Outcome of treatment of proximal tibial plateau fractures by minimally invasive percutaneous plating osteosynthesis technique
Keywords:Proximal tibial plateau fractures, MIPPO, Outcome
Background: Fractures of the proximal tibia are accompanied by a wide range of severity which may include stable undisplaced fractures with minimal soft tissue injury to highly comminuted unstable fractures, and severe soft tissue involvement. With the better understanding of fracture healing biology and biomechanics of fracture fixation and healing, the trend of treatment is towards biological fixation, which can be accomplished by Minimally Invasive Percutaneous Plating Osteosynthesis (MIPPO) technique.
Methods: Demographic data of patients were recorded on admission and thorough history and clinical examination was done. The fractures were assessed for soft tissue injuries and followed by radiological assessment of fracture with schatzkers classification. The surgeries included anterolateral and anteromedial approaches for all patients with ‘inverted hockey stick incision’ and were treated with MIPPO. They were regularly followed up at 6-8 weeks interval till complete fracture union. A clinical and radiological evaluation was carried out using the modified Rasmussen clinical and radiological criteria.
Results: Out of the 20 patients treated, most of them were males and belonged to the age group of 20-40 years (75%). Unilateral fractures were more common than bilateral fractures and were of the type 4 and type 5 of Schatzkers classification which was usually associated with high velocity RTA. One patient each had infection, varus deformity and knee joint stiffness. 10 fractures gave excellent result, 7 fractures healed with good results. Only 2 of the patients showed fair results and 1 had poor result.
Conclusions: All the fractures treated with MIPPO technique was found to be rapidly healing by secondary fracture union and hence achieving strong bone union across the fracture site due to inherent benefits of less tissue damage and minimal disturbance of fracture site biology.
Egol KA, Koval KJ. In: Fracture of proximal tibia: chapter 50, Rockwood and Green’s “Fracture in Adults”, Vol. 2, 6th edition, Lippincott Williams and Wilkins. 1999.
Shepherd L, Abdollahi K, Lee J, Vangsness CT Jr. The prevalence of soft tissue injuries in nonoperative tibial plateau fractures as determined by magnetic resonance imaging. J Orthop Trauma. 2002;16(9):628-31.
Lansinger O, Bergman B, Korner L, Andersson GB. Tibial condylar fractures. A twentyyear follow-up. J Bone Joint Surg Am. 1986;68:13-9.
Pape HC, Giannoudis P, Krettek C: The timing of fi;racture treatment in polytrauma patients: Relevance of damage control orthopedic surgery. Am J Surg. 2002;183(6):622-9.
Schulak DJ, Gunn DR. Fracture of the tibial plateaus. Clin Orthop. 1975;109:166-77.
Cotton FB. Fender fracture of the tibia at the knee. N Engl J Med. 1929;201:989.
Koval KJ, Hulfut DL. Tibial plateau fracture: evaluation and treatment. J Am Acad Orthop Surg. 1995;3(2):86-94.
Biyani A, Reddy NS, Chaudhary et al. The results of surgical management of displaced tibial plateau fracture in the elderly. Injury. 1995;26(5):291-7.
Sirkin MS, Bono CM, Reilly MC and Behrens FF. Percutaneous methods of tibial plateau fixation. Clin Orthop 2000;375:60-8.
Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am. 1973;55:1331-50.
Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev 1994;23:149-54.
SchatzkerJ, McBroom R, Bruce D:The tibial plateau fracture: The Toronto experience 1968-1975. Clin Orthop. 1979;(138):94-104.
Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, et al. Complications after tibia plateau fracture surgery. Injury. 2006;37:475–484. doi: 10.1016/j.injury.2005.06.035.
Cole PA, Zlowodzki M, Kregor PJ. Less invasive stabilization system (LISS) for fractures of the proximal tibia: indications, surgical technique and preliminary results of the UMC Clinical Trial. Injury. 2003;34(Suppl 1):A16-29.
Cole PA, Zlowodzki M, Kergor J. Treatment of proximal tibia fracture using the Less Invasive Stabilization System. Surgical experience and early clinical results in 77 fractures. J Orthop. 2004;18:528-35.
Ricci WM, Rudzki JR, Borrelli J Jr. Treatment of complex proximal tibial fracture with the less invasive skeletal stabilization system. J Orthop Trauma. 2004;18:521-7.
Stannard JP, Wilson TC, Volgas DA, Alonso JE. Fracture stabilization of proximal tibial fracture with the proximal LISS: early experience in Birmingham, Alabama (USA). Injury. 2003;34:A30-5.
Rakesh Sharma, Rajesh Kapila, Brahm Preet Singh, Yadwinder Singh Sohal. Traditional buttress plating v/s MIPO in management of proximal tibial fractures - A clinical study. Pb Journal of Orthopaedics. 2013;14(1):11-6
Marsh JL, Smith ST, Do TT. External fixation and limited internal fixation for complex fractures of the tibial plateau. J Bone Joint Surg Am. 1995;77A:661-73.
Raza H, Hashmi P, Abbas K, Hafeez K. Minimally invasive plate osteosynthesis for tibial plateau fractures. Journal of Orthopaedic Surgery 2012;20(1):42-7.
Egol KA, Su E, Tejwani NC, Sims SH, Kummer FJ, Koval KJ. Treamtent of complex tibial plateau fractures using the less invasive stabilization system plate. J trauma. 2004;57:340-6.
Phisitkul P, McKinley TO, Nepola JV, Marsh JL. Complications of locking plate fixation in complex proximal tibia injuries. J Orthop Trauma; 2007;21,83-91.
Reddy JPK, Nazeer BS, Arun HS, Kumar NM. Study of surgical management of proximal tibial fractures using locking compression plate. IJBAR. 2016;07(03):123-7.
Rohra N, Suri HS, Gangrade K. Outcome of Schatzker Type V and VI Tibial Plateau Fracture Treatment with Dual Plates. Journal of Clinical and Diagnostic Research. 2016;10(5):RC05-10.
Yu Z, Zheng L, Zhang Y, Li J, Ma B. Functional and radiological evaluations of high energy tibial plateau fractures treated with double-buttress plate fixation. Eur J Med Res. 2009;14(5):200-05.
Prasad GT, Kumar TS, Kumar RK, Murthy GK, Sundaram N. Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates. Indian J Orthop. 2013;47(2):188-94.
Zhang Y, Fan D, Ma B, Sun S. Treatment of complicated tibial plateau fractures with dual plating via a 2-incision technique. Orthopedics. 2012;35(3):e359-64.
Oh CW, Oh JK, Kyung HS, Jeon IH, Park BC, Min WK, et al. Double plating of unsta-ble proximal tibial fractures using minimally invasive percutaneous osteosynthesis tech-nique. Acta Orthop. 2006;77(3):524-30.