Clinical Outcome of Proximal Tibia Plates in Extra
Clinical Outcome of Proximal Tibia Plates in Extra
Clinical Outcome of Proximal Tibia Plates in Extra
DOI: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20223304
Original Research Article
1
Department of Regulatory Affairs, Kaulmed Private Limited, Sonipat, Haryana, India
2
Department of Clinical Research, Kaulmed Private Limited, Sonipat, Haryana, India
*Correspondence:
Dr. Akash Sharma,
E-mail: [email protected]
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Tibial fractures, which account for 2.2% of all intra-articular fractures, are frequent. These fractures are
prevalent in two age groups: younger patients experience higher-energy fractures, whereas elderly patients experience
lower-energy fractures as a result of osteopenia. These injuries are linked to a higher frequency of complications such
as non-union, infection, mobility limitation, and post-traumatic arthritis in the younger population. The study's primary
objective was to assess the results of proximal tibial fracture treated with a locking plate.
Methods: Thirty patients with proximal tibia fractures are included in this retrospective clinical study. They are all
treated with a tibia plate system made by Kaulmed private limited in Sonipat, Haryana, India. Thirty patients consisting
of 18 males and 12 females, with average age of 42 years. Fractures categorized based on AO classification and type of
soft tissue injury. Patients assessed clinically, radiologically, functionally using VAS, post-op radiographs and ROM.
Results: All 30 cases that were chosen were monitored for 6 months. The average time for fracture union was 21 weeks,
with a range of 18 to 24 weeks. No delayed union and non-union was observed. Infection, valgus, Knee stiffness were
the complication that was observed. Two patients complained about the mild pain on the post-operative visit. Acceptable
knee ROM of angle >120° was achieved and all patients were satisfied at their last visit based on parameters of pain,
ADLs, aesthetics and full weight bearing.
Conclusions: Excellent results were achieved in the surgical treatment of proximal tibia fractures by MIPO (minimal
invasive plate osteosynthesis) and ORIF (Open reduction and internal fixation) using proximal tibia plate technique.
Optimum knee function is achieved with reduction, rigid fixation to restore articular fragments, and early mobility.
preventing osteoarthritis following trauma.
Keywords: Proximal tibia fracture, Locking plate, Tibia plate system, MIPO, ORIF
The ORIF and MIPO are surgical techniques are some of The fixed angle constructs avoids implant translation or
implant fixation techniques that provide better clinical loosening as this allows for less precise contouring of
outcomes in case of complex proximal tibia fracture.6,7 plates, as fixation depends on the plate-screw construct
Therefore, orthopaedic surgeons have advanced from rather than the friction between plate bone interface, in the
conservative treatment to the internal fixation of fractures case of compression plates.
as the first choice of treatment in case of proximal tibia
fractures. Conservative treatment can be result stiffness in The following images show the plates that are used in this
the knee, non-union, and malunion. Surgical techniques study that includes locking plates. Different plates system
use implants that are locking compression plates for includes LISS (less invasive stabilization system) plates,
optimal clinical results, fracture union, and patient variable angle locking and non-locking plates (Figure 1).
outcomes. In this clinical study, the post-operative results
are assessed retrospectively by addressing improvements METHODS
using VAS, radiographs and ROM in the follow-up visit
after proximal tibia plate surgery. Data were gathered from 30 patients who were treated with
a tibia plate system during this retrospective study, which
Tibia plate system took place at Jawahar Lal Nehru hospital, Mauritius from
September 2021 to July 2022. The data collected from the
The tibia plate system consists of both dynamic hospital includes age, gender, fracture type, aetiology of
compression plates and locking plates. The locking plates injuries and post-operative visits. The study is approved by
are often used because of the locking screw and plate the institutional ethics committee.
provide stable construct the provide stability to the
fractures.8 The plates also feature compression holes Inclusion criteria
which provide compression when a non-locking screw is
inserted through them. The locking plates construct are Male or female participants who were at least 18 years old
also available in axial and poly-axial constructs. Both are and had recently suffered a proximal tibia fracture due to
fixed angle constructs. The main difference between such an injury between 12 and 72 hours before pre-operative
plates is that in fixed angle locking, the locking screw can investigation were included in the research. The patients
be implant only in nominal angle whereas in multi-axial included in the study have suffered from the fractures that
construct, the screw can be fixation the cone angle on 15° are amendable from the proximal tibia plates. The patient
which in result provide better result as this construct allows with at-least three follow-up visit in the period of one year.
