Outcome of Minimally Invasive Percutaneous Plate Osteosynthesis Technique for Management of Extra Articular Distal Tibial Fractures
Objective: To assess the outcome of the minimally invasive percutaneous plate osteosynthesis (MIPPO) method applied for the management of extra-articular distal tibial fractures.
Materials and Methods: This quasi-experimental study was conducted at the Department of Orthopaedic Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan. Total 57 patients have included extra-articular type A distal tibial fracture, duration of injury <1 week, and competent neurological and vascular status of the fractured site. All the patients were treated with MIPPO Technique by using the distal tibial medial locking plate and the outcome of all patients was assessed radiologically in terms of union and functionally by using the Ovadia-Beals clinical scoring system. Data were analysed by using SPSS v. 21.
Results: As per sample size calculation, 57 patients were included with a mean age of 37.19 ± 9.22 years. There were 45 (78.94%) male patients and 12 (21.05%) female patients. According to AO classification; the most common type was 43A1 with 31 patients (54.38%) whereas 18 (31.57%) were in Type 43A2 and 8 (14.03%) in Type 43A3. In our study, fracture union was achieved in a mean duration of 19.6 ± 3.45 weeks. When the functional outcome was analyzed, 41 (71.92%) patients had excellent outcome, 8 (14.03%) had good results, 5 (8.77%) had fair and 3 (5.26%) had poor outcome based on the subjective result and 44 (77.19%) patients had excellent, 7 (12.28%) had good, 3 (5.26%) had fair and 3 (5.26%) had poor result based on an objective result of Ovadia-Beals clinical scoring system.
Conclusion: Thus MIPPO can be highly successful in achieving good to excellent outcomes in the maximum number of patients presented with a distal tibia fracture. So in the future, we can rely on this technique for such types of fractures.
2. Sitnik A, Beletsky A, Schelkun S. Intra-articular fractures of the distal tibia. EFORT Open Reviews 2017;2(8):352-61.
3. 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 Nov;49(11):2068-74.
4. Clement N, Beauchamp N, Duckworth A, McQueen M. The outcome of tibial diaphyseal fractures in the elderly. Bone Joint J 2013;95(9):1255-62.
5. Chua W, Murphy D, Siow W, Kagda F, Thambiah J. Epidemiological analysis of outcomes in 323 open tibial diaphyseal fractures: a nine-year experience. Singapore Med J 2012;53(6):385-9.
6. Madadi F, Farahmandi MV, Eajazi A, Besheli LD, Madadi F, Lari MN. Epidemiology of adult tibial shaft fractures: a 7-year study in a major referral orthopedic center in Iran. Med Sci Monitor Basic Res 2010;16(5):CR217-CR21.
7. Newman SDS, Mauffrey CPC, Krikler S. Distal metadiaphyseal tibial fractures. Injury 2011;42(10):975-84.
8. Babis G, Kontovazenitis P, Evangelopoulos D, Tsailas P, Nikolopoulos K, Soucacos P. Distal tibial fractures treated with hybrid external fixation. Injury 2010;41(3):253-8.
9. Mahajan N. Minimally invasive techniques in distal tibial fractures. Jk Science 2008(2):78-80.
10. Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M, Group E-BOTW. Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. Journal of orthopaedic trauma 2006;20(1):76-9.
11. Kumar A, Charlebois SJ, Cain EL, Smith RA, Daniels A, Crates JM. Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing. J Bone Joint Surg Am 2003;85(4):604-8.
12. Bedi A, Le TT, Karunakar MA. Surgical treatment of nonarticular distal tibia fractures. Journal of the American Academy of Orthopaedic Surgeons 2006;14(7):406-16.
13. Robinson C, McLauchlan G, McLean I. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing. Bone & Joint Journal 1995;77(5):781-7.
14. Gorczyca JT, McKale J, Pugh K, Pienkowski D. Modified tibial nails for treating distal tibia fractures. Journal of orthopaedic trauma 2002;16(1):18-22.
15. Sarmiento A, Latta LL. 450 closed fractures of the distal third of the tibia treated with a functional brace. Clinical orthopaedics and related research 2004;428:261-71.
16. Mosheiff R, Safran O, Segal D, Liebergall M. The unreamed tibial nail in the treatment of distal metaphyseal fractures. Injury 1999;30(2):83-90.
17. Konrath G, Moed BR, Watson JT, Kaneshiro S, Karges DE, Cramer KE. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. Journal of orthopaedic trauma 1997;11(3):200-5.
18. Tornetta III P, Casey D, Creevy W. Nailing proximal and distal tibia fractures. Rosemont. IL: Orthopaedic Trauma Association Final Program & Membership Directory 2000:131-2.
19. Richter D, Ostermann P, Ekkernkamp A, Hahn M, Muhr G, editors. Distal tibial fracture--an indication for osteosynthesis with the unreamed intramedullary nail? Langenbecks Archiv fur Chirurgie Supplement Kongressband Deutsche Gesellschaft fur Chirurgie Kongress; 1996.
20. Liverneaux P, Ichihara S, Facca S, Hidalgo JD. Outcomes of minimally invasive plate osteosynthesis (MIPO) with volar locking plates in distal radius fractures: a review. Hand surgery & rehabilitation 2016;35:S80-S5.
21. Jha AK, Bhattacharyya A, Kumar S, Ghosh TK. Evaluation of results of minimally invasive plate osteosynthesis (MIPO) of distal tibial fractures in adults. Journal of the Indian Medical Association 2012;110(11):823-4.
22. Helfet DL, Shonnard PY, Levine D, Borrelli J. Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury 1997;28:A42-A8.
23. Oh C-W, Kyung H-S, Park I-H, Kim P-T, Ihn J-C. Distal tibia metaphyseal fractures treated by percutaneous plate osteosynthesis. Clinical orthopaedics and related research 2003;408:286-91.
24. Maffulli N, Toms AD, McMurtie A, Oliva F. Percutaneous plating of distal tibial fractures. International orthopaedics 2004;28(3):159-62.
25. Khoury A, Liebergall M, London E, Mosheiff R. Percutaneous plating of distal tibial fractures. Foot & ankle international 2002;23(9):818-24.
26. Lakhotia D, Sharma G, Khatri K, Kumar GK, Sharma V, Farooque K. Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: evaluation of results and complications. Chinese J Traumatol 2016;19(1):39-44.
27. Ronga M, Longo UG, Maffulli N. Minimally invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat Res 2010;468(4):975-82.
28. Mohammad MM, Hafez KMAH, Abdelkader AA, Mohamed EGK. Short-term results for the management of distal tibial fractures by minimally invasive locked plating. Egypt Orthop J 2014;49(4):314.
29. ur Rehman MK, Hanif M, Ullah SH, Ghani I. Functional and Radiological Outcome of Longer Lever Arm Plates with Minimally Invasive Plate Osteosynthesis (MIPO) in AO Type C Distal Femoral Fracture. Journal of Pakistan Orthopaedic Association 2018;30(03):128-32.
30. Jang JH, Ahn JM, Lee HJ, Moon NH. Surgical outcomes of biologic fixation for subtrochanteric fracture using locking compression plates. Hip & pelvis 2017;29(1):68-76.
31. Rizk AS, Al-Ashhab ME. Primary bone grafting with locked plating for comminuted distal femoral fractures: can it improve the results?. The Egyptian Orthopaedic Journal. 2015 Apr 1;50(2):77.
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