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Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

  • Original Article • LOWER LIMB - FRACTURES
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the clinical and functional outcomes of failed plate fixation in distal tibia fractures salvaged with hexapod circular fixators.

Materials and methods

The database of a specialized limb reconstruction center was searched for all patients with failed plate fixation undergoing limb reconstruction with a circular external fixator between 2008 and 2017. Patients between the ages of 18–65 years, with a symptomatic distal tibia malunion or non-union following plate and screw fixation were included. The SF-12 and Foot Function Index (FFI) scoring systems were used to measure clinical and functional outcomes.

Results

Ten patients with a mean age of 38 ± 13 years met the inclusion criteria. Seven patients had an infected non-union, two hypertrophic non-unions, and one a malunion. The mean follow-up was 41.7 ± 28.3 months. The mean duration of external fixation was 232.9 ± 146.6 days. The SF-12 demonstrated a mean score of 49.4 ± 7.7 for the physical component and a mean score of 55.3 ± 8.1 for the mental component. Five patients (50%) scored above 45 points for the SF12 physical component, and nine patients (90%) scored above 45 points for the mental component, indicating good outcome can be achieved. The mean FFI score was 24.9 ± 19.9, and six patients had a score below 14 points (good outcome). Radiological union was observed in all 10 patients at a mean of 29 ± 14 months.

Conclusions

The results of this study suggest that hexapod circular external fixation is an attractive surgical alternative for the treatment of failed plate fixation of distal tibial fractures, and can reliably achieve bony union and result in very satisfactory clinical outcomes.

Level of Evidence

Level IV case series.

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References

  1. Sirkin M, Sanders R (2001) The treatment of pilon fractures. Orthop Clin North Am 32:91–102. https://doi.org/10.1016/S0030-5898(05)70196-6

    Article  CAS  PubMed  Google Scholar 

  2. Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M (2006) Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma 20:76–79. https://doi.org/10.1097/01.bot.0000202997.45274.a1

    Article  PubMed  Google Scholar 

  3. Gao H, Zhang CQ, Luo CF, Zhou ZB, Zeng BF (2009) Fractures of the distal tibia treated with polyaxial locking plating. Clin Orthop Relat Res 467:831–837. https://doi.org/10.1007/s11999-008-0459-1

    Article  PubMed  Google Scholar 

  4. Bozkurt M, Ocquder DA, Uguru M, Kalkan T (2008) Tibial Pilon Fracture repair using Ilizarov External Fixation, Capsuloligamentotaxis and early Rehabilitation of the ankle. J Foot Ankle Surg 47(4):302–306. https://doi.org/10.1053/j.jfas.2008.02.013

    Article  PubMed  Google Scholar 

  5. Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P et al (2010) Distal tibia fractures: management and complications of 101 cases. Int Orthop 34:583–588. https://doi.org/10.1007/s00264-009-0832-z

    Article  PubMed  Google Scholar 

  6. Antonova E, Le Burge TKR, Mershon J (2013) Tibia shaft fractures: costly burden of nonunions. BMC Musculoskeletal Disord 14:42. https://doi.org/10.1186/1471-2474-14-42

    Article  Google Scholar 

  7. Vallier HA, Cureton BA, Patterson BM (2011) Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma 25:736–741. https://doi.org/10.1097/BOT.0b013e318213f709

    Article  PubMed  Google Scholar 

  8. Barcak E, Collinge CA (2016) Metaphyseal distal tibia fractures: a cohort, single-surgeon study comparing outcomes of patients treated with minimally invasive plating versus intramedullary nailing. J Orthop Trauma 30(5):169–174. https://doi.org/10.1097/BOT.0000000000000530

    Article  Google Scholar 

  9. Eralp IL, Kocaoglu M, Goksel D, Azam ME, Balci HI, Bilen E (2016) Treatment of infected non-unions of the juxta-articular region of distal tibia. Acta Orthop Traumatol Turc 50(2):139–146

