Minimal Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Fractures: A Prospective Study

Background: Fractures of distal tibia and pilon fractures are one of the most common fractures and are difficult to treat on account of, absence of muscle tissue attachment on lower 1⁄4 tibia and metaphyseal cancellous comminution. Most of them are compound fractures and result in poor blood supply to the distal tibia. The conventional technique of Open Reduction and Internal Fixation (ORIF) with plating of distal tibia fracture requires wide exposure, extensive soft tissue stripping with subsequent risk of infection and skin necrosis. Minimal Invasive Percutanous Plate Osteosunthesis (MIPPO) technique avoids all of the above and hence is associated with better functional results. Aim: The purpose of the study was to assess the complications and treatment outcome of closed extra-articular distal tibia fracture. Material and Methods: The results of the management for 50 patients with closed extraarticulardistal tibia fracture percutaneous plating were reviewed prospectively. The variables included Arbeitsgemeinschaft fur osteosynthesefragen (AO) classification of tibia fracture, the mean duration of union, malunion, and nonunion. Results: The most common type of fractures seen were A1 type observed in 33 patients. Initial union occurred in 44 patients. 2 patients had superficial wound infection and 1 had deep infection in plating group while the rest of 3 patients had other complications. None of the patients had restriction in knee and ankle motion. All fractures healed within one year. There was no fracture malunion. Conclusion: The use of indirect reduction techniques and small incisions to insert hardware is technically more demanding and requires strict radioscopic control throughout the procedure, but it considerably decreases surgical trauma to the soft tissues.