J Korean Fract Soc.  2009 Jan;22(1):6-12. 10.12671/jkfs.2009.22.1.6.

Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture

• Kim JW
• Oh CW
• Oh JK
• Kyung HS
• Min WK
• Park BC
• Kim KH
• Kim HJ

• KMID: 2183881
• DOI: http://doi.org/10.12671/jkfs.2009.22.1.6

Abstract

PURPOSE
To assess the results of staged MIPO (Minimally Invasive Plate Osteosynthesis) for proximal tibial fractures with compromised soft tissue.
MATERIALS AND METHODS
Eighteen proximal tibial fractures (AO 41:9 cases, AO 42:9 cases) included this study. Ten were open fractures. After temporary external fixation until soft tissue healed (mean 27.3 days), MIPO was performed secondarily without bone graft. We assessed the bony union and knee function, and affecting factors of the results were investigated.
RESULTS
All fractures united at 20 weeks (range, 11~32) except 1 case. Mean range of knee flexion was 134.4degrees and mean IOWA knee score was 89.1. There were 2 superficial and 2 delayed deep infections from open fractures (grade II:1 case, grade III:3 cases), although they healed after implant removal. Open fractures seem to influence the infection rate. Otherwise, there was no related factor affecting the results.
CONCLUSION
MIPO after temporary external fixation can provide favorable results in proximal tibial fractures with soft tissue injuries, but attention of delayed infection should be paid in open fractures.

Keyword

Proximal tibial fracture; Minimally invasive plate osteosynthesis; External fixation; Staged treatment

MeSH Terms

Fractures, Open
Iowa
Knee
Soft Tissue Injuries
Tibial Fractures
Transplants

Figure

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  Fig. 1 (A~C) A 51-year old man suffered from type IIIA open proximal tibial fracture. (D) Bridging external fixation was performed on that day.

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  Fig. 2 (A, B) After wound healed at 13 days, MIPO was done (C) Satisfactory alignment was achieved on the postoperative radiograph. (D, E) Follow-up radiograph after 10 month shows complete union of fracture.

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  Fig. 3 (A) A 52-year old man sustained proximal tibial fracture with severe comminution. (B) Severe soft tissue swelling and contusion with fracture blisters implies compartment syndrome. (C) Bridging external fixation with fasciotomy was done immediately. (D) Wound was closed and swelling completely subsided after 21 days.

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  Fig. 4 (A, B) With MIPO procedure, (C) a good alignment was obtained. (D, E) The fracture healed 14 weeks after surgery.

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