European Journal of Molecular & Clinical Medicine

Abstract

Introduction: Treatment of distal tibial fractures has always been challenging. Fractures of the distal third tibia are unique in that the bone is subcutaneous with depleted muscular cover; the consequent decreased vascularity leads to complications like delayed bone union, wound complications such as dehiscence and infection. Minimally invasive Percutaneous plate osteosynthesis (MIPPO) is an established technique for fixation of fractures of the distal third tibia. The aim of our study was to manage extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed.
Methods: The patients coming to Mysore Medical College & Research Institute, Mysore during January 2019 to June 2020 with distal tibial fractures. The patients treated with locking compression plates using Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) would be reviewed for inclusion and exclusion criteria’s. The sample size in our study is 30. The patients will be followed minimum for 6 months, 9 months, upto 12 months. Functional outcome was assessed using AOFAS scoring system.
Results: Out of the total 30 cases, 20 were males and 10 were females. The mean fracture healing time was 17 weeks (range 16-22weeks) and average AOFAS score was 87.2 out of a total possible 100 points. According to AOFAS scoring system, excellent results were observed in 15 cases, good results in 9 cases, satisfactory results in 3 cases and poor results in 3 cases. At last follow up, superficial infection occurred in 6 patients, deep infection in 1 patient, ankle stiffness in 1 patient, LLD<1cm in 1 patient and malunion in 3 patients.
Conclusion: MIPPO technique provides good bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures.