Minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft fractures

Abstract

Background The most notable change in the treatment of fractures has been the shift from the mechanical aspects of internal fixation with absolute stability and primary bone union as the goal to the biological aspects of internal fixation with relative stability and healing with callus as the preferred method, with a huge focus on preservation of the blood supply of bone and soft tissue to ensure the continued vitality of the individual fragments to improve fracture healing. Percutaneous plate fixation minimizes soft tissue compromise with decreased incidence of wound breakdown and deep infection. It also preserves the vascularity of the bone fragments, and thus reduces the time for union, decreases the need for bone grafting even in comminuted fractures, and also decreases the incidence of nonunion, which requires a second major open intervention. Aim The aim of this study was to evaluate the outcome of minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft (upper and middle thirds) fractures in adults using conventional nonlocked plates through the medial approach. Patients and methods This prospective study included 16 adult male patients who had high-energy closed tibial shaft fractures (upper and middle thirds) with varying degrees of displacement and comminution. All patients were evaluated clinically and radiologically before and after surgery, followed up for a mean time of 14 months postoperatively, and evaluated radiologically and functionally according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system. All patients were treated using conventional nonlocked plates inserted percutaneously on the medial surface of the tibia. Results All the fractures united with a mean union time of 16.2 weeks, ranging from 13 to 36 weeks. Clinical and radiological outcomes according to the ASAMI scoring system in this study showed excellent results in 14 patients, representing 87.5% of the studied group, and good results in two patients, representing 12.5% of the studied group. No neurovascular complications, no persistent limitation of the knee or ankle motions, no deep wound infection, and no implant failure occurred in any of the patients until the last follow-up, and none of the patients required a second major open intervention. Conclusion The minimally invasive percutaneous plate fixation technique is an effective method of stabilization for closed tibial shaft fractures, yielding good bone alignment and protecting soft tissues, leading to higher union rates with good functional outcome. The use of conventional nonlocked plates applied through the medial approach decreases the surgical time and the risk of postoperative compartmental syndrome.