2017, Vol. 1 Issue 3, Part A
Distal metaphysical fractures of Tibia are difficult to manage due to its poor blood supply and limited soft tissue envelope. Most of these are managed surgically using closed reduction with IMIL nail, ORIF with plating, closed reduction and percutaneous plating or external fixation. Principles of biological fixation advocate realignment by manipulation at a distance from fracture site, leaving comminuted fragments out of mechanical construct and preserving soft tissues with limited exposure. Thus MIPPO with LCP has emerging as a popular treatment option for distal tibial fractures.
Objectives: To evaluate the functional and radiological results of Locking Compression Plate (LCP) osteosynthesis in extra articular distal tibial fractures using Minimal Invasive Percutaneous Plate Osteosynthesis Technique (MIPPO)
Methodology: Patients with closed extra articular distal tibial fractures admitted under orthopedics in KIMS hospital were operated by Locking Compression Plate using MIPPO technique. Patients were followed up at regular intervals of 6 weeks for about 6 to 10 months. They were assessed clinically, functionally and with radiological evaluations. Functional assessment was done using AOFAS scoring system.
Results: In our study, the average age of patients was 46 years (19 – 68) with the male predominance (75%). Average time interval between injury and operation in our study was 3.2 days (2-7 days). Mean duration of surgery was 98.80 minutes. Mean interval of follow up was 7.8 months (6 to 10 months). Average period for radiological consolidation was 22 weeks. All patients achieved functional range of ankle movements during follow up period of 6-10 months. Functional outcome was measured using AOFAS score and mean AOFAS score was 88 at the end of 24 weeks. 02 cases of superficial wound infection/ delayed wound healing were encountered. 01 of case Deep Infection needing implant removal was seen. No other complications like deformities, compartment syndrome, non-union, implant irritation/skin impingement or implant failure were seen in our study.
Conclusion: LCP using MIPPO offers a biological advantage by preserving periosteal blood supply, which is particularly critical with distal tibial injuries. Combined with C arm guidance helps in indirect reduction of distal tibial fractures in restoring length and alignment, thus reducing the chances of malunion and deformities. There is decrease in the rate of deep infection in patients treated with MIPPO technique with good radiological union. It helps in early mobilization of ankle movements and reducing ankle stiffness thus improving clinical and functional outcome.