A clinical study: management of distal tibial fractures with minimally invasive plating osteosynthesis

Background: Distal tibial fractures of bone poses major challenge to the trauma orthopaedic surgeons as this bone is subcutaneous associated with soft tissue injuries and precarious blood supply. Distal tibial fractures require accurate reduction, perfect articular restoration with stable fixation with minimal stripping of soft tissues, thereby preserving the blood supply. Minimally invasive osteosynthesis using locking plates has emerged as viable option of fixing such fractures due to poor results associated with open plating which leads to extensive soft tissues stripping and subsequently poor blood supply.Methods: 27 patients with closed distal tibial fractures with or without articular involvement without vascular compromise were treated with LCP fixation using MIPO technique studied from June 2017 to December 2018.Results: All fractures in our series united well at the end of 5 months with mean time to clinical and radiological union was 17 weeks. There was no case of implant failure while 2 patients had varus angulation. Very few soft tissue complications with excellent functional outcome were seen.Conclusions: We concluded that distal tibial fractures can be effectively managed with LCP using MIPPO technique with excellent functional outcome and avoiding the complications associated with other treatment methods.

Download Full-text

Outcome of Minimal Invasive Percutaneous Plate Osteosynthesis in closed fractures of distal tibia

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v9i2.9686 ◽

2014 ◽

Vol 9 (2) ◽

pp. 38-44

Author(s):

Anil K Mishra ◽

PK Chalise ◽

SB Shah ◽

V Adhikari ◽

RP Singh

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Soft Tissues ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Tibial Fractures ◽

Intraoperative Complication ◽

Distal Tibial Fractures ◽

The Mean ◽

Osteosynthesis Technique

Background: The limited soft tissue, subcutaneous location and poor vascularity render the dista tibial fractures very challenging. Treatment of distal tibial fractures using minimally invasive percutaneous plate osteosynthesis technique may minimise damage to soft tissues and vascular integrity of bony fragments, leaving comminuted fragments out of the mechanical construct, preserving soft tissues with limited operative exposure. Objective: To assess the outcome of patients treated with minimally invasive percutaneous plate osteosynthesis technique for closed distal tibial fractures. Methods: The study included total of 30 patients (24males and 6females) with close distal tibia fracture, which were treated with distal tibia locking plate using minimally invasive percutaneous plate osteosynthesis technique. Results: The mean ages of the patient were 44.23 years (30 to58 years). Patients were followed up at 2 weeks, 6weeks, 12weeks, 24weeks and 1 year after the operation and evaluated clinically and radiologically. Among 30 pateints, all fractures went to union. The mean American orthopaedic foot and ankle score was 89.23% (SD-3.92). There was 2case of superficial infection and 3 case of plate impingement with no intraoperative complication and mortality rates. Conclusion: Minimally invasive percutaneous plate osteosynthesis is an effective technique for the management of distal tibial fractures. It is minimally invasive, though technically demanding, but preserves the biological environment by preserving the soft tissue with better outcome in terms of radiological union and functional outcome. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 38-44 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9686

Download Full-text

Minimally Invasive Percutaneous Plate Osteosynthesis Does Not Increase Complication Rates in Extra-Articular Distal Tibial Fractures

The Open Orthopaedics Journal ◽

10.2174/1874325001509010073 ◽

2015 ◽

Vol 9 (1) ◽

pp. 73-77 ◽

Cited By ~ 4

Author(s):

Izzet Bingol ◽

Nadir Yalcin ◽

Vedat Bicici ◽

Tolga Tulunay ◽

Kaan Yuksel ◽

...

Keyword(s):

Minimally Invasive ◽

Soft Tissues ◽

Callus Formation ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Cohort Analysis ◽

Tibial Fractures ◽

Full Weight Bearing ◽

Complication Rates ◽

Distal Tibial Fractures

Background : Selection of a treatment method in cases of unstable, nonarticular distal tibial fractures is still a matter of discussion. Intramedullary nailing, which is a “gold standard” for tibial shaft fractures, does not always work for this specific transition area between diaphysis and metaphysis. Instead, new minimally invasive techniques with special implants are popular. Aims : To determine the functional and radiological results of distal tibial fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Study Design : Retrospective cohort analysis. Methods : Thirty distal tibial fractures treated with MIPPO method, between January 2006 and December 2010, were evaluated retrospectively. All patients were classified according to AO/OTA classification. Period of hospital stay, time of fracture union, time to allow full weight bearing, early and late complications were inquired. Functional outcomes were assessed by AOFAS scores. Results : There were 13 male and 17 female patients with an average age of 44.26 (range, 22-77 years). One superficial infection and one malunion were observed. Two patients were revised for the loss of reduction and healed uneventfully. According to the AO/OTA classification, 23 patients were 43-A1 (76.6%), 3 were 43-A2 (10%) and 4 were 43-A3 (13.3%). Post-operative mean stay of patients at the hospital was 2.6 ± 1.42 days (range, 1-7 days). Mean full weight-bearing period of the patients was found out as 13.16 ± 2.6 weeks (range, 10-22 weeks). The mean period of union of fracture for patients was found out as 19.8 ± 2.99 weeks (range, 16-34 weeks). Conclusion : Treatment of distal tibial fractures with MIPPO method provides a successful treatment strategy as long as used as per the technique, and it respects and does not harm soft tissues which allows early callus formation and rapid healing that enable the patient to walk as early as possible after the operation. The overall clinical and functional outcome is still good despite minor complications.

