External Fixation by Locking Plate as a Definitive Treatment of Tibial Distal Metaphyseal Fractures

Abstract

Background: Traditional external fixation used for open or soft tissue compromised tibial distal metaphyseal fractures is used both as a temporizing or definitive treatment to minimize more traumas to the soft tissue, but it has its own shortcomings such as joint spanning and bulky construct. Lower profile locked plates used as external fixation may overcome such problems.
Methods: A series of 16 open or with soft tissue compromised tibial distal metaphyseal fractures were treated using locking plate as a definitive external fixator. Time to union, nonunion, malunion, device failure, function for the knee and ankle, and deep and pin tract infections were evaluated.
Results: All fractures healed without any complications (nonunion, malunion, device failure, or infections including deep and pin tracts). The mean time of fracture healing was 18 weeks (ranged 12 to 26). After walking with full weight-bearing for 1 month, the patients underwent plate removal. The mean hospital for special surgery (HSS) score was 89 (ranged 84 to 100) and 95 (ranged 91 to 100), and the mean American orthopaedic foot and ankle society (AOFAS) score was 93 (ranged 89 to 100) and 95 (ranged 92 to 100) at 4 weeks postoperatively and final follow-up (mean period of 16 months).
Conclusions: Application of the locking plate as an external fixator for definitive treatment of distal tibial fractures had the advantages of traditional external fixators and at the same time overcame its shortcomings due to its low-profile frame; therefore, it was more acceptable to patients and Joint-sparing frame gave the opportunity for early range of motion and function exercise. It was a safe and reliable technique with minimal complications and excellent outcomes.