An evaluation of functional outcome following minimally invasive plate osteosynthesis in fractures of the distal tibia

Yeshwanth Subash, Prabhu Manickam S., Ravikrishna R., Priyadarshini S., Gunalan K. Naidu


Background: Management of fractures of the distal tibia remains a challenging proposition due to the fact that the major part of the bone is in a subcutaneous location and the blood supply is quite precarious. Conventional forms of osteosynthesis are associated with high rates of infection and nonunion. Due to extensive soft tissue stripping, the vascularity is compromised and often results in poor wound healing and tends to compromise fracture healing as well. Closed reduction with minimally invasive plate osteosynthesis (MIPO) addresses these issues and has emerged as a viable treatment option with minimal complications. The aim of this study was to assess the functional outcome MIPO using locking compression plates (LCP).

Methods: 32 patients with distal tibial fractures treated by MIPO technique with LCP fixation were studied from January 2012 to January 2014 and were followed up for a period of 2 years.

Results: All the fractures in our series united well at the end of 6 months with mean time to radiological evidence of callus formation at 10 weeks and the mean time to fracture union was 20 weeks. There were 2 cases with varus angulation in our series and no cases with implant failure. There were 3 patients with superficial skin infections and no cases of deep infection.

Conclusions: We conclude that MIPO with LCP is an effective treatment option for distal tibial fractures avoiding all the complications associated with other forms of internal fixation. We strongly recommend its usage in these types of complex injuries.


Distal tibia, MIPO, LCP, Osteosynthesis

Full Text:



Oni OO, Stafford H, Gregg PJ. A study of diaphyseal fracture repair using tissue isolation techniques. Injury. 1992;23:467–70.

Russell TA. Fractures of the tibia and fibula. In: Rockwood CA, Green DP, Buckolz RW, Heckman JD, editors. Fractures in adults. 4th ed. Philadelphia: Lippincott; 1996: 2139-2157.

Rüedi TP and Murphy WM. AO Principles of Fracture Management. New York: Thieme Medical Publishers; 2001: 253-255.

Fisher WD, Hamblen DL. Problems and pitfalls of results and complications. Injury. 1978;10:99–107.

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

Rüedi T. Fractures of the lower end of the tibia into the ankle joint: results 9 years after open reduction and internal fixation. Injury. 1973;5:130-4.

Ruedi TP, Allgower M. The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop Relat Res. 1979;138:105–10.

Rammelt S, Endres T, Grass R, Zwipp H. The role of external fixation in acute ankle trauma. Foot ankle Clin. 2004;9:455–74.

Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001;15:153–60.

Robinson CM, McLauchlan GJ, McLean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. J Bone Joint Surg. 1995;77:781–7.

Mafulli N, Toms A, MC Murtle A, Oliva F. Percutaneous plating of distal tibial fractures. Int Orthop. 2004;28:159-62.

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

Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia. Results in 20 patients. Injury. 2006;37(9):877–87.

Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury. 2007;38:365–70.

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.

Collinge C, Kuper M, Larson K, Protzman R. Minimally Invasive Plating of High- energy Metaphyseal Distal tibial fractures. J Orthop Trauma. 2007;21:355-61.

Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury. 1997;28(1):7–12.

Lawrence M, Mar F, Swanson SAV. Engineering considerations in the internal fixation of fractures. J Bone Joint Surg. 1969;51B:754-68.

Barie DP. Pilon fractures. In: Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P. Rockwood and Green’s Fractures in Adults. 7th edition. Philadelphia: Lippincott Williams and Wilkins; 2010: 1928-1974.

Sanders R, Haidukewych GJ, Milne T, Dennis J, Latta LL. Minimal versus maximal plate fixation techniques of the ulna: the biomechanical effect of number of screws and plate length. J Orthop Trauma. 2002;16:166-71.

Dhakar A, Annappa R, Gupta M, Harshavardhan H, Kotian P, Suresh PK. Minimally invasive plate osteosynthesis using locking plate for distal tibia fractures. J Clin Diagnostic Res. 2016;10(3):1-4.

Perren SM, Perren T, Schneider E. Are the terms “biology” and “osteosynthesis” contradictory? Ther Umsch. 2003;60:713-21.

Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating system for the ankle, hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int. 1994;15:349-53.

Fan CY, Chiang CC, Chuang TY, Chiu FY, Chen TH. Interlocking nails for displaced metaphyseal fractures of the distal tibia. Injury. 2005;36:669–74.

Borrelli J, Prickett W, Song E, Becker D, Ricci W. Extra osseous blood supply of the distal tibia and the effects of different plating techniques: Human cadaveric study. J Orthop Trauma. 2002;16:691-5.

Gao H, Zhang CO, Luo CF, Zhou ZB, Zeng BF. Fractures of the distal tibia treated with polyaxial locking plating. Clin Orthop Relat Res. 2009;467:831–83.

Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br. 2002;84(8):1093-110.