Is Far Cortical Locking More Effective Than Bicortical Locking in Treating AO 43A1-3 Fractures?
Condition: Tibia Distal Fracture; Nonunion of Fracture of Tibia
MeSH terms: Fractures, Bone; Fractures, Ununited; Tibial Fractures
Study type: Observational

Summary: 
      Delayed union or nonunion, which is a common complication of periarticular fractures repaired
      with angled locking plate systems, may be due to the unintentionally rigid formation of this
      system. This study aimed to compare the results of the treatment of distal tibial fractures
      made more flexible using the far cortical locking (FCL) technique with the classical
      bicortical locking screw (BL) technique.
    

Detailed description: 
      Extra-articular distal tibia fractures are uncommon; it constitutes less than 10% of all
      lower extremity fractures, but even if the fracture is closed, contusion and fracture
      blisters may accompany these fractures, which can be very effective in deciding the type of
      treatment because the soft tissue envelope surrounding the tibia is very thin. Discussions on
      the method of fixation of these fractures continue and seem to never end. Since comparative
      studies with two popular methods, intra-medullary nailing (IMN) and minimally invasive plate
      osteosynthesis (MIPO), eventually yielded similar results, the choice based on experience and
      patient-specific characteristics, described as surgeon comfort, has been more accepted.

      Malunion after IMN is a common problem and may be caused by the gradual enlargement of the
      canal after the isthmus or the incomplete centering of the proximal insertion site of the
      nail. On the contrary, the most common complications reported after MIPO are delayed union,
      nonunion and infection. In the MIPO technique, angle-stable locked plates are used, which can
      prevent shear displacement and provide more than 0.2 mm of axial interfragmentary movement,
      allowing the formation of natural callus tissue. Different methods can be applied to make the
      partially rigid mechanical environment created by these plates more flexible. These can be
      diaphyseal fixation with conventional non-locking screws or far cortical locking (FCL),
      lengthening the bridging plate, or dynamizing the plate with active plates. The FCL method,
      which changes the axial load with the more parallel interfragmentary method and provides
      progressive symmetrical mineralization of the callus tissue, is based on the principle that a
      system that works like an external fixator but works as an internal fixator.

      It is thought that this method, which can be defined biomechanically in this way, can prevent
      the formation of insufficient callus, which may occur especially between plate and bone, in
      the treatment of periarticular fractures. However, studies on this subject are insufficient
      in number. Therefore, we aimed to compare the radiological and clinical results of two
      different diaphyseal fixation models that we performed in the treatment of extra-articular
      distal tibial metaphyseal fractures with the MIPO method. Our hypothesis is that fixation
      with the FCL method will provide faster complete union compared to the classical locking
      plate technique, where the diaphyseal fixation is fixed at all three points with locking
      screws.
    

Intervention name(s): Far Cortical Locking Technique
Intervention type(s): Procedure
Intervention description(s): Apart from the traditional 3 point fixation of the locking screw this technique compromises two point fixation of the screw where one into the plate and the other is into the far cortex of the diaphysis. The near cortex was widened by 3.2 mm of dirll bit to eliminate the fixation of the screw into the near cortex
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Skeletally mature patients with closed extra articular AO 43A1-3 distal tibial fractures
      
Keywords: Extra-articular; distal tibia; MIPO; far cortical locking