DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20164517

Evaluation of results of minimally invasive plating osteosynthesis (MIPO) technique in the treatment of fractures of distal tibia

Waseem Akram, Ajay Kumar Mahto, Masroor Alam

Abstract


Background: The limited soft tissue, subcutaneous location of large portion of tibia and precarious blood supply renders the treatment of distal tibial fracture very challenging. The main treatment of this type of fracture is reinstatement of the normal alignment and articular congruity. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed Reduction and MIPO with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia, maintains fracture haematoma and provides biomechanically stable construct, early mobilization, less complications and relatively higher rates of union.The aim of this study was to evaluate the functional and clinical outcomes of distal tibia fracture of patients, treated by internal fixation by minimally invasive plating osteosynthesis (MIPO) technique with locking compression plate (LCP).

Methods: Sixty patients with distal tibia fracture with or without intra articular extension were treated in our department, Katihar Medical College and Hospital, Katihar with MIPO with LCP and were prospectively followed for average duration of 16 months (6-24 months).

Results: There were 60 patients in the study including 48 males and 12 female of mean age 43 years. The mean follow up period of our patients varied ranging from 6 months to 24 months (average– 16 months). All fractures united at an average of 16 weeks (range- 12 to 20 weeks) except two cases of delayed union(>20 weeks) in patients with Gustilo – Anderson type III A fracture. There were five superficial wound infections which were treated with oral antibiotics and progressed to union and there were no failures of implants. There were two cases of delayed union and malalignment.

Conclusions: Minimally invasive plating osteosynthesis (MIPO) is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incision is technically demanding as it is effective, minimally invasive, optimises the operation time, promotes early healing and reduces the incidence of infections.


Keywords


Distal tibia fracture, LCP, MIPO, Osteosynthesis, Plating

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References


Konrat G, Moed BR, Watson JT, Kaneshiro S, Karges DE, Cramer KE. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. J Orthop Trauma. 1997;1:200-5.

Salton HL, Rush S, Schuberth J. Tibial plafond fractures: Limited incision reduction with percutaneous fixation. J Foot Ankle Surg. 2007;46(4):261–9.

Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M. Evidence based Orthopaedic Trauma working group. Treatment of distal tibia fractures without articular involvement: a systemic review of 1125 fractures. J Orthop Trauma. 2006;(1):76–9.

Othman M, Strzelczyk P. Results of conservative treatment of “pilon” fractures. Ortop Traumatol Rehabil. 2003;5:787–94.

Digby JM, Holloway GM, Webb JK. A study of function after tibial cast bracing. Injury. 1983;14:432–9.

Metcalfe BP. Pilon fractures of the tibia. Curr Orthop. 2003;17(3):190–9.

Ruëdi T, Allgöwer M. Fractures of the lower end of the tibia into the ankle joint. Injury 1969;1:92–99.

Anglen JO. Early outcome of hybrid external fixation for fracture of the distal tibia. J Orthop Trauma. 1999;13:92–7.

McFerran MA, Smith SW, Boulas HJ, Schwartz HS. Complications encountered in the treatment of pilon fractures. J Orthop Trauma. 1992;6:195–200.

Ronga M, Longo UG, Maffulli N. Minimally invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat Res. 2010;468(4):975–82.

Redfern DJ, Syed SU, Davies SJM. Fractures of the distal tibia: minimally invasive plate osteosynthesis. Injury. 2004;35:615–20.

Apivatthakakul T, Phornphutkul C, Patumasutra S. Idea and innovation: Simple minimally invasive plate osteosynthesis (MIPO) instruments. Injury Extra. 2009;40:39–44.

Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma. 2008;22(5):307-11.

Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: Plating versus shortened intramedullary nailing. Injury. 2006;37:531–5.

De Boer P, Metcalfe R. Mini-symposium: Tibial fractures, (iv) Pilon fractures of the tibia. Curr Orthop. 2003;17:190-9.

Field JR, Hearn TC, Caldwell CB. Bone plate fixation: anevaluation of interface contact area and force of the dynamic compression plate (DCP) and the limited contact-dynamic compression plate (LC-DCP) applied to cadaveric bone. J Orthop Trauma. 1997;11:368-73.

Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg [Am]. 1976;58(4):453-8.

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

Helfet DL, Shonnard PY, Levine D, Borrelli BJr. Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury. 1997;28(1):42-8.

Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia – Results in 20 patients. Injury. 2006;37:877-87.

Koval KJ, Meek R, Schemitsch E, Liporace F, Strauss E, Zuckerman JD. An AOA critical issue. Geriatric trauma: young ideas. J Bone Joint Surg Am. 2003;85:1380-8.

Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop. 2001;25:360-2.

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

Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high energy metaphyseal distal tibia fractures. J Orthop Trauma. 2007;21:355-61.