    PubMed  Google Scholar 

  10. Richard RD, Kubiak E, Horwitz DS (2014) Techniques for the surgical treatment of distal tibia fractures. Orthop Clin N Am 45:295–312. https://doi.org/10.1016/j.ocl.2014.04.001

    Article  Google Scholar 

  11. Piper KJ, Won HY, Ellis AM (2005) Hybrid external fixation in complex tibial plateau and plafond fractures: an Australian audit outcomes. Injury 36:178–184. https://doi.org/10.1016/j.injury.2004.04.006

    Article  CAS  PubMed  Google Scholar 

  12. Leung F, Kwok HY, Pun TS, Chow SP (2004) Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures. Injury 35:278–283. https://doi.org/10.1016/S0020-1383(03)00172-4

    Article  PubMed  Google Scholar 

  13. Guo JJ, Tang N, Yang HL, Tang TS (2010) A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg 92:984–988

    Article  CAS  Google Scholar 

  14. Zalavras CG, Patzakis MJ, Thordarson DB, Shah S, Sherman R, Holtom P (2004) Infected fractures of the distal tibial metaphysis and plafond, achievement of limb salvage with free flaps, bone grafting and ankle fusion. Clin Orthop Relat Res 427:57–62

    Article  Google Scholar 

  15. Marsh JL, Rattay RE, Dulaney T (1997) Results of ankle arthrodesis for treatment of supramalleolar non-union. Foot Ankle Int 18:138–143

    Article  CAS  Google Scholar 

  16. Molina CS, Stinner DJ, Fras AR, Evans JM (2015) Course of treatment and rate of successful salvage following the diagnosis of deep infection in patients treated for pilon fractures(AO/OTA:43). J Orthop 12:S18–S24. https://doi.org/10.1016/j.jor.2015.01.023

    Article  PubMed  PubMed Central  Google Scholar 

  17. Green SA, Roesler S (1987) Salvage of the infected pilon fracture. Techniques in Orthopedics 2(3):37–41

    Article  Google Scholar 

  18. Van der Merwe L, Birkholtz F, Tetsworth K, Hohmann E (2016) Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction. Injury 47:1756–1760. https://doi.org/10.1016/j.injury.2016.05.027

    Article  PubMed  Google Scholar 

  19. Borrelli J, Leduc S, Gregush R, Ricci W (2009) Tricortical bone grafts for treatment of malaligned tibias and fibulas. Clin Orthop Relat Res 467:1056–1063. https://doi.org/10.1007/s11999-008-0657-x

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wyrsch B, Mcferran M, McAndrew M, Limbird T, Harper M, Johnson K et al (1996) Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg Am 78:1646–1657. https://doi.org/10.2106/00004623-199611000-00003

    Article  CAS  PubMed  Google Scholar 

  21. Cierny G 3rd, Mader JT, Penninck JJ (2003) A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res 414:7–24. https://doi.org/10.1097/01.blo.0000088564.81746.62

    Article  Google Scholar 

  22. Hohmann E, Birkholtz F, Glatt V, Tetsworth K (2017) The “road to union” protocol for the reconstruction of isolated complex high-energy tibial trauma. Injury 48(6):1211–1216. https://doi.org/10.1016/j.injury.2017.03.018

    Article  PubMed  Google Scholar 

  23. Masquelet AC, Begue T (2010) The concept of induced membranes for reconstruction of long bone defects. Orthop Clin North Am 41:27–37. https://doi.org/10.1016/j.ocl.2009.07.011

    Article  PubMed  Google Scholar 

  24. Tetsworth K, Cierny G 3rd (1999) Osteomyelitis debridement techniques. Clin Orth Relat Res 360:87–96. https://doi.org/10.1097/00003086-199903000-00011

    Article  Google Scholar 

  25. Heitmann C, Patzakis MJ, Tetsworth KD, Levin LS (2003) Musculoskeletal sepsis: principles of treatment. Instr Course Lect 52:733–743

