Posted in Volume 15 - Number 4
ASADULLAH MAKHDOOM, P.A.LATIF QURESHI, M. AYOOB LAGHARI, M.A AKHUND, KHALEEQUE A. SIDDIQUI
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BACKGROUND: Distal tibia fractures generally considered to be a difficult surgical technique because, lies subcutaneously, has precarious blood supply, high risk of infection, risk of necrosis after internal fixation and also develops malunion and non-union. Our research question was that the Naseer Awais external fixation systems with T-clamp have the advantages over the Ilizarov external fixation. We compared the outcome of both fixators and the following factors were considered to evaluate the results, like age, sex, mode of injury, classification of fractures, and effect of early and late weight bearing on union time of distal tibia fractures. Our hypothesis was that there is no significant effect of weight bearing on union time in these types of fractures.
METHODS: Thirty distal tibia fractures with single limb injury were randomized to be treated with Ilizarov Fixator and Naseer Awais External Fixation with T-Clamp. There were 23 men and 7 women were divided in two groups A and B, 15 patients were treated with the Ilizarov external fixator (Group A) and 15 with the Naseer Awais External Fixator with T-Clamp (Group B) between May 2005 to April 2007. The fractures were classified according to modified Gustilo classification. The systems allowed early and late weight bearing in all patients. Our surgical delay was not more then 24 hours. All patients were mobilized either on bed or non or partial weight bearing with walking aids after 06 hours or when the patient tolerated the pain and maximum time of mobilization was not more then 24 to 48 hours..
RESULTS: Twenty (66%) patients road traffic accident victims, 05 (16%) fall from height, 04 (13%) fire arm injury and fallen a heavy object on leg in only 01 (3.33%) patients. Fractures were classified according to Gustilo classification, five (n=05) 16% type I, six (n=06) 20% type II, twelve (n=12) 40% type IIIA and seven (n=07) 23% were type IIIB. Tolerance in both the groups was generally good and the pin track infection, superficial was seen in two cases. There were neither thromboembolic nor neurological complications. Bone healing was achieved at 18.37 weeks in group A patients and at 17.25 weeks in group B patients and P-value of both groups was 0.368. Partial weight bearing walking in group A was 13.3 week as against 11.88 weeks in group B, likewise full weight bearing was 8.27 week and 16.67, respectively and P-value of both group was 0.000.
CONCLUSION: Although application of both External Fixators was in same age group (15-45 years) but union time did not differ significantly between group A & B. However, weight bearing was significantly earlier in Group A. Early weight bearing did not enhance union in the distal tibia fractures.
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