MINIMAL INVASIVE PLATE OSTEOSYNTHESIS OF CLOSE FRACTURES OF DISTAL TIBIA
Abstract
Background: The limited soft tissue, subcutaneous location and poor vascularity render the tibialfractures very challenging. Treatment of distal tibial fractures using minimally invasive plateosteosynthesis (MIPO) technique may minimise damage to soft tissues and the vascular integrityof bony fragments, leaving comminuted fragments out of the mechanical construct, preserving softtissues with limited operative exposure. This descriptive study was conducted to assess theoutcome of patients treated with MIPO technique for distal tibial fractures. Methods: Seventythree cases of multifragmentary fractures of the distal tibia admitted in Bahawal VictoriaHospitals, Bahawalpur between April 2009 and October 2010 were included in this study.Patient’s outcome in terms of period of radiologic union of the fractured segments and period offull weight bearing capacity were accessed. Results: There were 66 males and 7 females of meanage 43 years. The mean follow-up period was 13 weeks. (Ranging from 9–16 weeks). All patientswere fully weight bearing at 16 weeks (ranging 9–16 weeks) showing radiological union. Therewere two superficial infections treated successfully using oral antibiotics and no failures offixation. There were no cases of rotational malalignment. Conclusion: MIPO is an effectivemethod of treatment for distal tibial fractures. The use of indirect reduction techniques and smallincisions is technically demanding but decreases surgical trauma to soft tissues.Keywords: Distal tibial fractures, Minimally invasive plate osteosynthesis, MIPOReferences
McFerran MA, Smith SW, Boulas HJ, Schwarz HS.
Complications encountered in the treatment of pilon fractures. J
Orthop Traum 1992;6(2):195–200.
Teeny SM, Wiss DA. Open reduction and internal fixation of
tibial plafond fractures; variables contributing to poor results and
complications. Clin Orthop 1993;292:108–17.
J Ayub Med Coll Abbottabad 2011;23(2)
http://www.ayubmed.edu.pk/JAMC/23-2/Shabbir.pdf
Ronga M, Longo UG, Maffulli N. Minimally invasive locked
plating of distal tibia fractures is safe and effective. Clin Orthop
Relat Res 2010 Apr;468(4):975–82.
Konrat G, Moed BR, Watson JT, Kaneshiro S, Karges DE,
Cramer KE. Intramedullary nailing of unstable diaphyseal
fractures of the tibia with distal intraarticular involvement. J
Orthop Trauma 1997;1:200–5.
Salton HL, Rush S, Schuberth J. Tibial plafond fractures: Limited
incision reduction with percutaneous fixation. J Foot Ankle Surg
;46(4):261–9.
Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M,
Evidence based Orthopaedic Trauma working group. Treatment
of distal tibia fractures without articular involvement :a systemic
review of 1125 fractures. J Orthop Trauma 2006;(1):76–9.
Othman M, Strzelczyk P. Results of conservative treatment of
“pilon” fractures. Ortop Traumatol Rehabil 2003;5:787–94
Digby JM, Holloway GM, Webb JK. A study of function after
tibial cast bracing. Injury 1983;14:432–9.
Metcalfe BP. Pilon fractures of the tibia. Curr
Orthop 2003;17(3):190–99.
Ruëdi T, Allgöwer M. Fractures of the lower end of the tibia into
the ankle joint. Injury 1969;1:92–99.
Anglen JO. Early outcome of hybrid external fixation for fracture
of the distal tibia. J Orthop Trauma 1999;13:92–97.
Anglen JO. Early outcome of hybrid external fixation for fracture
of the distal tibia. J Orthop Trauma 1999;13:92–7.
McFerran MA, Smith SW, Boulas HJ, Schwartz HS.
Complications encountered in the treatment of pilon fractures. J
Orthop Trauma 1992;6:195–200.
Ruedi T, Webb JK. Experience with the dynamic compression
plate in 418 recent fractures of the tibia. Injury 1976;7:252.
Olerud S, Karlstrom G. Tibial fractures treated by AO
compression osteosynthesis. Experiences from a five year
material. Acta Orthop Scand Suppl 1972;140(1):1–104.
Chandler Robert W. Principles of internal fixation. Rockwood and
Greene’s fractures in adults, 4th edition. 1996;1:159–217.
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.
Probe RA. Minimally invasive fixation of tibial pilon fractures.
Operative Techniques in Orthopaedics 2001;11(3):205–17.
Leone VJ, Ruland RT, Meinhard BP. The management of the soft
tissues in pilon fractures. Clin Orthop Relat Res 1993;292:315–20.
Leonard M, Magill P, Khayyat G. Minimally-invasive treatment
of high velocity intra-articular fractures of the distal tibia. Int
Orthop 2009 Aug;33(4):1149–53.
Shrestha D, Acharya BM, Shrestha PM. Minimally invasive plate
osteosynthesis with locking compression plate for distal
diametaphyseal tibia fracture. Kathmandu Univ Med J (KUMJ).
;9(34):60–6.
Mandracchia VJ, Evans RD, Nelson SC, Smith KM. Pilon
fractures of the distal tibia. Foot Ankle Trauma 1999;16:743–67.
Aksekili MA, Celik I, Arslan AK, Kalkan T, Uğurlu M. The
results of minimally invasive percutaneous plate osteosynthesis
(MIPPO) in distal and diaphyseal tibial fractures. Acta Orthop
Traumatol Turc 2012;46(3):161–7.
Helfet DL, Shonnard PY, Levine D, Borrelli B Jr. Minimally
invasive plate osteosynthesis of distal fractures of the tibia. Injury
;28(Suppl 1):SA42–8.
Eid A. Minimally invasive plate osteosynthesis for tibial pilon
fractures. Orthopaedia 2009. [Serial Online]. 2009.
[cited;24.5.2010]. Available from: http://www.orthopaedia.net/
display/Main/Minimally+Invasive+Plate+Osteosynthesis+for+
Tibial+Pilon+Fractures+(Case+Series)
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