Minimally Invasive Plate Osteosynthesis for Open Fractures of the Proximal Tibia

Abstract

BackgroundRelatively few studies have addressed plate osteosynthesis for open proximal tibial fractures by now. The purpose of this study was to assess the results of minimally invasive plate osteosynthesis (MIPO) for open fractures of the proximal tibia.MethodsThirty-four patients with an open proximal tibial fracture were treated by MIPO. Thirty of these, who followed for over 1 year, constituted the subject of this retrospective study. According to the AO Foundation and Orthopaedic Trauma Association (AO-OTA) classification, there were 3 patients of type 41-C, 6 of type 42-A, 8 of type 42-B, and 13 of type 42-C. In terms of the Gustilo and Anderson's open fracture grading system, 11 patients were of grade I, 6 were of grade II, and 13 were of grade III (III-A, 6; III-B, 6; III-C, 1). After thorough debridement and wound cleansing, when necessary, a soft tissue flap was placed. Primary MIPO (simultaneous plate fixation with soft tissue procedures) was performed in 18 patients, and staged MIPO (temporary external fixation followed by soft tissue procedures and subsequent conversion to plate fixation after soft tissue healing) was performed in 12 patients. Results were assessed according to the achievement and time to union, complications (including infections), and function of the knee joint using Knee Society scores. Statistical analysis was performed to identify factors influencing results.ResultsPrimary union was achieved by 24 of the 30 study subjects. Early bone grafting was performed in 6 cases with a massive initial bone defect expected to result in non-union. No patient had malalignment greater than 10°. The mean Knee Society score was 88.7 at final follow-up visits, 23 patients achieved an excellent result, and 7 a good result. There were 3 superficial and 5 deep infections, but none required early implant removal. Functional results were similar for primary and staged MIPO (p = 0.113). Fracture pattern (p = 0.089) and open fracture grade (p = 0.079) were not found to influence the results.ConclusionsIf soft tissue coverage is adequately performed, MIPO could be regarded as an acceptable method for the treatment of open proximal tibial fracture.

Study of surgical management of proximal tibial fractures using locking compression plate

“…Feng et al [9] reported good results when fixed with LCP in comparison with dynamic compression plate (DCP) with an additional benefit of minimally invasive surgery. Kim et al [10] reported good results with MIPPO technique in treatment of open proximal tibial fractures with adequate soft tissue coverage.…”

Fixator-assisted Technique Enables Less Invasive Plate Osteosynthesis in Medial Opening-wedge High Tibial Osteotomy: A Novel Technique

“…Recently, surgical approaches using less invasive plate osteosynthesis have been used in various fracture surgeries to diminish soft tissue complications and promote biologic bone healing [3,17,28]. Although the less invasive technique has shown to have fewer soft tissue complications, faster union, and better cosmesis [6,17,19,21,28], it has never been devised to use in opening-wedge high tibial osteotomy.…”

“…Although the less invasive technique has shown to have fewer soft tissue complications, faster union, and better cosmesis [6,17,19,21,28], it has never been devised to use in opening-wedge high tibial osteotomy.…”

Postoperative Complications of Minimally Invasive Plate Osteosynthesis (MIPO) for Distal Tibial Metaphyseal Fractures

“…A high success rate and good clinical results from the MIPO technique have been reported in patients with distal tibial metaphyseal fractures [2,[7][8]. Although this technique has many advantages, several complications have been reported, such as skin irritation overlying the plates, skin necrosis, and plate exposure [2,[9][10][11][12]. Little has been reported about postoperative complications of the MIPO technique in patients with distal tibial metaphyseal fractures.…”