To analyze the functional outcome of proximal tibial fractures treated with minimally invasive percutaneous plate osteosynthesis technique

Sivakumar Arumugam, Venkateshwara Arumugam, V. Raviraman


Background: Tibial plateau fractures constitute about 1% of all fractures and complex bicondylar fractures constitute 30% of all Tibial plateau fractures. Minimally Invasive Percutaneous Plate Osteosynthesis [MIPPO] is a method of biological fixation in which a plate is percutaneously inserted and fixed at a distance proximally and distally from the fracture site. By minimal exposure, this helps in the preservation of the essential fracture hematoma, minimal soft tissue dissection, avoidance of periosteal stripping and providing an adequate fixation. The objective of the study was to analyze the functional outcome of proximal Tibial fractures treated with MIPPO technique. The method of fixation shall be evaluated for the time period required for the patients to return to active work following surgery.

Methods: In our study, all 18 patients with proximal Tibial fractures underwent definitive fixation by MIPPO technique. All our cases underwent initial stabilization as per the ATLS guidelines. Patients with closed Tibial plateau fractures associated with a tense haemarthrosis underwent aspiration of the joint under aseptic precautions. The limb was immobilized either in an above knee slab or through skeletal traction using a distal Tibial or calcaneal pin traction on a Bohler Braun splint until definitive fixation was carried out. In cases complicated with excessive swelling and blistering, definitive fixation was delayed until the swelling/ blistering subsided.

Results: The post-operative results were designated as excellent, good, fair and poor according to pain, walking capacity, the range of motion and stability of the knee using Rasmussen’s grading system. In our study, the average functional knee score was 22.89. Rasmussen’s score does not consider articular congruity while assessing the functional outcome of the knee.

Conclusions: MIPPO technique gives good to excellent results even in high energy Tibial condyle fractures [72.22% cases in our study]. Our patients were able to achieve a good functional range of movement, averaging 120 degrees. [Krettek et al – 124 degrees]. Those who were treated with early fixation and early mobilization were found to have a better functional outcome irrespective of the fracture type. No secondary bone grafting was required. 


Tibial plateau fractures, MIPPO technique, Rasmussen’s grading system, Closed interlocking intramedullary nail fixation

Full Text:



Dendrinos GK, Kontos S, Katsenis D Dallas K; Treatment of high energy tibial plateau fractures by Ilizarov external fixator. J Bone Joint Surg. 1996;78B:710-71.

Kennedy JC Bailey WH: Experimental tibial plateau fractures. J Bone Joint Surg. 1968;50:1522.

Honkonen SE. Degenerative arthritis after tibial plateau fractures. J Orthop Trauma. 1995;9:273-7.

Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: definition, demographics, treatment rationale and long term results of closed traction management or operative reduction. J Orthop Trauma. 1987;2:97-117.

William S, J Mills, Sean E Nork: Open reduction and internal fixation of high energy tibial plateau fractures. Orthop clinic. North America. 2002;33:177-98.

Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994;23:149-54.

Brunner CF, Weber BG. Special techniques in internal fixation. Berlin: Springer – Verlag, 1982

Gerber C, Mast JW, Ganz R. Biological internal fixation of fractures. Arch Orthop Trauma Surg. 1991;109(6):295-303.

Koval KJ, Sanders R, Borrelli J, Helfet D, DiPasquale T, Mast JW. Indirect reduction and Percutaneous screw fixation of displaced tibial plateau fractures. J Orthop Trauma. 1992;63(3):340-6.

Mast J, Jakob R, Ganz R. Planning and reduction technique in fracture surgery. Berlin; Springer- Verlag; 1989: 254.

Perren SM. The concept of biological plating using the limited contact DCP. Injury 1991;22(1):s1-s41.

Weber BG, Cech O. Pseudoarthrosis: Pathology, Biomechanics, Therapy, Results. Berne, Switzerland: Hans Huber Medical Publisher; 1976: 323.

Rockwood CA. Rockwood and Green’s – Textbook of fractures in adults. Volume 1. 5th edition. 2001: 191.

Apley AG. Fractures of the lateral tibial condyle treated by skeletal traction and early mobilization. A review of 60 cases with special reference to long term results. J Bone Joint Surg. 1956;38B:699.

Shelton WR, Sage FP. Modified Nicoll graft. Treatment of gap nonunion in the upper extremity. J Bone Joint Surg. 1981;63(2):226-31.

Barrington T, Dewar F. Tibial plateau fractures. Can J Surg. 1965;8:146.

Anger R. Critical intraarticular fractures of the proximal tibia. Rev Chir Orthop. 1968;54:259.

Rasmussen P. Tibial condyle fractures, impairment of knee joint stability as an indicator of surgical treatment. J Bone Joint Surg. 1973;55A:1331-50.

Burn C, Bartzka G, Coldeway J, Muggler E. Fractures of the tibial plateau. Clin Orthop. 1979;138:84.

De Coster TA, Nepola JV: Cast brace treatment proximal tibial plateau fractures. Ten years follow up study. Clin Orthop. 1988;231:196-204.

Sarmiento A, Kingman KB, Latta LL. fractures of the proximal tibia and tibial condyle. A clinical and laboratory comparative study. Clin Orthop. 1979;145:136-49.

Schatzker J, MC Broom R, Bruce D. Tibial plateau fractures: the Toronto experience 1968-1975, Clin Orthop. 1979;138:94-104.

Brunner CF, Weber BG. Besondere Osteosynthesetechniken. Berlin Heidelberg. New York Springer; 1981.

Weber BG, Blatter. Wave plate Osteosynthesis as a salvage procedure. Acta Chir Orthop Traumatol Cech. 1993:60(5):273-7.

Muller ME, Allgower M, Schneider R, Willengger H. Manual of internal fixation technique recommended by AO ASIF group Ed3, Berlin 1990, Springer Verlag; 1991: 2,229-231,738-739.