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

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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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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The prospective analysis of functional outcome of osteosynthesis of extra-articular distal tibia fractures using minimally invasive percutaneous plate osteosynthesis technique

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201555 ◽

2020 ◽

Vol 6 (3) ◽

pp. 536

Author(s):

Arjun Mandri ◽

Nuthan Jagadeesh ◽

Sunil Nanjareddy ◽

Vishwanath Muttagaduru Shivalingappa

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Functional Outcome ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Research Centre ◽

Tibia Fractures ◽

Distal Tibia Fractures ◽

Prospective Longitudinal

Background: Extra-articular distal tibial fractures are one of the most complicated ones to treat, specially comminuted fractures. Its subcutaneous nature and lack of adequate musculature makes it more prone for soft tissue damage and bone loss. The key to handle these troubling fractures is to skilfully preserve and reconstruct the soft tissues, early mobilisation and functional use of the extremity with the maintenance of satisfactory length and alignment of the fracture.Methods: This prospective longitudinal study involved 30 patients with extraarticular distal tibia fracture, who are admitted in Vydehi Institute of Medical Sciences and Research Centre between January 2017 to 2019. All were treated with closed reduction and internal fixation using pre-contoured anatomical distal tibia locking plate using minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Functional and radiological outcome along with associated complications are evaluated in serial follow up.Results: 30 patients with minimal follow up criteria of 6 months was evaluated with AOFAS score for functional outcome. At the end of 1 year, 21 cases (70%) of the cases had excellent results, 5 cases (16.7%) had good results, 3 cases had fair results and only 1 case had poor result.Conclusions: With the use of pre-contoured anatomical locking plates used, MIPPO technique is effective in extra articular distal tibia fractures where it not only helps in decreasing operating time but also in achieving excellent functional outcome with radiological union the fractures by preserving osseous vascularity and minimal soft tissue insult due to surgery.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/1749-799x-9-35 ◽

2014 ◽

Vol 9 (1) ◽

pp. 35 ◽

Cited By ~ 3

Author(s):

Sebastian Kuhn ◽

Philipp Appelmann ◽

Dorothea Mehler ◽

Philip Pairon ◽

Pol M Rommens

Keyword(s):

Minimally Invasive ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Angle Stable ◽

Tibia Fractures ◽

Distal Tibia Fractures ◽

Angle Stable Plate

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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

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Functional outcome of minimally invasive plate osteosynthesis with the use of locking plate in fracture distal end of tibia

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204591 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1239

Author(s):

Prashant Kamble ◽

Nandan Marathe ◽

Sudhir Sharan ◽

Ayush Sharma ◽

Ashwin Sathe ◽

...

Keyword(s):

Minimally Invasive ◽

Open Reduction ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Minimally Invasive Plate Osteosynthesis ◽

Locking Plates ◽

X Rays ◽

Functional Scores ◽

Tibia Fractures ◽

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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