Functional and clinical outcome of MIPPO anterolateral plating for proximal tibia fracture both proximal one third and coronal intrarticular fracture

Background: The proximal tibial fractures are one of the commonest intraarticular fractures. Generally these injuries fall into two broad categories, high energy fractures and low energy fractures. The tibial plateau fractures are mostly due to high velocity road traffic accidents and fall from height, where fractures result from direct axial compression, usually with a valgus (more common) or varus moment and indirect shear forces.Methods: This is a prospective study and includes operations by MIPPO technique that were undertaken between January 2020 till June 2021 in RNT government hospital; Udaipur. The total number of cases studied were 25 with the youngest being 25 years old and oldest 70 years old. Intraoperative complications were noted. Functional outcome was assessed using Modified Rasmussen’s Criteria.Results: Patients with fracture in our study occurred between the age of 25 to 70 years with maximum incidence involving the productive age group of 21-30 years (90%). Majority of the patients was males- 90%.Conclusions: From the minimally invasive percutaneous plate osteosynthesis of proximal tibial fracture there is an increase in the complexity of proximal tibial fractures with increasing road traffic accident. As most of the patients sustained these fractures belong to physically highly active and productive age group, they need optimal treatment to get back to their previous work capacity and avoid long term complications like osteoarthritis. We treated all fractures in our study with MIPPO technique and found rapid healing by secondary fracture union and hence achieving strong bone union across the fracture site due to inherent benefits of less tissue damage and minimal disturbance of fracture site biology. We operated 20 proximal tibial fractures with MIPPO technique and observed rapid healing and good functional recovery.

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MINIMALLY INVASIVE PLATING OF HIGH ENERGY METAPHYSEAL PROXIMAL TIBIAL FRACTURES: OUR EXPERIENCE

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2015/496 ◽

2015 ◽

Vol 04 (20) ◽

pp. 3433-3442

Author(s):

Mishil Parikh ◽

Sunirmal Mukherjee ◽

Nisarg Patel ◽

Amit Dhond ◽

Ravindra Khedekar

Keyword(s):

Minimally Invasive ◽

High Energy ◽

Tibial Fractures ◽

Proximal Tibial Fractures ◽

Minimally Invasive Plating

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To analyze the functional outcome of proximal tibial fractures treated with minimally invasive percutaneous plate osteosynthesis technique

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174715 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1205

Author(s):

Sivakumar Arumugam ◽

Venkateshwara Arumugam ◽

V. Raviraman

Keyword(s):

Minimally Invasive ◽

Functional Outcome ◽

Tibial Plateau ◽

Plate Osteosynthesis ◽

High Energy ◽

Tibial Plateau Fractures ◽

Tibial Fractures ◽

Soft Tissue Dissection ◽

Proximal Tibial Fractures ◽

Walking Capacity

Background: Tibial plateau fractures constitute about 1% of all fractures and complex bicondylar fractures constitute 30% of all Tibial plateau fractures. Minimally Invasive Percutaneous Plate Osteosynthesis [MIPPO] is a method of biological fixation in which a plate is percutaneously inserted and fixed at a distance proximally and distally from the fracture site. By minimal exposure, this helps in the preservation of the essential fracture hematoma, minimal soft tissue dissection, avoidance of periosteal stripping and providing an adequate fixation. The objective of the study was to analyze the functional outcome of proximal Tibial fractures treated with MIPPO technique. The method of fixation shall be evaluated for the time period required for the patients to return to active work following surgery.Methods: In our study, all 18 patients with proximal Tibial fractures underwent definitive fixation by MIPPO technique. All our cases underwent initial stabilization as per the ATLS guidelines. Patients with closed Tibial plateau fractures associated with a tense haemarthrosis underwent aspiration of the joint under aseptic precautions. The limb was immobilized either in an above knee slab or through skeletal traction using a distal Tibial or calcaneal pin traction on a Bohler Braun splint until definitive fixation was carried out. In cases complicated with excessive swelling and blistering, definitive fixation was delayed until the swelling/ blistering subsided.Results: The post-operative results were designated as excellent, good, fair and poor according to pain, walking capacity, the range of motion and stability of the knee using Rasmussen’s grading system. In our study, the average functional knee score was 22.89. Rasmussen’s score does not consider articular congruity while assessing the functional outcome of the knee.Conclusions: MIPPO technique gives good to excellent results even in high energy Tibial condyle fractures [72.22% cases in our study]. Our patients were able to achieve a good functional range of movement, averaging 120 degrees. [Krettek et al – 124 degrees]. Those who were treated with early fixation and early mobilization were found to have a better functional outcome irrespective of the fracture type. No secondary bone grafting was required.

