Open Distal Tibia Fractures: Fixation Techniques

The inclusion criteria for this study is as follow: (1) open fracture of distal tibia and fibula, fracture type: AO-42; (2) surgical methods: simple external fixation, external fixation combined with plate-screw osteosynthesis, external fixation combined with K-wire intramedullary fixation; (3) regular follow-up. Exclusion criteria: (1) ankle joint surface damaged severely, normal correspondence congruence and joint space can’t be restored through fixation; (2) associated with serious hypertension, heart disease and other serious diseases, reduced operative-tolerance; (3) associated with brain and spinal nerve functional impairment, severely affected the function of the lower limbs; (4) previous history of severe degenerative arthritis, rheumatoid arthritis, cerebral infarction, and dyskinesia in the lower extremities.
From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were enrolled into this study, among which 35 patients were treated by simple external fixation (group A, n = 35), 30 patients were treated by external fixation combined with plate-screw osteosynthesis (group B, n = 30), and 26 patients were treated by external fixation combined with K-wire (2.0–3.0 mm) intramedullary fixation (group C, n = 26). There was no significant difference in gender, age, cause of injury, Gustilo classification and AO classification among the three groups (P > 0.05) (Table 1).
Table 1

General information

Group	Patients (n)	Gender		Age (years, x ± s)	Mechanism of injury		Gustilo classification			AO classification
		Male	Female		Traffic injuries	Others	I	II	III	42-A	42-B	42-C
A	35	27	8	46.83 ± 15.83	25	10	4	12	19	13	16	6
B	30	25	5	44.27 ± 12.37	21	9	7	11	12	11	14	5
C	26	22	4	44.96 ± 14.48	19	7	3	7	16	11	11	4
P	–	>0.05		>0.05	>0.05		>0.05			>0.05

Group A: simple external fixator fixation

Group B: external fixator combined with plate-screw osteosynthesis

Group C: external fixator combined with k-wire intramedullary fixation