A prospective study on functional outcome of distal tibial fracture fixation with locking compression plate using minimally invasive percutaneous osteosynthesis technique

Abstract

Introduction: Treatment of distal tibia fractures is challenging because of its subcutaneous location, poor vascularity and limited soft tissue envelope. Various modalities of surgical treatment such as Intramedullary nailing, Open reduction and internal fixation with conventional plate osteosynthesis and external fixation have reported good functional outcome but had high complication rate. The newer technique of distal tibia fracture fixation with Minimally invasive plate osteosynthesis (MIPO) using Locking compressing Plates (LCP) has emerged as an alternative treatment option because it involves less soft tissue handling, minimal periosteal stripping resulting in low infection rate, faster healing and it respects biology of distal tibia and also provides biomechanically stable construct.Aim: To assess the functional role of locking compression plates in treatment of distal tibial fractures using minimally invasive percutaneous osteosynthesis technique.Materials and Methods: In this study, 30 patients with distal 1/3rd tibia extra articular fractures (AO type 43A1, 43A2, 43A3) with or without associated fibula fractures were treated with LCPs using MIPO technique. The present prospective study was conducted in Department of Orthopaedics, Geetanjali medical college and hospital, Udaipur between January 2019- May 2020.Results: All fractures had excellent clinical and functional outcome, the fractures were stabilized by LCP using MIPO technique with an average operative time of 48.16 minutes. The age of the patients ranged from 20 to 76 years with the fracture being most common in the 3rd and 4th decade. Out of 30 patients, 21 (70%) patients were males and 9 (30%) patients were females showing male preponderance. Functional outcome evaluation was done using American Orthopaedic Foot and Ankle Society (AOFAS) score. At the end of this study, 21 (70%) patients had excellent outcome, 08 (26.66%) had good results, 01 (3.33%) had fair outcome and no patient had poor functional outcome. None of the cases had implant failure or any significant deformity.Conclusion: The present study shows that MIPO technique using LCP proves to be most effective and safer technique in the management of distal tibial fractures with or without intra-articular comminution by providing good fracture healing, enabling rapid functional recovery and avoiding major complications.