Minimally Invasive Plating Osteosynthesis with Nonlocked Small Fragment Implants for Extra-articular Fractures of the Distal Tibia

Author(s):

Vincenzo Giordano*, Renato Caravellos Glória, Hilton A. Koch, Felipe Serrão Souza, Paulo di Tullio, Marco Martins Lages and Ney Pecegueiro do Amaral

Background: In most diaphyseal and metaphyseal fractures of the distal tibia, treatment with open reduction and absolute stability with a plate is gradually changing to a concept of functional alignment and elastic fixation, a concept based on indirect reduction and percutaneous plating osteosynthesis, known as the MIPO (minimally invasive plating osteosynthesis) technique. In this technique, the bone is accessed through soft-tissue windows away from the fracture, thus avoiding direct exposure of the fracture site. Aim: The aim of this study is to evaluate a case series of distal diaphyseal and metaphyseal extra-articular tibia fractures treated according to the MIPO technique using small fragment non-locked implants. Materials and methods: This retrospective study reviewed of all cases of distal diaphyseal and metaphyseal extra-articular tibia fractures treated at our institution with the MIPO technique using conventional small fragment implants between January 2008 and January 2012. Patient demographics, operative reports, and clinical notes were reviewed, and time to radiographic union was assessed. Clinical outcomes were retrieved from patients at their follow-up visits, using the criteria by Olerud and Molander. Outcome parameters were compared between the 2 groups, distal diaphyseal and distal metaphyseal tibia fractures. Results: Thirty-eight patients with distal diaphyseal and metaphyseal extra-articular tibia fractures treated with MIPO technique using small fragment non-locked implants were identified. The mean time for radiographic union was 14 weeks (range: 12–17 weeks). There was no statistically significant difference between both groups regarding time for union. Of the 38 patients, 20 had a score superior to 91 (excellent) and 18 had between 61 and 90 (good). None of the patients had bad or poor results according to the criteria of Olerud and Molander (less than 60). The main complaints were sporadic or permanent perimalleolar edema, inability to run or jump, and slight reduction in work capacity or daily activities. We found no implant loosening, early loss of reduction, intraoperative malreduction, delayed union or nonunion, refractures, soft tissue irritation, or infection. Implant removal was not necessary in any cases. Conclusion: The use of non-locked small fragment implants is simple, affordable, and reliable method in clinical practice, and presents a good alternative for treating distal tibia fractures, with low rates of technical problems and complications, and satisfactory outcomes.