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MON-377 Fracture Site in High-Energy Trauma Is Associated with Osteoporosis Risk

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1013 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Charilaos Paulos Chourpiliadis ◽

Dimitra Bantouna ◽

Hara Hourpiliadi ◽

Evangelos Karvounis ◽

Juan Carlos Jaume ◽

...

Keyword(s):

Vitamin D ◽

Vertebral Fractures ◽

High Energy ◽

Fracture Site ◽

Tibial Fractures ◽

Continuous Variables ◽

Z Score ◽

Mineral Density ◽

Dexa Scan ◽

History Of

Abstract Background: In our recent studies, we noted that patients with history of high energy fractures commonly have underlying endocrine abnormalities and low bone mineral density (BMD). In this expanded patient population, we aimed to investigate whether the fracture site can better predict the risk of abnormal BMD. Methods:We prospectively enrolled adult patients of both genders, with any history of high energy fracture. We measured serum PTH, vitamin-D and calcium and we performed BMD measurements with a DEXA scan. We split our subjects’ BMD, based on the lowest T- or Z-score in “Normal” (≥-0.9), “low bone mass” (LBM) (-1.0 to -2.4) and “Osteoporosis” (OST) (≤-2.5). We classified our patients according to fracture site, in vertebral, humeral, hip, tibial, malleolar-carpal, radial-ulnar and others, including rib fractures. Ratios were compared with χ 2 test, and continuous variables with one-way ANOVA. Results: We enrolled 444 consecutive subjects with 543 fractures. n=315 (71.0%) subjects had low BMD: OST 25.9% and LBM 45.1%. Among subjects <50 years of age, 43.1% had LBM and 9.2% OST, while in those >50, 46.3% had LBM and 36.6% OST (p<0.0001). The cohort’s mean lowest T/Z score was -1.6±1.2. Subjects with >1 fracture had more frequently low T/Z score (p=0.015). History of vertebral fractures provided the lowest mean T/Z score overall (-2.4±1.1), in females (-2.5±0.9) and subjects >50 (-2.5±1.1). The same holds true for hip fractures in males (-1.9±1.2) and subjects <50 (-2.1±1.4). Subjects with vertebral fractures had the lowest Hip (-1.7±1.2) and Spine (-2.3±1.2) T/Z scores, while those with tibial fractures had the lowest Radius T/Z score (-1.8±1.3). History of vertebral fractures was associated with the highest rate of OST (65.9%) in our overall population, males (50%), females (67.5%), subjects >50 (70.0%), while subjects with history of tibial fractures had the highest rate of normal BMD (46.2%), in males (80%) and females (50.4%), and those <50 (75.0%). Vitamin-D deficiency was present in 81.4% of all subjects. PTH was significantly higher in patients with OST compared to LBM or normal BMD (p=0.0006). Discussion: Patients with history of high energy fractures need to be screened with DEXA scan early, as they have high likelihood to suffer from osteoporosis.

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Surgical management of proximal tibial fractures with locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172549 ◽

2017 ◽

Vol 3 (4) ◽

pp. 756

Author(s):

Girisha B. A. ◽

Rajesh P. ◽

Satish Kumar C. ◽

Muralidhar N.

Keyword(s):

Knee Joint ◽

Road Traffic ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Locking Compression Plate ◽

The Body ◽

Tibial Fractures ◽

Minimally Invasive Plate Osteosynthesis ◽

Proximal Tibial Fractures ◽

Compression Plate

Background: Incidence of proximal tibial fractures is increasing due to increasing incidence of road traffic accidents (RTA). Knee joint being one of the major weight bearing joint of the body, appropriate management of fracture around it will be of paramount importance in maintaining mobility. The recent development of locking compression plate (LCP) has revolutionized the treatment of proximal tibial fractures by overcoming the few drawbacks of conventional buttress plate.Methods: We studied 30 patients involving proximal tibial fracture manged using LCP [23 patients with minimally invasive plate osteosynthesis, (MIPO) technique and 7 patients with Open reduction and internal fixation (ORIF) technique]. We followed up all the patients until complete union of fractures.Results: The average time for union of fracture was 14 weeks (range: 12-24 weeks). Overall 96.7% patients had acceptable outcome (70% excellent and 26.7% good). Patients treated with MIPO technique healed earlier and more frequently had excellent results than those treated with ORIF. A total of four patients had complications (knee joint stiffness in 1, postoperative loss of reduction in 1, infection in 1 and knee instability in 1). Conclusions: Locking compression plate system acts as a good biological fixation for proximal tibial fractures even in difficult fracture situations. MIPO technique offers faster healing and better outcome than ORIF in patients with proximal tibial fractures.

