Published: 2016-12-29

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


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.


Distal tibia fracture, LCP, MIPO, Osteosynthesis, Plating

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