A study of MIPO by locking compression plate fixation in the management of distal tibial metaphyseal fractures

Kurukunda Venkateswarlu, Nagaraju Madiga, Sivababu P

Abstract


Background: Management of distal tibial metaphyseal fractures has been a difficult area because of the subcutaneous position of tibia. Exposure of implant has been a major problem in open reduction and fixation of these fractures. Minimally Invasive Plate Osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study is aimed at management of intra-articular and extra-articular fractures of the distal third tibia by minimally invasive plate osteosynthesis technique by locking compression plate and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed.  

Methods: From June 2012 to May 2014, 22 patients of closed distal tibial metaphyseal fractures were operated by MIPO technique with a distal tibial locking compression plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 2 years at our hospital.

Results: The mean fracture healing time was 5.5 months (range 4-13months). We had 90% of union rate with good ankle movements and walking distance in 75% of the patients. Pos-operatively we had complications of, superficial infection occurred in 2 patients, implant failure in 1 patient leading to non-union and delayed union in 1-patient each.

Conclusion: MIPO technique provides good, stable fixation of distal tibial metaphyseal fractures. Although slightly delayed bone healing, MIPO decreases the incidence of non- union and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension.

 


Keywords


Metaphyseal, Locking, Minimally invasive, Osteosynthesis

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References


Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury. 1997;28(Suppl 1):A7-12.

Mohammed A, Saravanan R, Zammit J, King R. Intramedullary tibial nailing in distal third tibial fractures: distal locking screws and fracture non-union. Int Orthop. 2008;32:547-9.

Wrysch B, McFerran MA, McAndrew M. Operative treatment of fractures of the tibial plafond. A randomised, prospective study. J Bone Jt Surg Am. 1996;78:1646-67.

Williams T, Schenk W. Bridging-minimally invasive locking plate osteosynthesis (Bridging-MILPO): technique description with prospective series of 20 tibial fractures. Injury. 2008;39:1198-203.

Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury. 2007;38:365-70.

Pugh KJ, Wolinsky PR, McAndrew MP, Johnson KD. Tibial pilon fractures: a comparison of treatment methods. J Trauma. 1999;47:937-41.

Gupta RK, Rohilla RK, Sangwan K, Singh V, Walia S. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients. Int Orthop. 2010;34:1285-90.

Anglen JO. Early outcome of hybrid external fixation for fracture of the distal tibia. J Orthop Trauma. 1999;13:92-7.

Borg T, Larsson S, Lindsjo U. Percutanous plating of distal tibial fractures - preliminary results in 21 patients. Injury. 2004;35:608-14.

Ronga M, Longo UG, Mafilli N. Minimally invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat Res. 2010;468:975-82.

Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia. Results in 20 patients. Injury. 2006;37:877-8.

Wagner M. General principles for the clinical use of the LCP. Inj Int J Care Inj. 2003;34:S-B31-42.

Sarmiento A, Latta LL. 450 closed fractures of the distal third of the tibia treated with a functional brace. Clin Orthop Relat Res. 2004;428:261-71.

Maffuli N, Toms A, McMurtie A, Oliva F. Percutaneous plating of distal tibia fractures. Int Orthop. 2004;28:159-62.

Sitnik AA, Beletsky AV. Minimally invasive percutaneous plate fixation of tibia fractures: results in 80 patients. Clin Orthop Relat Res. 2013;471:2783-9.