Management Of Tibial Fractures Research Articles

Early Results of Minimally Invasive Percutaneous Plate Osteosynthesis for Fractures of the Distal Tibia: A Retrospective Case Series and Review of the Literature.

Minimally invasive percutaneous plate osteosynthesis was developed on the concept that preservation of the soft tissue envelope during surgical management of distal tibial fractures is of paramount importance. We report on our early experience using this technique over a 1-year period with 14 such injuries that were treated by a locking compression plate via minimally invasive surgery. The surgical reduction was excellent in most of the cases and all fractures healed uneventfully. One superficial infection and a wound slough were the only complications recorded. The mean follow-up was at 15 months, and all patients were satisfied with a mean ankle-hindfoot score of 84. Early results of such management are very encouraging.

Original Research Article - Management of fracture tibia with closed intramedullary interlocking nail

Tibial shaft fracture is the most common type of long bone fracture. The most common cause of fracture shaft tibia is vehicular accident followed by fall. Severe complications and major disabilities are common outcome of this fracture. This study was conducted to find out results and advantage of interlocking nailing for the management of tibial fractures. A prospective study had been conducted at SRTR Govt. Medical College Ambejogai, Maharashtra State, from Jan 2011 to Dec 2013. Twenty eight patients of closed or grade1compound fracture tibia who underwent fixation by interlocking nail were included in this study. Patient evaluated completely in the form of history, clinical and radiological evaluation. All the fractures united with union time ranging from 12 weeks to 28 weeks. In majority cases mode of injury was vehicular accident. None of the patients developed complications like hardware breakdown, patellar tendinitis, deep infection and non-union The results obtained in this study have shown that interlocking nailing is ideal method of fixation of fracture tibia with least complications.

Comparison of different treatment modalities for tibial fractures: A clinical study

Background: The management of unstable distal tibia fractures remains Challenging. The proximity to the ankle makes the surgical treatment more complicated. The present study was carried out to compare different treatment modalities for management of tibial fractures. Materials & Methods: This study was conducted in the department of orthopaedics in 2014. It consisted of 200 patients with tibial fractures. It involves males (100) and females (100). Patients were informed regarding the study and written consent was taken. Patient data such as name, age, gender etc was recorded. Patients were divided into 2 groups of 100 patients each. Group I treated with plaster cast and Group II treated with fixation with plate and screws. Factors such as time to fracture healing, numbers of delayed union, nonunion and malunion, incidence of infection, and other complications were recorded in all groups.Results: Patients were divided into 2 groups. Group I treated with plaster cast (100) with 50 males and 50 females. Group II treated with fixation with plate and screws with plaster cast (100) with 50 males and 50 females. The difference was non significant (P>0.05). Non union or delayed union seen in group I was 12% and in group II was 10%. The difference was non significant (P>0.05). Malunion seen in group I was 22% and in group II was 16%. The difference was non significant (P>0.05). There was no superficial infection in group I. In group II, 7% of infection was seen. The difference was significant (P0.05). Reason for tibial fractures was road side accident (RSA) (65%), sports injury (25%) and fall from height (10%) in group I. In group II, the reason was road side accident (72%), sports injury (22%) and fall from height (6%). The difference was non significant (P>0.05). Conclusion: Tibial fractures are becoming common due to road side accidents, fall from height and sports injury. Closed reduction and immobilization and open reduction with plates and screws are widely used. Complications are common with both techniques. Therefore selection of specific treatment modality is essential in preventing complications.

