Assessment of Alignment in Proximal Extra-articular Tibia Fractures Managed at the Kenyatta National Hospital

Abstract

Background Proximal tibia fractures account for about 5% -11% of all tibia fractures and contribute to significant morbidity leading to gait disturbance and reduced quality of life. These fractures are challenging to manage due to the deforming forces and the strut effect of the fibula thus malalignment is a common occurrence. There is paucity of data locally to assess the early outcomes following treatment of the proximal extra-articular tibia fractures. Objectives To determine the alignment of extra-articular proximal tibia fractures managed in Kenyatta National Hospital. Design Cross sectional study Study setting Kenyatta National hospital Methods Consecutive sampling technique was used to recruit 30 patients who sustained proximal tibia fractures and underwent treatment surgically or non-operatively. Outcomes were measured at 6 weeks postoperatively. Malalignment was based on coronal angulation >5 degrees, sagittal angulation>10 degrees, shortening > 2 cm and rotation > 15 degrees. Data was cleaned and entered into SPSS version 24.0 for data analysis. The prevalence of defined malalignment after proximal tibia treatment was derived as a proportion of patients who has a specific outcome after fixation out of the total sample size. Fischer’s exact test and Chi-square test for association were used to investigate factors associated with angulation. Statistical significance was set at <0.05. This was presented in tables and charts. Results: The average age was 29.9(SD±8.9) years with a range of between 19 and 49 years. Most of the patients were male;76.7%. Causes of injury included motorcycle

accidents at 43.3% followed by motor vehicle accidents accounting for 30%. The majority (66.7%) of these fractures were multifragmentary, with most patients presenting with closed fractures (70%). Management approaches utilized included plates (36.7%), nails (30%), POP application (20%) and external fixation (13.3%). The findings established that 36.7% of the patients had coronal and sagittal malalignment. Seven patients (23.3%) had shortening of ≥2cm while that 33.3%(n =10) had a rotation of ≥15 degrees. Malalignment was 18% in patients managed with locking plates, 50% in those managed with POP application, 33.3% in those managed by intramedullary nailing while 75% among those managed by external fixation. Further, in patients managed with nailing, there was zero(0) percent malalignment where poller screws were utilized and 50% malalignment where no poller screws were used. For non-locking plates, 33.3% had malalignment and 12.5% malalignment in locking plates. All those managed with MIPO technique had malalignment with no malalignment observed with open technique. The study found one patient with segmental fractures had malalignment, 50% of those with oblique fractures, and 40% with multifragmentary fractures had malalignment. Shortening occurred in 35% of multifragmentary fractures but not in other types. Conclusion and recommendations Most of malalignment occurred in patients with multifragmentary fracture pattern, patients managed with external fixation, POP application, MIPO technique and non-poller screw interlocking nails. Despite advances in surgical techniques and implant designs, which have reduced malalignment rates, challenges remain in achieving optimal outcomes. Therefore, there is need to promote the use of advanced surgical techniques such as angular stable, anatomical locking plates and poller screws in nailing to improve alignment