Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients

Abstract

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified.

Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Diametaphyseal Tibia Fracture

“…12 MIPO with LCP for distal diametaphyseal tibia fracture has been found to be an effective treatment option. 1,14,15,[20][21][22][23][24][25] 27 In spite of use of MIPO with LCP as internal external fixators, anatomical reduction of the fracture by using indirect reduction maneuvers before applying the plate is very important surgical step. Malreduction and suboptimal pre contouring of the plate can result delayed union, non union, prominent hardware, malleolar skin irritation and pain.…”

Locking versus non-locking neutralization plates for treatment of lateral malleolar fractures: a randomized controlled trial

“…The locking plate can be used in various ways; it may serve as a bridging plate, a compression plate, a tension band plate or a neutralization plate [7][8][9][10][11]. The use of a locking plate as a neutralization device for lag screw fracture fixation is one of the most important techniques for locking plate [7].…”

Minimally Invasive Plate Osteosynthesis with Conventional Compression Plate for Diaphyseal Tibia Fracture

“…As it requires indirect reduction of the fracture, there are risks of mal-reduction and mal-alignment which subsequently may cause mal-union 4 . Severe mal-union in tibial shaft fractures may deviate the mechanical axis of the lower limb causing imbalance in force distribution to the adjacent joints, with adverse joint effects.…”

“…This less invasive surgery has been described widely for proximal and distal tibial fractures, especially fractures at the diametaphyseal region and peri-articular fractures [3][4] . The outcomes of this techniques showed good wound healing as well as fracture union.…”