J Korean Fract Soc.  2010 Jul;23(3):289-295. 10.12671/jkfs.2010.23.3.289.

Staged Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures

• Park SK
• Oh CW
• Oh JK
• Kim KH
• Min WK
• Park BC
• Jeong WJ
• Ihn JC

• KMID: 1712344
• DOI: http://doi.org/10.12671/jkfs.2010.23.3.289

Abstract

PURPOSE
To assess the result of staged minimally invasive plate osteosynthesis (MIPO) for distal tibial fracture with an open wound or injured soft tissue.
MATERIALS AND METHODS
In 20 patients (mean age, 47.8 year-old) with distal tibial fractures, there were 4 type A fractures and 16 type C fractures based on the AO classification system. Eight of the 20 patients had open fractures. MIPO was performed on average 23.9 days after bridging external fixation. At the final follow-up, we assessed the radiological results of bone union and alignment. Functional results were also evaluated by measuring the degrees of ankle motion and the American Orthopedic Foot & Ankle Society (AOFAS) scores.
RESULTS
Seventeen of 20 cases (85%) achieved primary union at an average of 21.3 weeks. There were 3 cases of nonunion requiring a bone graft. The mean AOFAS score was 88.5 (range, 67~92) and the average range of ankle motion was 49.2degrees (plantarflexion: 37.4degrees, dorsiflexion: 11.8degrees). Complication included 2 cases of minor mal-alignment, 1 case of claw toe and 1 case of peroneal neuropathy. Patients over the age of 60 had lower functional results. Additional factors did not affect the final results.
CONCLUSION
Staged MIPO may achieve satisfactory results in distal tibial fractures with soft tissue compromise, decreasing deep infections and soft tissue complications.

Keyword

Distal tibial fracture; External fixation; Minimally invasive plate osteosynthesis

MeSH Terms

Animals
Ankle
Follow-Up Studies
Foot
Fractures, Open
Hammer Toe Syndrome
Humans
Orthopedics
Peroneal Neuropathies
Tibial Fractures
Transplants

Figure

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  Fig. 1 (A) A 48-year old man sustained the distal tibial fracture with grade IIIA open wound. (B) After fixation of fibula fracture, bridging external fixation was done with wound debridement and closure. (C, D) After the improvement of soft tissue condition, medial plating was done with minimally invasive technique. (E) At 6 month, a successful union was achieved with the good alignment.

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  Fig. 2 (A) An AO-OTA 43-C2 fracture. (B) A bridging external fixation was applied. (C, D) After the improvement of soft tissue condition, medial MIPO was done with joint reconstruction. (E) A successful healing was achieved after 8 months.

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