scholarly journals MIPO vs. nail for extra-articular distal tibia fractures and the effect of intra-operative alignment control

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
N J Bleeker ◽  
N van Veelen ◽  
B van de Wall ◽  
B -C Link ◽  
R Babst ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Plate Osteosynthesis ◽  
Distal Tibia ◽  
Surgical Techniques ◽  
Definitive Treatment ◽  
Rotational Malalignment ◽  
Non Union ◽  
Articular Fractures ◽  
Significant Difference ◽  
Tibia Fractures

Abstract Objective Definitive treatment of distal extra-articular fractures of the tibia is challenging and both minimal invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are considered feasible surgical modalities with their own implant-specific merits and demerits. This retrospective study was designed to compare MIPO versus IMN in terms of fracture healing, complications, functional and radiological outcomes and to assess the efficacy of intra-operative alignment control in order to reduce the rate of malalignment after definitive fixation of distal extra-articular fractures of the tibia. Methods All consecutive adult patients with extra-articular distal meta- or diaphyseal tibia fractures that were treated in a level 1 trauma center in Switzerland between January 2012 and September 2019 either with plating or IMN were included. Outcome measures included fracture healing, complications (infection, malalignment, subsequent sur-geries), functional and radiological outcomes. Intra-operative alignment control encompassed bilateral draping of the lower extremities. Results A total of 135 patients were included out of which seventy-two patients (53%) were treated with MIPO and 63 patients (47%) underwent IMN. There was a significantly higher incidence of non-union for fractures treated with an IMN (13 (22%) vs. 4 (6%), p = 0.037). There was no significant difference between both groups in terms of rotational malalignment (4% vs. 9%) and angular malalignment (4% vs. 5%). The incidence of malalignment in both groups was lower than reported in literature. A significantly higher rate of infection was found after MIPO (13% vs. 6%, p = 0.028). No differences were found in subsequent surgeries or functional outcomes. Conclusion Both MIPO and IMN are reliable surgical techniques. IMN is associated with higher rates of non-union whereas MIPO results in a higher risk for infection. The incidence of malalignment was surprisingly low endorsing the utility of the intra-operative alignment control.

scholarly journals Retrospective analysis of minimal invasive plating versus intramedullary nailing for treatment of extra-articular distal tibia fracture

2020 ◽  
Vol 6 (6) ◽  
pp. 1176
Author(s):  
Yogesh Soni ◽  
Ghanshyam Kakadiya ◽  
Akash Shakya ◽  
Viraj Gandbhir
Keyword(s):  
Complication Rate ◽  
Plate Osteosynthesis ◽  
Distal Tibia ◽  
Minimal Invasive ◽  
Demographic Variables ◽  
Functional Score ◽  
Distal Tibial Fractures ◽  
Non Union ◽  
Tibia Fractures ◽  
Distal Tibia Fractures

<p class="abstract"><strong>Background:</strong> The volume of cases of distal tibia fractures at trauma care centre are quite high in Indian scenario. These type of fracture often creates a dilemma for the orthopaedic surgeons over the choice of the implant for the management. The aim of our study was to compare intramedullary interlocking nail (IMILN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) on the basis of various parameters.</p><p class="abstract"><strong>Methods:</strong> We collected data of 40 patients with extra-articular distal tibial fractures (within 2 muller square from tibial plafond). Patients were divided into two groups: IMILN and MIPPO. We compared the 2 groups for demographic variables, union time, complication rate and functional score.<strong></strong></p><p class="abstract"><strong>Results:</strong> There was no statistical difference of union time, complication rate, functional outcome and other demographic variables among the groups. Only 2 patients developed non-union and two patients had infection. Overall 38 patients obtained excellent or good result (95%) and two patient had fair outcome (5%).</p><p class="abstract"><strong>Conclusions:</strong> The overall analysis suggested that both MIPPO and IMILN treatment option are comparable with consideration of all the parameters. Detailed results indicate a superiority of MIPPO over IMILN in terms of better anatomical reductions of the fracture with less incidence of malalignment while IMILN is better in terms of having lower rates of infections.</p><p> </p>

scholarly journals Efficacy of Ultrasonography for MIPO in Distal Tibia Fractures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0031
Author(s):  
Gi-Soo Lee ◽  
Jaehwang Song ◽  
Chan Kang
Keyword(s):  
Plate Osteosynthesis ◽  
Distal Tibia ◽  
Tibia Fracture ◽  
Minimally Invasive Plate Osteosynthesis ◽  
3 Dimensional ◽  
Non Invasive ◽  
Significant Difference ◽  
Tibia Fractures ◽  
Distal Tibia Fractures ◽  
Emergency Department Patients