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Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

10.21203/rs.3.rs-41966/v1 ◽

2020 ◽

Author(s):

Jiazhao Yang ◽

Wanbo Zhu ◽

Qirong Dong

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

High Energy ◽

Study Data ◽

Fracture Site ◽

Tibial Fractures ◽

Early Complications ◽

The Mean ◽

Staged Treatment

Abstract Background and Objective: Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment. However, early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed. This study aimed to analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.Materials and Methods: A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a level-1 trauma center from 2014 to 2018 were enrolled in this retrospective study. Data regarding the demographic information, Tscherne soft tissue injury, fracture site, entry point placement, and duration of traction were recorded. Procedure-related complications such as movement and sensation disorder, vessel injury, discharge, infection, loosening, and iatrogenic fracture were analyzed.Results: The mean patient age was 42.5 (18–71) years and the mean duration of traction was 7.5 (0–26) days. In total, 19 (4.7%) patients presented with procedure-related complications, including technique-associated complications in 6 patients and nursing-associated complications in 13. Differences in the incidence of complications with respect to sex, affected side, soft tissue injury classification, and fracture sites were not observed. However, the number of complications due to hammer insertions was significantly fewer than those due to drill insertions (2.9% vs. 7.4%).Conclusion: The application of preoperative external traction fixation had been proved to be an ideal alternative treatment for high energy tibial fractures. In this study, we found the incidence of early complications of the fixation is low, and it is not significantly associated with the severity of soft tissue injury and fracture site. Although relatively rough and more likely to cause pain, complications of hammer insertions were significantly fewer than drill insertions. The possible reason was higher probability of heat damage and loosening by drilling.

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Outcome of Two Ring Hybrid Ilizarov Fixator in the Management of Proximal Tibial Fractures in Adults

10.53350/pjmhs2115103485 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3485-3487

Author(s):

Mohammad Younas ◽

Syed Usman Shah ◽

Naseer Ullah Khattak ◽

Amina Gul Shehzar Khan ◽

Sultan Shah ◽

...

Keyword(s):

Knee Flexion ◽

Traffic Accidents ◽

Road Traffic ◽

Delayed Union ◽

Tibial Fractures ◽

Definitive Treatment ◽

Chi Square ◽

Schatzker Type ◽

Proximal Tibial Fractures ◽

Ilizarov Fixator

Objective: The aim of this study is to determine the outcomes of using two ring hybrid ilizarov fixator for the management of proximal tibial fractures in adult patients. Study Design: Descriptive Study Place and Duration: Methods: There were 60 patients of both genders were presented in this study. Patients were aged between 25-65 years. Informed written consent was taken from all the patients for detailed demographics age, sex, body mass index and cause of fracture. All the patients had proximal tibial fractures were included, type of fractures were assessed by schatzker technique. Outcomes were assessed by using Rasmussen score in terms of excellent, good and fair. Radiological outcome was measured by fracture healing on radiography. Student t-test and chi square test was used. SPSS 24.0 was used to analyze all of the data. Results: There were 45 (75%) patients were males and 15 (25%) were female patients. Mean age of the patients was 42.3±7.43 years with mean BMI 25.07±6.29 kg/m2. Falling was the most common cause of fracture found in 33 (55%), followed by road traffic accidents in 17 (28.3%) and 10 (16.7%) fractures by assault. Majority of the patients were schatzker type VI fractures 34 (56.7%) followed by schatzker type V fractures in 11 (18.3%), metaphyseal fractures found in 8 (13.3%) cases and proximalone third shaft fractures in 7 (11.7%) cases. Mean surgery time was 4.2±6.17 hours and mean union time of fractures was 19.8±6.61 weeks. According to Rasmussen score 39 (65%) cases showed excellent results with knee flexion more than 90 degree, good results found in 17 (28.3%) patients and fair results in 4 (6.7%) cases. Pin tract infection was the most common complication found in 12 (20%) cases, followed by compartment syndrome in 4 (6.7%) and delayed union in 3 (5%). No any poor outcome was assessed in this study. Conclusion: We concluded in this study that the use of two ring hybrid ilizarov fixator in the management of proximal tibial fractures were effective and useful in terms of excellent and good outcomes of knee flexion. The ilizarov approach allowed for early definitive treatment with a low rate of complications and a favourable clinical outcome. Keywords: Proximal Tibial fracture, Ilizarov Fixator, Shatzker, Rasmussen score, Outcomes

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A prospective study to analyse the outcome of locking compression plating by minimally invasive percutaneous plate osteosynthesis technique in proximal tibial fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20181798 ◽

2018 ◽

Vol 4 (3) ◽

pp. 442

Author(s):

Anjaneyulu Reddy D. ◽

Krishna Redy P.

