Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

Background : 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.Methods: 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.Result: 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. Conclusion: 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.

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A Comparison between Minimally Invasive Plate Osteosynthesis & Interlocking Intramedullary Nailing in Distal Tibia Fractures

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2008.21.4.286 ◽

2008 ◽

Vol 21 (4) ◽

pp. 286 ◽

Cited By ~ 7

Author(s):

Kee-Byung Lee ◽

Si-Young Song ◽

Duek-Joo Kwon ◽

Yong-Beom Lee ◽

Nam-Kyou Rhee ◽

...

Keyword(s):

Minimally Invasive ◽

Intramedullary Nailing ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Minimally Invasive Plate Osteosynthesis ◽

Tibia Fractures ◽

Distal Tibia Fractures

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Mid-Term Results of Minimally Invasive Plate Osteosynthesis and Circular External Fixation in the Treatment of Complex Distal Tibia Fractures

Journal of the American Podiatric Medical Association ◽

10.7547/14-120 ◽

2017 ◽

Vol 107 (1) ◽

pp. 3-10 ◽

Cited By ~ 1

Author(s):

Yunus Imren ◽

Engin Eren Desteli ◽

Mehmet Erdil ◽

Hasan Hüseyin Ceylan ◽

Ibrahim Tuncay ◽

...

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

External Fixation ◽

Bone Grafting ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Plate Group ◽

Tibia Fractures ◽

Distal Tibia Fractures ◽

Tract Infections

Background: The treatment of pilon tibia fractures is challenging. Anatomical reduction of the joint surface is essential. Excessive soft-tissue dissection may interfere with the blood supply and can result in nonunion. We sought to compare the outcomes of distal tibia fractures treated with medial locking plates versus circular external fixators. Methods: We retrospectively evaluated 41 consecutive patients with closed pilon tibia fractures treated with either minimally invasive locking plate osteosynthesis (n = 21) or external fixation (EF) (n = 20). According to the Ruedi and Allgower classification, 23 fractures were type B and 18 were type C. Soft-tissue injury was evaluated according to the Oestern and Tscherne classification. Time to fracture union, complications, and functional outcomes were assessed annually for 3 years with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score. Results: Mean ± SD values in the plate group were as follows: age, 42.4 ± 14 years; union time, 19.4 ± 2.89 weeks (range, 12–26 weeks); and AOFAS ankle scores, 86.4 ± 2.06, 79.5 ± 1.03, and 77.9 ± 0.80 at 1, 2, and 3 years, respectively. Four patients in the plate group needed secondary bone grafting during follow-up. In the EF group (mean ± SD age, 40.7 ± 12.3 years), all of the patients achieved union without secondary bone grafting at a mean ± SD of 22.1 ± 1.7 weeks (range, 18–24 weeks). In the EF group, mean ± SD AOFAS ankle scores were 86.6 ± 1.69, 82.1 ± 0.77, and 79.7 ± 1.06 at 1, 2, and 3 years, respectively. There were no major complications. However, there were soft-tissue infections over the medial malleolus in five patients in the plate group and grade 1-2 pin-tract infections in 13 patients and grade 3 pin-tract infections in one patient in the EF group. Post-traumatic arthritis was detected in eight plate group patients and seven EF group patients. Conclusions: Minimally invasive plating and circular EF methods have favorable union rates with fewer complications.

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Minimally Invasive Plate Osteosynthesis with Locking Plates for Distal Tibia Fractures

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2016/15367.7332 ◽

2016 ◽

Author(s):

Ajeet Dhakar

Keyword(s):

Minimally Invasive ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Minimally Invasive Plate Osteosynthesis ◽

Locking Plates ◽

Tibia Fractures ◽

Distal Tibia Fractures

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Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214185 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1177

Author(s):

Anil Sharan ◽

Johney Juneja ◽

Raghvendra Choubisa ◽

Nitin Jeenjwadia ◽

A. K. Mehra ◽

...

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Comparative Study ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Distal Tibia ◽

Tibia Fractures ◽

Group A ◽

Distal Tibia Fractures ◽

Group B

Background: Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.Methods: This was the prospective comparative study of 50 patients with distal third tibia fractures divided into two groups. First group of patients were treated with MIPPO technique while second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, non-union, superficial and deep infection between the two groups.Results: Average time taken by patients for full weight bearing in group A was 17.6 weeks as compared to 16.7 weeks in group B. All patients were able to bear weight prior to complete union of fracture. By the process of weight bearing, we believed that it would promote secondary bone healing. On taking X-rays during follow up of included patients starting of radiological union was observed carefully by looking for bridging callus, haziness of fracture line. Appearance of callus was taken average time of 12.5 weeks in group A and 12.1 weeks in group B.Conclusions: Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

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