Research Article| Volume 28, SUPPLEMENT 1, A42-A48, 1997

Minimally invasive plate osteosynthesis of distal fractures of the tibia

      This paper is only available as a PDF. To read, Please Download here.


      Minimally invasive plate osteosynthesis of distal tibial fractures is technically feasible and may be advantageous in that it minimizes soft tissue compromise and devascularization of the fracture fragments. The technique involves open reduction and internal fixation of the associated fibular fracture when present, followed by temporary external fixation of the tibia until swelling has resolved. Subsequent limited, but open reduction and internal fixation of the articular fragments when displaced followed by minimally invasive plate osteosynthesis of the tibia utilizing precontoured tubular plates and percutaneously placed cortical screws is performed. The semitubular plate was chosen because it adapts more easily to the bone contours than the stiffer small fragment LC-DCP does.
      Twenty patients (age 25–59 years) with unstable intraarticular or open extruarticular fractures have been treated including 12 A-type, 1 B-type and 7 C-type fractures according to the AO classification. Two fractures were open (both Gustilo Type I). Closed soft tissue injury was graded according to Tscherne with 3 type CO, 7 type C1, 7 type C2 and 1 type C3. All fractures healed without the need for a second operation. Time to full weight-bearing averaged 10.7 weeks (range 8–16 weeks). Two fractures healed with >5° varus alignment and 2 fractures healed with >10° recurvatum. No patient had a deep infection. The average range of motion in the ankle for dorsiflexion was 14° (range 0–30°) and plantar flexion averaged 42° (range 20–50°).
      With longer follow-up and a larger number of patients, the authors feel confident that the minimally invasive technique for plate osteosynthesis for the treatment of distal tibial fractures will prove to be a feasible and worthwhile method of stabilization while avoiding the severe complications associated with the more standard methods of internal or external fixation of those fractures.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McFerran M.A.
        • Smith S.W.
        • Boulas H.J.
        • Schwartz H.S.
        Complications encountered in the treatment of pilon fractures.
        J. Orthop. Trauma. 1992; 6: 195-200
        • Brumback R.J.
        • McGarvey W.C.
        Fractures of the tibia] plafond.
        Orthop. Clin. North Am. 1995; 26: 273-285
        • Teeny S.M.
        • Wiss D.A.
        Open reduction and internal fixation of tibial plafond fractures;Variable contributing to poor results and complications.
        Clin. Orthop. 1993; 292: 108-117
        • Tornetta III, P.
        • Weiner L.
        • Bergman M.
        • et al.
        Pilon fractures: Treatment with combined internal and external fixation.
        J. Orthop. Trauma. 1993; 7: 489-496
        • Trumble T.E.
        • Benirschke S.K.
        • Vedder N.B.
        Use of radial forearm flaps to treat complications of closed pilon fractures.
        J. Orthop. Trauma. 1992; 6: 358-365
        • Wyrsch B.
        • McFerran M.
        • Johnson K.
        • et al.
        A randomized, prospective study comparing the complications encountered in the management of pilon fractures.
        in: Presented at the Annual Meeting of the Orthopaedic Trauma Association, New Orleans, LouisianaSeptember 23, 1993
        • Kellam J.G.
        • Waddell J.P.
        Fractures of the distal tibia metyaphysis with intra-articular extension: the distal tibia explosion fracture.
        J. Trauma. 1979; 19: 593
        • Ovadia D.N.
        • Beals R.K.
        Fractures of the tibial plafond.
        J. Bone Joint Surg. Am. 1986; 68: 543-551
        • Rüedi T.
        • Allgöwer M.
        The operative treatment of intraarticular fractures of the lower end of the tibia.
        Clin. Orthop. 1979; 138: 105-110
        • Rüedi T.
        • Allgöwer M.
        Fractures of the lower end of the tibia into the ankle joint.
        Injury. 1969; 1: 92
        • Bone L.B.
        Fractures of the tibial plafond. The pilon fracture.
        Orthop. Clin. North Am. 1987; 18: 95-104
        • Bourne R.B.
        • Rorabeck C.H.
        • Macnab J.
        Intra-articular fractures of the distal tibia: the pilon fracture.
        J. Trauma,. 1983; 23: 591-596
        • Mast J.W.
        • Spiegel P.G.
        • Pappas N.J.
        Fractures of the tibial pilon.
        Clin. Orthop. 1988; 230: 68-82
        • Helfet D.L.
        • Koval K.
        • Pappas J.
        • Sanders R.W.
        • DiPasquale T.
        Intraarticular “Pilon” fracture of the tibia.
        Clin. Orthop. 1994; 298: 221-228
        • Gerber C.
        • Mast J.W.
        • Ganz R.
        Biological internal fixation of fractures.
        Arch. Orthop. Trauma Surg. 1990; 109: 295-303
        • Mast J.W.
        Reduction techniques in fractures of the distal tibial articular surface.
        Techniques Orthop. Surg. 1987; 2/3: 29-36
        • Müller M.
        • Nazarian S.
        • Koch P.
        • Schatzker J.
        The comprehensive classification for fractures of long bones.
        Springer, Berlin Heidelberg New York1990
        • Gustilo R.B.
        • Anderson J.T.
        Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. Retrospective and prospective analyses.
        J. Bone Joint Surg. Am. 1976; 58: 453-458
        • Tscherne H.
        • Gotzen L.
        Fractures with soft tissue injuries.
        Springer, Berlin Heidelberg New York1984