Distal tibial fracture: An ideal indication for external fixation using locking plate

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomaterials engineering

Background:

• Distal tibial fractures present significant challenges in treatment due to complex anatomy and limited soft tissue coverage.
• Traditional fixation methods may lead to complications such as nonunion, infection, and poor functional outcomes.
• The development of locking plate technology offers potential for improved stability and reduced soft tissue complications.

Purpose of the Study:

• To assess the feasibility and efficiency of a one-stage external fixation technique utilizing a locking plate for distal tibial fractures.
• To evaluate the radiographic and clinical outcomes of this innovative fixation method.
• To determine the safety profile and complication rates associated with this surgical approach.

Main Methods:

• A prospective study involving 28 patients (21 males, 7 females; mean age 43 years) with distal tibial fractures (AO/OTA Type A1, A2, A3).
• One-stage external fixation was performed using a locking plate positioned anteromedially, secured with bicortical screws in the distal metaphysis and diaphysis.
• Radiographic and clinical assessments, including fracture healing time and AOFAS scores, were conducted post-operatively.

Main Results:

• The average surgery duration was 38 minutes, with a mean follow-up of 16 months.
• Fracture healing times varied by type: 14.6 weeks (A1), 17.5 weeks (A2), and 18.4 weeks (A3) (p < 0.05).
• Excellent functional outcomes were observed with mean AOFAS scores of 96.11 (A1), 92.67 (A2), and 92.00 (A3) (p > 0.05), with no instances of nonunion, deep infection, or hardware failure.

Conclusions:

• One-stage external fixation with a locking plate is an effective and safe treatment for distal tibial fractures.
• This technique is characterized by its ease of performance, minimally invasive nature, and reduced soft tissue impingement.
• The method provides good functional recovery and cosmesis, with convenient hardware removal.