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

Suh, Lee, Han, and Jeong: Anterolateral Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures Using an Anterolateral Locking Plate

Abstract

Purpose

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.

Results

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.

Conclusion

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.

References

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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.
jkfas-24-19f1.tif
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.
jkfas-24-19f2.tif
Figure 3.
The medial locking plate was exposed on medial side of the ankle.
jkfas-24-19f3.tif
Table 1.
Patients' Data
Case Sex/age (yr) AO/OTA
classification
G-A
classification
Injury
classification
1 M/71 A2 TA
2 M/59 C1 IIIA TA
3 F/68 B1 TA
4 M/52 A2 I FD
5 F/78 A3 SD
6 M/31 A3 II TA
7 M/39 A3 FD
8 F/49 A1 IIIA TA
9 M/45 C1 FD
10 M/36 A3 TA
11 M/56 A1 FD
12 F/71 A2 SD
13 M/52 A3 TA
14 M/49 B1 TA
15 F/52 A3 II FD
16 F/46 A3 TA
17 M/57 A2 II FD

AO/OTA: AO Foundation/Orthopaedic Trauma Association, G-A: Gustilo-Anderson, M: male, F: female, TA: traffic accident, FD: fall down, SD: slip down.

Table 2.
Outcomes and Complications
Case W Weeks to union Time to lateral
MIPO (day)
Mean 2nd op time
(min)
Iowa score Blood loss (mL) ROM of ankle
DF/PF (°)
Complications
1 16 14 55 88 72 10/40  
2 16 14 72 68 142 0/20  
3 18 14 45 93 91 20/40  
4 16 14 55 77 135 5/20  
5 20 21 50 92 128 5/30 Superficial infection
6 22 14 57 86 140 20/40  
7 12 10 46 78 112 10/35  
8 25 14 42 78 149 15/35  
9 20 21 34 75 122 5/20  
10 14 14 40 95 108 20/40  
11 16 14 36 78 116 10/30 Deep peroneal nerve irritation
12 14 14 31 95 148 10/40  
13 18 14 40 74 131 10/30  
14 12 10 35 85 128 20/30  
15 16 14 32 67 151 10/15  
16 14 10 37 96 120 15/20  
17 16 14 41 88 135 15/35  

MIPO: minimally invasive plate osteosynthesis, op: operative, ROM: range of motion, DF: dorsi flexion, PF: plantar flexion.

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