Management of Fractures of Distal Tibia by Minimally Invasive Plate Osteosynthesis through an Anterior Approach

Gu-Hee Jung; Jae-Do Kim; Jae-Ho Jang; Sung-Keun Heo; Dong-won Lee

doi:10.4055/jkoa.2010.45.6.473

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Jung, Kim, Jang, Heo, and Lee: Management of Fractures of Distal Tibia by Minimally Invasive Plate Osteosynthesis through an Anterior Approach

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(6): 473-481.

Published online: 24 December 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.6.473

Management of Fractures of Distal Tibia by Minimally Invasive Plate Osteosynthesis through an Anterior Approach

Gu-Hee Jung, M.D., Jae-Do Kim, M.D., Jae-Ho Jang, M.D., Sung-Keun Heo, M.D.^*, Dong-won Lee, M.D.^*

Department of Orthopedic Surgery, Gospel Hospital, Kosin University, Busan, Korea.

^*Gi-Jang Hospital, Busan, Korea.

Correspondence to: Gu-Hee Jung, M.D. Department of Orthopaedic Surgery, Gospel Hospital, Kosin University, 34, Anam-dong, Seo-gu, Busan 602-030, Korea. TEL: +82-51-990-6229, FAX: +82-51-243-0181 jyujin2001@kosin.ac.kr

Received 10 January 2010 Accepted 6 July 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate functional results and complications after minimally invasive plate osteosynthesis through an anterior approach for distal tibial fractures, including pilon fracture.

Materials and Methods

Between March 2007 and December 2008, thirteen patients with fractures of the distal tibia were treated with minimally invasive plate osteosynthesis through an anterior approach, and were followed for a mean of 16.2 months (range, 12-30 months). Fractures according to the AO/OTA classification were six 43A, four 43B and three 43C. We analyzed functional results by bone union, postoperative complications, and the Olerud and Molander ankle scoring system.

Results

All fractures were united after a mean of 15.7 weeks (range, 12 to 24 weeks) except one case. There were 2 cases of superficial wound infection, one case of fibular shortening and metal failure, and two cases of tibialis anterior tendon adhesion. The average functional score was 79 points (range, 35-95 points) and results were four excellent, six good and three fair.

Conclusion

Minimally invasive plate osteosynthesis through an anterior approach may be used for distal tibial fracture with medial soft tissue injury, and has an advantage in that the metaphyseal and distal articular fracture are fixed at the same time through a single incision However, it should be approached with caution because of the risk of complications due to the anterior approach, such as iatrogenic injury of the tibialis anterior tendon.

Keywords: distal tibia, fracture, plate, minimally invasive plate osteosynthesis (mipo), anterior approach

Figures and Tables

Figure 1

(A) After a single calcaneal transfixation pin and two half-pins are inserted in the tibia, the fibular is fixed with the semitubular plate. (B) The spanning external fixator is applied. (C) The articular surface is repaired with the 2.0 mm implant, if needed. (D) After the acceptable reduction, the wound is closed.

Figure 2

(A) The distal tibia is approached through the interval between extensor hallucis longus and extensor digitorum longus. There are two options for distal tibial fracture that include single ALDTP® (B) and ALDTP® with medial LCP® (C).

Figure 3

An active 16-year-old man fell down 15 m from a tree. (A) Initial radiographs showed the severely comminuted fracture of the distal tibia and fibula (Pilon fracture). (B) He was treated primarily with spanning external fixator and fibular fixation. The articular surface was repaired with the 2.0 mm implant. (C) After the resolution of edema, the fracture was managed with minimally invasive plate osteosynthesis (ALDTP®) through anterior approach. (D) He had good clinical outcomes.

Table 1

Summary of Cases

^*Tscherne and Gotzen grading system of soft-tissue injury; ^†Gustilo-Anderson open fracture grading system; ^‡Olerud and Molander ankle score system (E: excellent, G: good, F: fair, P: poor); ^§Fall down; ^∥Spanning external fixator; ^¶Traffic accident; ^**Tibialis anterior.

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