Distal tibia framing KOLD

Distaltibia

FRAMING

SørenKoldAarhusUniversity Hospital

Indicationsforringfixationindistaltibia

• Isitsafe (soft-tissues!/co-morbidity)• andtechnicallypossible(bonequality/fracturepattern)toobtain

• goodreductionandstableinternalfixation(NAIL/plate)?

– Iftheanswerisno:RINGFIXATION

17-yearsoldmale

Fallfromhighspeedcarousel.

Anterior:Soft-tissueswith blisters

Postero-lateral:soft-tissues ok.

Fibula:ORIF

Tibia:Hexapodframeincluding foot

Fracture leftinflexion andshort.

Gradualcorrection oftibial fractureover1week

Foot frameremovedafter 9weeks

Frame time:15weeks.

Comorbidity

45years old male

Rheumatoid arthritis• Methotrexate• TNFinhibitor• NSAID

Fragilesoft tissues• plateL

• Stablefixation• Closedreduction• Immediate,unrestrictedweight-bearing

• Fullweight-bearing:Nolossoffunction• KeptonTNF-inhibitor/methotrexate: noRAprogression• Circ-aid®compression: edematreatment• Frame-time:5months

72-yearsold male

Motorbike accident

GCS:7Multipleinjuries

Righttibia:closed diaphyseal #:IMN

Left tibia:Segmental #•middiaphyseal:Gustilo IIIA• distaltibia:Tscherne II

Gustilo IIIBshaftandTscherne IIdistaltibiaWhatdoesitendwith?

What will itendwith?

Frameconvertable tobonetransport

Stableforfullweight-bearing

Outcome after distaltibial?

TraumaIlizarovDatabase:• Patientreported outcome:

EQ5D-5L,Olerud-Molander Ankle Score,MajorDepressionInventory Score

• Radiological outcome:Union,fracture reduction,arthrosis level

• Objective outcome:Rangeofmotion

TraumaIlizarovDatabase

• 20distal(AOtype43-)tibial fractures:postoperativetoframe removal

• Unionin20/20

• Timeinringfixator:25weeks (13– 51weeks)

Patientreported outcome 12months after frame removal

• 17AOtype43- fractures (AO43A:5,AO43B:6,AO43C:6).2open fractures.

• VASpain scoreatrest:mean 1(range0-8).13outof17patientsno pain atrest.

Distalfracture(AO43-):

EQ5D-5L Index Olerud-Mollander Ankle Score

Studypopulation Mean 0,591 4395%CI 0.476– 0.706* 28- 58

Referencepopulation****Mean 0.888/0.858

(Male/female50-59years)

95%CI 0.880-0.896(male)0.850-0.866(female)

*significantly different compared with referencepopulation.

Unpublished data,Elsoe etal,2017

Radiological outcome 12monthsafter frame removal

• 3outof17:•malalignment of>3degrees or• articular depressionof>5mm

• Kellgreen LawrenceOsteoarthritis Score:

• Noneor doubtful OA(score0-1):7

•MinimalOA(score2):4

•ModerateOA(score3):4

• Severe OA(score4):2–

• treated later with talo-crural fusion

Unpublished data,Elsoe etal,2017

Indicationsforringfixationindistaltibia

• Isitsafe (soft-tissues!/co-morbidity)andtechnicallypossible(bonequality/fracturepattern)

toobtaingoodreductionandstableinternalfixation(nail/plate)?– Iftheanswerisno:RINGFIXATION