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Distal Tibia Fractures: is the Tibia First Technique a Rational Approach?

INTRODUCTION: In this retrospective case-series study we discuss the clinical and radiographic outcomes obtained following the “tibia-first concept” in the treatment of distal tibia fractures, both in patients with fibular comminution and in cases with a simple fibula fracture. MATERIALS AND METHODS...

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Detalles Bibliográficos
Autores principales: Touloupakis, G, Messori, M, Gilli, A, Theodorakis, E, Ghirardelli, S, Antonini, G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Malaysian Orthopaedic Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103912/
https://www.ncbi.nlm.nih.gov/pubmed/37064623
http://dx.doi.org/10.5704/MOJ.2303.020
Descripción
Sumario:INTRODUCTION: In this retrospective case-series study we discuss the clinical and radiographic outcomes obtained following the “tibia-first concept” in the treatment of distal tibia fractures, both in patients with fibular comminution and in cases with a simple fibula fracture. MATERIALS AND METHODS: We analysed a consecutive series of 64 patients who presented at our emergency department with a distal articular tibial and fibular fracture from January 2015 to September 2020. A total of 22 patients met the inclusion and exclusion criteria and were included in the study. Clinical and radiographic examination were performed at each follow-up. To quantify pain and functional disability, the Foot and Ankle Outcome Score (FAOS) and the American Orthopaedic Foot and Ankle Society’s ankle-hindfoot scale (AOFAS) were applied. RESULTS: The overall mean age was 52.8 years, and the mean follow-up was 13.18 months. Multiple scales data from the FAOS were as follows: pain score 80.70; symptoms score 81.69; activities of daily living score 87.22; quality of life 76.05. The mean AOFAS ankle-hindfoot score was 74.36. CONCLUSIONS: Even though the principles of Rüedi and Allgöwer are still valid, in specific circumstances, the tibia-first concept could be considered as a valid option for the treatment of these demanding fractures. If a good reduction is obtained intra-operatively by ligamentotaxis, we recommend fixing the tibia first, avoiding surgical stress on tissues derived from a previous fibular fixation.