Two-staged Delayed Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Open Fractures

Jung Hwan Yang; Seok Hyun Kweon; Jeung Woo Kim; Jin Young Park; Hyun Jun Kim; Chul Min Lim

doi:10.12671/jkfs.2008.21.1.24

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Yang, Kweon, Kim, Park, Kim, and Lim: Two-staged Delayed Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Open Fractures

Original Article

Journal of the Korean Fracture Society 2008; 21(1): 24-30.

Published online: 31 January 2008

DOI: https://doi.org/10.12671/jkfs.2008.21.1.24

Two-staged Delayed Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Open Fractures

Jung Hwan Yang, M.D., Seok Hyun Kweon, M.D., Jeung Woo Kim, M.D., Jin Young Park, M.D., Hyun Jun Kim, M.D., Chul Min Lim, M.D.

Department of Orthopaedic Surgery, School of Medicine, Wonkwang University, Iksan, Korea.

Address reprint requests to: Seok Hyun Kweon, M.D. Department of Orthopaedic Surgery, Wonkwang University Hospital, 344-2, Sinyong-dong, Iksan 570-711, Korea. Tel: 82-63-859-1360, Fax: 82-63-852-9329, osksh@wonkwang.ac.kr

(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 the outcomes of distal tibial open fractures treated by two-staged delayed minimally invasive percutaneous plate osteosynthesis (MIPPO) technique.

Materials and Methods

25 cases of distal tibial open fractures were treated with temporary ring fixation and two-staged delayed MIPPO. A mean age was 46 years old, follow-up was 23 months. The type of fracture was evaluated using the AO/OTA classification. The type of open fracture was evaluated using the Gustilo-Anderson classification that revealed 6 cases of type I, 9 cases of type II, 8 cases of type IIIA and 2 cases of type IIIB. We analyzed the radiologic results and postoperative complications. The clinical and functional result were evaluated by using Teeny and Wiss scores.

Results

The average time of bone union was 18 weeks in 24 cases. There were three delayed union that achieved union twenty weeks after second operation, and 1 case underwent bone graft with additional plate fixation. 6 cases of skin necrosis were treated with skin graft, 2 cases were treated with flap. The clinical and functional assessment showed that 6 cases were excellent, 16 cases were good, 2 cases were fair, and 1 case were poor results.

Conclusion

Two-staged MIPPO technique for distal tibia open fractures seems to be a good procedure to obtain bone union.

Keywords: Distal tibia, Open fracture, Minimal invasive percutaneous plate osteosynthesis (MIPPO)

Figures and Tables

Fig. 1

(A) AO/OTA type A3 and Gustilo-Anderson type II tibia fracture with fibular shaft fracture.

(B) Open wound about 9 cm was located on the anterior area of lower leg, and fracture site was being exposured.

(C) Immediate postoperative radiographs after hybrid external fixation.

(D) Immediate postoperative radiographs after two-staged MIPPO technique.

(E) At 21 weeks after two-staged MIPPO technique, the radiographs showed bony union and good alignment.

Fig. 2

(A, B) AO/OTA type C1 and Gustilo-Anderson type II tibia fracture with distal 1/3 fibular fracture of 61-years old male.

(C, D) Immediate postoperative radiographs after hybrid external fixation using olive wire about distal tibia fracture, rush pin fixation about distal fibular fracture.

(E) Immediate postoperative radiographs after two-staged MIPPO technique.

(F) At 14 weeks after secondary operation, bone union of fibula was not achieved.

(G) At 20 weeks after secondary operation, the patient underwent open reduction and internal fixation about fibular fracture, additional bone graft and plate fixation about tibial fracture.

Table 1

Analysis of patient data

^*Gustilo-Anderson classification, ^†Traffic accident, ^‡Spilit thickness skin graft, ^§Full thickness skin graft, ^∥Delayed union, ^¶Reverse saphenous flap.

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