Closed minimally invasive osteosynthesis of metaepiphyseal fractures of distal tibial bones

V.L. Vasyuk, О.А. Koval


Background. Surgical treatment of distal tibial fractures (43 and 44 segments by АО) is a topical issue, there is a number of scientific papers dealing with it reporting different treatment technologies for fractures of distal tibia metaepiphysis (including pilon); meanwhile, the complication and failure rate remains high. The purpose of the work is to improve the results of surgical treatment of distal metaepiphyseal tibial fractures by means of development, substantiation and implementation of the improved technology of minimally invasive osteosynthesis. Materials and methods. Reduction is performed using general or conduction anaesthesia under fluoroscopic control. Ligamentotaxis principle is applied when pulling fragments by means of distractor. If separated bone fragments are not reduced, awl or sharp hooks are used through separate pricks of the skin. Every step is controlled by image intensifier. After luxation or subluxation is eliminated and reduction completed, transarticular fixation of fragments is performed by inserting 3 wires 2 mm in diameter from the sole in the direction of the tibia middle part. Separate bone fragments are additionally fixed by means of wires and screws percutaneously. The limb is immobilized with external fixation or plaster bandage. Additional disturbances in the periosteal and endosteal blood supply are being minimized. 265 patients were examined. Their average age was 45.15 ± 15.98 (from 18 to 86) years. The patients were divided into clinical groups according to the type of surgery performed. Clinical group I included patients who underwent minimally invasive osteosynthesis with wires and screws (n = 113; 42.64 %); clinical group ІІ consisted of patients with external fixation (n = 36; 13.58 %); and clinical group ІІІ included patients who underwent plate osteosynthesis (n = 116; 43.77 %). Results. The analysis of using the improved minimally invasive osteosynthesis technology for distal tibial fractures compared with the traditional methods of surgical treatment of these injuries in 265 patients from the three clinical groups demonstrated that closed reduction and improved technique result in better outcomes and consi­derable reduction of costs for the treatment compared to traditional osteosynthesis. Conclusions. Placing the care of blood supply of the bone and soft tissues in the first position, the role of biology as a prior factor of proper healing is emphasized, concerning treatment of the distal metaepiphyseal tibial fractures. Advanced technology of minimally invasive osteosynthesis for distal metaepiphyseal tibial fractures was developed, substantiated and used in surgical treatment of 265 patients from the three clinical groups. It was demonstrated that using advanced technique results in improved results and conside­rable reduction of costs for treatment in comparison with traditional osteosynthesis.


ankle joint; ankle fractures; pilon fractures; minimally invasive osteosynthesis; surgical treatment


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