J Korean Orthop Assoc.  2014 Aug;49(4):278-284. 10.4055/jkoa.2014.49.4.278.

Medial Minimally Invasive Percutaneous Plate Osteosynthesis in Proximal Tibial Comminuted Fractures

• Sim JA
• Kim KH
• Lee YS
• Lee SJ
• Lee BK

• KMID: 2185183
• DOI: http://doi.org/10.4055/jkoa.2014.49.4.278

Abstract

PURPOSE
This goal of this study is to evaluate the clinical and radiological outcomes of proximal tibial comminuted fractures treated with medial minimally invasive percutaneous plate osteosynthesis (MIPPO).
MATERIALS AND METHODS
We evaluated 43 patients who underwent medial MIPPO from February 2008 to February 2012 and were followed up for more than one year. According to the AO/OTA classification, there were 30 patients of 41-A3 and 13 patients of 41-C2. Thirty-six patients had closed fractures and seven patients had open fractures. We assessed clinical outcomes, radiologic results and postoperative complications.
RESULTS
All fractures were united at an average of 18.3+/-8.1 weeks except three patients with nonunion. According to Schatzker and Lambert assessment, excellent results were achieved for 22 patients and good results were achieved for 21 patients. The average tibial plateau angle was 89.1degrees+/-2.7degrees and the average posterior tibial slope angle was 10.5degrees+/-4.6degrees. In assessment of lower limb alignment, the average femorotibial angle was 175.1degrees+/-2.9degrees and the mean deviation of mechanical axis was 46.5%+/-12.7%. In terms of complications, three patients had nonunion, but complete bony union was achieved by autogenous cancellous bone grafting. Seven patients complained of skin irritation around the plate. However, there was no skin necrosis, infection, or limited range of motion in seven patients with skin irritation.
CONCLUSION
Medial MIPPO for proximal tibial comminuted fractures provides favorable clinical outcomes and good radiological alignments.

Keyword

tibia; comminuted fractures; minimally invasive percutaneous plate osteosynthesis

MeSH Terms

Axis, Cervical Vertebra
Bone Transplantation
Classification
Fractures, Closed
Fractures, Comminuted*
Fractures, Open
Humans
Lower Extremity
Necrosis
Postoperative Complications
Range of Motion, Articular
Skin
Tibia

Figure

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  Figure 1 Operative technique. (A) Skin incision. (B) Dissecting between the pes ancerinus and the medial collateral ligament by Cobb's elevator. (C) Closure.

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  Figure 2 Anterior-posterior and lateral radiographs. (A) Preoperation. (B) Immediate postoperation. (C) Two years after the operation.

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  Figure 3 Radiologic evaluation. (A) Tibial plateau angle. (B) Posterior tibial slope angle. (C) Femorotibial angle. (D) Mechanical axis. (E) Deviation of mechanical axis.

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  Figure 4 Skin irritation around the implant in full flexion of the knee (arrow).

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