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

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

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

2015 ◽  
Vol 9 (1) ◽  
pp. 73-77 ◽  
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.

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

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

<p class="abstract"><strong>Background:</strong> 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).</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p><strong>Conclusions:</strong> 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.</p>

scholarly journals RESULT OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) WITH USE OF LOCKING PLATE IN FRACTURE TIBIA DISTAL END

2021 ◽  
pp. 1-3
Author(s):  
Kunal Shankar ◽  
Vikash M. Harinandan ◽  
Laljee Chaudhary ◽  
Debarshi Jana
Keyword(s):  
Soft Tissue ◽  
Locking Plate ◽  
Road Traffic ◽  
Plate Osteosynthesis ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Soft Tissue Coverage ◽  
Distal Tibial Fractures ◽  
Fracture Tibia

Background: The fractures of distal tibia including tibial pilon pose a great challenge to the surgeon due to subcutaneous location, scarcity of blood supply and paucity of soft tissue coverage. Minimal invasive plating osteosynthesis (MIPO) has evolved as a newer concept to treat distal tibial fractures with minimal articular comminution and minimal soft tissue damage. Aim of the present study was to evaluate the results of MIPO technique with use of a locking plate in fracture tibia distal end. Method: During the study period of two years, total 45 cases of closed distal tibial fractures (Diaphyseal and metaphyseal region) were operated by MIPO technique with a distal tibial anatomical locking plate (3.5 and 4.5 mm). They were followed up at regular intervals and results were evaluated. Results: The age of the patients ranged from 20-60 years with the majority (19; 42.22%) of them being in the age of 40-50 years. The most common mode of injury was road traffic accident (33; 73.33%). In all patients MIPO was performed, in none of them, fracture site was opened. Mobilization of adjacent joints was carried out mostly from second to fourth postoperative day. Most of the fractures united between 10-12 weeks (26; 57.77%). On analyzing the results of MIPO, excellent results were seen in 66.66% cases and 33.34% had satisfactory results. Conclusion: Hereby we concluded that though various modalities of treatment of fractures of the distal tibia are present MIPO seem to be better technique if done under skillful guidance as done in this study.

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

2019 ◽  
Vol 5 (4) ◽  
pp. 665
Author(s):  
Gaurav Singla
Keyword(s):  
Soft Tissue ◽  
Minimally Invasive ◽  
Functional Outcome ◽  
Blood Supply ◽  
Soft Tissues ◽  
Soft Tissue Injuries ◽  
Tibial Fractures ◽  
Minimally Invasive Osteosynthesis ◽  
Distal Tibial Fractures ◽  
Excellent Functional Outcome

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p><strong>Conclusions:</strong> 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. </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 Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: a systematic review and meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Bo Wang ◽  
Yang Zhao ◽  
Qian Wang ◽  
Bin Hu ◽  
Liang Sun ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Functional Outcomes ◽  
Plate Osteosynthesis ◽  
Meta Analysis ◽  
Deep Infection ◽  
Tibial Fractures ◽  
Low Risk ◽  
Wound Complications ◽  
Distal Tibial Fractures ◽  
Randomized Controlled

Abstract Background The treatment for distal tibial fractures remains controversial to date. Minimally invasive percutaneous plate osteosynthesis (MIPPO) and intramedullary nailing (IMN) are well-accepted and effective methods for distal tibial fractures, but these methods were associated with complications. This study aimed to assess and compare the clinical and functional outcomes in patients with distal tibial fractures treated with MIPPO or IMN. Methods We systematically reviewed randomized controlled trials (RCTs) that compared MIPPO with IMN in patients with distal tibial fractures from inception till 15 August 2019. Also, quantitative summaries of time to reunion, rate of complications, and functional outcomes were evaluated. Results The pooled results suggested that patients in the MIPPO group had a longer time to reunion with a mean difference of 1.21 weeks [P = 0.02; 95% confidence interval (CI) 0.16–2.26)] than those in the IMN group. The overall union complications and deep infection between IMN and MIPPO were similar (P > 0.05). IMN had a significantly low risk of wound complications [risk ratio (RR) = 0.51, P = 0.00, 95% CI 0.34–0.77)]. The pooled functional outcomes of the two groups remained controversial by different evaluating scores. Conclusions Compared to MIPPO, IMN had a significantly low risk of wound complications and associated with limited time for reunion. Although the pooled functional outcomes of the two groups were controversial due to different evaluating scores, IMN was the preferred surgical technique than MIPPO for treating distal tibial fractures.

scholarly journals Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

2014 ◽  
Vol 20 (1) ◽  
pp. 44-49
Author(s):  
Șerban Al. ◽  
Obadă B. ◽  
Turcu R. ◽  
Anderlik St. ◽  
Botnaru V.
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Ankle Joint ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Surgical Trauma ◽  
Distal Tibial Fractures

ABSTRACT Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours) open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68). The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks). All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks) showing radiological union. There were no cases of failures of fixation, or rotational misalignment. No significant complication was observed in our patients. MIPO is an effective method of treatment for distal tibial fractures, reduce surgical trauma and maintain a more biologically favorable environment for fracture healing, reducing risks of infection and nonunion.

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