Functional outcome following fixation of distal tibial fracture (Extra articular) with locking compression plate (LCP) using the minimally invasive percutaneous osteosynthesis (MIPO) technique

Abstract

Background: Distal tibia is more superficial, with minimal soft tissue coverage and poor blood supply, hence operative treatment can lead to complications, making it a challenging surgery. The aim is to see the results of the distal tibial fracture fixation with LCP using MIPO technique.Methodology: Twenty consecutive patients with type AO 43A distal tibia fractures were prospectively included into the study during the period of march 2018 to march 2019 with a follow-up of minimum one year. Fourteen male and six female patients with a mean age of 47 years were reviewed. Patients of Bidar institute of medical sciences with closed extra articular distal tibial fractures who fulfill the inclusion & exclusion criteria were taken in to study after obtaining informed written consent. History, Clinical examination and details of investigations were recorded in the study Performa. Minimally Invasive Percutaneous Plate Osteosynthesis was carried out depending on requirement for specific fracture pattern. These cases were reviewed periodically at 6, 12, 24 weeks and regularly both clinically and radiologically for bony union. Clinical outcome and Radiological criteria (RUST SCORE) regarding fracture union and complications was evaluated and documented. Functional outcome was measured by lower extremity functional score (LEFS).Results: Mean time to union was 6.5 months (range 4–16 months). Sixteen fractures healed with good functional outcome. Two patient had delayed union. One patient had nonunion which was treated with iliac crest bone grafting that ultimately healed with good functional outcome. One patient developed superficial infection that was treated with appropriate antibiotics and the fracture united eventually.Discussion: The MIPO technique for pilon A type fractures is proven ti be more effective over the conventional methods. Early mobilization with no risk of secondary displacement helps to prevent stiffness of the ankle joint and good wound healing.