Materials and Methods: A total of 30 patients with type V and VI proximal tibial fractures who presented between January 2012 to January 2015 were managed with hybrid external fixation and were followed-up for a period of 3 years.
Results: The mean age of the patients was 42.26 years with the left knee being more commonly affected. Schatzkers type V was the more common fracture type seen. The mean time to union was 12.06 weeks and the average range of motion achieved was 0 to 100°. The mean Rasmussens functional score was 25.4 at last follow-up and we had excellent results in 5 patients and good results in 22 patients.
Conclusion: Through this study, we conclude that the hybrid external fixation is an excellent option in the type V and VI fractures with extensive soft tissue compromise. It is easy to apply, facilitates early mobilisation of the joint and gives good functional results.
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.
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.
METHODS: We retrospectively reviewed the radiographic parameters of 22 patients (32 lower limbs) with Blount's disease who underwent gradual correction of deformity using a ring external fixator without surgical elevation of the depressed medial tibial plateau at a mean age of 15 (range 10-37) years. Preoperative and postoperative angles of depressed medial tibia plateau (ADMTPs) of the same patient were compared for any significant change. Normally distributed data were analysed using Student's t -test when comparing two groups or one-way analysis of variance when comparing more than two groups. Skewed data were analysed using Mann-Whitney test.
RESULTS: After extra-articular mechanical alignment surgery, statistically significant improvements in medial tibial plateau depression were seen in the infantile ( P = 0.03) and juvenile ( P = 0.04) Blount's subgroups. Change in ADMTP was greater in patients who were operated on at age <17 years, before skeletal maturity ( P = 0.001). The improvement was likely due to ossification of unossified cartilage at the posteromedial proximal tibia and the remodelling potential of proximal tibia physis after mechanical realignment.
CONCLUSION: Improvement of medial tibia plateau depression is possible after mechanical realignment without surgical hemiplateau elevation in cases of infantile and juvenile Blount's disease that present late for treatment, especially when the operation is performed before 17 years of age.