distal tibia framing kold
TRANSCRIPT
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Unpublished data,Elsoe etal,2017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Unpublished data,Elsoe etal,2017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