Abstract
In a prospective study, we reviewed 72 distal tibial fractures treated by percutaneous plating between July 1996 and June 2001. The patient’s mean age was 36 years (19 to 76). The majority of them were men. Seven fractures were open, with three of them Gustilo grade IIIA. Of 65 closed fractures, 15 were Tscherne grade III. All fractures were type 43A according to AO classification and were less than 5 cm from the ankle joint. Most of the fractures were group A3, with 22 group A3.3. Percutaneous plating was delayed for a mean of five days (2 to 15). Pre-contoured small fragment dynamic compression plate was placed on the medial aspect of the tibia under image intensifier control, through a short distal skin incision. On average, three distal and two proximal screws were inserted. Fibular fractures were stabilised in a similar fashion. Satisfactory fracture reduction was achieved in all cases. Postoperatively a below-knee cast was applied for six weeks and weight-bearing was permitted at eight weeks. Fracture healing occurred within 12 weeks (10 to 16). One patient needed bone grafting for treatment of delayed union. All patients had a functional range of ankle movement. In one patient, breakage of all screws was observed in a united fracture with shortening of the fracture. Local late infection where the skin was tented by skin screw heads occurred in eight patients and was resolved by debridement and hardware removal.
Percutaneous plating of type A43 tibial fractures is safe, reproducible and successful and has few complications. The few adverse affects may well be eliminated by the use of newly-introduced low profile plates and screws.
The abstracts were edited by Prof. M.B.E. Sweet. Correspondence should be addressed to him at the Department of Orthopaedic Surgery, Medical School, University of the Witwatersrand, 7 York Road, Parktown, 2193 South Africa
