Author(s): Lokesh Holagundi1, Dayanand M2, Deepak S3, Hemanth H. P4
Most of these fractures except intra-articular fractures are treated with interlocking nail.1,2 These nails are a boon for these fractures. But as the fracture nears to the joint stability the fracture fixation will be compromised due to malreduction and alignment, it leads to increased chances of delayed and nonunion.3 Locking anatomical plates are evaluated for anatomical and relative stability fixation. Since then most intra and near intra-articular fractures are fixed with these plates with minimally invasive percutaneous plate osteosynthesis method, these plates have given excellent result4. But again these plates have some disadvantages5. This study is done to see the outcome of locking plates in distal tibia fracture.
This study is done in the Department of Orthopaedics, Bangalore Medical College, Bangalore. This study is done from 2013 to 2015. 30 patients who came to outpatient department were treated with locking plates. All patients above 16 years having distal third tibia fracture are included. All open fractures except type 1 and elderly above 60 years and pathological fractures are excluded in our study. All patients were followed up for initial 5 months, thereafter, once in 3 months, for clinical and radiological evaluation of union status, knee range of motion, ankle range of motion and other complications. Assessment of the patient with functional recovery was done with American Orthopaedic Foot and Ankle Surgery(AOFAS)6 minimum 5 months after injury.
Majority of the patients are from age group 18-29 years (50%). Average age group was 30 years. Majority of the patients were males 80.6% (25). All fractures were closed fractures except 2 cases which are type 1. There were 12 cases of AO type A, 8 patients were AO type B and 10 patients were type C. Majority of the patients had fracture due to road traffic accidents, 74%. All fractures were united by the end of 20 weeks. There was delayed union in (22%) 4 patients for which secondary surgery with bone grafting procedure was done after 4 months. According to AOFAS,7 we scored the functional outcome of the patients after 5 months of injury. We had 23% of excellent result, 30.4% good and 46% fair with plate.
Locking anatomical plates are a boon and have started a new era in orthopaedic surgery in fixation with articular fractures. But due to lack of locking plate principle it is again cumbersome. Locking plates give relative stability for fracture and need as much as possible anatomical reduction of articular margins unlike in nail where we can do dynamisation if fracture going for delayed union in locking plates is not possible, hence doing as much as possible fracture alignment and then stabilising the fracture with screws is recommended.