A clinical study: management of distal tibial fractures with minimally invasive plating osteosynthesis
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20192681Keywords:
Distal tibia, MIPPOAbstract
Background: Distal tibial fractures of bone poses major challenge to the trauma orthopaedic surgeons as this bone is subcutaneous associated with soft tissue injuries and precarious blood supply. Distal tibial fractures require accurate reduction, perfect articular restoration with stable fixation with minimal stripping of soft tissues, thereby preserving the blood supply. Minimally invasive osteosynthesis using locking plates has emerged as viable option of fixing such fractures due to poor results associated with open plating which leads to extensive soft tissues stripping and subsequently poor blood supply.
Methods: 27 patients with closed distal tibial fractures with or without articular involvement without vascular compromise were treated with LCP fixation using MIPO technique studied from June 2017 to December 2018.
Results: All fractures in our series united well at the end of 5 months with mean time to clinical and radiological union was 17 weeks. There was no case of implant failure while 2 patients had varus angulation. Very few soft tissue complications with excellent functional outcome were seen.
Conclusions: We concluded that distal tibial fractures can be effectively managed with LCP using MIPPO technique with excellent functional outcome and avoiding the complications associated with other treatment methods.
References
Russell TA. Fractures of the tibia and fibula. In Rockwood CA, Green DP, Buckolz RW, Heckman JD, editors. Fractures in adults. 4th ed. Philadelphia: Lippincott, 1996: 2139-2157.
Kneifel T, Buckley R. A comparison of one versus two distal locking screws in tibial fractures treated with undreamed tibial nails: a prospective randomized clinical trial. Injury. 1996;27: 271-3.
Trafton PG. Tibial Shaft fractures. In: Browner DB, Jupiter JB, Levine AN, Trafton PG, Krettek C (eds). Skeletal trauma. 4th ed. Philladelphia: Saunders Elsevier.; 2009: 2319-2452.
Mosheiff R, Safran O, Segal D, Liebergall M. The unreamed tibial nail in the treatment of distal metaphyseal fractures. Injury. 1999;30:83-90.
Ruedi TP. Murphy WM. AO principles of fracture management. New York: Thieme Medical Publishers: 2001: 253-255.
Fisher WD, Hambledon DL. Problems and pitfalls of compression fixation of long bone fractures: a review of results and complications. Injury. 1978;10:99-107.
McFerran MA, Smith SW, Boulas HJ, Shwartz HS. Complications encountered in treatment of pilon fractures. J Orthop Trauma. 1992;6:273-85.
Olerud S, Karlstrom G. Tibial fractures treated by AO Compression osteosynthesis. Acta Orthop. Scand Suppl. 1972;1:1-104.
Ruedi T, Allgower M. Fractures of lower end of tibia into the ankle joint. Injury. 1969;1:92.
Ruedi T, Allgower M. The operative treatment of intra-articular fractures of lower end of tibia. Clin Orthop. 1979;138:105-10.
Tornetta P, Weiner L, Bergman M, Watnik N, Steuer J, Kelley M, et al. Pilon fractures: treatment with combied internal and external fixation. J Orthop Trauma. 1993;7:489-96.
Rammelt S, Enders T, Grass R, Zwipp H. The role of external fixation in acute ankle trauma. Foot Akle Clin. 2004;9:455-74.
Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for the treatment ofsevere tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001;15:153-60.
Mafulli N, Toms A, MC Murtle A, Oliva F. Percutneous plating of distal tibial fractures. Int Orthop. 2004;28:259-162.
Redfern DJ, Syed SU, Davies SJM. Fractures of Distal Tibia: minimally invasive plate osteosynthesis. Injury. 2004;35:615-20.
Hazarika S, Chakravarthy J, Cooper J. Minimally Invasive locking plate osteosynthesis for fractures of distal tibia. Results in 20 patients. Injury. 2006;37(9):877-87.
Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally plate osteosynthesis in diaphyseal and distal tibia fracture: a retrospective study of 32 patients. Injury. 2007;38:365-70.
Vallier HA, Le TT, Bedi A. Radiographic and clinical comparison of distal tibia shaft fractures (4 to 11 cm proximal to plafond): plating versus intramedullary nailing. J Orthop Trauma. 2008;22(5):307-11.
Collinge C, Kuper M, Larson K, Protzman R. Minimally treatment of high energy metaphyseal distal tibial fractures. J Orthop Trauma. 2007;21:355-61.
Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy p, Tscherne H. Minimallly Invasive plate osteosynthesis and vascularity. Preliminary results of a cadaver injection study. Injury. 1997;28(1):7-12.
Leung FK, Law TW. Application of minimally invasive locking compression plate in treatment of distal tibial fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009;23:1323-5.
Faschingbauer M, Kienast B, Schulz AP. Treatment of distal lower leg fractures: Results with fixed angle plate osteosynthesis. Eur J Trauma Rmerg Surg. 2009;35:513-9.
Mushtaq A, Shahid R, Asif M. Distal tibia fractures fixation with locking compression plate using MIPPO technique. Eur J Trauma Emerg Surg. 2009;35:159-64.
Ronga M, Longo UG, Maffulli N. Minimally invasive locked plating of distal tibial fractures is safe and effective. CORR. 2009;468:110-4.
Bahari S, Lenehan B, Khan H, McElwain JP. Minimally Invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg. 2007;73:635-40.
Jha G, Chen Z, Qi X. Minimally invasive percutaneous locking compression plate internal fixation in the treatment of distal tibial fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008;22:1448-50.
Protzman R, Collinge C. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibial fractures. J Orthop Trauma. 2010;24:24-9.
