Distal Tibial Metaphyseal Fracture: Plating
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A 14-year-old boy sustained a crushing injury to his left foot. The injury was isolated to the left lower extremity. Neurovascular examination did not show any abnormalities. Clinical examination and imaging revealed a left closed distal tibial and fibular fracture. The tibia fracture was comminuted, oblique, and displaced with a recurvatum deformity. Since this type of fracture is unstable, surgical fixation was indicated. In this particular case, the decision was made to proceed with open reduction and plating of both the distal tibial and the fibular fractures.
Although tibial fractures are common in children, the incidence of distal metaphyseal fractures is not known. Options to surgically address distal tibial fractures include internal fixation or external fixation. Different internal fixation options are available to address distal tibial fractures such as an interlocking intramedullary nails or plate and screws. The distal tibial plate can be placed on the medial or lateral side of the tibia with advantages and disadvantages for each method. Care should be taken not to injure the open physes in the distal tibia and fibula while implants are placed.
After the procedure was completed, the leg was placed in a well-padded short leg splint. Pain control, 24 hours of antibiotics, and strict leg elevation were recommended. The patient was discharged home in good condition the next day with instructions of non-weight-bearing. Regular outpatient follow-up visits were arranged. After 6 weeks, radiographs showed satisfactory healing and weight-bearing as tolerated was allowed. The fracture healed uneventfully, and the last follow-up was at 6 months after surgery with full ankle range of motion.
References and Suggested Reading
- Vaienti E, Schiavi P, Ceccarelli F, Pogliacomi F (2018) Treatment of distal tibial fractures: prospective comparative study evaluating two surgical procedures with investigation for predictive factors of unfavourable outcome. Int Orthop. [Epub ahead of print]Google Scholar