Download Full-text

An evaluation of functional outcome following minimally invasive plate osteosynthesis in fractures of the distal tibia

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174696 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1136

Author(s):

Yeshwanth Subash ◽

Prabhu Manickam S. ◽

Ravikrishna R. ◽

Priyadarshini S. ◽

Gunalan K. Naidu

Keyword(s):

Minimally Invasive ◽

Functional Outcome ◽

Treatment Option ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Tibial Fractures ◽

Minimally Invasive Plate Osteosynthesis ◽

Distal Tibial Fractures ◽

Superficial Skin ◽

Mean Time

Background: Management of fractures of the distal tibia remains a challenging proposition due to the fact that the major part of the bone is in a subcutaneous location and the blood supply is quite precarious. Conventional forms of osteosynthesis are associated with high rates of infection and nonunion. Due to extensive soft tissue stripping, the vascularity is compromised and often results in poor wound healing and tends to compromise fracture healing as well. Closed reduction with minimally invasive plate osteosynthesis (MIPO) addresses these issues and has emerged as a viable treatment option with minimal complications. The aim of this study was to assess the functional outcome MIPO using locking compression plates (LCP).Methods: 32 patients with distal tibial fractures treated by MIPO technique with LCP fixation were studied from January 2012 to January 2014 and were followed up for a period of 2 years.Results: All the fractures in our series united well at the end of 6 months with mean time to radiological evidence of callus formation at 10 weeks and the mean time to fracture union was 20 weeks. There were 2 cases with varus angulation in our series and no cases with implant failure. There were 3 patients with superficial skin infections and no cases of deep infection.Conclusions: We conclude that MIPO with LCP is an effective treatment option for distal tibial fractures avoiding all the complications associated with other forms of internal fixation. We strongly recommend its usage in these types of complex injuries.

Download Full-text

Evaluation of functional outcome of distal tibial fractures stabilized with distal tibial locking plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205022 ◽

2020 ◽

Vol 7 (1) ◽

pp. 39

Author(s):

Naveen Kumar ◽

Manoj Thakur ◽

Sandeep Kashyap

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Plate Osteosynthesis ◽

Open Reduction Internal Fixation ◽

Tibial Fractures ◽

P Value ◽

Minimally Invasive Plate Osteosynthesis ◽

Distal Tibial Fractures

Background: The present study is an attempt to evaluate the results of locking compression plate for distal tibia in lower tibial fractures using open reduction internal fixation and minimally invasive plate osteosynthesis technique.Methods: Prospective and retrospective study was conduct on patients attending the outpatient department (OPD)/Emergency OPD in Indira Gandhi Medical College, Shimla during September 2015 to August 2016 with distal tibial fractures. The patients treated with locking compression plates using minimally invasive plate osteosynthesis (MIPO) or open reduction internal fixation (ORIF) are reviewed for inclusion and exclusion criteria. All data were collected and analyzed by Epi-info software.Results: Out of 52 patients, 48.4% patients undergo open reduction internal fixation had excellent results and 28.6% patients undergo surgery by MIPPO technique had excellent results. p value is 0.352 which is not significant. Overall, 40.4% patients had excellent results. In our study, 32.6% patients having AO/OTA type A fractures had excellent score while type B and C had 1.9% excellent score. This is attributed to more comminution and involvement of ankle joint. Overall, 40.4% patients had excellent score. P value is 0.863 which is insignificant.Conclusions: We observed excellent/ good functional outcome in 65.3% of patients.

