Treatment of distal metaphyseal tibia fractures using an external fixator in children

Abstract

Introduction: Current treatment of pediatric distal metaphyseal tibial/fibular fractures is challenging due to poor skin and soft tissue coverage and limited blood supply to the distal tibia area in children. It remains unknown whether the SK combined external fixator (made by Double Medical Technology Inc., China) is effective for the treatment of distal metaphyseal tibia/fibula fractures in children.

Hypothesis: We hypothesized that SK combined external fixator could achieve satisfying outcomes for pediatric distal metaphyseal tibia/fibula fractures.

Patients and methods: A total of 19 pediatric patients with a median age of 6 years (range: 3.8-12.0 years), who had distal tibia/fibula metaphyseal fractures and attended our hospital between January 2017 and November 2017, were evaluated. All patients with tibia fracture had closed reduction and percutaneously fixed SK combined external fixators. Radiographs were taken at an average of every 4 weeks to evaluate the healing of the fracture. Complications were recorded, and the stability of the pin clamp and rod were also checked. Follow-up was conducted for up to 13 months. All patients provided informed consent for publication of the case.

Results: All patients achieved a satisfactory clinical outcome at the final follow-up. Weight-bearing exercises were started at post-operative 2 weeks. Bone union was obtained at 8 weeks post-operation on average. No delayed healing or nonunion was observed, although one case of pin site infection and three cases of pin clamp loosening occurred.

Discussion: Three-dimensional SK combined external fixators are light, easy to apply, minimally invasive, and result in low rates of complications. They provide excellent stability for pediatric distal tibia/fibula metaphyseal fractures.

Level of evidence: IV.

Conflict of interest statement

We declare that we have no conflict of interest.

Figures

Figure 1

(A) The tibia shaft bone can be divided into eight segments. (B) Method A: The double plane parallel pin used for the proximal bone, and single plane multi-channel individual pin for the distal bone. (C) Method B: The single-plane multi-channel individual pins used for both the distal and proximal bone.

Figure 2

Typical Case 1. Method A was applied in a 6-year-old boy, in which the pins were placed in proximal parallel planes and single-plane dual tunnels in the distal tibia. The pre-operative X-ray film from the lateral view of both sides (A and B) during surgery. The post-operative X-ray film from the lateral view of both sides (C and D). The appearance of the leg after the operation (E).

Figure 3

Typical Case 2. Method B was performed in a 8-year-old boy. Single-plane dual channel individual pins were placed both in the distal and proximal ends. The pre-operative X-ray film from lateral view of both sides (A and B) during surgery. The post-operative X-ray film from the lateral view of both sides (C and D). The appearance of the leg after the operation (E).