Titanium Elastic Nailing System (TENS) for Tibia Fractures in Children: Functional Outcomes and Complications

Closed reduction and cast application is still regarded as first line treatment for pediatric tibial fractures. Over the past few decades, management of pediatric tibial fractures has shifted more towards operative intervention because of quicker recovery, shorter rehabilitation period, less immobilization, lack of stiffness of adjoining joints, and less psychological impact to the children. Flexible intramedullary nails not only fulfill the above advantage but also maintain alignment and rotation. This was a retrospective study of pediatric tibial fractures fixed with two titanium elastic nails through proximal ends of bones. Alignment of fracture, any infection, delayed union, non union, limb length discrepancy, motion of knee joint, and fracture union time were measured during follow-up examination. Forty-five patients were enrolled into the study out of which 28 (62.2%) were male and 17 (37.8%) were female. Average age of patient was 9.48±2.17 years and average time taken to heal the fractures (both clinical and radiological) was 11.17±2.81 weeks. There were 2 (4.4%) of malunion, 4 (8.8%) of delayed union, 3 (6.6%) of limb shortening, 2 (4.4%) of limb lengthening, 6 (13.6%) of nail prominence and skin irritation, 2 (4.4%) of superficial infection at nail entry site and one case of re-fracture. Titanium elastic nail fixation is a simple, easy, rapid, reliable and effective method for management of pediatric tibial fractures in patients with operative indications. There may be the chances of complication following the TENS in tibia but these are avoidable as well as manageable with careful precautions.

Joshi’s external stabilization system in the management of distal tibial and fibular fractures with associated soft tissue injury in children

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Injuries around ankle and distal third of tibial shaft are among common paediatric bone trauma. Some of these cases are associated with soft tissue injury over the lower third of leg or around the ankle joint as tibia is subcutaneous on the anteromedial aspect. This study was conducted to know the outcome of these injuries with minimal invasive external fixation.</span></p><p class="abstract"><strong>Methods:</strong> Eleven patients in the age group of 4-14 years were included in this study. All patients had closed fracture of distal third tibial shaft or injury of distal tibial physis with associated soft tissue injury. Joshi’s external stabilization system was used to retain the reduction of fracture and appropriate wound care was taken. JESS was removed after radiological signs of fracture union.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Patients were followed up for mean period of 8.9 month. After JESS fixation healing of wound occurred at an average of 12.45 day and external fixator was removed at 6-8 weeks period. Three patients had grade 1 pin tract infection which was controlled by local dressing. No patient had stiffness of ankle at the time of JESS removal. No limb length discrepancy was seen in any of the patients in this study at their final follow up. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">JESS gives good results in fractures of distal tibial with associated soft tissue injury. It helps in better management of wound and fracture stabilization.</span></p><p> </p>

A New Modified Open Posterior Approach for the Fixation of Posterior Cruciate Ligament Tibial Avulsion Fractures

Background: The most efficient treatment of posterior cruciate ligament (PCL) tears and the consequences of untreated PCL injuries is still debatable. Objectives: The aim of this study was to assess the outcomes of a modified technique for the fixation of tibial posterior cruciate ligament (PCL) avulsion fractures. Methods: From January 2009 to March 2012, 45 cases of PCL tibial avulsion fractures were managed through a modified technique. We used a lag screw and washer in the open posterior approach for our patients. Assessment of the range of motion of the knee was initiated on the day after the surgery. Clinical stability, range of motion of the knee, strength of the gastrocnemius muscle, radiographic investigation, and the quality of life of each of our patients was analyzed upon the last follow-up evaluation. Results: The mean of the overall musculoskeletal functional assessment (MFA) scores was 15 (range 3 - 35). At the last follow-up evaluation, all of the fractures in our patients were unified, and all of their knees were stable upon physical examination. Preoperative assessments showed that the mean Lysholm score for 15 knees was 62 ± 8 with a range of 50 - 75, which changed to 92 ± 7 with a range of 75 - 101 after the operation; our analysis showed that this difference was significant (P < 0.05). At the first-year follow-up evaluation, differences of less than 10 mm in thigh circumference were observed in 42 (93%) patients when comparing their injured to healthy knee. Conclusions: The management of tibial PCL avulsion fractures with the use of a cancellous lag screw and a washer by means of a modified open posterior approach leads to satisfactory clinical, radiographic, and functional results, and reduces operation time and blood loss.

