European Journal of Molecular & Clinical Medicine

Background: Distal tibial metaphysis is defined by constructing a square, with sides of length defined by widest portion of tibial plafond. Various surgical modalities used for these fractures include closed intramedullary nailing, plating by open or closed methods, and various types of external fixators. The purpose of this prospective study was to compare the two primary modalities of treatment for these fractures: namely, distal tibial locking compression plate by Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) and closed intramedullary interlocking nailing (IMIL), and to know the efficacy of these techniques in the management of closed fractures of distal tibia.
Materials& Methods: A hospital based prospective comparative study done on 30 adult patients with fractures of lower third tibia admitted in department of Orthopaedics at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India during one year period. All patients with distal tibiafractures who satisfy the inclusion criteria have been included in the study. Patients willbe allocated randomly into two groups using computer generated random numbers i.e., IMIL group and MIPPO group each with 15 patients. Patients were followed up for 3 months, 6 months, and 12 months for clinical, radiological and functional outcome evaluation.
Results: Mean age of the patients in IMIL group is 40.56 ± 11.23 years and 44.32 ± 15.46 years in MIPPO group. The most common mode of injury was found to be Road Traffic Accident (RTA), seen in 63.33% of the patients, followed by fall 23.33%, sports injury 6.66% and direct blow 6.66%. The functional results, as assessed by Teeny And Weiss Criteria (Functional Evaluation of Ankle), showed that majority (60%) of the patients in the study hadgood functional results (IMlLN: 66.66%; MIPPO: 53.33%) and 33.33% had excellent results (IMILN: 26.66%;MIPPO: 40%). The difference in functional outcome showed mean score of 84.36 ± 8.78 in IMIL group where as in MIPPO group it is 84.12± 9.65. Using Chi-square test, these differences were not found to be statistically significant (P >0.05). In our study, most of the patients had no complications. In patients who had complications, in IMIL group most common complication is superficial infection (13.33%) followed by malunion (6.66%) and deep infection (6.66%), whereas in MIPPO group most common complication was deep infections (13.33%) and implant failure (13.33%) and delayed union (3.33%).
Conclusion: We concluded that multidirectional locked nailing is an efficient method for treating distal tibia fracture. Compared with MIPO, IMIL nailing should still be considered the gold standard for distal tibia fracture management

Introduction:Tibial plateau fractures have always been difficult to treat because of thesubcutaneous location of its anteromedial surface. These days significant attention hasbeen paid to the condition of soft tissue envelope. Study aims and objectives were to evaluate functional outcome of tibial plateau fracture treated by Locking compression plate in regards to Knee range of movements and complications.

Osteosynthesis with open reduction technique in comminuted fracture has several disadvantages like increase rate of non-union, non-healing of soft tissue, infection and failure of implant. These problems can be managed by percutaneous minimally invasive plating technique which preserve the vascularity and soft tissue anatomy of fracture fragments.
A total of 40 patients were involved in this study. Distal tibia with or without fibula fracture (12), Diaphyseal tibia (10), Proximal tibia (8), Supra condylar Femur (6) and Subtrochanteric Femur (4) were operated by using the principles of indirect reduction and biological fixation with plates under C-arm guidance. Weight bearing was allowed according to the clinical and radiological union at follow up.
Most patients regained excellent range of motion of adjoining joints. Mean time of radiological union was 20.12 weeks. Two patients had soft tissue infections which healed with wound care and dressing. One patient had non-union which was managed by bone grafting. In this study excellent result was seen in eighteen cases, good in five and fair in other patients.
This study indicates that minimally invasive percutaneous plating is an effective method for treatment of comminuted diaphyseal fracture of long bones. These complex fractures goes onto complete recovery and normal limb function at an early stage with fewer complication

Objectives:

Outlines the necessity of early diagnosing and management of lisfranc injury and metatarsal fracture to avoid chronic instability.
Advantages of plate fixation for (proximal) fifth metatarsal fracture in addition to k-wire.
To assessing the functional outcome and duration of union using MIPPO technique in the management of distal third tibia fracture.

Materials and Methods:
Case Report: We report a case of 32 year old man presenting with multiple injuries to foot and ankle diagnosed as comminuted distal third tibia fracture (with medial malleolus fracture) with panmetatarsal fracture with lifranc dislocation of right lower limb. A single stage procedure done for fixation of all these injuries.
Result; The patient follow up for one year, mean duration union of all fractures noted radiologically by 11±2 weeks. Patient allowed to weight bear after 3 months, Functional range of motion improved from the end of 3 months to 8 months. Prospective functional evaluation of this patient assessed by American orthopaedic foot and ankle society score (AOFAS) 96/100 at the end of 6 months and Pain relief is evaluated periodically by visual analogue scale.
Conclusion: Best results are obtained by immediate anatomical reduction and fixation of lisfranc injuries. In addition to k-wire, plate fixation for fifth metatarsal provides alignment with high union rate, especially when the fracture is comminuted. MIPPO technique is reliable fixation in fracture of distal tibia preserving most osseous (periosteal) blood supply and haematoma  in fracture site and in turn provides  more biological repair.