Dimensional Optimization in Screw Fixation for Personalized Treatment of the Tibial Plateau Fracture

Moldovan, Flaviu; Gligor, Adrian; Bățagă, Tiberiu

doi:10.1007/978-3-030-93817-8_69

Cited by 6 publications

(1 citation statement)

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“…Distal tibial fractures have a high risk of complications such as infection and soft tissue defects due to their complex fracture pattern and the small amount of soft tissue around the ankle joint [19], making it challenging for surgeons to select an appropriate treatment method. Owing to its biomechanical advantage of minimizing damage to the injured soft tissue and maintaining the vascular integrity of the periosteum, MIPO is one of the preferred procedures for treating distal tibial fractures [20][21][22]. However, when a metal plate is inserted into the inside of the ankle joint, the metal plate and the bone often float without being in close contact with each other, which can cause discomfort and pain (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Soft Tissue Defects after Minimally Invasive Plate Osteosynthesis in Fractures of the Distal Tibia: Clinical Results after Reverse Sural Artery Flap

Lee,

Yang

et al. 2023

Medicina

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Introduction: Distal tibial fractures make up approximately 3% to 10% of all tibial fractures or about 1% of lower extremity fractures. MIPO is an appropriate procedure and method to achieve stable metal plate fixation and osseointegration by minimizing soft tissue damage and vascular integrity at the fracture site. MIPO to the medial tibia during distal tibial fractures induces skin irritation due to the thickness of the metal plate, which causes discomfort and pain on the medial side of the distal leg, and if severe, complications such as infection and skin defect may occur. The reverse sural flap is a well-researched approach for covering defects in the lower third of the leg, ankle, and foot. Materials and Methods: Among 151 patients with distal tibia fractures who underwent minimally invasive metal plate fixation, soft tissue was injured due to postoperative complications. We treated 13 cases with necrosis and exposed metal plates by retrograde nasogastric artery flap surgery. For these patients, we collected obligatory patient records, radiological data, and wound photographs of the treatment results and complications of reconstructive surgery. Results: In all the cases, flap survival was confirmed at the final outpatient follow-up. The exposed area of the metal plate was well coated, and there was no plate failure due to complete necrosis. Three out of four women complained of aesthetic dissatisfaction because the volume of the tunnel through which the skin mirror passed and the skin plate itself were thick. In two cases, defatting was performed to reduce the thickness of the plate while removing the metal plate. Conclusions: Metal plate exposure after distal tibial fractures have been treated with minimally invasive metal plate fusion and can be successfully treated with retrograde nasogastric artery flaps, and several surgical techniques are used during flap surgery.

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