Minimally Invasive Plate Osteosynthesis for Fractures of Distal Tibia

Article information

Kosin Med J. 2014;29(1):23-29

Publication date (electronic) : 2014 December 17

doi : https://doi.org/10.7180/kmj.2014.29.1.23

Department of Orthopedic Surgery, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: So Hak Chung, Department of Orthopaedic Surgery, Kosin University Gospel, Hospital, 34 Amnam-dong, Seo-gu, Busan, 602-702, Korea TEL: +82-51-990-6467 FAX: +82-51-243-0181 E-mail: shchung@kosin.ac.kr

Received 2013 April 05; Revised 2013 October 27; Accepted 2013 December 16.

Abstract

Objectives

This study analyzed clinical and radiologic results, and complications of minimally invasive plate osteosynthesis(MIPO) for distal tibia fracture.

Methods

16 patients (17 cases) who were performed MIPO for distal tibia fractures between January 2007 and June 2011, postoperative followed up at least for one year, were selected for this study. The average age was 55.0(26-76) years old and the average period of followup was 15.1(6-27) months. Most of the patients were encouraged to perform ankle dorsiflexion and straight leg raising exercise on splints, from the next day of the operation. As radiologic evaluation, we checked period until bone union, degree of angulation. And postoperative complications were also checked. For functional evaluation of the ankles, American Orthopaedic Foot and Ankle Society(AOFAS) score was used.

Results

16 of the 17 cases were achieved primary bone union, and average period of bone union in all the cases was 17.4 (12-42) weeks. Mean varus/valgus angulation after the bone union was 0.8 degrees and mean anteroposterior(AP) angulation was 1.8 degrees. Mean AOFAS score was 85.2(71-95) points; 5 cases of excellent, 10 cases of good, 1 case of fair, showing that 93.8% of the patients represented at least good AOFAS scores. As complications, there were 2 cases of superficial infection, and each 1 case of nonunion and skin irritation. There were no cases of deep infection, metal breakage, nor limb length discrepancy.

Conclusions

MIPO for distal tibia fracture is considered to be an effective operative method, because of its high bone union rate and low complications by minimal disruption of soft tissue and improved bone fixation strength. Also, for earlier return to daily life, ankle joint exercise should be started as soon as possible after the operation.

Keywords: Distal tibia; Early range-of-motion exercise; Facture; Mimimally invasive plate osteosynthesis (MIPO)

Fig. 1.

(A) A 73 yeared-old woman was sustained distal tibiofibular comminuted fracture by slip down. (B) The distal tibia fracture was stabilized with LCP metaphyseal plate using minimal invasive technique. (C) At 16 weeks postoperatively, radiographs shows bone union.

Fig. 2.

(A) A 65-yeared old woman was sustained distal tibiofibular fracture by slip down. (B) The distal tibia fracture was treated with MIPO technique using LCP metaphyseal plate on medial side. (C) At 12 weeks postoperatively, radiograph shows bone union.

Table 1.

Patient data

References

1. Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma 2010;24:24–9.

2. Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res 1993;292:108–17.

3. Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop 2008;32:697–703.

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

5. Holbrook JL, Swiontkowski MF, Sanders R. Treatment of open fractures of the tibial shaft: Ender nailing versus external fixation. A randomized, prospective comparison. J Bone Joint Surg Am 1989;71:1231–8.

6. Brumback RJ, McGarvey WC. Fractures of the tibial plafond. Evolving treatment concepts for the pilon fracture. Orthop Clin North Am 1995;26:273–85.

7. 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.

8. Borrelli J Jr, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: A human cadaveric study. J Orthop Trauma 2002;16:691–5.

9. Helfet DL, Suk M. Minimally invasive percutaneous plate osteosynthesis of fractures of the distal tibia. Instr Course Lect 2004;53:471–5.

10. Lee KB. Distal Tibia Fracture. Plate Osteosynthesis. J Korean Fract Soc 2009;22:306–13.

11. Kim SK, Lee KB, Lim KY, Moon ES. Minimally invasive osteosynthesis with locking compression plate for distal tibia fractures. J Korean Fract Soc 2011;24:33–40.

12. Yoo JS, Park HW. Clinical outcomes of locking compression plate fixation through minimally invasive percutaneous plate osteosynthesis in the treatment of distal tibia fracture. J Korean Fracture Soc 2012;25:117–22.

13. Wilber MC, Evans EB. Fractures of the femoral shaft treated surgically. Comparative results of early and delayed operative stabilization. J Bone Joint Surg Am 1978;60:489–91.

14. Segal D, Wiss DA, Whitelaw GP. Functional bracing and rehabilitation of ankle fractures. Clin Orthop 1985;199:39–45.

15. Vander Griend R, Michelson JD, Bone LB. Instructional course lectures, the american academy of otrhopaedic surgeons. Fractures of the ankle and the distal part of the tibia. J Bone Joint Surg Am 1996;78:1772–83.

16. Gul A, Batra S, Mehmood S, Gillham N. Immediate unprotected weight-bearing of operatively treated ankle fracture. Acta Orthop Belg 2007;73:360–5.

17. Egol KA, Dolan R, Koval KJ. Functional outcome of surgery for fractures of the ankle. A prospective, randomised comparison of management in a cast or a finctional brace. J Bone Joint Surg Br 2000;82:246–9.

18. Ahmad MA, Sivaraman A, Zia A, Rai A, Patel AD. Percutaneous locking plates for fractures of the distal tibia: Our experience and a review of the literature. J Trauma Acute Care Surg 2012;72:E81–7.

19. 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.

20. Hong KD, Ha SS, Chung NS, Sim JC, Ahn SC. Lateral plate fixation of distal tibial metaphyseal fracture using minimally invasive plate osteosynthesis technique. J Korean Fract Soc 2006;19:24–8.

21. Shon OJ, Park CH. Minimally invasive plate osteosynthesis of distal tibial fractures: A comparison of medial and lateral plating. J Orthop Sci 2012;17:562–6.

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Fig. 1.

Fig. 2.

Table 1.

Patient data

Case	Age/Sex	Injury mechanism	AO/OTA ^⋆ classification	G-A^† classification	Union time (week)	Ankle^‡ score	Complication
1 2	62/F	SD^§	A2 A1	Closed Closed	13 17	86 81	No
3	49/F	TA^∥	A1	Closed	21	80	Metal irritation
4	37/M	TA	A2	Type I	42	82	Nonunion
5	30/M	TA	A1	Type I	17	85	No
6	65/F	SD	A2	Closed	12	84	No
7	53/M	SD	A1	Closed	14	91	No
8	50/F	SD	A1	Closed	17	91	No
9	73/F	SD	B1	Closed	18	81	No
10	76/M	FD^¶	A1	Closed	15	88	No
11	26/M	FD	A1	Closed	12	95	No
12	64/F	SD	A2	Closed	14	81	No
13	51/M	TA	A1	Type II	24	71	Skin infection
14	54/F	SD	A1	Type I	14	92	No
15	48/M	SD	A1	Closed	13	95	No
16	73/F	SD	A3	Closed	16	85	No
17	69/M	FD	A3	Closed	18	81	Skin infection

^⋆

AO/OTA: Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association

^†

G-A: Gustillo-Anderson

^‡

Ankle score: ankle-hindfoot functional scale of AOFAS

^§

SD: Slip down

^∥

TA: Traffic accident

^¶

FD: Fall down.