fixation of many fractures that are not treatable through
standard compression plates.9 Exclusion criteria
load at surgical site. It was taken off after the confirmation Table 1: Demographic data.
of bone union. The mobilization was achieved after
removal of splint. After removal of sutures, physiotherapy Demographics Percentage (%)
exercise started for early recovery and motion, which was Sample size 30 (100)
done for a period of 25-30 days. Partial weight bearing also Mean age (years) 42
started after completion of physiotherapy. Youngest: 23
Range (years)
Oldest: 68
Statistical analysis Male 18 (60)
Female 12 (40)
All statistical analyses will be performed using Minitab. Adults 22 (73.33)
Results are reported as means ± standard deviations for Elderly 8 (26.67)
continuous variables and as number (%) for nominal
variables. The endpoints are summarized using Table 2: Aetiology.
descriptive statistics (Mean, Median standard deviation,
minimum, maximum). For a normal distribution, Fracture cause Percentage (%)
parametric tests will be applied; otherwise equivalent non- Adults
parametric tests will be applied for analysis. For normally Motor vehicle accidents 16 (72.7)
distributed data, intra group at various follow-up using Slip and fall 4 (16.7)
Paired-t-test using the statistical software. P≤ 0.05 to be Other (sports, etc.) 1 (10.6)
considered as statistically significant. Elderly
Motor vehicle accidents 1 (12.5)
RESULTS Slip and fall 7 (87.5)
The surgery from tibia plate fixation includes 18 males and
Table 3: Injury description.
12 females with mean age of 42 years (Table 1). In adults
the primary cause of proximal tibia accidents includes AO fracture type N
vehicle accidents, fall from heigh and sport injury whereas
41 A2-A3 23
in elderly (age>60) the primary cause includes low energy
41 B1-B3 2
trauma that includes fall different activities (Table 2). As
41 C1-C3 5
per the AO classification the patients have 41A, 41B and
41C type of fractures. The patients suffered from both Soft tissue injury
closed and open fractures. Open fracture are categorized Gustilo-Anderson I 16
based on Gustilo-Anderson I, II and III (Table 3). There Gustilo-Anderson II 10
were 25 isolated fractures and 5 compound fractures which Gustilo-Anderson III 4
were managed separately. In this study, the 19 patients
sustained injury on the right side and 11 on left side. Table 4: Post-operative complication.
At each follow up, radiological evaluation was performed Complication Percentage (%)
to assess the bone union progress. The meantime taken for Infection 5 (16.7)
full bone union was 21 weeks with a range of 18-24 weeks. Knee stiffness 3 (10)
No patient had delayed union and non-union. Post-ope Valgus 1 (3.3)
complication includes infection (5 patients) which were Normal 21 (70)
managed through orally, knee stiffness (3 patients) and
valgus deformity (1 patient) (Table 4). The clinical Table 5: Patient satisfaction.
assessment includes knee ROM and pain evaluation using
VAS score. The acceptable Knee ROM of >125° was Parameters Percentage (%)
achieved by 25 patients. At last visit 28 patients showed No pain 30 (100)
no pain whereas 2 patients showed mild pain (Figure 2). Full weight bearing 28 (93.3)
No complication related to implant was observed and all Aesthetics 24 (80)
the patients evaluated shows satisfactory results based on ADLs 30 (100)
parameters of pain reduction, full weight bearing,
aesthetics and ADLs (Activities of daily living) (Table 5). DISCUSSION
wound healing process along with the use of external conduct the study. The author(s) also thankful to Kaulmed
fixator.10 Such fractures are managed in stages with second private. Limited for providing the opportunity to
stage is the use of MIPO technique to stabilize the fracture participate in the study.
after the wound healed. The use of MIPO techniques in
management of proximal tibia fracture shows that it Funding: No funding sources
provides optimum results of rapid healing, minimization Conflict of interest: None declared
of soft-tissue injury, loss of function and prevention of Ethical approval: The study was approved by the
non-union and mal-union.11,12 institutional ethics committee