Category: Ankle; Trauma Introduction/Purpose: Restoration of normal anatomic alignment is most important aspect of the minimally invasive plate osteosynthesis (MIPO) for tibia fracture. The purpose of this study was to verify the usefulness of ultrasonography of MIPO in tibia fractures. Methods: Of the tibia fracture patients were admitted to the emergency department patients who plan to MIPO surgery were enrolled. We measured maximum angular formation in posteromedial and anterior edge of tibia using ultrasonography (US). And then, we measured maximum angular formation using mobile C-arm images after closed reduction in operating room. The accuracy was measured and compared using 3-dimensional computed tomography (3D-CT). Results: There was no significant difference in accuracy between C-arm and US. However, the use of C-arm during surgery was reduced by using US. By using US, we could determine that the reduction is adequate without the lateral and oblique C-arm images. Conclusion: The use of US is useful in reduction for tibia fracture. It seems that US is effective for confirmation of reduction state and considered safe and non-invasive because it can reduce the radiation exposure by using C-arm.

scholarly journals A comparative study of locking plate by minimally invasive percutaneous plate osteosynthesis versus closed interlocking intramedullary nail in extra-articular distal tibia fractures

2021 ◽  
Author(s):  
Jojin Jose Chitten ◽  
R. Balasubramaniam
Keyword(s):  
Minimally Invasive ◽  
Functional Outcome ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Small Sample Size ◽  
Distal Tibia ◽  
Small Sample ◽  
Articular Fractures ◽  
Tibia Fractures ◽  
One Year

<p><strong>Background</strong>: To compare functional outcome between minimally invasive percutaneous plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMIL) in the distal one-third extra-articular tibia fracture.</p><p><strong>Methods</strong>: We retrospectively analysed 32 patients with closed distal tibia extra-articular fractures who underwent IMIL nail and locking plate MIPO technique in 16 patients each. All patients were followed for at least one year with assessment of clinico-radiological union and functional outcome scoring.</p><p><strong>Results</strong>: There was comparable functional outcomes, time to union and surgical time both in IMIL nail and MIPO fixation of closed distal extra-articular tibia fractures with similar complication rate.   </p><p><strong>Conclusions</strong>: Our study suggests that both IMIL nail and MIPO fixation could be used for closed distal extra-articular tibia fractures as per surgeon’s preference. However, due to small sample size in our study, we cannot draw any definitive conclusions from our preliminary results but consider them as valuable basis for future studies.</p>

Minimally Invasive Plate Osteosynthesis Using Locking Plates for AO 43–Type Fractures: Lessons Learnt From a Prospective Study

2017 ◽  
Vol 11 (3) ◽  
pp. 236-241 ◽  
Author(s):  
Rajeev Shukla ◽  
Nikhil Jain ◽  
Ravi Kant Jain ◽  
Shravan Patidar ◽  
Vivek Kiyawat
Keyword(s):  
Soft Tissue ◽  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Distal Tibia ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Surgical Trauma ◽  
Locking Plates ◽  
Soft Tissue Dissection ◽  
Tibia Fractures ◽  
Radiological Union

