Management of Fractures of Distal Tibia by Minimally Invasive Plate Osteosynthesis through an Anterior Approach

Abstract

Purpose: To evaluate functional results and complications after minimally invasive plate osteosynthesis through an anterior approach for distal tibial fractures, including pilon fracture. Materials and Methods: Between March 2007 and December 2008, thirteen patients with fractures of the distal tibia were treated with minimally invasive plate osteosynthesis through an anterior approach, and were followed for a mean of 16.2 months (range, 12-30 months). Fractures according to the AO/OTA classification were six 43A, four 43B and three 43C. We analyzed functional results by bone union, postoperative complications, and the Olerud and Molander ankle scoring system. Results: All fractures were united after a mean of 15.7 weeks (range, 12 to 24 weeks) except one case. There were 2 cases of superficial wound infection, one case of fibular shortening and metal failure, and two cases of tibialis anterior tendon adhesion. The average functional score was 79 points (range, 35-95 points) and results were four excellent, six good and three fair. Conclusion: Minimally invasive plate osteosynthesis through an anterior approach may be used for distal tibial fracture with medial soft tissue injury, and has an advantage in that the metaphyseal and distal articular fracture are fixed at the same time through a single incision However, it should be approached with caution because of the risk of complications due to the anterior approach, such as iatrogenic injury of the tibialis anterior tendon.