Evaluation of Outcome of Proximal Tibia Fractures managed with MIPPO

Abstract

Background: the concept of minimally invasive Osteosynthesis using percuatneous plate was established when it is realized that the length and alignment of proximal tibia can be restored with indirect manipulation and reduction technique. Biological fixation with percutaneous plating augments the healing process without additional risk of wound disruption and infection. Purpose: The aim of the study was to evaluate the result of proximal tibial fractures with minimal invasive percutaneous plate osteosynthesis and to assess the clinical, radiological and functional outcome of the same. Method & Material: The present study was conducted in the Department of Orthopaedics, during the period of August 2013 and August 2015, at Acharya Vinoba Bhave Rural Hospital, Wardha. The design of study was prospective cohort study. This study included 32 patients with the fracture proximal tibia of the patients and age of patient ranging from 20 to 75 years. All the patients with proximal tibia fractures were included in the study. Result: A total of 32 patients of proximal tibial fractures were treated with minimally invasive percutaneous plate osteosynthesis technique. There were 29 male and female patient, with maximum patients in the age group of 31 to 40 years. Road traffic accident evolved as most common mode of injury. Fractures were classified according to AO classification. C1 type of fracture seen in 8 (25 %) patients and A2 type in 7 (21.9%) patients. Rasmussen’s clinical and radiological scoring system was used for final evaluation of the results. The average Rasmussens clinical score was 23 .53 and average radiological score was 14.3. In present study according to Rasmussen clinical score good result were seen in 26 (81.4 %) patients and poor result seen in only 1 (3.1 %) patient. According to Rasmussen’s radiological score good results were seen in 26 (81.3 %) patients and only in 1(3.1 %) patient poor result was seen. In only 2(6.4%) patients there was implant related problem in the form of screw back out and plate prominence. The average range of knee flexion was 136.25 degree and 17 patients (53.12 %) achieved 131 -140 degrees of flexion. While 14 (43.75 %) patients achieved extension up to -2 degrees. Conclusion: Minimally invasive percutaneous plate Osteosynthesis is better technique, and should be considered as primary option for the surgical treatment of the proximal tibia fractures. Clinical outcome of MIPPO technique are favourable and comparable to world literature in terms of fracture union, early mobilization and functional outcome. MIPPO technique preserve the soft tissues around the fracture site hence healing of the fracture is early. For the same reason MIPPO can be a treatment option for the grade I compound fractures. MIPPO technique can be successfully used for the simple or grade I compound fracture of proximal tibia. Key words: Tibia, Minimal Invasive Plate Osteosynthesis, Clinical, Functional, Radiological