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Comparison of Plate VS. Nail Fixation for the Treatment of Distal Tibial Shaft Fractures in a Sample of Trauma Patients

Author: Ali A. Ali
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 172-178
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Fractures of the distal third of the tibia are the major cause of morbidity in patients with lower extremity injuries. Most fractures are sustained in young adults during high velocity injuries.PATIENTS AND METHODS: Forty patients with closed fractures of distal third of the tibia were treated in Al-Yarmouk Teaching hospital between May 2012 and April 2014. 20 patients had been treated with open reduction and internal fixation by heavy-duty plate and screws and were matched to 20 patients treated with closed reduction and intramedullary nailing fixation, with regard to gender, age, and the AO classification of the fracture.RESULTS: There were no significant differences in regard to: time of surgical procedures, non-union, hardware failure or deep infections between plate fixation and intramedullary nailing. Open reduction and plate fixation was associated with higher risk of: delayed union, osteopenia, ankle joint stiffness and algodystrophy. Closed reduction with intramedullary nailing was associated with higher rates of rotational malalignment and knee joint pain/stiffness. The limb length difference was of no clinical significance in all patients.CONCLUSION: Intramedullary nailing is the preferred method for treating closed distal tibial fractures but open reduction and plate fixation may provide superior results in terms of optimal alignment.


Article
OPEN REDUCTION AND INTERNAL FIXATION WITH CORTICOCANCELLOUS BONE GRAFT FOR TREATMENT OF VOLARY MALUNITED FRACTURE OF DISTAL RADIUS

Author: Falih Waheed Hashim
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2018 Volume: 24 Issue: 1 Pages: 31-38
Publisher: Basrah University جامعة البصرة

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Abstract

OPEN REDUCTION AND INTERNAL FIXATION WITH CORTICOCANCELLOUS BONE GRAFT FOR TREATMENT OF VOLARY MALUNITED FRACTURE OF DISTAL RADIUS Falih Waheed Hashim MB,ChB, FICMS Orthopedics, Lecturer, Department of Surgery, College of Medicine, University of Basrah, IRAQ. Abstract Malunion of the distal radius is actually a late complication, not salvageable by re-manipulation or a change of immobilization, it requires different management technique. The aim of this study is to choose a technique that corrects the deformity as much as possible, with less complications. An assessment was done for 24 patients with unilateral malunited fractures of the distal radius. The mean age was 42 years (range 25-61 years). They were treated by open-wedge volar osteotomy with corticocancellous graft from upper tibia. Both osteotomy and graft were fixed by volarly applied plate and screws. Preoperative antero-posterior and lateral wrist radiographs were obtained and fracture pattern and radio-carpal alignment were assessed. Radial length and palmar tilt were also measured. The clinical outcome was assessed depending on the modified Gartland and Werley score. Radiological assessment of the parameters was done postoperatively to detect how much these parameters were corrected. This study shows that volar open-wedge osteotomy with corticoocancellous bone graft and internal fixation is a method for correction of malunited distal radial fractures with encouraging results. About 90% of the patients were satisfied with their results regarding the correction of the deformity and improvement of wrist and hand function, as well as limited complications when it is done carefully with appropriate facilities. In conclusion, the corrective osteotomy should be considered only when there is a clear-cut indication. It is actually a method to correct the deformity, rather than treatment of symptoms, specially pain.

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