Keyword(s):

Minimally Invasive ◽

Functional Outcome ◽

Plate Osteosynthesis ◽

High Energy ◽

Tibial Fractures ◽

Articular Fractures ◽

Tibial Condyle ◽

Proximal Tibial Fractures ◽

Compression Plating ◽

Osteosynthesis Technique

Background: The proximal tibial fractures are one of the commonest intra articular fractures majority are of high energy fractures. We did the study to measure the outcome of locking compression plating by minimally invasive percutaeneous plate osteosynthesis technique in proximal tibial fractures.Methods: Study comprises 20 cases of proximal tibial fractures, which have been managed by MIPPO technique during the period December 2014 to August 2016.Results: The sex distribution in our study was 18 males and 2 females with 30 to 57 years age. The most common mode of injury in this study was road traffic accident. Type V Schatzker tibial plateau fractures were the commonest in 8 patients. 70% of our patients had excellent and good results in the functional outcome. In our study the average functional knee score was 22.40. The average range of movement achieved was 120 degrees. The average time taken for fracture healing was 16.52 weeks. In conclusion, MIPPO technique gives good to excellent results even in high energy tibial condyle fractures (70% cases in our study). Those who were treated with early fixation and early mobilization were found to have a better functional outcome irrespective of the fracture type. No secondary bone grafting was required.Conclusions: The study reports that MIPPO technique is an effective method of treating proximal tibial fractures due to its overall good functional outcome.

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The Anterior T-Frame External Fixator for High-Energy Proximal Tibial Fractures

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-200011000-00032 ◽

2000 ◽

Vol 380 ◽

pp. 234-240 ◽

Cited By ~ 15

Author(s):

George K. Bal ◽

Roderick S. Kuo ◽

Jens R. Chapman ◽

M. Bradford Henley ◽

Stephen K. Benirschke ◽

...

Keyword(s):

External Fixator ◽

High Energy ◽

Tibial Fractures ◽

Proximal Tibial Fractures

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Reconstruction of a Combined Frontal Bone and Orbital Roof Defect With Associated Meningoencephalocele Using 3D Modeling and 3D Navigation

Craniomaxillofacial Trauma & Reconstruction Open ◽

10.1177/24727512211023340 ◽

2021 ◽

Vol 6 ◽

pp. 247275122110233

Author(s):

Rory C. O’Connor ◽

Sead Abazi ◽

Jehuda Soleman ◽

Florian M. Thieringer

Keyword(s):

3D Modeling ◽

Road Traffic ◽

Treatment Algorithm ◽

Visual Disturbance ◽

High Energy ◽

Frontal Bone ◽

3D Navigation ◽

Orbital Roof ◽

Close Observation ◽

Orbital Roof Fractures

Introduction: Orbital roof fractures are uncommon and normally associated with high energy trauma in which multiple other injuries are present. Most can be managed non-operatively with close observation. However, in a small proportion the defect is such that it permits the development of a meningoencephalocele, which can cause exophthalmos, a reduction in visual acuity and pain, all of which are unlikely to improve without surgical treatment. In light of their scarcity and the potential of serious risks with surgery that includes meningitis and visual disturbance (or even loss), thorough planning is required so that the meningoencephalocele can be reduced safely and the orbital roof adequately reconstructed. Methods: We report a case of a patient with a frontal bone defect, orbital roof fracture and associated meningoencephalocele that presented years after being involved in a road traffic accident in another country, who complained of a significant headache and orbital pain. The use of 3D modeling to help plan the surgery, and intraoperative 3D navigation to help negotiate the anterior skull base are described along with the reconstruction of the frontal bone and orbital roof using titanium mesh contoured on the 3D model. Conclusions: Although conservative management of orbital roof fractures predominates; those that are symptomatic, have associated neurologic symptoms or pose a risk to the eyesight warrant a surgical approach. The methods of repair, which center around separating the intracranial and intraorbital contents, are described in the context of this patient and previous cases, and a treatment algorithm is proposed.

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