Circular Frame Management of Distal Tibial Fractures; 15 Years of Practice in a Tertiary Referral Unit

Patrick Hickland, Denise Wilson, Conor Mullan, Michael McMullan, Gerard Kelly

Belfast Health and Social Care Trust

Introduction: Distal tibial fractures, although relatively uncommon, are a concern to orthopaedic surgeons owing to their high energy nature and the associated soft tissue damage, metaphyseal comminution and articular involvement. Presently, there is no robust evidence to guide operative management, although circular frame fixation is one technique that can address and obviate some of these problems. Method: A retrospective review was undertaken to identify patients who had undergone circular frame fixation (CFF) of a distal tibia fracture in a UK major trauma centre from Jan 2010 – Dec 2023 inclusive. Outcomes of interest were postoperative complications, particularly those evidenced by an unplanned return to theatre. Regional electronic record and imaging systems were reviewed to identify these events. Results: 232 fractures were identified in 230 patients from 2010-2023 inclusive, with a mean age of 48.7 years and of whom 62.5% were male. 18.1% of fractures were open and 65.5% AO class 43C. The mean time from injury to CFF was 6.6 days, with frames being retained for an average of 5.1 months. At a mean of 8.4 years (range 0.6-15) post-operatively, the unplanned reoperation rate was 14.2%, as indicated for; deep surgical site infection (SSI) 6.9%, septic non-union 2.6%, and aseptic non-union 2.2%. The rate of clinically significant post-traumatic ankle arthritis was 6.9%, but overall arthrodesis rate only 2.2%. The amputation rate was 1.3%. Cases of open fractures or with diabetes were more likely to develop a deep SSI (p<0.05). Conclusions: This study describes the mid-to-long term outcomes of patients who underwent CFF of a distal tibia fracture, representing the largest available series, and demonstrating favourable rates of major complications compared to those available in the existing literature. Our results support this practice, in an appropriately resourced multi-disciplinary service, and furthermore provide invaluable information that can be used when counselling relevant patients."

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