Is the Addition of a Foot Ring to the Circular External Fixator Necessary in the Treatment of Extra-Articular Distal Tibia Fractures?

OBJECTIVES:The purpose of this study was to evaluate the effects of adding foot ring to circular external fixator (CEF) on the functional outcomes in the treatment of extra-articular distal tibia fractures. DESIGN:Retrospective comparative study. SETTING:Level III. PATIENTS AND METHODS:Fifty-six patients [CEF32 patients with an average follow-up of 65.03 months; circular external fixator with a foot ring (CEF-FR)24 patients with an average follow-up of 93.04 months] who received treatment between December 1995 and September 2012 were retrospectively evaluated. INTERVENTION:We included the patients with extra-articular distal tibia fractures who were treated with CEF with or without foot ring. MAIN OUTCOME MEASUREMENTS:At the final follow-up visit, we evaluated our patients for AOFAS (American Orthopaedic Foot and Ankle Society) score, ankle dorsiflexion, ankle plantar flexion, inversion, eversion, and muscle strength. RESULTS:There were no statistical differences in the age, sex, and follow-up period of the 2 groups. The mean overall AOFAS score was 77.78 (47–100), and the mean AOFAS scores for the CEF-FR and CEF groups were 71.54 (47–88) and 82.47 (52–100), respectively. Significantly better results were observed in the CEF group (P = 0.03). The mean overall visual analog scale (VAS) score was 1.89 (0–4), and the visual analog scale (VAS) scores for the CEF-FR and CEF groups were 1.96 (0–4) and 1.72 (0–3), respectively. This difference was not statistically significant (P = 0.236). CONCLUSION:We conclude that CEF without the addition of a foot ring may result in better functional outcomes in the treatment of extra-articular distal tibia fractures. LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.