Assessment of Outcome of Distal Tibia Fractures treated by Anterolateral Plating and Medial Plating at a tertiary care centre in Central India

Volume 15 | Issue 2 | Apr-Jun 2020 | Page 22-26 | R.K. Jain, Mandar Deshpande, Pranav Mahajan, Shubham Jain


Authers: R.K. Jain [1], Mandar Deshpande [1], Pranav Mahajan [2], Shubham Jain [1]

[1] Department of Orthopaedics, Sri Aurobindo Medical College & Post Graduate Institute, Indore Ujjain Highway, Gram Bhanwrasala, Indore, Madhya Pradesh, India, Pin – 453555
[2] Department of Orthopaedics, Mahatma Gandhi Memorial Medical College & M.Y. Hospital, AB Road, Indore, Madhya Pradesh, India, Pin – 452001.

Address of Correspondence
Dr. Pranav Mahajan,
Department of Orthopaedics, MGM Medical College, AB Road, Indore, MP, India, Pin – 452001
E-mail: pranav.mahajan@gmail.com


Abstract

Background: There are various treatment modalities in treatment of distal tibia fractures including plating, nailing, hybrid or ring fixator, etc. But very little work has been done to show the comparison between anterolateral plating and medial plating techniques for distal tibia fractures.
Methods: We included 58 patients with distal tibia fractures treated with anterolateral plating and medial plating. Patients were randomized using odd and even number allotment system and were operated upon with stainless steel pre contoured distal tibia locking plates using either medial or anterolateral approach. The functional and radiological outcome was assessed using Olerud and Molander score at six weeks, three months, six months, and one year.
Results: There were 58 patients included in the study. The mean age in the anterolateral group was 49.26 ± 15.73 years and in the anteromedial group was 39.77 ± 13.22 years. The most common mode of injury was road traffic accident. AO 43A1 was more common type of fracture seen in the anteromedial plating group (31.42%), while 43A3 fracture was more common in anterolateral plating group (34.78%),. The mean Olerud and Molandar score was significantly lower in the anteromedial plating group at 6 weeks postoperatively while it was comparable between the two groups at 3 months, 6 months and 12 months.
Conclusion: Anterolateral plating technique is associated with better functional outcome at the end of three months while both the techniques showed similar outcomes at long term follow up (one year). Patient selection, timing before surgery are also important factors while planning surgery.
Keywords: Distal tibia fracture, Anterolateral plating, Medial plating, Functional Outcome.


References

1. Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fracture: cover versus pin: a retrospective result analysis of matched pairs of patients. IntOrthop.2007;31:709e714.
2. Vallier HA, Le TT, Bedi A. Radiographic alsoscientificcomparison of distal tibia shaft fracture (4 to 11 cm proximal to the plafond): plateagainst intra- medullary nailing. J Orthop Trauma. 2008;22:307e311
3. Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for thetreatment of ssevere tibial pilon fractures: A study of three techniques. J Orthop Trauma.2001;15(3):153e160.
4. Helfet D, Shonnard P, Levine D, Borrelli Jr J. Minimally invasive plate osteo- a synthesis of distal fractures of the tibia. Injury. 1997;28(suppl 1):A42eA48.
5. Im GI, Tae SK. Distal metaphyseal fractures of the tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction andplate and screwsfixation. J Trauma.2005;59(5):1219e1223.
6. McFerran MA, Smith SW, Boulas HJ, Schwartz HS (1992) difficultyencounter in the treatment of pilon fractures. J Orthop Trauma6(2):195–200
7. Clifford RP, Beauchamp CG, Kellam JF, et al. Platethe tibia. J Bone Joint Surg Br.1988;70:644e648.
8. Jensen JS, Hansen FW, Johansen J. Tibial shaft fractures. A comparison of con-servative treatment and internal fixation with conventional plates or AOcompression plates. Acta Orthop Scand.1977;48:204e212.
9. Deangelis JP, Deangelis NA, Anderson R. Anatomy of the superficial peronealnerve in relation to fixation of tibia fractures with the less invasive stabilization system. J Orthop Trauma.2004;18(8):536e539
10. Wagner M, Frigg R (2006) AO manual of fracture management—internal fixators: concepts and cases using LCP/LISS. Thieme Publishing Group, Nederlands Tijdschrift voor Traumatologie
11. Wagner M (2003) General principles for the clinical use of the LCP. Injury 34(Suppl 2:B):31–42.
12. Hak DJ (2012) Anterolateral approach for tibial pilon fractures. Orthopedics 35(2):131–133. doi:10.3928/01477447-20120123-31
13. Mehta S, Gardner MJ, Barei DP, Benirschke SK, Nork SE (2011) Reduction strategies through the anterolateral exposure for fixation of type B and C pilon fractures. J Orthop Trauma 25(2):116–122. doi:10.1097/BOT.0b013e3181cf00f3.
14. Redfern DJ, Syed SU, Davies SJM. Fractures of the distal tibia: minimal invasive plate osteosynthesis. Injury. 2004;35:615e620.
15. Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury. 2007;38:365e370.
16. Sitnik AA, Beletsky AV. Minimally invasive percutaneous plate fixation of tibia fractures: results in 80 patients. Clin Orthop Relat Res. 2013;471:2783e2789.
17. Borg T, Larsson S, Lindsjo U. Percutanous plating of distal tibial fractures- preliminary results in 21 patients. Injury. 2004;35:608e614.
18. Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis e A prospective series of 50 patients Siddhartha Venkata Paluvadi M.S.(Ortho)a, , Hitesh Lal S.(Ortho)b , Deepak Mittal M.S.(Ortho)c , Kandarp Vidyarthi M.S.(Ortho)d journal of clinical orthopaedics and trauma 5 (2014) 129 e136
19. Lee YS, Chen SH, Lin JC, Chen YO, Huang CR, Cheng CY (2009) Surgical treatment of distal tibia fractures: a comparison of medial and lateral plating. Orthopedics 32(3):163.
20. K. Piatkowski, P. Piekarczyk, K. Kwiatkowski, M. Przybycien, B. ChwedczukComparison of different locking plate fixation methods in distal tibia fractures Int. Orthop., 39 (11) (2015), pp. 2245-2251
21. Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis e A prospective series of 50 patients Siddhartha Venkata Paluvadi M.S.(Ortho)a,*, Hitesh Lal M.S.(Ortho)b, Deepak Mittal M.S.(Ortho)c, Kandarp Vidyarthi M.S.(Ortho)dj o u rnal of c l i n i c a l orthop a edi c s and t rauma 5 ( 2 0 1 4 ) 1 2 9 e1 3 6
22. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Jt Surg Br. 2010;92-B:984e988.
23. Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma. 2010;24(1):24e29.


How to Cite this article: Jain R K, Deshpande M, Mahajan P, Jain S. Assessment of Outcome of Distal Tibia Fractures treated by Anterolateral Plating and Medial Plating at a tertiary care centre in Central India. Journal of Trauma and Orthopaedic Surgery. April – Jun 2020;15(2):22-26.

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