• 대한족부족관절학회지
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• 제1권1호
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• pp.51-58
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• 1997

The purpose of this study is to evalute the efficacy af the Ilizarov external fixation for the surgical treatment. of the tibial plafond fractures. We reviewed retrospectively fourteen cases of tibial plafond fractures with moderate to severe soft. tissue damage, which were fixed with Ilizarov external fixator. Using the AO Muler classification, there were four Type C1 fractures, six Type C2 and four Type C3. In most, of the cases, the ankles were operated on with other associated fractures within a few days after injury. We reduced the fracture indirectly by soft issue taxis and fixed externally across the ankle joint. using the circular external fixator with tensioned wires and ankle hinge. In cases of inadequate closed reduction, we applied limited open reduction and internal fixation. Range of motion exercise began immediately. Postoperative follow-up averaged fourteen months (ranges, 8-30 months). Overall clinical results rated good or excellent in 7 cases, fair in 4 and poor in 3. There were three cases of pin tract infection which were resolved with short-term antibiotics and local care; one delayed wound closure in a patient. whose fracture was associated with Type III open wound; one wound slough in a patient associated with Type II open wound, which was closed later by skin graft; and one osteoarthritis. From this review, we concluded that cross-ankle circular external fixation with tensioned wires with or without. limited open reduction is a reasonable alternative for the treatment of the tibial plafond fractures with severe soft tissue damage.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.58-64
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• 2006

Purpose: Management of soft-tissue defect after open tibial fractures includes immediate and repeated debridement, skeletal stabilization, and early soft-tissue coverage with muscle flaps. The purpose of this study was to evaluate the outcome of the free rectus abdominis muscle flap (RA flap) for treatment of open fractures of the tibia and to discuss its advantages compared with the latissimus dorsi muscle flap (LD flap) in poly trauma patients. Materials and Methods: We performed a retrospective review of 5 patients who had a severe (Gustilo IIIb or IIIc) open fracture of the tibia treated with RA flap from May 2003 to March 2006. All were men, and the mean age was 46.6 years (range, $28{\sim}68$). Three patients had combined injuries such as pelvic bone fractures, multiple rib fractures with hemothorax, and contralateral tibial fracture. All patients received RA flap within 7 days after trauma except two with established chronic osteomyelitis. Results: All flaps survived, and there was no marginal flap necrosis. During the follow-up period, there was no evidence of persistent or recurrent osteomyelitis. The size of RA flap ranged from $8{\sim}20\;cm$ in length and $6{\sim}10\;cm$ in width. The average time required for RA flap elevation was 32 minutes, which is shorter than LD flap. Flap elevation could be done in supine position which is essential in poly trauma patients. Conclusion: Although a wide variety of options are available, RA flap is regarded as an optimal method for coverage of soft-tissue defect of the open tibial fracture in poly trauma patients. LD flap is reserved for large sized soft-tissue defect which cannot be covered by RA flap.

• 한국임상수의학회지
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• 제34권3호
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• pp.200-203
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• 2017

The objective of this study was to evaluate the effectiveness of the minimally invasive plate osteosynthesis (MIPO) method for treatment of tibial shaft fractures in dogs by comparing MIPO radiographic and fracture healing time results with those from the popular open reduction and internal fixation (ORIF) technique. In this clinical study at the Royal Animal Medical Center, five consecutive dogs with diagnoses of comminuted tibial shaft fractures were treated with the MIPO surgical approach. For comparison, an additional five breed-, age-, and weight-matched dogs with comminuted tibial shaft fractures were treated with the ORIF technique. Mean healing time was $75.6{\pm}12.5$ days in the MIPO group and $131.8{\pm}18.6$ days in the ORIF group (p < 0.01). The mean surgery time in the MIPO group ($36.4{\pm}3.5$ minutes) was significantly shorter (p < 0.01) than that for the ORIF group ($47.0{\pm}2.2$ minutes). Based on the short surgical and healing times, the MIPO approach is clinically superior to the ORIF approach and should be the preferred approach in tibial fracture cases.

• 대한족부족관절학회지
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• 제24권1호
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• pp.19-24
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• 2020

Purpose: Anterolateral minimally invasive plate osteosynthesis (MIPO) was performed to treat patients with distal tibial fractures associated with open fractures or extensive soft tissue injuries, which is limited medial MIPO. The treatment results of the anterolateral MIPO technique were evaluated and analyzed. Materials and Methods: Seventeen patients with distal tibial fractures associated with an open fracture or large bullae formation on the distal tibia medial side were treated with anterolateral MIPO using anterolateral locking plates. Within 24 hours of visiting the emergency room, external fixation was applied, and the medial side wound was managed. After damage control, the anterolateral locking plate was applied using an anterolateral MIPO technique. The union time, nonunion, or malunion were evaluated with regular postoperative radiographs. The ankle range of motion, operative time, blood loss, Iowa score, and wound complications were investigated. Results: Radiological evidence of bony union was obtained in all cases. The mean time to union was 16.7 weeks (12~25 weeks). The mean operation time was 44.0 minutes. Regarding the ankle range of motion, the mean dorsiflexion was 15°, and the mean plantarflexion was 35°. Satisfactory results were obtained in 15 out of 17 cases; five results were classified as excellent, four were good, and six were fair. The mean blood loss was 125.2 mL. Two complications were recorded. Conclusion: In distal tibial fractures with severe medial soft tissue damage caused by high-energy trauma, the staged anterolateral MIPO technique using anterolateral locking plates is a useful alternative treatment to achieving optimal wound care, rapid union with biological fixation, and intra-articular reduction.

