Comparison of minimally invasive percutaneous plate osteosynthesis with open reduction and internal fixation for treatment of extra-articular distal tibia fractures

      Abstract

      Introduction

      Minimally invasive percutaneous plate osteosynthesis (MIPPO) has become a widely accepted technique to treat distal tibia fractures. However, it remains unclear whether this strategy of biological osteosynthesis with a bridge plate is superior to that of absolute stability with traditional open reduction and internal fixation (ORIF).

      Methods

      In this pilot study, patients with distal tibia fractures, aged from 18 years to 60 years, were included from October 2005 to June 2007. Patients were randomly assigned to a closed group (the patients were treated by MIPPO) or an open group (the patients were treated by traditional ORIF) before they were categorised by AO fracture type. Wound healing was assessed at 2 weeks, 4 weeks, and 3 months postoperatively. Follow-up was performed once a month until the fractures achieved clinical union based on the standard criterion (pain-free full weight-bearing). Evaluation was performed for ankle range of motion, limb rotation, fracture healing, and radiographic alignment.

      Results

      Forty-two patients were randomised to the open group and 52 to the closed group. According to AO/OTA classification, fractures were classified as Types A (55.3%), B (25.5%), and C (9.1%). The median follow-up time was 14.0 months for the open group and 15.0 months for the closed group. There was no significant difference between the groups in healing time for Type A and Type B fractures; however, for Type C fractures, there was a trend towards shorter healing time in the closed group compared with the open group.

      Conclusions

      Our findings suggest that the strategy of biological osteosynthesis with a bridge plate might be superior to that of absolute stability for treating Type C tibia fractures. Further studies are needed to confirm our findings.

      Keywords

      To read this article in full you will need to make a payment
      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Perren S.M.
        Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology.
        J Bone Joint Surg Br. 2002; 84: 1093-1110
        • Sommer C.
        • Gautier E.
        • Muller M.
        • Helfet D.L.
        • Wagner M.
        First clinical results of the locking compression plate (LCP).
        Injury. 2003; 34: B43-B54
        • Wagner M.
        General principles for the clinical use of the LCP.
        Injury. 2003; 34: B31-B42
        • Farouk O.
        • Krettek C.
        • Miclau T.
        • Schandelmaier P.
        • Guy P.
        • Tscherne H.
        Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique?.
        J Orthop Trauma. 1999; 13: 401-406
        • Edwards S.L.
        • Wilson N.A.
        • Zhang L.Q.
        • Flores S.
        • Merk B.R.
        Two-part surgical neck fractures of the proximal part of the humerus: a biomechanical evaluation of two fixation techniques.
        J Bone Joint Surg Am. 2006; 88: 2258-2264
        • Peindl R.D.
        • Zura R.D.
        • Vincent A.
        • Coley E.R.
        • Bosse M.J.
        • Sims S.H.
        Unstable proximal extraarticular tibia fractures: a biomechanical evaluation of four methods of fixation.
        J Orthop Trauma. 2004; 18: 540-545
        • Krettek C.
        • Schandelmaier P.
        • Miclau T.
        • Tscherne H.
        Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures.
        Injury. 1997; 28: A20-A30
        • Schuz M.
        • Muller M.
        • Krettek C.
        • Höntzsch D.
        • Regazzoni P.
        • Ganz R.
        • et al.
        Minimally invasive fracture stabilization of distal femoral fractures with the LISS: a prospective multicenter study. Results of a clinical study with special emphasis on difficult cases.
        Injury. 2001; 32: SC48-SC54
        • Stannard J.P.
        • Wilson T.C.
        • Volgas D.A.
        • Alonso J.E.
        Fracture stabilization of proximal tibial fractures with the proximal tibial LISS: early experience in Birmingham, Alabama (USA).
        Injury. 2003; 34: A36-A42
        • Collinge C.
        • Sanders R.
        • DiPasquale T.
        Treatment of complex tibial periarticular fractures using percutaneous techniques.
        Clin Orthop Relat Res. 2000; 375: 69-77
        • Egol K.A.
        • Kubiak E.N.
        • Fulkerson E.
        • Kummer F.J.
        • Koval K.J.
        Biomechanics of locked plates and screws.
        J Orthop Trauma. 2005; 18: 488-493
        • Greiwe R.M.
        • Archdeacon M.T.
        Locking plate technology: current concepts.
        J Knee Surg. 2007; 20: 50-55
        • Farouk O.
        • Krettek C.
        • Miclau T.
        • Schandelmaier P.
        • Guy P.
        • Tscherne H.
        Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study.
        Injury. 1997; 28: A7-A12
        • Collinge C.
        • Sanders R.
        Minimally-invasive plating.
        J Am Acad Orthop Surg. 2000; 8: 211-216
        • Borrelli Jr., J.
        • Prickett W.
        • Song E.
        • Becker D.
        • Ricci W.
        Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study.
        J Orthop Trauma. 2002; 16: 691-695
        • Collinge C.
        • Kuper M.
        • Larson K.
        • Protzman R.
        Minimally invasive plating of high-energy metaphyseal distal tibia fractures.
        J Orthop Trauma. 2007; 21: 355-361
        • Partenheimer A.
        • Gösling T.
        • Möller M.
        • Schirmer C.
        • Kääb M.
        • Matschke S.
        • et al.
        Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation.
        Unfallchirurg. 2007; 12: 456-459
        • Redfern D.J.
        • Syed S.U.
        • Davies S.J.M.
        Fractures of the distal tibia: minimally invasive plate osteosynthesis.
        Injury. 2004; 35: 615-620
        • Borg T.
        • Larsson S.
        • Lindsjo U.
        Minimally-invasive plating of distal tibia fractures: preliminary results in 21 patients.
        Injury. 2004; 35: 608-614
        • Collinge C.
        • Protzman R.
        Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures.
        J Orthop Trauma. 2010; 24: 24-29
        • Helfet D.L.
        • Shonnard P.Y.
        • Levine D.
        • Borrelli Jr., J.
        Minimally invasive plate osteosynthesis of distal fractures of the tibia.
        Injury. 1997; 28: S-A42-8
        • Guo J.J.
        • Tang N.
        • Yang H.L.
        • Tang T.S.
        A prospective, randomized trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia.
        J Bone Joint Surg Br. 2010; 92: 984-988