Published: 2020-04-22

The prospective analysis of functional outcome of osteosynthesis of extra-articular distal tibia fractures using minimally invasive percutaneous plate osteosynthesis technique

Arjun Mandri, Nuthan Jagadeesh, Sunil Nanjareddy, Vishwanath Muttagaduru Shivalingappa


Background: Extra-articular distal tibial fractures are one of the most complicated ones to treat, specially comminuted fractures. Its subcutaneous nature and lack of adequate musculature makes it more prone for soft tissue damage and bone loss. The key to handle these troubling fractures is to skilfully preserve and reconstruct the soft tissues, early mobilisation and functional use of the extremity with the maintenance of satisfactory length and alignment of the fracture.

Methods: This prospective longitudinal study involved 30 patients with extraarticular distal tibia fracture, who are admitted in Vydehi Institute of Medical Sciences and Research Centre between January 2017 to 2019. All were treated with closed reduction and internal fixation using pre-contoured anatomical distal tibia locking plate using minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Functional and radiological outcome along with associated complications are evaluated in serial follow up.

Results: 30 patients with minimal follow up criteria of 6 months was evaluated with AOFAS score for functional outcome. At the end of 1 year, 21 cases (70%) of the cases had excellent results, 5 cases (16.7%) had good results, 3 cases had fair results and only 1 case had poor result.

Conclusions: With the use of pre-contoured anatomical locking plates used, MIPPO technique is effective in extra articular distal tibia fractures where it not only helps in decreasing operating time but also in achieving excellent functional outcome with radiological union the fractures by preserving osseous vascularity and minimal soft tissue insult due to surgery.


Distal tibia fractures, MIPPO technique, AOFAS score

Full Text:



Bergdahl DWC. Epidemiology and incidence of tibia fractures in the Swedish Fracture Register. Injury. 2018;49(11):2068-74.

White TO, Guy P, Cooke CJ, Kennedy SA, Droll KP, Blachut PA, et al. The results of early primary open reduction and internal fixation for treatment of OTA 43.C-type tibial pilon fractures: a cohort study. J Orthop Trauma. 2010;24(12):757-63.

Zhao L, Li Y, Chen A, Zhang Z, Xi J, Yang D. Treatment of type C pilon fractures by external fixator combined with limited open reduction and absorbable internal fixation. Foot Ankle Int. 2013;34(4):534-42.

Austin RT. The Leicester Royal Infirmary UK. The Sarmiento tibial plaster: a prospective study of 145 fractures. Injury. 1981;13(1):10-22.

Justin E, Richards MD, Magill M, Marc A, Tressler DO, Shuler FD, et al. Southeast Fracture Consortium. External Fixation Versus ORIF for Distal Intra-articular Tibia Fractures. Orthopedics. 2012;35(6):862-7.

Kneifel T, Buckley R. A comparison of one versus two distal locking screws in tibial fractures treated with unreamed tibial nails: a prospective randomized clinical trial. Injury. 1996; 27:271-3.

Mao Z, Wang G, Zhang L. Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis. J Orthopaedic Surg Res. 2015;10:95.

Teitz CC, Carter DR, Frankel VH. Problems associated with tibial fractures with intact fibulae. J Bone Joint Surg Am. 1980;62:770-6.

Ronga M, Longo UG, Maffulli N. Minimally Invasive Locked Plating of Distal Tibia Fractures is Safe and Effective. Clinical Orthop Rel Res. 2010;68(4):975-82.

Bahari S, Leneham B, Khan H, Mcelwain JP. Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg. 2007;73:635-40.

Gupta RK, Rohilli RK, Sangwan K, Singh V, Walia S. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients. Inter Ortho. 2010;34:1285-90.

Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Ortho Trauma. 2010;24:24-29.

Sharma CB, Waikhom S. Management of Fracture Distal Tibia with locking ledial Metaphyseal plate. J Evidence Based Med Healthcare. 2015;2(29):4209-42.

Shrestha D, Acharya BM, Shrestha FPM. Minimally invasive plate Osteosynthesis with locking compression plate for distal diametaphyseal tibia fracture. Kathmandu Univ Med J. 2011;(34):62-8.

Reddy M, Kumar AV, Shaik T. Outcome of distal tibia fractures managed with locking compression plate using MIPPO technique. IJOS. 2019;5(3):304-10.

Abdulla S, Senna A. Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures. J American Sci. 2013;9(10).

Shikhar D, Singh, Manohar PV, Butala R. Mnimally invasive plate osteosynthesis in management of distal tibial fractures. IJSR. 2015;4(6).

American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a study protocol for the translation and validation of the Dutch language version. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a study protocol for the translation and validation of the dutch language version. BMJ Open. 2017;7(2):012884.