J Korean Fract Soc.  2007 Oct;20(4):323-329. 10.12671/jkfs.2007.20.4.323.

Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator

• Choo SK
• Nha KW
• Oh HK
• Lee DB

• KMID: 2297513
• DOI: http://doi.org/10.12671/jkfs.2007.20.4.323

Abstract

PURPOSE
We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern.
MATERIALS AND METHODS
We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern.
RESULTS
Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%).
CONCLUSION
The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.

Keyword

Distal tibial fracture; Delayed union; Translation of metaphyseal fracture; Ilizarov external fixator

MeSH Terms

Arthritis
Classification
External Fixators*
Prognosis
Tibial Fractures*

Figure

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  Fig. 1 Displacement of the diaphyseal-metaphyseal fracture line was measured by the method described by Green and Gibbs. Translationmm=APtransmm2+LATtransmm2

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  Fig. 2 A 17-year-old male was suffered from right distal tibial fracture. He was treated with Ilizarov external fixator and minimal invasive screw fixation for intra-articular fracture. The last follow-up x-ray show complete union of fracture.

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  Fig. 3 This graph shows that residual translational displacement is closely related to delayed metaphyseal healing (p=0.01).

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  Fig. 4 A 47-year-old female was suffered from right distal tibial fracture. She was treated with Ilizarov external fixator. But, after removal of external fixator, anterior angulation and posttraumatic arthrosis was developed. Then, total ankle arthroplasty was performed.

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