Journal List > J Korean Foot Ankle Soc > v.24(1) > 1144009

J Korean Foot Ankle Soc. 2020 Mar;24(1):19-24. Korean.
Published online Mar 13, 2020.
Copyright © 2020 Korean Foot and Ankle Society
Anterolateral Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures Using an Anterolateral Locking Plate
Dongwhan Suh, Hwan Hee Lee, Young Hoon Han and Jae Jung Jeong
Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.

Corresponding Author: Jae Jung Jeong. Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea. Tel: 82-42-220-9530, Fax: 82-42-221-0429, Email:
Received Jan 16, 2020; Revised Feb 01, 2020; Accepted Feb 04, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



Anterolateral minimally invasive plate osteosynthesis (MIPO) was performed to treat patients with distal tibial fractures associated with open fractures or extensive soft tissue injuries, which is limited medial MIPO. The treatment results of the anterolateral MIPO technique were evaluated and analyzed.

Materials and Methods

Seventeen patients with distal tibial fractures associated with an open fracture or large bullae formation on the distal tibia medial side were treated with anterolateral MIPO using anterolateral locking plates. Within 24 hours of visiting the emergency room, external fixation was applied, and the medial side wound was managed. After damage control, the anterolateral locking plate was applied using an anterolateral MIPO technique. The union time, nonunion, or malunion were evaluated with regular postoperative radiographs. The ankle range of motion, operative time, blood loss, Iowa score, and wound complications were investigated.


Radiological evidence of bony union was obtained in all cases. The mean time to union was 16.7 weeks (12~25 weeks). The mean operation time was 44.0 minutes. Regarding the ankle range of motion, the mean dorsiflexion was 15°, and the mean plantarflexion was 35°. Satisfactory results were obtained in 15 out of 17 cases; five results were classified as excellent, four were good, and six were fair. The mean blood loss was 125.2 mL. Two complications were recorded.


In distal tibial fractures with severe medial soft tissue damage caused by high-energy trauma, the staged anterolateral MIPO technique using anterolateral locking plates is a useful alternative treatment to achieving optimal wound care, rapid union with biological fixation, and intra-articular reduction.

Keywords: Distal tibial fracture; Minimally invasive plate osteosynthesis; Anterolateral locking plate


Figure 1
(A) A 71-year-old female was sustained distal tibia fracture with severe soft tissue swelling and blister. (B) Plain radiographs of the left ankle showed a distal tibial fracture of AO type A2 (AO Foundation/Orthopaedic Trauma Association classification). (C) A temporary external fixtor was applied to maintain for reduction of fracture, the length and alignment of the limb. (D) After the damage control, anterolateral plate was inserted through minimal anterior approach minimally invasive plate osteosynthesis (MIPO) technique. During anterolateral MIPO, an external fixator was used to maintain for reduction of the fracture. (E) At postoperative 1-year, the bony union of the fracture with callus site is visible.
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Figure 2
(A) A 49-year-old female was sustained painful swelling and an open wound on the medial side of the right ankle due to a traffic accident. The fracture site of the distal tibia, which was a type IIIA open fracture, was exposed. (B) Plain radiographs of the left ankle showed a distal tibial fracture of AO type A1 (AO Foundation/Orthopaedic Trauma Association classification). (C) After the damage control by temporary external fixator, anterolateral plate was inserted through minimal anterior approach minimally invasive plate osteosynthesis (MIPO) technique. (D) Photograph after wound closure. Because anterolateral MIPO was performed, wound problems could be avoided. At postoperative 1-year, ankle anteroposterior (E) and lateral (F) plain radiographs show a bony union of the fracture site with callus formation.
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Figure 3
The medial locking plate was exposed on medial side of the ankle.
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Table 2
Outcomes and Complications
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Financial support:None.

Conflict of interest:None.

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