Publication: Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Diametaphyseal Tibia Fracture
Date
2011
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Distal diametaphyseal tibia fracture though requires operative treatment is difficult
to manage. Conventional osteosynthesis is not suitable because distal tibia is
subcutaneous bone with poor vascularity. Closed reduction and minimally invasive
plate osteosynthesis (MIPO) with locking compression plate (LCP) has emerged
as an alternative treatment option because it respects biology of distal tibia and
fracture hematoma and also provides biomechanicaly stable construct.
Objectives
To find out suitability of MIPO with LCP for distal diametaphyseal tibia fracture
including union time and complicatios and compare wih other available
management options in literature.
Methods
Twenty patients with closed distal diametaphyseal tibia fracture with or without
intra articular extension (AO classification: 12 type 43A1, 4 type 43A2, 2 type 43A3
and 2 type 43B1) treated with MIPO with LCP were prospectively followed for
average duration of 18.45 months (range 5-30 months).
Results
Average duration of injury-hospital and injury-surgery interval was 12.8 hrs (range
2-44 hrs) and 4.45 days (range 1-10 days) respectively. All fractures got united
with an average duration of 18.5 weeks (range14-28weeks) except one case of
delayed union which was managed with percutaneous bone marrow injection.
Two patients had union with valgus angulation < 5 degees but no nonunion was
found. There were two superficial and one deep post operative wound infection. All
infections healed with extended period of intravenous antibiotics besides repeated
debridemet for deep infection. Implants were removed in eight patients among
whom six (30%) had malleolar skin irritation and pain due to prominent hardware.
Conclusion
The present case series shows that MIPO with LCP is an effective treatment
method in terms of union time and complications rate for distal diametaphyseal
tibia fracture. Malleolar skin irritation is common problem because of prominent
hardware.
Key Words
Distal diametaphyseal tibia fracture; LCP, MIPO
Description
Shrestha D,1 Acharya BM,2 Shrestha PM3
1Department of Orthopaedics and Traumatology Dhulikhel Hospital-Kathmandu University Hospital Dhulikhel, Nepal
2Department of Orthopaedics Patan Academy of Health Sciences Patan, Nepal
3Department of Orthopaedics Norvic International Hospital Kathmandu, Nepal