    PubMed  Google Scholar 

  26. Maruish M (2012) User’s manual for the SF-12v2 Health Survey, 3rd edn. Lincoln, London

    Google Scholar 

  27. Swiontkowski MF, Engelberg R, Martin DP, Agel J (1999) Short Musculoskeletal function assessment Questionnaire validity, Reliability and Responsiveness. JBJS 81A(9):1245–1260

    Article  Google Scholar 

  28. Budiman-Mak E, Condrad KL, Roach KE (1991) The foot function index a measure of foot pain and disability. J Clin Epidemiol 44(6):561–570. https://doi.org/10.1016/0895-4356(91)90220-4

    Article  CAS  PubMed  Google Scholar 

  29. Harris AM, Patterson BM, Sontich JK, Vallier HA (2006) Results and outcomes after operative treatment of high-energy tibial plafond fractures. Foot Ankle Int 27(4):256–265. https://doi.org/10.1177/107110070602700406

    Article  PubMed  Google Scholar 

  30. Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R et al (2010) Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma 68:629–632. https://doi.org/10.1097/TA.0b013e3181a7c16d

    Article  PubMed  Google Scholar 

  31. Richmond J, Colleran K, Borens O, Kloen P, Helfet DL (2004) Nonunions of the distal tibia treated by reamed intramedullary nailing. J Orthop Trauma 18:603–610. https://doi.org/10.1097/00005131-200410000-00005

    Article  PubMed  Google Scholar 

  32. Laklouk MAS (2003) Ilizarov fixator as a method of treatment of failed internal fixation of distal tibial fractures. Egypt Orthop J 48:88–94

    Google Scholar 

  33. Arvesen JE, Watson T, Israel H (2017) Effectiveness of treatment for distal tibial nonunions with associated complex deformities using a hexapod external fixator. J Orthop Trauma 31:e43–e48. https://doi.org/10.1097/BOT.0000000000000726

    Article  PubMed  Google Scholar 

  34. Demetriades D, Martin M, Salim A, Rhee P, Brown C, Chan L (2005) The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg 242:512–519. https://doi.org/10.1097/01.sla.0000184169.73614.09

    Article  PubMed  PubMed Central  Google Scholar 

  35. Cudnik MT, Newgard CD, Sayre MR, Steinberg SM (2009) Level I versus Level II trauma centers: an outcomes-based assessment. J Trauma 66(5):1321–1326. https://doi.org/10.1097/TA.0b013e3181929e2b

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pretoria, Pretoria, South Africa

    Maketo Molepo & Franz Birkholtz

  2. Walk-A-Mile Centre for Advanced Orthopaedics, Centurion, Pretoria, South Africa

    Annette-Christi Barnard & Franz Birkholtz

  3. Department of Orthopaedic Surgery, Royal Brisbane Hospital, Brisbane, Australia

    Kevin Tetsworth

  4. Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia

    Kevin Tetsworth

  5. Queensland University of Technology, Brisbane, Australia

    Kevin Tetsworth

  6. Orthopaedic Research Centre of Australia, Brisbane, Australia

    Kevin Tetsworth & Vaida Glatt

  7. University of Texas Health Science Center, San Antonio, Tx, USA

    Vaida Glatt

  8. School of Medicine, University of Pretoria, Pretoria, South Africa

    Erik Hohmann

  9. Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, PO Box 414296, Dubai, United Arab Emirates

    Erik Hohmann

Authors
  1. Maketo Molepo
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  2. Annette-Christi Barnard
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  3. Franz Birkholtz
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  4. Kevin Tetsworth
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  5. Vaida Glatt
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  6. Erik Hohmann
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Corresponding author

Correspondence to Erik Hohmann.

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Conflict of interest

The authors declare no conflict of interest in relation to the presented body of research.

Human and animal rights

This project was approved by the University of Pretoria, South Africa, Institutional Review Board and Human Research Ethics Committee.

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Molepo, M., Barnard, AC., Birkholtz, F. et al. Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator. Eur J Orthop Surg Traumatol 28, 1617–1624 (2018). https://doi.org/10.1007/s00590-018-2231-x

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  • DOI: https://doi.org/10.1007/s00590-018-2231-x

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