Outcome of Minimally Invasive Percutaneous Plate Osteosynthesis Using Locking Compression Plate for Distal Tibial Fractures

Sagar Rampure, Harsh Choraria, Krishna Hanchate, Sujay K Mahadik, Shrikant Deshpande

Abstract


Objectives: To assess the functional and radiological outcomes of the distal tibia fractures managed surgically with a locking compression plate by MIPPO technique.

Methods: This prospective observational study included 34 patients with distal tibial fractures treated at Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, India. After ethics committee approval and informed consent, eligible adults with complex or unfavorable simple, closed fractures were enrolled. Exclusions were patients under 18 with pathological fractures or comorbidities affecting functional outcomes. Standard preoperative protocols and imaging were conducted. All patients were surgically managed with a locking compression plate by MIPPO technique. Postoperatively, exercises and staged weight-bearing were implemented. Follow-up assessments at 45, 90, 135, and 180 days evaluated pain, movement, and radiological union using Olerud and Molander score. Statistical analysis utilized paired t-test and Chi-Square test.

Results: Out of 34 patients with distal tibial fractures, 24 (70.6%) were males and 10 (29.4%) were females with a mean age of 41.88 years. Most fractures were 42A1 (35.3%) and 43A2 (32.4%). Post-operative superficial wound infection occurred in 3 (8.8%) and deep infection in 2 (5.9%). Mean union time was 16.62 weeks. Functional outcomes were excellent in 3 (8.8%), good in 22 (64.7%), and fair in 9 (26.5%). At six months, complications included ankle stiffness (29.4%), non-union (20.6%), and malunion (8.8%). No cases had plate or screw breakage.

Conclusion: MIPPO technique allows for good functional outcomes while reducing complications, especially in fractures with poor soft tissue conditions.


Keywords


Distal tibial fractures, functional outcome, locking compression plate, percutaneous plate osteosynthesis

Full Text:

