Staged Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures

Sung-Ki Park; Chang-Wug Oh; Jong-Keon Oh; Kyung-Hoon Kim; Woo-Kie Min; Byung-Chul Park; Won-Ju Jeong; Joo-Chul Ihn

doi:10.12671/jkfs.2010.23.3.289

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Park, Oh, Oh, Kim, Min, Park, Jeong, and Ihn: Staged Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2010; 23(3): 289-295.

Published online: 31 July 2010

DOI: https://doi.org/10.12671/jkfs.2010.23.3.289

Staged Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures

Sung-Ki Park, M.D., Chang-Wug Oh, M.D., Jong-Keon Oh, M.D.^*, Kyung-Hoon Kim, M.D., Woo-Kie Min, M.D.

, Byung-Chul Park, M.D., Won-Ju Jeong, M.D., Joo-Chul Ihn, 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.

^†Department of Orthopedic Surgery, Daegu Veterans Hospital, Daegu, 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, Deagu 700-422, Korea. Tel: 82-53-420-5630, Fax: 82-53-422-6605, cwoh@knu.ac.kr

Received 17 October 2009 Revised 28 April 2010 Accepted 12 May 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 assess the result of staged minimally invasive plate osteosynthesis (MIPO) for distal tibial fracture with an open wound or injured soft tissue.

Materials and Methods

In 20 patients (mean age, 47.8 year-old) with distal tibial fractures, there were 4 type A fractures and 16 type C fractures based on the AO classification system. Eight of the 20 patients had open fractures. MIPO was performed on average 23.9 days after bridging external fixation. At the final follow-up, we assessed the radiological results of bone union and alignment. Functional results were also evaluated by measuring the degrees of ankle motion and the American Orthopedic Foot & Ankle Society (AOFAS) scores.

Results

Seventeen of 20 cases (85%) achieved primary union at an average of 21.3 weeks. There were 3 cases of nonunion requiring a bone graft. The mean AOFAS score was 88.5 (range, 67~92) and the average range of ankle motion was 49.2° (plantarflexion: 37.4°, dorsiflexion: 11.8°). Complication included 2 cases of minor mal-alignment, 1 case of claw toe and 1 case of peroneal neuropathy. Patients over the age of 60 had lower functional results. Additional factors did not affect the final results.

Conclusion

Staged MIPO may achieve satisfactory results in distal tibial fractures with soft tissue compromise, decreasing deep infections and soft tissue complications.

Keywords: Distal tibial fracture, External fixation, Minimally invasive plate osteosynthesis

Figures and Tables

Fig. 1

(A) A 48-year old man sustained the distal tibial fracture with grade IIIA open wound.

(B) After fixation of fibula fracture, bridging external fixation was done with wound debridement and closure.

(C, D) After the improvement of soft tissue condition, medial plating was done with minimally invasive technique.

(E) At 6 month, a successful union was achieved with the good alignment.

Fig. 2

(A) An AO-OTA 43-C2 fracture.

(B) A bridging external fixation was applied.

(C, D) After the improvement of soft tissue condition, medial MIPO was done with joint reconstruction.

(E) A successful healing was achieved after 8 months.

Table 1

Distal tibial fractures treated with staged MIPO technique

^*TA: Traffic accident, ^†AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen and orthopedic trauma association, ^‡Ex-Fix: External fixator, ^§DMT: LCP distal medial tibia, ^∥ALDT: LCP Anterolateral distal tibia plate, ^¶PP-ADT: Periarticular anterolateral distal tibia plate, ^**ROM: Range of motion, ^††AOFAS: American orthopedic foot and ankle society.

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ORCID iDs: Woo-Kie Min
https://orcid.org/http://orcid.org/0000-0003-2079-5085
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