Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture

Joon-Woo Kim; Chang-Wug Oh; Jong-Keon Oh; Hee-Soo Kyung; Woo-Kie Min; Byung-Chul Park; Kyung-Hoon Kim; Hee-Joon Kim

doi:10.12671/jkfs.2009.22.1.6

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Kim, Oh, Oh, Kyung, Min, Park, Kim, and Kim: Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture

Original Article

Journal of the Korean Fracture Society 2009; 22(1): 6-12.

Published online: 31 January 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.1.6

Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture

Joon-Woo Kim, M.D., Chang-Wug Oh, M.D., Jong-Keon Oh, M.D.^*, Hee-Soo Kyung, M.D., Woo-Kie Min, M.D., Byung-Chul Park, M.D., Kyung-Hoon Kim, M.D., Hee-Joon Kim, M.D.

Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

^*Department of Orthopedic Surgery, School of Medicine, Korea University, Seoul, Korea.

Address reprint requests to: Chang-Wug Oh, M.D. Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, 101, Dongin-dong 2-ga, Jung-gu, Daegu 700-422, Korea. Tel: 82-53-420-5630, Fax: 82-53-422-6605, cwoh@knu.ac.kr

Received 20 October 2008 Accepted 10 December 2008

(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 assess the results of staged MIPO (Minimally Invasive Plate Osteosynthesis) for proximal tibial fractures with compromised soft tissue.

Materials and Methods

Eighteen proximal tibial fractures (AO 41:9 cases, AO 42:9 cases) included this study. Ten were open fractures. After temporary external fixation until soft tissue healed (mean 27.3 days), MIPO was performed secondarily without bone graft. We assessed the bony union and knee function, and affecting factors of the results were investigated.

Results

All fractures united at 20 weeks (range, 11~32) except 1 case. Mean range of knee flexion was 134.4° and mean IOWA knee score was 89.1. There were 2 superficial and 2 delayed deep infections from open fractures (grade II:1 case, grade III:3 cases), although they healed after implant removal. Open fractures seem to influence the infection rate. Otherwise, there was no related factor affecting the results.

Conclusion

MIPO after temporary external fixation can provide favorable results in proximal tibial fractures with soft tissue injuries, but attention of delayed infection should be paid in open fractures.

Keywords: Proximal tibial fracture, Minimally invasive plate osteosynthesis, External fixation, Staged treatment

Figures and Tables

Fig. 1

(A~C) A 51-year old man suffered from type IIIA open proximal tibial fracture.

(D) Bridging external fixation was performed on that day.

Fig. 2

(A, B) After wound healed at 13 days, MIPO was done (C) Satisfactory alignment was achieved on the postoperative radiograph.

(D, E) Follow-up radiograph after 10 month shows complete union of fracture.

Fig. 3

(A) A 52-year old man sustained proximal tibial fracture with severe comminution.

(B) Severe soft tissue swelling and contusion with fracture blisters implies compartment syndrome.

(C) Bridging external fixation with fasciotomy was done immediately.

(D) Wound was closed and swelling completely subsided after 21 days.

Fig. 4

(A, B) With MIPO procedure, (C) a good alignment was obtained.

(D, E) The fracture healed 14 weeks after surgery.

Table 1

Proximal tibial fractures treated with staged percutaneous plate stabilization

AO/OTA: Fracture classification according to arbeitsgemeinschaft für osteosynthesefragen and orthopaedic trauma association, Soft tissue condition includes the type of open fracture or compartment syndrome, CS: Compartment syndrome, Ex-Fix: External fixator, ROM: Range of motion.

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