Distal Tibia Metaphyseal Fractures Treated by Percutaneous Plate Osteosynthesis

Abstract

Twenty-one patients with fractures of the distal tibial metaphysis, some with minimal displacement in the ankle, were treated by percutaneous plate osteosynthesis with a narrow limited contact-dynamic compression plate. Using the classification by the Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association, 17 fractures had no articular involvement, whereas four included intraarticular extension. At final followup (mean, 20 months), all the fractures healed without second procedures and the mean union time was 15.2 weeks. One patient had malalignment of the limb with 10؇ internal rotation, but there were no angular deformities greater than 5؇ or any shortening greater than 1 cm. All patients had excellent or satisfactory ankle function. There were no infections or any soft tissue compromise. Percutaneous plate osteosynthesis is a safe and worthwhile method of managing such fractures, which avoids some of the complications associated with conventional open plating methods.Conservative treatment of fractures of the distal tibia with extension into the ankle results in an unacceptable deformity and ankle stiffness. Conventional open reduction and plate fixation often requires extensive exposure and can result in the devitalization of surrounding tissue, infection, wound breakdown, and ankle stiffness. 20 These results have motivated orthopaedic surgeons to do biologic surgical techniques to reduce damage to soft tissues and the vascular supply to bone. 2 Intramedullary nailing, a main treatment of tibia diaphyseal fractures, sometimes fails to stabilize fractures in the distal metaphysis because of malreduction.Because of problems with other operative techniques, osteosynthesis with a percutaneous plate in which the fracture site is minimally exposed was investigated to better define its advantages and disadvantages as a treatment method for distal tibia metaphyseal fractures. MATERIAL AND METHODS PatientsThis retrospective study included 21 patients who sustained fractures of the distal tibia metaphysis.

Double plating of unstable proximal tibial fractures using minimally invasive percutaneous osteosynthesis technique

“…(Marsh et al 1995) Recently, the MIPO technique has been developed-not only to improve the rate of fracture healing (Krettek et al 1997, Collinge et al 2000, but also to limit soft tissue elevation at the fracture site (Farouk et al 1999). In our series, all fractures united without primary or secondary bone graft, as has been reported for distal tibial metaphyseal fractures (Oh et al 2003).…”

Fractures of the Distal Tibia Treated with Polyaxial Locking Plating

“…Malalignment has been recognized as a potential pitfall when using MIPO techniques because the bone is not directly visualized. With the MIPO technique and conventional or monoaxial locking plate osteosynthesis for fractures of the distal tibia, 7% to 35% of distal tibia fractures have been reported to have problems with malalignment [6,19,21,23,26,29,31]. In our series, no cases of postoperative malalignment were observed and no cases of postoperative stability failure were seen.…”

Comparative Multicenter Study of Treatment of Multi-Fragmented Tibial Diaphyseal Fractures With Nonreamed Interlocking Nails and With Bridging Plates

“…Bridging plates are used more often in diaphyseal fractures that compromise the proximal and distal ends of the tibia [11][12][13][14][15] ; however, in this study this aspect was not considered, since patients were randomly allocated. The placement of the plate on the anterior-medial tibial face is technically easier and leads to less compromise of its vascularization.…”