Minimally invasive plating: a good option for distal tibia fractures with simple or no articular involvement

Abstract

Background Despite great improvements in treatment procedures and implants, management of distal tibia fractures remains challenging. Objective The purpose of the present prospective study was to evaluate the use of minimally invasive plating for treating distal tibia fractures with simple or no articular involvement, and to suggest the factors that may improve the results. Patients and methods In this prospective, noncontrolled cohort study, 46 patients with distal tibia fractures (excluding AO 43-B3, 43-C3 fractures) were treated with the medial distal tibia anatomical locked plate. Only the results for 40 patients were reported in our study; the remaining six were excluded as they did not complete the follow-up. There were 28 men and 12 women, with a mean age of 37.5 years. According to the AO classification, there were 22 fractures of type A, 13 of type B, and five of type C. Seven fractures were open. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for functional assessment. Results The mean follow-up period was 53.25 ± 9.53 months (range: 36-66 months). All the fractures united with acceptable alignment in a mean time of 17.17 weeks (range: 10-28 weeks). Five (12.5%) patients caught infections - three superficial and two deep. Secondary surgeries were carried out only for debridement or implant removal, but none to achieve union. Six (15%) patients had angular deformities less than or equal to 5°. None of these deformities required a secondary operation for correction. At the end of follow-up, the mean AOFAS score was 90. A total of 32 (80%) patients resumed their preinjury activity and sports and 37 (92.5%) were back to their previous employment. Conclusion Minimally invasive plating provides a secure, easily applied good solution for the challenging distal tibia fracture, even with simple articular extension. Surgeon experience and skill, efficient preoperative planning, and well-planned postoperative protocol are important for improving the outcome.