Distal extraarticular and minimally dislocated intraarticular fractures of the tibia

Abstract text (incl. references and figure legends)

Introduction. Operative treatment of fractures of the distal third of the lower leg continues to be a debatable topic in the specialized literature. These are high-energy injuries at a young age caused by height, sport trauma or road accidents.

Material and method. For the set goal, we followed 19 patients operated on in our clinic for the period from May 2021 to June 2022 (1 year and 2 months). Thirteen of the patients were men and six were women. The average age for men is 44.3 years and for women 61.5 years. In men, high-energy altitude injuries from parachute jump predominate, and in women- twisting injuries with a fixed foot, mainly ski trauma. 18 of the patients underwent delayed emergency surgery within 3 to 6 days of trauma after critical reassessment of soft tissue status. In one of the patients, the insertion of an external fixator was necessary due to the development of bullous edema, which necessitated a two-stage osteosynthesis.

Results. All patients were followed functionally and radiographically up to 6 postoperative months. We reported complete bone union radiographically between 4 and 6 months, a mean of 95 points on the AOFAS point scale with a maximum score of 100. We used the Karlstrom-Olerud criteria to report functional outcomes. We registered excellent results in 12 patients, good in 6 and poor in one patient. There was no patient with nonunion in our series. In four of the patients, we observed soft tissue complications, within the framework of delayed healing of the operative wounds. A deep bone infection was found in one patient, necessitating premature removal of the osteosynthesis material.

Conclusion. Extra-articular fractures of the distal tibia are a pathology that requires special attention and a surgical approach to the soft tissues. This is determined by the anatomy of the area and addressing the soft tissue trauma is the key to proper bone healing.

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