Functional outcome of minimally invasive plate osteosynthesis with the use of locking plate in fracture distal end of tibia


  • Prashant Kamble Department of Orthopedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
  • Nandan Marathe Department of Orthopedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
  • Sudhir Sharan Department of Orthopedics, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
  • Ayush Sharma Central Railway Hospital, Byculla, Mumbai, Maharashtra, India
  • Ashwin Sathe Department of Orthopedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
  • Abhinav Jogani Department of Orthopedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India



Distal tibia, Tibia fracture, Internal fixation, MIPO


Background : Distal tibia fractures or pilon fractures are usually the result of combined compressive and shearing forces, which may lead to instability of the metaphysis. Poor vascularity, lack of muscle cover and frequent intra-articular extension often make these fractures very challenging to manage. There are plenty of options available to treat a distal tibia fracture which includes intramedullary nailing, external fixation, open reduction and internal fixation and minimally invasive plate osteosynthesis (MIPO). The aim of this study was to evaluate the results of MIPO with respect to the healing of fracture site, the incidences of complications and to conclude whether MIPO circumvents the problems of formal open reduction and fixation with other implants.

Methods: A series of forty patients with fracture of the distal tibia on preoperative X-rays were treated with minimally invasive plate osteosynthesis using pre-contoured locking plates from June 2014 to October 2018 and followed up at regular intervals with X-rays and monitoring for complications.

Result: The functional scores were evaluated using Teeny and Wiss clinical rating system for ankle joints. Thirty-two patients had an ‘Excellent’ or ‘Good’ outcome. One patient was diagnosed with a soft tissue complication and delayed union and 3 patients were diagnosed with malunion without significant functional disability at follow up.

Conclusion: Minimally invasive plate osteosynthesis with pre-contoured locking plates is associated with high union rate and good functional outcomes. It is an effective treatment modality for distal tibia fractures.


Rockwood CA, Bucholz RW, Green DP, Court-Brown CM, Heckman JD, Tornetta P. Rockwood and Green's Fractures in Adults: Wolters Kluwer Health/Lippincott Williams and Wilkins. 2010;2213.

Borrelli J Jr, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma. 2002;16(10):691-5.

Brumback RJ, McGarvey WC. Fractures of the tibial plafond. Evolving treatment concepts for the pilon fracture. Orthop Clin North Am. 1995;26(2):273-85.

Oh CW, Kyung HS, Park IH, Kim PT, Ihn JC. Distal tibia metaphyseal fractures treated by percutaneous plate osteosynthesis. Clin Orthop Relat Res. 2003;408:286-91.

Collinge C, Sanders R, DiPasquale T. Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop Relat Res. 2000;375:69-77.

Leunig M, Hertel R, Siebenrock KA, Ballmer FT, Mast JW, Ganz R. The evolution of indirect reduction techniques for the treatment of fractures. Clin Orthop Relat Res. 2000;375:7-14.

Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res. 1993;292:108-17.

Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Berlin: Springer Verlag. 1990.

Daolagupu AK, Mudgal A, Agarwala V, Dutta KK. A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures. Indian J Orthop. 2017;51(3):292-8.

Dogra AS, Ruiz AL, Thompson NS, Nolan PC. Dia-metaphyseal distal tibial fractures--treatment with a shortened intramedullary nail: a review of 15 cases. Injury. 2000;31(10):799-804.

Robinson CM, McLauchlan GJ, McLean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing. J Bone Joint Surg Br. 1995;77(5):781-7.

Helfet DL, Suk M. Minimally invasive percutaneous plate osteosynthesis of fractures of the distal tibia. Instr Course Lect. 2004;53:471-5.

Gerber C, Mast JW, Ganz R. Biological internal fixation of fractures. Arch Orthop Trauma Surg. 1990;109(6):295-303.

Vasanad GH, Antin SM, Akkimaradi RC, Policepatil P, Naikawadi G. The Role of Fibular Fixation in Distal Tibial Fractures. J Clin Diagn Res. 2016;10(4):1.

Devkota P, Khan JA, Shrestha SK, Acharya BM, Pradhan NS, Mainali LP et al. Minimally invasive plate osteosynthesis for distal tibial fractures. J Orthop Surg. 2014;22(3):299-303.

van der Linden W, Larsson K. Plate fixation versus conservative treatment of tibial shaft fractures. A randomized trial. J Bone Joint Surg Am. 1979;61(6A):873-8.

De Bastiani G, Aldegheri R, Renzi Brivio L. The treatment of fractures with a dynamic axial fixator. J Bone Joint Surg Br. 1984;66(4):538-45.

Cheng W, Li Y, Manyi W. Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation. Int Orthop. 2011;35(5):737-42.






Original Research Articles