• 대한족부족관절학회지
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• 제15권2호
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• pp.51-57
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• 2011

Pilon fractures involving distal tibia remain one of the most difficult therapeutic challenges that confront the orthopedic surgeons because of associated soft tissue injury is common. To introduce and describe the diagnosis, current treatment, results and complications of the pilon fractures. In initial assessment, the correct evaluation of the fracture type through radiographic checkup and examination of the soft tissue envelope is needed to decide appropriate treatment planning of pilon fractures. Even though Ruedi and Allgower reported 74% good and excellent results with primary open reduction and internal fixation, recently the second staged treatment of pilon fractures is preferred to orthopedic traumatologist because of the soft tissue problem is common after primary open reduction and internal fixation. The components of the first stage are focused primarily on stabilization of the soft tissue envelope. If fibula is fractured, fibular open reduction and internal fixation is integral part of initial management for reducing the majority of tibial deformities. Ankle-spanning temporary external fixator is used to restore limb alignment and displaced intraarticular fragments through ligamentotaxis and distraction. And the second stage, definitive open reduction and internal fixation of the tibial component, is undertaken when the soft tissue injury has resolved and no infection sign is seen on pin site of external fixator. The goals of definitive internal fixation should include absolute stability and interfragmentary compression of reduced articular segments, stable fixation of the articular segment to the tibial diaphysis, and restoration of coronal, transverse, and sagittal plane alignments. The location, rigidity, and kinds of the implants are based on each individual fractures. The conventional plate fixation has more advantages in anatomical reduction of intraarticular fractures than locking compression plate. But it has more complications as infection, delayed union and nonunion. The locking compression plate fixation provides greater stability and lesser wound problem than conventional implants. But the locking compression plate remains poorly defined for intraarticular fractures of the distal tibia. Active, active assisted, passive range of motion of the ankle is recommended when postoperative rehabilitation is started. Splinting with the foot in neutral is continued until suture is removed at the 2~3 weeks and weight bearing is delayed for approximately 12 weeks. The recognition of the soft tissue injury has evolved as a critical component of the management of pilon fractures. At this point, the second staged treatment of pilon fractures is good treatment option because of it is designed to promote recovery of the soft tissue envelope in first stage operation and get a good result in definitive reduction and stabilization of the articular surface and axial alignment in second stage operation.

• 대한족부족관절학회지
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• 제8권2호
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• pp.166-170
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• 2004

Purpose: To evaluate the results of MIPPO (minimal invasive percutaneous plate osteosynthesis) technique for distal tibial metaphyseal fractures. Materials and Methods: It is a retrospective study of 13 patients who were treated by MIPPO technique for distal tibial metaphyseal fractures from Jan. 2001 to Jan. 2003. The average age was 46.7 years and mean follow-up period was 13.3 months. According to AO classification, there were 8 cases of A1, 3 cases of A2, 1 case of B1 and 1 case of C2. One case of A1 was a Gustilo-Anderson type I open fracture and fibular fractures were combined in 12 cases. We applied anatomical reduction and internal fixation for the fibular fractures and internal fixation on the medial side of the tibia by MIPPO technique for distal tibial metaphyseal fractures. Clinical results were evaluated using radiographic results, Neer score, the starting time of postoperative exercise and clinical complications. Results: According to the Neer score, all cases showed satisfactory results. Active ankle ROM was started at average 2.4 weeks ($2{\sim}4$ weeks) and full weight bearing ambulation at average 5.2 weeks ($4{\sim}8$ weeks) postoperatively. Union of fractures was obtained by average 14.4 weeks ($8{\sim}18$ weeks) postoperatively. Two cases showed $5^{\circ}$ limitation of motion without functional deficits and other cases showed satisfactory ROM results. One case had $6^{\circ}$ valgus deformity without functional deficits. There were not any other complications like soft tissue problems and delayed-or non-union. Conclusion: MIPPO technique for the treatment of distal tibial metaphyseal fractures is a feasible technique with a good clinical outcomes.

