Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Orthopaedic Surgery

Background: The complex biomechanics of distal tibial fractures, lack of robust soft tissue coverage and a wide metaphysis makes their treatment a challenging prospect even for experienced surgeons. Methods: A total of 60 patients of distal tibia extra articular fracture were randomly treated with multidirectional intramedullary nailing and ILIZAROV. Fibula was fixed in selected cases either with nailing or a low profile plate. Outcome was measured with using subjective and objective criteria of Ovadia. Results: In this study 60 patients included 30 patients treated with multidirectional IM nail and 30 patients treated with ILIZAROV. Fractures were classified according to AO classification. In present study, Fibular fractures were present in all patients Fibular osteosynthesis was performed in twenty patients (23.3%). patients of nail group ,seven patients had an intramedullary K-wire due to soft tissue compromise.and in thirteen (43.3%) patients of Ilizarov group . seven patients had an intramedullary K-wire due to soft tissue compromise , six patient had one third tubular plate fixation . In the study all the fractures united except one ILIZAROV case. Mean time for union was 19 weeks. Time range for union was from 16-24 weeks. Nine patients of both groups had mal-alignment. One patient had superficial infection which was treated with oral antibiotics. in nail group there was twenty five cases(83.3%) of excellent results, three cases (10%) of good results, two cases (6.7%) of fair results.In Ilizarov groupthere was twenty two cases(73.3%) of excellent results, six cases (20%) of good results, one case (3.3%) of fair results. and one case (6.3%)of poor results in the current series. Conclusions:EXPERT nail and Ilizarov fixation technique yields good to excellent clinical outcomes with accepted functional outcome for management of the distal extra articular tibia fractures

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