Abstract
INTRODUCTION: Unstable distal and proximal tibial fractures that are not suitable for intramedullary nailing are often treated by open reduction and internal fixation (ORIF) and/or external fixation techniques. Discuss the treatment of these injuries with Percutaneous Plating technique which offers advantages over standard external fixation and/or ORIF as it minimises soft tissue trauma and does not disturb the osteogenic fracture haematoma.
PURPOSE: We report on the experience using percutaneous plating of unstable distal fractures in a district General Hospital setting and discuss the technique used and the applicability of this method to military personnel with high functional demands.
METHOD: a retrospective review of all patients treated with percutaneous plating technique for an unstable distal tibial fracture between 1998 and 2001 was undertaken. Fractures were classified to the AO system Reudi and Allgower. Indications for use of the percutaneous plate technique were distal tibial fractures which were initially managed in plaster until definitive fixation. No external fixation was used. The operation consisted of supine position on a radiolucent table. The fracture was reduced by closed methods and a DCP was shaped to fit the tibia. This was then positioned on the medial tibia in an extraperiosteal, subcutaneous tunnel. 4.5mm screws were fitted via stab incisions as appropriate to hold the plate in position. No splinting was used other than the plaster itself unless the patient was felt to be unable to comply with a touch weight bearing regime. Clinical and radiological follow up was 6–8 weeks, 3 months and 6 months post injury.
RESULT: 22 patients were identified, 20 of whom were available to follow up. Mean age was 38.3 years (range 17–71). There were 18 males and 4 females. Mechanism of injury was a fall in 12, motorcycle RTA in 6, and rugby/ football injury in 4. Most fractures were 42-A1/42-B1. 4 fractures had distal intra-articular fracture extensions. All were closed injuries. Over 50% of patients underwent fixation within 24 hours of the injury. Mean hospital stay was 6.5 days (2–31). There were no deep infections (one superficial infection which resolved with oral antibiotic treatment). Most patients achieved callus by 8 weeks, all by 3 months. Mean time to full weight bearing was 12 weeks (8–17). By 6 months only 2 fractures had not united. These united at 7 months. There were no non-unions and only one mal-union. There were no cases of failure of fixation.
These abstracts were prepared by Squadron Leader G. Pathak FRCS (Trauma & Orth). Correspondence should be addressed to him at Royal Hospital Haslar, Gosport, Hampshire PO12 2AA.
