Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) for Distal Tibial Metaphyseal Fracture: A Better Option

Authors

  • Dr Muhammad Akhtar Services Insititute of Medical Sciences
  • Muhammad Tasneem Javed
  • Omer Iqbal Cheema
  • Shahzad Anver Qureshi
  • Saif-ur-Rehman
  • Omar Anwar
  • Rana Dilawaiz Nadeem

DOI:

https://doi.org/10.51273/esc23.251913

Keywords:

Locking compression plate, Minimally invasive percutaneous plate osteosynthesis

Abstract

Objective: The objective of this study was to evaluate the radiological and functional outcomes in of treatment of fracture distal tibial metaphysis fixed with pre-contoured anatomical locking compression plate using minimally invasive percutaneous plate osteosynthesis (MIPO) technique.

Methods: This was a prospective study conducted at Department of Orthopedic Surgery, Services Hospital Lahore. Total of 58 closed distal tibial metaphyseal fractures (AO classification 43A) included in the study. All patients were operated using anatomical LCP with MIPO technique. The functional outcome was assessed by Tenny & Wiss criteria at 6 weekly intervals with final scoring at 24th week. Functional outcome was graded as excellent, good, fair and poor. Similarly, radiological outcome was also assessed at 6 week intervals using Hammer et al criteria and grade 3 labelled as union.

Results: We observed excellent functional outcome in 48 patients (82.6%) and good outcome in 6(10.34%) at last follow-up. Radiological union was achieved in 100% (58) patients at 24th week. The average time of union was 16.5 weeks with a range of 12 to 23 weeks. Total 03 patients (5.17%) developed superficial wound infection which was successfully managed with antibiotic therapy and no surgical site deep infection reported.

Conclusion: Results of this study advocate that treatment of distal tibial metaphyseal fractures with LCP by MIPPO technique is an effective modality resulting in low complication rate, high union rates and good functional outcome.

 

 

References

Weiss RJ, Montgomery SM, Ehlin A, Dabbagh ZA, Stark A, Jansson KA. Decreasing incidence of tibial shaft fractures between 1998 and 2004: information based on 10,627 Swedish inpatients. Acta orthopaedica 2008; 79:526-33.

Bedi A, Le TT, Karunakar MA. Surgical treatment of nonarticular distal tibia fractures. Journal of the American Academy of Orthopaedic Surgeons 2006; 14:406-16.

Digby JM, Holloway G,Webb JK. A study of function after tibial cast bracing. Injury 1983; 14:432-9.

Rammelt S, Endres T, Grass R, Zwipp H. The role of external fixation in acute ankle trauma. Foot and ankle clinics 2004; 9:455-74.

Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. Journal of orthopaedic trauma 2008;22:307-11.

Mushtaq A, Shahid R, Asif M, Maqsood M. Distal tibial fracture fixation with locking compression plate (LCP) using the minimally invasive percutaneous osteosynthesis (MIPO) technique. European Journal of Trauma and Emergency Surgery 2009; 35: 159-64.

Ronga M, Longo UG, Maffulli N. Minimally invasive locked plating of distal tibia fractures is safe and effective. Clinical Orthopaedics and Related Research 2010; 468: 975-82.

Gupta RK, Rohilla RK, Sangwan K, Singh V, Walia S. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients. International orthopaedics 2010; 34: 1285-90.

Hazarika S, Chakravarthy J, Cooper, J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia-results in 20 patients. Injury 2006; 37:877-87.

Ahmad MA, Sivaraman A, Zia A, Rai A, Patel AD. Percutaneous locking plates for fractures of the distal tibia: our experience and a review of the literature. Journal of Trauma and Acute Care Surgery 2012; 72: 81-7.

Hammer RRR, Hammerby S, Lindholm B. Accuracy of radiologic assessment of tibial shaft fracture union in humans. Clin Orthop 1985; 199:233-8.

Bailey IS, Karran SE, Toyn K, Brough P, Ranaboldo C, Karran SJ. Community surveillance of complications after hernia surgery. BMJ 1992; 304(6825): 469-71

Wagner M. General principles for the clinical use of the LCP. Injury 2003;34:31-42.

Sommer C, Gautier E, Müller M, Helfet DL, Wagner M. First clinical results of the Locking Compression Plate (LCP). Injury 2003; 34:43-54.

Borg T, Larsson S, Lindsjö U. Percutaneous plating of distal tibial fractures: preliminary results in 21 patients. Injury 2004; 35:608-14.

Maffulli N, Toms AD, McMurtie A, Oliva F. Percutaneous plating of distal tibial fractures. International orthopaedics 2004; 28:159-62.

Frigg, R. Development of the locking compression plate. Injury 2003; 34:6-10.

Gurung BB, Dahal M, Pradhan R, Giri RBSK. Minimal invasive percutaneous plate osteosynthesis of fracture of tibia. Post-Graduate Medical Journal of NAMS 2007; 7.

Pai V, Coulter G, Pai V. Minimally invasive plate fixation of the tibia. International orthopaedics 2007; 31:491-6.

Shabbir G, Hussain S, Nasir ZA, Shafi K, Khan JA. Minimal invasive plate osteosynthesis of close fractures of distal tibia. J Ayub Med Coll Abbottabad 2011; 23.

Bahari S, Lenehan B, Khan H, McElwain JP. Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthopædica Belgica 2007; 73:635.

Aksekili MAE, Celik I, Arslan AK, Kalkan T, Ugurlu M. The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures. Acta orthopaedica et traumatologica turcica 2012;46:161-7.

Rajneesh G, Renu G. Locking Compression Plate Osteosynthesis In Fracture Of Distal Tibia–Result Of 27 Patients. International Journal of Innovative Research and Development 2013.

Shrestha DAB, Shrestha PM. Minimally invasive plate osteosynthesis with locking compression plate for distal diametaphyseal tibia fracture. Kathmandu Univ Med J 2011; 34:62-8.

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Published

2023-05-13

How to Cite

1.
Dr Muhammad Akhtar, Tasneem Javed M, Iqbal Cheema O, Anver Qureshi S, Saif-ur-Rehman, Anwar O, Dilawaiz Nadeem R. Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) for Distal Tibial Metaphyseal Fracture: A Better Option. Esculapio - JSIMS [Internet]. 2023 May 13 [cited 2024 May 15];19(01):13-7. Available from: https://esculapio.pk/journal/index.php/journal-files/article/view/166

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