The treatment of distal tibial fractures with compromised soft tissue poses many problems that usually occurs from the high-energy trauma, and the results are often unsatisfactory following lots of complications like loss of reduction, malunion, and inlection. We studied to evaluate the treatment results of Brooker intramedually nailing for the distal 1/3 tibial fractures with compromised soft tissue.
Twenty-three cases of distal tibial fractures with comprolnised soft tissue were reviewed and we analyzed the results of surgical treatment in the viewpoint of union time, loss of reduction, malunion, complication and its final outcome. The range of follow-up was 24 months to 38 months with mean 29 months follow-up. Most of patients were between twenty and sixty years, and average age was 43.2 years.
Acording to Gustilo and Andersons classification, 3 were Type I, 2 were Type II of 5 open fractures. According to Tschernes classification, 13 were Grade I, 5 were Grade II of 18 closed fractures.
The average to union was 15 weeks with range 11 to 20 weeks. The healing was slowest in Tschernes Type II and fastest in Tschernes Type I fracture.
There were 3 cases of malunion, more than 5 degrees. All of the 3 cases were posterior angulation.
Only 1 case was the loss of reduction. This case was 3 to 10 degrees of varus angulation.
There were 3 cases of superficial infection. The infection was controlled with antibiotic therapy.
Only 1 case was acceptable of the final outcome. This case waf limping gait because of pain and loss of ankle dorsiflexion to 15 degrees. But, the limitation of ordinary work was not seen.
And 18 cases were excellent and 4 cases were good.
We recommand that wherever possible, Brooker intramedually nailing can be used for distal tibial fractures with compromised soft tissue. And a high rate of union and a low rate of complication can be expected with thit treatment modality.
Intertrochanteric fractures of the femur usually occur in the elderly and osteoporotic patients. These appear to be increasing in frefuence and are usually unstable. Sixthy two cases were treated ai our hospital from September 1993 through October 1995. 29 elderly patients underwent bipolar hemiarthroplasty and 33 patients underwent internal fixation with compression hip screw(C.H.S). The results were as follows ; 1. Functional results according to hip rating scale of Merle D,Aubiigne was superior in bipolar group.
2. The incidence of postoperative complications was much fewer in bipolar group than in compression hip screw group.
3. In casees of definite osteoporosis with Singhs index below 3 and Evans unstable type frartures, the incidence of mechanical complications was increased, especially in compression hip screw group.
4. There was no siginificant difference between 2 groups in operative time and blood loss.
Citations
Citations to this article as recorded by
Fixation of Greater Trochanter Using an AO Trochanteric Reattachment Device (AO TRD) in Arthroplasty for Intertrochanteric Femur Fracture of Elderly Patients Weon-Yoo Kim, Young-Yul Kim, Jae-Jung Jeong, Do-Joon Kang Hip & Pelvis.2013; 25(4): 274. CrossRef
Hemiarthroplasty for Hip Fractures in Elderly Patients over 80 Years Old - Comparative Analysis between Femoral Neck Fracture and Intertrochanteric Fracture - Chae-Hyun Lim, Young-Yool Chung, Jeong-Seok Kim, Chung-Young Kim Hip & Pelvis.2013; 25(1): 44. CrossRef
Hip Arthroplasty Using Collarless Polished Tapered Stem -Minimum 2 Years Follow-up Results- Yerl-Bo Sung, Jung-Yun Choi, Su-Chan Oh Hip & Pelvis.2012; 24(1): 18. CrossRef
Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients Sung-Hwan Kim, Soo-Won Lee, Gyu-Min Kong, Mid-Um JeaGal Hip & Pelvis.2012; 24(1): 45. CrossRef
Cemented Bipolar Hemiarthroplasty for Intertrochanter Fracture in Elderly Patients - Minimum 2-Years Follow-up Results - Sung Kwan Hwang, Dong Hyun Kang, Tae Yeon Cho, Chang Ho Yi Hip & Pelvis.2010; 22(3): 209. CrossRef