Treatment of distal metaphyseal tibia fractures using an external fixator in children

INTRODUCTION: Current treatment of pediatric distal metaphyseal tibial/fibular fractures is challenging due to poor skin and soft tissue coverage and limited blood supply to the distal tibia area in children. It remains unknown whether the SK combined external fixator (made by Double Medical Technology Inc., China) is effective for the treatment of distal metaphyseal tibia/fibula fractures in children. HYPOTHESIS: We hypothesized that SK combined external fixator could achieve satisfying outcomes for pediatric distal metaphyseal tibia/fibula fractures. PATIENTS AND METHODS: A total of 19 pediatric patients with a median age of 6 years (range: 3.8–12.0 years), who had distal tibia/fibula metaphyseal fractures and attended our hospital between January 2017 and November 2017, were evaluated. All patients with tibia fracture had closed reduction and percutaneously fixed SK combined external fixators. Radiographs were taken at an average of every 4 weeks to evaluate the healing of the fracture. Complications were recorded, and the stability of the pin clamp and rod were also checked. Follow-up was conducted for up to 13 months. All patients provided informed consent for publication of the case. RESULTS: All patients achieved a satisfactory clinical outcome at the final follow-up. Weight-bearing exercises were started at post-operative 2 weeks. Bone union was obtained at 8 weeks post-operation on average. No delayed healing or nonunion was observed, although one case of pin site infection and three cases of pin clamp loosening occurred. DISCUSSION: Three-dimensional SK combined external fixators are light, easy to apply, minimally invasive, and result in low rates of complications. They provide excellent stability for pediatric distal tibia/fibula metaphyseal fractures. LEVEL OF EVIDENCE: IV.