Introduction. Managing fractures of distal tibia is still a subject of debate for orthopaedic surgeons in terms of both, reduction and fixation. Subcutaneous location and soft tissue anatomy predisposes it to angular and rotational instability as well as other bony and soft tissue complexities. Minimally invasive plating offers many advantages over conventional open techniques. It causes minimal soft tissue dissection and surgical trauma to the bone. Minimally invasive plate osteosynthesis(MIPO) maintains biological configuration of distal tibia and fracture hematoma and also provides a construct, which is biomechanically more stable. Objectives. Evaluation of results of MIPO in management of distal tibia fractures considering radiological union, ankle function restoration, and complications. Materials and Methods. In our study, 25 closed distal one-third tibia fracture with/without articular extension were taken, fulfilling the inclusion criteria (AO classification: 10, 43A1; 3, 43A2; 2, 43B1; 4, 43B2; and 6, 43C1). MIPO with locking plates was the treatment undertaken. Patients were followed up for 18 months prospectively. Results. Average injury-hospital interval was 11.16 hours and average injury-operation interval was 2.44 days. All fractures showed radiological union at an average duration of 20.5 weeks (14-28 weeks). Olerud and Molander score was used for evaluation at 3, 6, and 18 months. One patient had union with valgus angulation >5° but there was no nonunion. There was 1 superficial postoperative wound infection. Conclusion. Our study shows that plating with MIPO is an effective treatment for closed distal one-third tibia fractures, considering union time and complications rate. Younger age promotes early union and functional recovery. Levels of Evidence: Therapeutic, Level II: Prospective

scholarly journals Distal Tibia Metaphyseal Fractures: Which is Better, Intra-medullary Nailing or Minimally Invasive Plate Osteosynthesis?

2018 ◽  
Vol 24 (1) ◽  
pp. 66-71
Author(s):  
Kawalkar Abhijit Chandrakant ◽  
Badole Chandrashekher Martand
Keyword(s):  
Intramedullary Nailing ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Early Weight Bearing ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Tibia Fractures ◽  
Distal Tibia Fractures

Introduction Tibia fractures are the most common long bone fractures encountered by the orthopedic surgeons and distal tibia fractures have the second highest incidence of all tibia fractures after the middle third of tibia the distal tibial fractures are unique and are considered as most challenging fractures to treat due to its proximity to the ankle joint and its superficial nature. The objective of this study is to compare two osteosynthesis systems developed for surgical treatment of distal tibia fractures: the intramedullary nailing and the MIPPO technique. Methods The study was conducted between Jan 2011 to Dec 2012. 63 patients with extra-articular distal tibia fracture treated with intramedullary nailing and MIPPO technique were reviewed retrospectively and clinical outcome was evaluated according to American Orthopaedic Foot and Ankle Score. Results 31 patients were treated with intramedullary nail & 32 with MIPPO technique. Fibular fixation was done in cases where fibular fracture was at or below the level of tibial fractures. We found no difference in terms of time for fracture union, mal-union, non-union, duration of surgery and amount of blood loss. But there was significant difference in terms of infection and duration of hospital stay. Also weight bearing was possible much earlier in intramedullary group as compared to the MIPPO group. Conclusion Thus we conclude that intramedullary nailing is better choice of implant in patients with extra- articular distal tibia fractures & helps in early weight bearing and ambulation of patient with fewer complications.

scholarly journals Functional outcome of minimally invasive plate osteosynthesis with the use of locking plate in fracture distal end of tibia

2020 ◽  
Vol 6 (6) ◽  
pp. 1239
Author(s):  
Prashant Kamble ◽  
Nandan Marathe ◽  
Sudhir Sharan ◽  
Ayush Sharma ◽  
Ashwin Sathe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Open Reduction ◽  
Plate Osteosynthesis ◽  
Distal Tibia ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Locking Plates ◽  
X Rays ◽  
Functional Scores ◽  
Tibia Fractures ◽  
Distal Tibia Fractures

