MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) FOR COMMINUTED FRACTURES OF DISTAL TIBIA

Minimally Invasive Plate Osteosynthesis

Abstract

Objective: To report experience with minimally invasive plate osteosynthesis (MIPO) for comminuted distal tibia fractures with specific reference to fracture union, complications encountered and functional outcome.
Design: Descriptive case series using purposive non-probability convenient sampling.
Place and duration of study: Study was conducted in the Department of Orthopaedic Surgery at Combined Military Hospital Multan and Muzaffarabad from March 2006 to October 2010.
Patients and Methods: Twenty three patients underwent MIPO for comminuted distal tibial fractures. Fractures were classified according to AO system. Open fractures were graded using Gustilo and Anderson classification. A 4.5mm Narrow Dynamic Compression Plate (DCP) was used for fixation in 16 cases whereas 7 fractures were fixed with 4.5mm Narrow Locking Compression Plate (LCP). Post-operative clinical and radiological assessment was done at monthly interval until radiological union and three monthly thereafter. The minimum follow-up period was eight months with a mean of 18 ± 4.1 months. Functional outcome was assessed in each case at final follow-up.
Results: There were 16 males and 7 females with mean age of 30.3 ± 9.2 years. Radiological and clinical union was achieved in all cases. Twenty one cases (91.3%) achieved union (primary) at mean of 17.5 ± 2.6 weeks whereas two cases (8.7%) required augmentation cancellous bone grafting before achieving union (secondary) at mean of 33 ± 2.8 weeks. Unsatisfactory radiological alignment (Coronal > 5°/ Sagittal > 5°) was observed in one (4.3%) case. There was one (4.3%) case of infection treated successfully with antibiotics. Single screw breakage was seen in 2 cases where conventional DCP had been used for fixation but neither led to loss of position nor affected the outcome adversely. Functional results were “excellent to good” in 91.3% cases and fair in two cases.
Conclusion: MIPO may be used successfully for treatment of high-energy peri-articular distal tibial fractures. The approach aims to preserve bone biology and minimize surgical soft tissue trauma. The technique certainly provides an answer to treat this challenging group of fractures.