PDF

References


  1. Stephens KR, Shahab F, Galat D. Management of distal tibial metaphyseal fractures with the SIGN Intramedullary Nail in 3 developing countries. J Orthop Trauma. 2015;29(12):e469–e475. doi:10.1097/BOT.0000000000000396
  2. van der Vliet QMJ, Ochen Y, McTague MF. Long-term outcomes after operative treatment for tibial pilon fractures. OTA Int. 2019;2(4):e043. doi:10.1097/OI9.0000000000000043
  3. Lua J, Tan VH, Sivasubramanian H, Kwek E. Complications of open tibial fracture management: risk factors and treatment. Malays Orthop J. 2017;11(1):18–22. doi:10.5704/MOJ.1703.006
  4. Greenfield J, Appelmann P, Wunderlich F, Mehler D, Rommens PM, Kuhn S. Retrograde tibial nailing of far distal tibia fractures: a biomechanical evaluation of double- versus triple-distal interlocking. Eur J Trauma Emerg Surg. 2022;48(5):3693–700. doi:10.1007/s00068-021-01843-5
  5. Carter TH, Duckworth AD, Oliver WM, Molyneux SG, Amin AK, White TO. Open reduction and internal fixation of distal tibial pilon fractures. JBJS Essent Surg Tech. 2019;9(3):e29. Published 2019 Sep 11. doi:10.2106/JBJS.ST.18.00093
  6. Sourougeon Y, Barzilai Y, Haba Y, Spector B, Prat D. Outcomes following minimally invasive plate osteosynthesis (MIPO) application in tibial pilon fractures - A systematic review. Foot Ankle Surg. 2023;29(8):566–75. doi:10.1016/j.fas.2023.07.013
  7. Qasem FH, Ahmed KE, Islam MS, Parvej M, Amin MS, Alamgir MM, et al. Management of fractures of the distal third of tibia by distal tibial locking plate by MIPO technique. Mymensingh Med J. 2021;30(1):148–53.
  8. Vidović D, Matejčić A, Ivica M, Jurišić D, Elabjer E, Bakota B. Minimally-invasive plate osteosynthesis in distal tibial fractures: Results and complications. Injury. 2015;46(Suppl 6):S96–99. doi:10.1016/j.injury.2015.10.067
  9. Bilge O, Dündar ZD, Atılgan N, Yaka H, Kekeç AF, Karagüven D, et al. The epidemiology of adult fractures according to the AO/OTA fracture classification. AO/OTA sınıflamasına göre yetişkin kırıklarının epidemiyolojik çalışması. Ulus Travma Acil Cerrahi Derg. 2022;28(2):209–16. doi:10.14744/tjtes.2020.26374
  10. Turhan E, Demirel M, Daylak A, Huri G, Doral MN, Çelik D. Translation, cross-cultural adaptation, reliability and validity of the Turkish version of the Olerud-Molander Ankle Score (OMAS). Acta Orthop Traumatol Turc. 2017;51(1):60–4. doi:10.1016/j.aott.2016.06.012.
  11. Sreenivas KD, Moses J. Functional outcome of distal tibial fractures treated by stainless steel locking plates with minimally invasive plate Osteosynthesis in rural population: A prospective study. International J Orthopaedics. 2020;6(1):1255–8.
  12. Wennergren D, Bergdahl C, Ekelund J, Juto H, Sundfeldt M, Möller M. Epidemiology and incidence of tibia fractures in the Swedish Fracture Register. Injury. 2018;49(11):2068–2074. doi:10.1016/j.injury.2018.09.008
  13. Gmachowska AM, Żabicka M, Pacho R, Pacho S, Majek A, Feldman B. Tibial stress injuries - location, severity, and classification in magnetic resonance imaging examination. Pol J Radiol. 2018;83:e471–e481. Published 2018 Nov 5. doi:10.5114/pjr.2018.80218
  14. Onta PR, Ranjeet N, Wahegaonkar K, Sapkota K, Thapa P, Thapa UJ. Study of unstable fracture of Distal Tibia and its outcome managed with Minimally Invasive Plate Osteosynthesis (MIPO). Asian J Medical Sciences. 2018;9(5):73–6.
  15. Ramesh G, Kumar NR. Study of complications and functional outcome of fixation of distal tibial fractures with anatomical locking plate using MIPO technique. J. Evolution Med. Dent. Sci. 2017;6(31):2489–92.
  16. Messori M, Touloupakis G, Gilli A, Theodorakis E, Pozzi P, Ghirardelli S, et al. The risk of infection in open distal tibial fracture: the DANGER score. Eur J Orthop Surg Traumatol. 2023;33(7):2965–70. doi:10.1007/s00590-023-03517-x
  17. Shah BM, Somshekhar PN. MIPO with anatomical plate for distal tibia extra articular fractures: A safe and effective modality. International Journal of Orthopaedics. 2019;5(1):12–7.
  18. Jabshetty A, Kazmi SS. Functional outcome following fixation of distal tibial fracture (Extra articular) with locking compression plate (LCP) using the minimally invasive percutaneous osteosynthesis (MIPO) technique. International Journal of Orthopaedics. 2020;6(1):687–91.
  19. Nath R, Saxena S, Singh C, Kumar C, Singh SK. Comparative study of the management of distal tibia fractures by nailing versus plating. Cureus. 2023;15(11):e48321. doi:10.7759/cureus.48321
  20. Patel YC, Jangid AK, Patel CB. Outcome of minimally invasive plate osteosynthesis (MIPO) technique in distal tibial fracture. International Journal of Orthopaedics. 2017;3(3):10–4.




DOI: https://doi.org/10.15850/ijihs.v12.n2.3991

Article Metrics

Abstract view : 110 times
PDF - 24 times



 

This Journal indexed by

                   

 


Creative Commons License
IJIHS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License



View My Stats