Jeevo Jerin, Hp Rajagopal, George Akhshay J, Pilar Anoop, Muniswamy Madan Mohan, Kurian Binu, Basappa Mallikarjunaswamy, Amaravati Rajkumar, Adarsh John, Thomas Merwin
Department of Orthopedics, St. John's Medical College Hospital, Bangalore, IND.
Cureus. 2024 Jun 20;16(6):e62777. doi: 10.7759/cureus.62777. eCollection 2024 Jun.
Introduction Managing distal tibia fractures is challenging for trauma surgeons because of their peculiar anatomy with less soft tissue coverage and poor blood supply. There are various treatment options for distal tibia fractures such as open reduction and plating, minimally invasive percutaneous plate osteosynthesis, and intramedullary interlocking nailing. Open reduction and internal fixation can lead to excessive soft tissue dissection and devascularization of fracture fragments. We conducted a study on the functional outcome of distal tibia fractures treated by biological fixation with minimally invasive percutaneous plate osteosynthesis. Methods A total of 23 patients with distal one-third tibia fractures, fulfilling the inclusion criteria, who were treated at St. John's Medical College Hospital with minimally invasive percutaneous plate osteosynthesis between November 2020 and November 2022 were studied using the American Orthopaedic Foot & Ankle Society (AOFAS) score at six weeks, three months, and six months postoperative follow-up. Results This study included 17 males and six females. The mean age of the study participants was 43.78 years, with most of the participants being in the age group between 51 and 60 years (29.2%, n = 7). All the study participants were employed. The mean operative time was two hours and 10 minutes. The mean duration for the radiological union was 22 weeks. The mean AOFAS score at six months was 92.43 + 5.696. There was only one case of superficial infection, which was treated with intravenous antibiotics. There were no cases of malunion/nonunion. Conclusion Minimally invasive percutaneous plate osteosynthesis is an effective treatment for distal tibia fractures avoiding most of the complications such as wound dehiscence and malunion/nonunion involved in conventional open reduction and internal fixation with plating. Therefore, we recommend this technique for all distal tibia fractures.
引言
由于胫骨远端骨折的解剖结构特殊，软组织覆盖较少且血供较差，创伤外科医生在处理此类骨折时面临挑战。胫骨远端骨折有多种治疗选择，如切开复位钢板内固定、微创经皮钢板接骨术和髓内交锁钉固定。切开复位内固定可能导致过度的软组织剥离和骨折碎片的血运障碍。我们开展了一项关于采用微创经皮钢板接骨术进行生物固定治疗胫骨远端骨折功能结局的研究。
方法
对2020年11月至2022年11月期间在圣约翰医学院医院接受微创经皮钢板接骨术治疗且符合纳入标准的23例胫骨远端三分之一骨折患者，在术后6周、3个月和6个月随访时采用美国矫形足踝协会（AOFAS）评分进行研究。
结果
本研究包括17例男性和6例女性。研究参与者的平均年龄为43.78岁，大多数参与者年龄在51至60岁之间（29.2%，n = 7）。所有研究参与者均有工作。平均手术时间为2小时10分钟。影像学愈合的平均时长为22周。6个月时的平均AOFAS评分为92.43 + 5.696。仅1例浅表感染，经静脉使用抗生素治疗。无骨不连/畸形愈合病例。
结论
微创经皮钢板接骨术是治疗胫骨远端骨折的有效方法，可避免传统切开复位钢板内固定所涉及的大多数并发症，如伤口裂开和骨不连/畸形愈合。因此，我们推荐将该技术用于所有胫骨远端骨折的治疗。
