Minimally Invasive Plate Osteosynthesis for Fractures of Distal Tibia

Tae Hun Kim; So Hak Chung

doi:10.7180/kmj.2014.29.1.23

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Kim and Chung: Minimally Invasive Plate Osteosynthesis for Fractures of Distal Tibia

Original Article

Kosin Medical Journal 2014;29(1):23-29.

Published online: 17 December 2014

DOI: https://doi.org/10.7180/kmj.2014.29.1.23

Minimally Invasive Plate Osteosynthesis for Fractures of Distal Tibia

Tae Hun Kim, So Hak Chung

Department of Orthopedic Surgery, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: So Hak Chung, Department of Orthopaedic Surgery, Kosin University Gospel, Hospital, 34 Amnam-dong, Seo-gu, Busan, 602-702, Korea TEL: +82-51-990-6467 FAX: +82-51-243-0181 E-mail: shchung@kosin.ac.kr

Received 5 April 2013 Revised 27 October 2013 Accepted 16 December 2013

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

Objectives

This study analyzed clinical and radiologic results, and complications of minimally invasive plate osteosynthesis(MIPO) for distal tibia fracture.

Methods

16 patients (17 cases) who were performed MIPO for distal tibia fractures between January 2007 and June 2011, postoperative followed up at least for one year, were selected for this study. The average age was 55.0(26-76) years old and the average period of followup was 15.1(6-27) months. Most of the patients were encouraged to perform ankle dorsiflexion and straight leg raising exercise on splints, from the next day of the operation. As radiologic evaluation, we checked period until bone union, degree of angulation. And postoperative complications were also checked. For functional evaluation of the ankles, American Orthopaedic Foot and Ankle Society(AOFAS) score was used.

Results

16 of the 17 cases were achieved primary bone union, and average period of bone union in all the cases was 17.4 (12-42) weeks. Mean varus/valgus angulation after the bone union was 0.8 degrees and mean anteroposterior(AP) angulation was 1.8 degrees. Mean AOFAS score was 85.2(71-95) points; 5 cases of excellent, 10 cases of good, 1 case of fair, showing that 93.8% of the patients represented at least good AOFAS scores. As complications, there were 2 cases of superficial infection, and each 1 case of nonunion and skin irritation. There were no cases of deep infection, metal breakage, nor limb length discrepancy.

Conclusions

MIPO for distal tibia fracture is considered to be an effective operative method, because of its high bone union rate and low complications by minimal disruption of soft tissue and improved bone fixation strength. Also, for earlier return to daily life, ankle joint exercise should be started as soon as possible after the operation.

Keywords: Distal tibia, Early range-of-motion exercise, Facture, Mimimally invasive plate osteosynthesis (MIPO)

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Fig. 1.

(A) A 73 yeared-old woman was sustained distal tibiofibular comminuted fracture by slip down. (B) The distal tibia fracture was stabilized with LCP metaphyseal plate using minimal invasive technique. (C) At 16 weeks postoperatively, radiographs shows bone union.

Fig. 2.

(A) A 65-yeared old woman was sustained distal tibiofibular fracture by slip down. (B) The distal tibia fracture was treated with MIPO technique using LCP metaphyseal plate on medial side. (C) At 12 weeks postoperatively, radiograph shows bone union.

Table 1.

Patient data

Case	Age/Sex	Injury mechanism	AO/OTA ^⋆ classification	G-A^† classification	Union time (week)	Ankle^‡ score	Complication
1 2	62/F	SD^§	A2 A1	Closed Closed	13 17	86 81	No
3	49/F	TA^∥	A1	Closed	21	80	Metal irritation
4	37/M	TA	A2	Type I	42	82	Nonunion
5	30/M	TA	A1	Type I	17	85	No
6	65/F	SD	A2	Closed	12	84	No
7	53/M	SD	A1	Closed	14	91	No
8	50/F	SD	A1	Closed	17	91	No
9	73/F	SD	B1	Closed	18	81	No
10	76/M	FD^¶	A1	Closed	15	88	No
11	26/M	FD	A1	Closed	12	95	No
12	64/F	SD	A2	Closed	14	81	No
13	51/M	TA	A1	Type II	24	71	Skin infection
14	54/F	SD	A1	Type I	14	92	No
15	48/M	SD	A1	Closed	13	95	No
16	73/F	SD	A3	Closed	16	85	No
17	69/M	FD	A3	Closed	18	81	Skin infection

^⋆ AO/OTA: Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association

^† G-A: Gustillo-Anderson

^‡ Ankle score: ankle-hindfoot functional scale of AOFAS

^§ SD: Slip down

^∥ TA: Traffic accident

^¶ FD: Fall down.

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