA22BH74XJ

MLA

Çiloğlu, Osman, et al. “Outcome of Minimal Invasive Plate Osteosynthesis in Distal Tibia Fractures”. Cukurova Medical Journal, vol. 42, no. 3, Sept. 2017, pp. 518-25, doi:10.17826/cutf.290352.

Cited By

Eklem dışı distal tibia kırıklarının (AO-43A) tedavisinde intramedüller çivi ve minimal invaziv perkütan plak osteosentez uygulamalarının karşılaştırılması

Cukurova Medical Journal

https://doi.org/10.17826/cumj.461674

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