Outcomes of Treating Tibial Shaft Fractures Using Intramedullary Nailing (IMN) versus Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO)

Abstract

Background: Tibia shaft fractures are one of the most common long-bone fractures, second most common open sport-related injuries and they are estimated to occur in 4 percent of the senior population. Objective: Management of tibial fractures has been updating to achieve the best outcomes and avoid complications especially when talking about most common long bone fractures. Less invasive fixation techniques are the preferred ones to reduce surrounding soft tissue injury, improve healing process and decrease complications. Minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intramedullary nailing (IMN) are the least invasive and most popular modalities used nowadays. This study compares outcomes and complications of both modalities. Methods: This is a retrospective cohort study conducted in orthopedics department at KAUH-Jordan. Patients were followed up for a mean of 15.3 months. Only MIPPO and IMN were used, and exclusively tibial shaft fractures were included. Open fractures were classified according to the Gustilo-Anderson classification. Results: Ninety patients with a mean age of 36.9 years (range, 9-79) were observed. Fifty nine of them were treated with IMN; nine of them had complications. Thirty one patients were treated with MIPPO and only three developed complications. Three patients treated with IMN had non-union, whereas none of MIPPO patients developed non-union. Only perioperative blood loss was more when MIPPO was used taking into consideration the amount in the suction tube, amount of fluid irrigation and soaked gauze. Conclusion: In treating tibial shaft fractures, MIPPO appears to cause fewer complications and provides better healing environment therefore attributes to lower non-union rates than IMN. Larger sample size might be needed to provide better results.

Wound infection and healing in minimally invasive plate osteosynthesis compared with intramedullary nail for distal tibial fractures: A meta‐analysis

“…Unlike IMN, MIPO does not damage the penetrating blood vessels and nutrient vessels of the broken bones, which ensures sufficient blood supply for osteogenesis and the growth pathway of osteoid to cartilage scab under low oxygen tension, providing a good growth environment for fracture healing, thus favouring fracture healing 16 . Studies have also found that MIPO provides a better healing environment when treating tibial shaft fractures 57 . Therefore, MIPO is superior to IMN in promoting wound healing.…”

Combined osteosynthesis for tibial shaft fracture treatment

“…Несмотря на улучшение технологии хирургических методов лечениятребуется, при переломах большеберцовой кости могут встречаться случаи замедленного костного сращения и неудовлетворительных результатов. Конечно, результаты лечения зависят как от характера перелома, так и от метода лечения [14][15][16][17].…”

“…При накостном остеосинтезе обычно требуется большой по протяжённости оперативный доступ, что приводит к увеличению кровопотери и дополнительной травматизации окружающих перелом мягких тканей, а, следовательно, к ухудшению кровоснабжения зоны перелома [14][15][16]. Основным недостатком интрамедуллярного остеосинтеза является значительное Гений ортопедии.…”

A retrospective comparison of double-hooked locking plates versus non-locking plates in minimally invasive percutaneous plate osteosynthesis for the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures

“…During MIPPO, an incision of approximately 3 cm in length was made at one end of the fracture, and then a steel plate was inserted percutaneously; after the force line and alignment of the fracture were restored, the screw was inserted percutaneously for fixation. Generally, MIPPO does not require cutting the fracture end, so it can maximize the preservation of blood supply to the fracture and is conducive to fracture healing [ 2 , 3 ]. Some scholars believe that MIPPO is suitable for treating comminuted fractures with lots of bone fragments, numerous cancellous bones and a large contact surface [ 4 ].…”