Role of minimally invasive percutaneous plate osteosynthesis in the treatment of distal diametaphyseal tibial fractures

Abstract

The fractures of the distal tibia represent 7-10% of all tibial fractures and they usually encompass a spectrum of skeletal injury ranging from fractures caused by low-energy rotational forces to fractures caused by high-energy axial compression forces arising from motor vehicle accidents or falls from a height. Rotational variants typically have a more favorable prognosis, whereas high-energy fractures frequently are associated with open wounds or severe, closed, soft-tissue trauma. The fracture may have significant metaphyseal or articular comminution or diaphyseal extension. Better prognosis are given in case of low energy traumas. The study evaluates the results of the surgical treatment of distal tibia fractures, using minimally invasive plate osteosynthesis (MIPPO) technique. We treated in our unit 18 patients with distal tibia fractures with the MIPPO technique. The fractures, intra-articular or extra-articular, were classified according to the AO classification. The cases studied did not involve compound fractures or local dermatological lesions and we excluded the C3 fractures, for which traditional osteosynthesis is preferable. On the whole the outcomes were positive, thanks to a correct clinical indication. In conclusion we think that two are the elements that direct the choice regarding the type of approach and the type of device for the synthesis. The first is the condition of the skin, as far as its integrity is concerned, and the second is the articular condition, as far as the comminution and the number of fragments are concerned. Therefore we need to choose a synthesis that can guarantee a good outcome and can avoid dreadful complications and MIPPO is a valid technique when used correctly and by experts.