A Study of Functional Outcome of Distal Tibial Extra-Articular Fracture Fixed With Locking Compression Plate Using MIPPO Technique
A Study of Functional Outcome of Distal Tibial Extra-Articular Fracture Fixed With Locking Compression Plate Using MIPPO Technique
A Study of Functional Outcome of Distal Tibial Extra-Articular Fracture Fixed With Locking Compression Plate Using MIPPO Technique
Introduction
Distal tibial fractures are one of the most complex injuries around the ankle joint, accounting
for approximately 7% of all tibial fractures [1]. Fractures of the distal tibial metaphysis with or
without intra-articular extension can present a management challenge because of their inherent
instability, scarcity of soft tissues, subcutaneous nature and poor vascularity of bone.
Treatment modality is dictated by the fracture displacement, comminution, intra-articular
extension and injury to the soft-tissue envelope [2]. Soft-tissue management has been seen to
Correspondence play a vital role in the management alongside the bony reconstruction [3].
Dr. Girish S Several methods of treatment are implemented including non-operative treatment, external
Department of Orthopedics, fixation, intramedullary nailing, and internal fixation with traditional implants (standard
Kempegowda Institute of
Medical Science and Research screws and plates) [4]. However, each of these treatment options is associated with certain
Centre, Bengaluru, Karnataka, challenges [5]. For the recent decade, nailing and plating for fracture stabilization have been
India successfully used in treating fractures of lower extremity, especially distal tibia.
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The goal of the techniques is to achieve stable fixation while 2. Old neglected fractures
maintaining the fracture biology and minimizing the soft tissue 3. Old fractures with implant failure
problems. The use of Locking Compression Plate has 4. Associated with Neuro-Vascular injuries or compartment
revolutionized the management of fractures by reducing syndrome
immobilization in bed and ensuring early return to work.
Compared to conventional plates, locking plates impart a higher Clinical Assessment
degree of stability and provides better protection against primary On admission of the patient, a careful history was elicited from
and secondary loss of reduction [6, 7, 8]. the patient and/or attenders to reveal the mechanism of injury
Locking plates have the biomechanical properties of internal and and the severity of the trauma.
external fixators, with superior holding power because of fixed The patients were then assessed clinically to evaluate their
angular stability through the head of locking screws, general condition and the local injury. Methodical examination
independent of friction fit [9]. Locking plates are particularly was done to rule out fractures at other sites.
useful in severely comminuted and fragility fractures due to their
biomechanical properties of fixation [10]. Stress is laid on Radiographic Assessment
maintaining a precarious balance between devascularisation and Standard guidelines were followed to get radiographs. Antero-
mechanical perfection. This system stimulates callus formation posterior and lateral radiographs of the affected leg along with
due to flexible elastic fixation [11]. ankle were taken and the fracture patterns were classified based
A mechanically stable fracture-bridging osteosynthesis can be on the AO/OTA classification of fractures of distal tibia.
obtained without significant dissection and surgical trauma to
the bone and surrounding soft tissues by minimally invasive Pre Operative Evaluation
percutaneous plate osteosynthesis (MIPPO) [12]. Inpatients meeting the inclusion and exclusion criteria were
The objective of this study was to evaluate the functional results selected for the study. All the patients were explained about the
as well as radiological results and various complications aims of the study, the methods involved and an informed written
associated with Locking Compression Plate osteosynthesis using consent was obtained before being included in the study. Anti-
MIPPO technique in extra-articular distal tibial fractures. edema measures were taken to reduce swelling. Pre-operative
antibiotics were administered 30 min before the operation
Materials and methods
Source of Data Operative Procedure
The study was conducted on 20 patients admitted with extra All patients were operated by Locking Compression Plate (LCP)
articular distal tibial fracture during June 2013 to June 2017, in done using MIPPO technique. Surgery was performed under
Department of Orthopaedics, Kempegowda institute of medical spinal or General Anesthesia. Tournique was used. A vertical or
sciences and research centre, Bangalore. curvilinear incision was made at the level of medial malleolus.
Care was taken not to injure great saphenous vein and saphenous
Inclusion Criteria nerve. Subcutaneous plane was made without disturbing the
1. Age: Above 18 years up to 70 years of either sex fracture hematoma. Indirect reduction of fracture was done
2. Closed Distal Tibial extra articular fractures (as per AO under C-arm guidance and fixed with LCP plate and screws. In
Classification [1] 43A1, 43A2, 43A3) some cases fibula fracture was fixed first by open reduction
using DCP/1/3 semitubular plate and screws.
Exclusion Criteria
1. Pathological fractures
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Clinical Photos
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