Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) using Locking Compression Plate (LCP) in Distal Tibial Fractures: A Prospective Study of 50 Cases.
Vol 4 | Issue 1 | May – Aug 2018 | page: 34-37 | Rakesh Sharma, Rajesh Kapila, Sarika Kapila, Dharam Singh, Jagsir Mann
doi-10.13107/ti.2018.v04i01.064
Author: Rakesh Sharma [1], Rajesh Kapila[1], Sarika Kapila [2], Dharam Singh [1], Jagsir Mann [1] .
[1] Department of Orthopaedics, Govt. Medical College, Amritsar – 143001 (Punjab). India
[2] Dept. Of Oral and Maxillofacial Surgery, SGRD institute of dental sciences. Amritsar
Address of Correspondence
Dr. Rajesh Kapila
2-B , circular road, Amritsar-143001
Email: kapila.rajesh@ yahoo.com
Abstract
Background: The limited soft tissue, subcutaneous location of large portion of tibia and precarious blood supply renders the treatment of distal tibial fracture very challenging. The main treatment of this type of fracture is reinstatement of the normal alignment and articular congruity. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed Reduction and MIPPO with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia, maintains fracture haematoma and provides biomechanically stable construct, early mobilization, less complications and relatively higher rates of union. The aim of this study was to evaluate the functional and clinical outcomes of distal tibia fracture of patients, treated by internal fixation by minimally invasive plating osteosynthesis (MIPPO) technique with locking compression plate (LCP).
Methods: 50 patients with distal tibia fracture with or without intra articular extension were treated in our department, with MIPO with LCP and were prospectively followed for average duration of 6 months. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) score ( Ankle – Hindfoot Scale )
Results: There were 50 patients (36 males and 14 female) with mean age of 38.4 years. The mean follow up period of our patients was 6 months. All fractures united at an average of 19.13 weeks (range- 16-24 to weeks) except two cases of non- union. There were 8 superficial wound infections which were treated with oral antibiotics and progressed to union and there were no failures of implants. According to AOFAS score at 6 months, 6 cases had score of 31 to 70 and 44 cases had score of 71 to 100.
Conclusions: Minimally invasive plating osteosynthesis (MIPPO) is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incision is technically demanding and it is effective, minimally invasive, optimises the operation time, promotes early healing and reduces the incidence of infections and complications associated with conventional method of open reduction and internal fixation.
Keywords: Distal tibia, LCP, MIPPO, Osteosynthesis, Plating.
References
1. Ruedi T, Algower M. Fractures of the lower end of tibia into the ankle joint. Injury 1969; 1:92-9.
2. Orthopaedic Trauma Associated Committee for Coding and Classification. Fracture and Dislocation compendium. J Orthop Trauma 1996;10(1):1.
3. Smith WR, Ziran BH, Anglen JO, Stahel PF. Locking plates: tips and tricks. J Bone Joint Surg Am. 2007 Oct 1;89(10):2298-307.
4. Gustilo open fracture classification. OrthopaedicsOne Articles. In: OrthopaedicsOne – The Orthopaedic Knowledge Network. Created Mar 01, 2009 16:47. Last modified May 09, 2012 08:33 ver.246. Retrieved 2017-03-15, from http://www.orthopaedicsone.com/x/r4EqAQ.
5. American Orthopaedic Foot and Ankle Society
http://www.afoas.org/14a/pages/index.cfm?pageid=3494
6. Hazarika S, Chakravarthy J, Cooper J. Minimaly invasive locking plate osteosynthesis for fractures of distal tibia-results in 20 patients. Injury 2006; 37(9): 877-87.
7. Mushtaq A, Shahid R, Asif M. distaltibial fracture fixation with locking compression plate (LCP) using minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Eur J Trauma Emerg Surg 2009; 35: 159-64.
8. Gupta RK, Rohilla RK, Sangwan K, Singh V, Walia S. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients. Int Orthop 2009; 33: 120-3.
9. Leung FK, Law TW. Application of minimally invasive locking compression plate in treatment of distal tibial fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009; 23: 1323-5.
10. Ronga M, Longo UG, Maffulli N. Minimally invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat Res 2009; 468: 110-4.
11. Bahari S, Lenehan B, Khan H, McElwain JP. Minimally invasive percutaneous plate fixationof distal tibia fractures. Acta Orthop Belg 2007; 73: 635-40.
12. Zha G, Chen Z, Qi X. Minimally invasive percutaneous locking compression plate internal fixation in the treatment of tibial fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2008; 22: 1448-50.
13. Protzman R, Collinge C. Outcomes of Minimally Invasive Plate Osteosynthesis for Metaphyseal Distal Tibia Fractures. J Orthop Trauma 2010; 24: 24-9.
14. Collinge C, Kuper M, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma 2007; 21(6): 355-61.
| How to Cite this article: Sharma R, Kapila R, Kapila S, Singh D, Mann J.Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) using Locking Compression Plate (LCP) in Distal Tibial Fractures. A Prospective Study of 50 Cases. Trauma International May-Aug 2018;4(1):34-37. |
