Two-stage operative treatment of complicated distal tibia intraarticular fractures using external fixator

Overview

PURPOSE:
To evaluate one-stage and two-stage surgical concept in the treatment of intra-articular distal tibia fractures type C (AO classification) using modern methods of temporary and permanent stabilization with new types of implants.

MATERIAL AND METHODS:
Both open fractures and comminuted closed fractures with extended edema and hematoma are indicated to the temporary stabilization by external fixator. Definitive internal fixation is performed after edema is diminished, conditions of soft tissue envelope are improved and wounds are healing with no inflammation signs and minimal infection risk. From 2008 to 2011 57 patients with C type fracture (AO classification) were operated at the Department of Trauma Surgery, University Hospital Brno. Thirty-three patients (58 % of the total number of patients) were acutely stabilized with external fixation with subsequent conversion to internal osteosynthesis. At the second stage locking compression plates, anatomically pre-formed plates to distal tibia, anterolateral and medial plates were used for fracture stabilization. Locking compression plates were used in 50 cases and 7 fractures were treated by miniosteosynthesis.

RESULTS:
Patients were divided into 2 groups. The first group of patients was primarily treated by external fixator and subsequently conversion to internal fixation was performed (two- stage concept). Fractures in the second group were stabilized with definitive osteosynthesis without temporary stabilization by external fixation (one-stage concept). Incidence of post-operative wound complications were statistically assessed.

CONCLUSION:
Open reduction and subsequent internal fixation with angular stable plates are fully indicated methods of operative treatment of intraarticular fractures of the distal tibia. Complicated high energy type C fractures should be acutely stabilized with external fixator (first stage). Subsequent conversion to internal fixation is performed after improvement of the soft tissues (second stage). Multifragmentary intra-articular fractures should be concentrated in specialized trauma centers due to the demands of specialized instruments and enough experience in treatment of these injuries (Ministry of Health Bulletin No. 6/2008).

KEY WORDS:
fractures of the distal tibia, external fixator, soft tissue envelope.