Single Midline Incision Technique for Dual Plating in Proximal Tibial Fractures: An Innovative Approach for Enhanced Fixation

Abstract

Background: High-velocity trauma causes proximal tibial fractures, which have extensive articular involvement, numerous displaced condylar fracture lines, and soft tissue injuries. Complications are possible with the standard treatment, which is open reduction and internal fixation by a dual midline incision and dual plating. Nevertheless, a single midline incision is sufficient for the procedure. That's why we decidedto conduct this intervention. Objective: To evaluate the effectiveness and outcomes of proximal tibial fracture fixation using a double plating technique through a single midline incision. Study type,settings& duration:This quasi-experimental study was conducted at Department of Orthopaedic Surgery, PAEC Hospital,Islamabad, from March 2020 to March 2023. Methodology:Patients, aged 16 or above were enrolled who presented with proximal tibial fracture and underwent dual plating by giving single midline incision. Patients were followed-up and outcomes including infection, union, needed bone grafting, additional split skin graft and flap surgery and others were noted. SPSS version 25 was used to analyse the data. Results:Total 100 patients were enrolled in the study with the mean age of 44.71±17.88 years. There were 58 (58.0%) male patients and 42 (42.0%) female patients. The mean duration of surgery was 74.11±8.91 minutes. Out of 100 patients, 57 (57.0%) patients had excellent functional outcome, 34 (34.0%) patients had good fictional outcome, while 7 (7.0%) patients had fair functional outcome and 2 (2.0%) had poor functional outcome. Out of 100 patients, union achieved in 81 (81.0%) cases. Infection occurred in 2 (2.0%) cases, Knee stiffness in 12 (12.0%) cases, body graft was applied in 1 (1.0%) cases and skin graft and flap surgery was done in 1 (1.0%) cases and deep venous thrombosis in 2 (2.0%) cases. Conclusion:Dual plating for proximal tibial fracture via single midline is an appropriate method and is more than 90% successful in achieving good to excellent results and can replace other techniques which need more incision and increases the risk of infection.

Keywords

• double plating
• proximal tibial fractures
• single midline incision
• union
• infection
• bone graft
• skin graft