Minimally Invasive Percutaneous Plate Osteosynthesis: A Blessing for Notorious Distal Tibia Fractures

Abstract

Introduction: Fractures of distal tibia are difficult to treat as they are high energy fractures, associated with extremely damaged soft tissues, poor vascularity, high incidence of compound injuries, skin complications following surgery and comminution of the metaphysis and articular surface makes anatomical reduction difficult. A mechanically stable osteosynthesis can be obtained with minimum dissection and surgical trauma by Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO). In this technique fracture is reduced indirectly, and is fixed with Locking Compression Plate (LCP). Aim: To assess functional and radiological outcomes of distal tibial fractures managed by MIPPO using LCP. Materials and Methods: In this cross-sectional study, 25 patients with distal tibia fractures were operated by LCP using MIPPO technique. Patients were followed-up at regular intervals for about one year. They were assessed clinically, functionally and with radiologically for fracture union. Functional assessment was done using American Orthopaedic Foot and Ankle Society Score (AOFAS) scoring system. Radiological outcome was evaluated using the Radiological Union Scale in Tibia Fracture (RUST) to assess union. Data was analysed using paired t-test. The chosen level of significance was p-value <0.05. Statistical Package for the Social Sciences (SPSS) version 21 was used for analysis. Results: Males were more commonly affected with Road Traffic Accident (RTA) being the most common mode of injury. All fractures healed with good functional outcome. Mean union time was 20 weeks. Mean AOFAS score at the end of one year was 88.83 (SD 5.65) and mean RUST score was 11.58 (SD 0.72) at the end of one-year follow-up, indicating good outcome. There was one case of superficial infection which was managed with antibiotics, one patient had implant failure. Conclusion: LCP using MIPPO offers biological advantage by preserving periosteal blood supply, which is particularly critical with distal tibia or pilon injury. Thus, fractures heal rapidly with very few complications.

Keywords

• american orthopaedic foot and ankle society score
• locking compression plate
• periosteal blood supply
• radiological union scale