Download Full-text

Evaluation of functional outcome of distal tibial fractures managed with locking compression plate using minimally invasive plate osteosynthesis (MIPPO) technique

National Journal of Clinical Orthopaedics ◽

10.33545/orthor.2021.v5.i3c.309 ◽

2021 ◽

Vol 5 (3) ◽

pp. 157-160

Author(s):

Dr. Pradyot Basak ◽

Dr. Rajib Debnath ◽

Dr. Abhijit Sarkar ◽

Dr. JM Datta

Keyword(s):

Minimally Invasive ◽

Functional Outcome ◽

Plate Osteosynthesis ◽

Locking Compression Plate ◽

Tibial Fractures ◽

Minimally Invasive Plate Osteosynthesis ◽

Distal Tibial Fractures ◽

Compression Plate

Download Full-text

Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications

Chinese Journal of Traumatology ◽

10.1016/j.cjtee.2015.07.010 ◽

2016 ◽

Vol 19 (1) ◽

pp. 39-44 ◽

Cited By ~ 3

Author(s):

Devendra Lakhotia ◽

Gaurav Sharma ◽

Kavin Khatri ◽

G.N. Kiran Kumar ◽

Vijay Sharma ◽

...

Keyword(s):

Minimally Invasive ◽

Locking Plate ◽

Tibial Fractures ◽

Minimally Invasive Osteosynthesis ◽

Distal Tibial Fractures

Download Full-text

Distal Tibial Fractures Managed by Minimally Invasive Plating Osteosynthesis: A Prospective Study

International Journal of Research and Review ◽

10.52403/ijrr.20211146 ◽

2021 ◽

Vol 8 (11) ◽

pp. 370-374

Author(s):

Amit Kumar ◽

Sanjeev Gupta ◽

Vinay Badya

Keyword(s):

Minimally Invasive ◽

Prospective Study ◽

Traffic Accidents ◽

Tibial Fracture ◽

Soft Tissues ◽

Road Traffic ◽

Tibial Fractures ◽

Distal Tibial Fractures ◽

A Prospective Study ◽

Minimally Invasive Plating

Background: Distal tibial fracture is a common results of road traffic accidents and fall injuries. The treatment of tibial fractures is very important and this bone is very subcutaneous associated with soft tissue injury and precarious blood supply. Distal tibial fractures require accurate reduction, followed by perfect articular reduction then stable fixation with minimally stripping of soft tissues. Aim: Distal tibial fractures managed by minimally invasive plating osteosynthesis: a prospective study. Methodology: The prospective study was taken in GMC Jammu from 2019 -2020 in Department of Orthopaedics. All patients are approved by the ethical clearance of the same hospital from 2019-2020. 32 cases of the distal tibial fracture is were admitted according to which twenty two male and ten females. All the necessary data collected and reported to separate sheets. Results: In our study two age group were taken 19-40 and 41-60. About 19-40 group was majority in fractures distal tibia. In our observation around 22 males and around 10 females were noted. Around 68.7% were males and around 31.2% were females they were affected. In our observation closed or open fractures is noted and around 75% (24) patients are closed and 25% (8) patients were open. In our observation AO/OTA classification 43-A1 is the most common classification which was around 65.6% (21) patients then 43-A2 is the 15.6%, 43-A3 is about 12.5% and 43-B1 is around 6.2%. Conclusion: In our study it is concluded that all the fracture are due to road traffic accidents and fall from height. In our patients around superficial infection, varus angulation and implant failures are very less and similar to other studies done by other authors. Soft tissues handling and the minimally invasive plating osteosynthesis (MIPPO) allows early rehabilitation and excellent functional outcome. Keywords: disital tibia, MIPPO, closed fractures.

Download Full-text

Using External Fixation in distal tibial fractures- good principle, debatable application- Case presentation

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2018-0081 ◽

2018 ◽

Vol 1 (2) ◽

pp. 60-66

Author(s):

Olivera Lupescu ◽

Mihail Nagea ◽

Alina Grosu ◽

Alexandru Dimitriu ◽

Gheorghe Ion Popescu ◽

...

Keyword(s):

Soft Tissue ◽

External Fixation ◽

Recovery Period ◽

Soft Tissue Injuries ◽

High Energy ◽

Tibial Fractures ◽

Distal Tibial Fractures ◽

Definitive Method ◽

Tissue Injuries

Abstract Distal tibial fractures usually result from high-energy trauma, affecting young, active people, producing long-term disability and numerous complications. Their treatment is difficult, especially in type C fractures, which affect both the articular surface and the metaphysis, are quite frequent comminuted fractures, and are accompanied by soft tissue injuries. In these situations, External Fixation (EF) is used as a temporary bridging method, either for treating concomitant soft tissue injuries (in open fractures) or for achieving and maintaining reduction in order to prevent blisters or compartment syndrome, possibly resulting from severe displacement, bleeding or oedema. It must be however underlined that EF is rarely a definitive method for these fractures, especially when the ankle is splinted, and it must be followed by definitive Internal Fixation (IF) - the so-called “sequential method”, otherwise restoration of a normal ankle anatomy and function is improbable, resulting in ankle stiffness or even osteoarthritis. This paper presents a case in which this principle was only partially applied, thus requiring corrective surgery followed by a long-term recovery period.

Download Full-text