Abstract :
Objective: Distal tibia extra articular fractures amount to nearly 10-13% of all tibial fractures. Precarious vascularity, propensity for open fractures and poor soft tissue coverage over these fractures make them particularly vulnerable for infection and non-union and surgical site complications.We evaluated the shortterm functional outcome of fracture distal tibia fibula treated by single stage external fixation using Joshi’s External stabilizing system (JESS).
Methods: In a non-control prospective interventional study on 30 patients with extra articular distal tibia fractures we used the JESS fixator as a definitive treatment modality. Fibula was internally fixed using a nail or plate when fractured. After achieving temporary fracture reduction, two pins were inserted each in tibia and calcaneum and were connected by JESS rods using clamps. In case of open fractures wound was managed by serial debridement and dressings as required. The patients were followed up for a minimum of 12 months.
Results: There were 20 male and 10 females. The mean age was 39.1 years (range 18-60 years). There were 18 open and 12 closed fractures. According to the AO/OTA classification of extra articular distal tibia fractures 20 belonged to type A1, 3 in type A2 and 7 in type A3. The mean time to union was 15 weeks and the average duration of surgery was 35 minutes. At the final follow up all fractures united except one and the mean AOFAS score was 83.13. There were 2 cases of pin track infections, one non-union and one mal-union. One patient had ankle arthritis managed conservatively till last follow up.
Conclusions: Definitive fixation of distal tibia extra- articular fractures with JESS is a simple procedure with good functional outcome and avoids complications associated with open reduction and internal fixation.
Keyword :
Distal tibia, JESS, Plating, ORIF, Fixator.