TREATMENT OF DISTAL TIBIAL FRACTURES BY INDIRECT SCREW FIXATION THROUGH FIBULAR PLATE
Mohamed Y Badawy, Ahmed M Ali*
Departments of Orthopedic Surgery, Faculty of Medicine, Cairo University, and *Beni Sweif Hospital
Background: Considering the subcutaneous nature of the distal tibia, soft tissue compromise over the fracture site can present a challenge to the treating surgeon. The Aim of this study was to evaluate the results of treatment of distal tibial fractures by indirect screw fixation through a fibular plate (The modified fibula pro tibia technique). Patients and Methods: Twenty patients with distal tibial fractures and bad soft tissue condition over the medial side of the leg. Fractures were classified according to AO/OTA classification as twelve fractures (60%) type A and eight fractures (40%) type C. As regards skin condition, patients were classified according to Tscherne and Goetzen classification and four patients were grade (0), twelve patients were grade (1) and four patients were grade (2). The mean duration of follow up was 9.6 months. The mean time to partial weight bearing was 8±2 weeks and the mean time to complete weight bearing was 12±2 weeks. Result: Out of the twenty patients five patients had mild varus deformity, two patients had mild superficial infection resolved with antibiotics and hard ware removal after union and one patient had back out of one trans-syndesmosis screws but does not affect the entire construct. After the follow up period the results were assessed according to Tenny & Wiss Criteria: 12 patients (60%) were classified as excellent, 4 (20%) were classified as good and 4 (20%) were classified as fair. Conclusion: The final results was statistically significant in relation to time elapsed before surgery; the earlier the surgery, the better the result. The skin condition correlated negatively with the final result; the worse the skin condition the worse the final result and the higher the rate of infection.