Quinnan Stephen Matthew
Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL.
J Orthop Trauma. 2016 Nov;30 Suppl 4:S26-S32. doi: 10.1097/BOT.0000000000000694.
Obtaining optimal results in the treatment of extraarticular distal tibia fractures can be challenging. Plate and screw and intramedullary fixation have proven to be effective treatments, but are associated with significant complication rates when used for open fractures and patient with severe medical comorbidities. External fixation is a third alternative that is less often employed, but provides a very effective means of treatment. Circular external fixation offers great flexibility in obtaining anatomic alignment and stable fixation for even the most challenging distal tibia fractures. In addition, it provides advantages in limiting the risk of deep infection, dealing with bone loss, and obtaining soft tissue coverage. The greater ease of treatment and potential economic advantage in patient cohorts with low complication rates, such as closed fractures, supports the preferential use of internal fixation. However, circular external fixation may be the preferred treatment for patients with higher-grade open fractures, a poor soft tissue envelope with limited fixation options distally, and major comorbidities (diabetes, immune deficiency) with an associated high risk of complications.
在治疗胫骨远端关节外骨折时获得最佳效果可能具有挑战性。钢板螺钉固定和髓内固定已被证明是有效的治疗方法，但用于开放性骨折和患有严重内科合并症的患者时，并发症发生率较高。外固定是第三种选择，使用频率较低，但提供了一种非常有效的治疗手段。环形外固定在实现解剖复位和为最具挑战性的胫骨远端骨折提供稳定固定方面具有很大的灵活性。此外，它在降低深部感染风险、处理骨缺损和实现软组织覆盖方面具有优势。在并发症发生率较低的患者群体（如闭合性骨折）中，治疗更容易且具有潜在的经济优势，这支持优先使用内固定。然而，对于高等级开放性骨折、远端固定选择有限的软组织条件差以及伴有高并发症风险的主要合并症（糖尿病、免疫缺陷）患者，环形外固定可能是首选治疗方法。