<p class="Body"><strong>Background : </strong>Distal tibia fractures or pilon fractures are usually the result of combined compressive and shearing forces, which may lead to instability of the metaphysis. Poor vascularity, lack of muscle cover and frequent intra-articular extension often make these fractures very challenging to manage. There are plenty of options available to treat a distal tibia fracture which includes intramedullary nailing, external fixation, open reduction and internal fixation and minimally invasive plate osteosynthesis (MIPO). The aim of this study was to evaluate the results of MIPO with respect to the healing of fracture site, the incidences of complications and to conclude whether MIPO circumvents the problems of formal open reduction and fixation with other implants.</p><p class="Body"><strong>Methods: </strong>A series of forty patients with fracture of the distal tibia on preoperative X-rays were treated with minimally invasive plate osteosynthesis using pre-contoured locking plates from June 2014 to October 2018 and followed up at regular intervals with X-rays and monitoring for complications.</p><p class="Body"><strong>Result: </strong>The functional scores were evaluated using Teeny and Wiss clinical rating system for ankle joints. Thirty-two patients had an ‘Excellent’ or ‘Good’ outcome. One patient was diagnosed with a soft tissue complication and delayed union and 3 patients were diagnosed with malunion without significant functional disability at follow up. <strong></strong></p><p class="Body"><strong>Conclusion: </strong>Minimally invasive plate osteosynthesis with pre-contoured locking plates is associated with high union rate and good functional outcomes. It is an effective treatment modality for distal tibia fractures.</p>

scholarly journals Outcome of minimally invasive plate osteosynthesis in distal tibial fractures

2017 ◽  
Vol 17 (2) ◽  
pp. 18-22
Author(s):  
Nabees Man Singh Pradhan ◽  
JA Khan ◽  
B Acharya ◽  
S Shrestha ◽  
R Tamrakar ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Internal Fixation ◽  
Plate Osteosynthesis ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Type I ◽  
Distal Tibial Fractures ◽  
Non Union ◽  
The Mean

Introduction: Distal tibial fractures present as a major challenge for the orthopedic trauma surgeons. Most non-operative treatments result in non-union or malunion and needs prolonged immobilization of the knee and ankle joints, with resulting stiffness. Open reduction and internal fixation as well as external fixation has high rate of infection and non-union. Minimally Invasive Plate Osteosynthesis has been shown to have a better outcome and has been the procedure of choice in most distal tibial fractures since the introduction of the locking compression plate. The objective of the study is to review the outcome of Minimally Invasive Percutaneous Osteosynthesis (MIPO) in unstable distal tibial fractures.Methods: Charts of patients who underwent MIPO from the year 2008 to 2013 for unstable distal tibial fractures over five years at Patan Hospital and Om Hospital were reviewed. All displaced closed fractures and Gustillo Anderson Type I and II fractures were included in the study. Plates consisted of the anatomically contoured 4.5 mm LCP and 3.5 mm LCP-Pilon form plate. A simple uniplanar external fixator was used to retain the reduction till the plate was inserted and secured with locking screws. The outcome of MIPO in distal tibial fractures were followed up and evaluated.  Clinical and radiological assessments were performed at 6 weeks, and at 3, 6, 9, 12 and 24 months.Results: Of the 75 patients (45 male, 30 female) age ranging from 19 to 70 years (mean 47 years), 5 patients were lost to follow-up. 28 patients at 3 months, 32 at 6 months, and 8 at 9 months met the criteria for a healed fracture. Two patients required autologous bone grafting at 9 months for non-union ultimately resulting in the fracture union at 16 months. There was one malunion attributable to the loss of reduction during plate fixation. There were no deep infections, no soft tissue complications and no failures of fixation. The cause of fracture were RTA (n=35), fall from height (n=9), twisting of ankle as a result of fall from standing height (n=22), and others (n=11). The mean time for surgery from the time of injury was 5 (range, 2 to 14) days; the mean hospital stay was 10 (range, 7 to 21) days.Conclusion: MIPO is an effective treatment for closed, unstable fractures of the distal tibia, avoiding the complications associated with more traditional methods of internal fixation and/or external fixation.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 7-11

scholarly journals Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yao Lu ◽  
Gen Wang ◽  
Bin Hu ◽  
Cheng Ren ◽  
Liang Sun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Fracture Healing ◽  
Closed Reduction ◽  
Distal Tibia ◽  
Reduction Rate ◽  
Healing Time ◽  
Reduction Technique ◽  
Surgical Time ◽  
Tibia Fractures ◽  
Distal Tibia Fractures

Abstract Background This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches. Methods A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements. Results A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P > 0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P < 0.05). Conclusions In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.

Sign in / Sign up

Export Citation Format

Share Document