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

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.

Download Full-text

Outcome of minimally invasive plate osteosynthesis in distal tibial fractures

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v17i2.17143 ◽

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

Download Full-text

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

ARS Medica Tomitana ◽

10.2478/arsm-2014-0009 ◽

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.

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

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

Anterolateral Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures Using an Anterolateral Locking Plate

Journal of Korean Foot and Ankle Society ◽

10.14193/jkfas.2020.24.1.19 ◽

2020 ◽

Vol 24 (1) ◽

pp. 19

Author(s):

Dongwhan Suh ◽

Hwan Hee Lee ◽

Young Hoon Han ◽

Jae Jung Jeong

Keyword(s):

Minimally Invasive ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Tibial Fractures ◽

Minimally Invasive Plate Osteosynthesis ◽

Distal Tibial Fractures

Download Full-text

EVALUATION OF FUNCTIONAL OUTCOME OF DISTAL TIBIAL FRACTURES STABILIZED WITH DISTAL TIBIAL LOCKING PLATE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i12.2366 ◽

2021 ◽

Vol 5 (12) ◽

Author(s):

Sumeet Verma ◽

Rakesh Thakur

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

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: The patients attending the OPD/Emergency OPD in post graduate institute of medical education and research, chandigarh during September 2018 to August 2019 with distal tibial fractures. The patients treated with locking compression plates using MIPO or ORIF are reviewed for inclusion and exclusion criteria’s. Patients fitting into inclusion criteria has formed the study group. Results: Out of 52 patients, 48.4% patients undergo open reduction internal fixation had excellent results and 28.6% patients undergo MIPPO technique had excellent results. p value is 0.352 which is not significant. Overall 40.4% patients had excellent results. Conclusion: We observed excellent/ good functional outcome in 65.3% of patients. Keywords: Functional outcome, MIPPO, Tibia

Download Full-text

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

Foot & Ankle Specialist ◽

10.1177/1938640017726134 ◽

2017 ◽

Vol 11 (3) ◽

pp. 236-241 ◽

Cited By ~ 1

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

Download Full-text