Comparative Analysis of Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Intramedullary Nailing in Distal Tibial Metaphyseal Fractures

Gwang Chul Lee; Jun Young Lee; Sang Ho Ha; Hong Moon Sohn; Yi Kyu Park

doi:10.12671/jkfs.2012.25.1.20

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Lee, Lee, Ha, Sohn, and Park: Comparative Analysis of Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Intramedullary Nailing in Distal Tibial Metaphyseal Fractures

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2012; 25(1): 20-25.

Published online: 31 January 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.1.20

Comparative Analysis of Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Intramedullary Nailing in Distal Tibial Metaphyseal Fractures

Gwang Chul Lee, M.D., Jun Young Lee, M.D., Sang Ho Ha, M.D., Hong Moon Sohn, M.D., Yi Kyu Park, M.D.

Department of Orthopaedic Surgery, College of Medicine, Chosun University Hospital, Gwangju, Korea.

Address reprint requests to: Jun Young Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 588, Seosuk-dong, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, leejy88@chosun.ac.kr

Received 24 May 2011 Revised 13 August 2011 Accepted 8 November 2011

(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 compare results between minimally invasive plate osteosynthesis using a periarticular plate and intramedullary nailing in distal tibial metaphyseal fractures in two treatment groups.

Materials and Methods

Sixty-one cases of distal tibial metaphyseal fractures from December 2008 to December 2009 were evaluated. The minimal follow-up period was 12 months. Thirty patients treated by minimally invasive plate osteosynthesis using a periarticular plate were Group A; 31 patients treated by intramedullary nailing were Group B. We compared and analyzed the results of each group by radiological and clinical assessments.

Results

The mean bony union time was 16.4 weeks in Group A and 17.2 weeks in Group B. The mean operation time was 45 minutes in Group A and 48 minutes in Group B. The mean radiation exposure times were 4.2 minutes and 4.8 minutes, respectively. VAS scores were 0.7 points and 0.5 points in each respective group. In Group A, the VAS score was 1.7 points when we applied pressure on the skin around the plate. The mean Olerud and Molander Ankle Score was 87.4 points and 86.3 points, respectively. A superficial wound infection occurred in 1 case in each group, and angular deformities more than 5 degrees occurred in 2 Group B cases.

Conclusion

No significant differences in results were observed between the two groups. However, a higher incidence of angular deformity was seen in the intramedullary nailing group. Therefore, we must be careful during surgery.

Keywords: Distal tibial metaphyseal fractures, Minimally invasive plate osteosynthesis (MIPO), Intramedullary nailing

Figures and Tables

Fig. 1

The fluoroscopic X-rays reveals joy stick method that parallel K-wire fixation on distal tibia for more accurate reduction during insertion of ball-tip guide wire and reaming of the medullary canal (In this case, excute conservative treatment about fibular fracture).

Fig. 2

The fluoroscopic X-rays (A~D) reveal using the poller screw for accurate insertion nail. Postoperative X-ray, (E) anteroposterior, and (F) lateral view.

Table 1

Distal tibial fracture pattern (AO classification) and combined fibular fractures between Group A and B

Table 2

Distance between Ankle articular surface and fracture site between Group A and B

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