title: Is the addition of a foot ring to the circular external fixator necessary in the treatment of extra-articular distal tibia fractures?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  Level III.
  
  
  METHODS
  Fifty-six patients [CEF: 32 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.
  
  
  METHODS
  We included the patients with extra-articular distal tibia fractures who were treated with CEF with or without foot ring.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopedics and Traumatology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey; †Department of Orthopedics and Traumatology, Silivri State Hospital, Istanbul, Turkey; and ‡Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Erdil
authors.forename: Okan
authors.initials: O
authors.lastname: Ozkunt
authors.forename: Gökhan
authors.initials: G
authors.lastname: Polat
authors.forename: Hasan Huseyin
authors.initials: HH
authors.lastname: Ceylan
authors.forename: Ali
authors.initials: A
authors.lastname: Ersen
authors.forename: Deniz
authors.initials: D
authors.lastname: Kara
authors.forename: Cengiz
authors.initials: C
authors.lastname: Sen
mesh_terms: D000328:Adult; D000368:Aged; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation*; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult