Limited internal fixation in the distal metaepiphyseal shin fractures

Background: The scientific papers deal with it reporting different treatment technologies for distal tibia metaepiphysis fractures; meanwhile the complication and failure rates remain high.

Material and methods: 265 patients were examined. Their average age was 45.15±15.98 years (from 18 to 86). The patients were distributed into clinical groups according to the type of surgery performed. Clinical group I included patients who underwent mini-invasive osteosynthesis with K-wires and screws (113 patients, 42.64% from general group); Clinical group ІІ included patients with external fixation osteosynthesis (36 patients, 13.58%); and Clinical group ІІІ included patients who underwent osteosynthesis with plates (116 patients, 43.77%).

Results: The technology of mini-invasive osteosynthesis of distal metaepiphysis fractures of the lower leg is improved. Reposition is performed under general or conduction anaesthesia under C-arm control. Ligamentotaxis principle is applied pulling fragments by means of distractor. In case separate bone fragments are not repositioned a pricker, single-toothed tenaculum are used through separate pricks of the skin. Every step is controlled by imagic intensifier. After subluxation is eliminated and reposition completed, trans-articular fixation of fragments is performed inserting 2-3 K-wires 2 mm in diameter from the sole in the direction of the tibia middle part.

Conclusions: The analysis of implementation of the improved mini-invasive osteosynthesis technology for fractures of the distal lower limb compared with the traditional methods of surgical treatment of these injuries in 265 patients from the three clinical groups demonstrated that the use of closed reposition and improved technique results in improved results and considerable reduction of costs for treatment in comparison with traditional osteosynthesis.