• 대한족부족관절학회지
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• 제23권3호
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• pp.110-115
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• 2019

Purpose: This study analyzed the clinical and radiological results of Reudi-Allgower type II and III open tibia pilon fracture patients who underwent plate fixation after the recovery of a soft tissue injury after external fixation. Materials and Methods: From 2010 to 2015, this study analyzed 14 patients who were treated for open tibial pilon fractures and could be followed up at least one year. The mean age was 49 years and the average follow-up period was 19 months. An emergency operation was performed for external fixation and open wounds, and secondary surgery was performed for definitive fixation using a plate. The radiological and clinical evaluations were analyzed retrospectively. Complications, such as post-traumatic osteoarthritis and wound infections were also analyzed. Results: The mean duration between two-staged surgery was 21 days and the mean bone union time was 9.2 months. Three cases of delayed union and one case of nonunion were reported. The malunion did not occur in all cases. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 68 points. A limitation of the ankle motion occurred in all cases. In four cases, wound infections due to initial open wounds occurred; one patient underwent a below the knee amputation due to chronic osteomyelitis. Post-traumatic arthritis occurred in 10 cases. Conclusion: Severe comminuted tibial plateau open fractures of Reudi-Allgower type II and III, which are high-energy injuries that result in extensive soft tissue damage, have a higher incidence of complications, such as ulcer problems and osteomyelitis, than closed tibia plateau fractures. Post-traumatic arthritis is the most common complication of tibia plateau open fractures, and staged surgery is recommended because of the relatively satisfactory clinical results.

• Archives of Reconstructive Microsurgery
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• 제23권1호
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• pp.18-20
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• 2014

Two aged patients who had open tibial fractures with arterial injury caused by high energy accidents underwent emergency arterial reconstruction using a greater saphenous vein and soft tissue repair using free flaps. In the patients, soft tissue necrosis developed and tibias were exposed at postoperative third week. Follow-up angiography through the superficial femoral artery showed occlusion of the anterior tibial artery. The anterior tibial artery was reconstructed using the contralateral greater saphenous vein graft and the latissimus dorsi myocutaneous and rectus abdominis muscle free flaps were transplanted for repair of necrotic soft tissue. The reconstructed arteries showed good perfusion to the new free flaps until union of the tibias occurred. The patients were followed-up for 21 years and 17 years postoperatively, respectively. In management of open comminuted fracture of the tibia, injury of the arterial system must be ruled out by angiography in addition to evaluation of the degree of soft tissue injury.

• Clinical Pain
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• 제19권2호
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• pp.111-115
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• 2020

We report a case of a healthy 38-year-old man presenting with insufficiency fracture of proximal tibia associated with unrecognized osteoporosis. Radiologic bone DEXA (Dual Energy X-ray Absorptiometry) assessment revealed osteoporosis, but the patient displayed no apparent risk factors for insufficiency fractures and osteoporosis except for a history of smoking. Following right proximal tibial open reduction and internal fixation, the patient commenced smoking cessation and began taking alendronate. The patient was treated for gait rehabilitation, which included quadriceps strengthening exercises and his condition improved with independent walking. This report highlights an unusual site of proximal tibial insufficiency fractures and the potential effect of smoking on low bone mineral density in a young male patient.

• 대한족부족관절학회지
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• 제16권2호
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• pp.94-100
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• 2012

Purpose: The purpose of this study is to analyze the clinical features of distal tibia fractures and to evaluate the treatment outcomes of minimally invasive plate osteosynthesis (MIPO). Materials and Methods: From January 2004 to December 2009, 84 cases of 81 patients treated with plate fixation for distal tibia fracture were enrolled in this retrospective review. We investigated age, sex, injury mechanism, fracture patterns, and complications, and the clinical features were analyzed. To evaluate the treatment outcomes of MIPO, we divided into two groups. MIPO group consisted of 55 patients were treated with MIPO technique and conventional group consisted of 18 patients were treated with open reduction and internal fixation with conventional anterolateral plating. The results were compared between two groups by assessing bony union time, operation time, amount of blood loss, range of ankle motion, clinical score by American Orthopaedic Foot and Ankle Society (AOFAS) score, and post-operative complications. Results: The mean age of 81 patients with distal tibia fracture was 54.8 years. According to AO classification, A1:2:3 were 16, 20, 16 patients, B1:2:3 were 2, 8, 7, C1:2:3 were 1, 3, 11 patients. According to injury mechanism, slip down injury was patients, traffic accident was 26, fall from height injury was 14 patients respectively. The type A fractures were lower energy trauma and more older patients. The type C fractures were higher energy trauma and younger patients. MIPO group was better than conventional group in operative time, blood loss, bony union time, and ankle joint motion. In complications, MIPO group showed no nonunion and infection, one malunion, one skin necrosis, nine skin irritations, and one screw breakage. Conventional group showed two nonunion, four infections, two skin necrosis, and one metal failure. Conclusion: Distal tibial fractures caused by low energy trauma were on the increase. Minimal invasive plate osteosynthesis was shorter bony union time and operation time, less blood loss, and larger ankle motions than conventional open reduction and plate fixation.