Functional Outcome of Various Modalities of Management of Distal Tibial Fractures

INTRODUCTION: Distal tibial fractures remain a challenge to orthopaedic surgeons. They usually occur as a result of high energy trauma in young patients, but in the elderly they can result from a simple fall. In the elderly, the problem is compounded by poor bone-stock, their limited ability to partially weight bear and co-morbid conditions. The main challenges: 1.The compromised skin and soft tissue envelope as in open fractures lead to a high incidence of complications following open reduction and internal fixation. 2. In the metaphysis, fixation is less rigid and early loosening is a frequent event as the cancellous bone is open and ‘cell- like’ and therefore ill equipped to support a screw thread. 3. Comminuted fracture patterns, which create difficulty in achieving rigid fixation since the purchase in trabecular bone is less than optimal to permit weight bearing or even start early joint mobilization.These conditions that restrict mobility lead to decubitus ulcers, deep vein thrombosis, joint stiffness and secondary osteoarthritis. 4. These high energy fractures may be associated with extremely damaged soft tissue envelope, as well as comminuted metaphyseal region and articular surface making anatomical reduction difficult. AIM OF THE STUDY: To analyze and individualize the choice of fixation in the management of distal tibial fractures. MATERIALS AND METHODS: The present study deals with the analysis of out come of various modalities of treatment of distal tibial fractures depending on the type of fracture, location of the fracture and the status of the soft tissue envelope. The Study was conducted in Government Royapettah Hospital, Kilpauk Medical College between 2004 – 2006. Patients admitted with distal tibial fractures with or without intra articular extension and those having closed or open injuries were considered for this study. All patients having distal third tibial fractures were admitted and evaluated for co-morbid conditions. Routine investigations are done for anesthetic fitness and also to rule out systemic illness. Associated medical conditions were treated by corresponding specialists. The patients were maintained in POP and calcaneal pin traction in the case of compound fractures. Patients with compound fractures were treated with broad spectrum antibiotics. The time of surgery varied from 5 days to 25 days. There were 10 open injuries, of which there were 6 – Grade1; 3 – Grade 2 and 1-grade 3 open injuries. Those 5 patients who were not willing to undergo surgical procedures were treated conservatively by applying POP after 3 weeks of pin traction and check x-ray. RESULTS: The outcome of treatment of distal tibial fractures, is most affected by the severity of injury, management of the fracture and occurrence of certain complications. There are no uniformly accepted criteria for rating results. A number of factors are important for assessing results of tibial shaft fractures. Most reports omit one (or) more of them. For example Anderson et al., used only shortening and angulation to classify results of treatment into categories of excellent, good, fair, and poor. He rejected range of motion of the ankle joint as a criteria. However Horne and Colleagues with Hutching found ankle motion was a major determinant of functions. CONCLUSION: A short series of results of various modalities of management of distal tibial fractures were analyzed and the overall results including quality of reduction, functional recovery and the presence or absence of complications have led to us to individualise the option of treatment according to the status of the soft tissue, fracture location; fracture pattern and articular involvement. We are aware of the fact that the number of patients and duration of study may not give us the liberty to conclusively arrive at a protocol and might need a more elaborate study for standardization of the different methods available for the management of fractures of distal tibia.

Plate failure by bending following tibial fracture stabilisation in 10 cats.

To describe the clinical findings and management of tibial fractures in cats in which osteosynthesis failed due to plate bending. Case records and radiographs of cat tibial fracture repairs from five referral centres were reviewed for signalment and to assess incidence of plate failure by bending. Cats that sustained plate bending following plate or plate-rod fixation were reviewed for fracture configuration, repair method, initial postoperative and postfailure tibial alignment, revision treatment and outcome. The incidence of plate bending in cat fractures managed with plate and plate-rod fixation in the four referral centres where the overall number could be established was 13% (8/60). In the 10 cats in which plates bent, initial fractures were generally oblique or spiral with mild comminution and located in the middle or distal third of the tibia. Mean time to implant failure was 24 days (range 2 to 56 days). Mean tibial valgus angle increased from 12·9° to 30·9° following bending of the plate. Short-term outcome following revision surgery using orthogonal plating or stacked medial plates was favourable with improvement in tibial valgus in all five fractures with follow-up data. Plate bending following tibial fracture stabilisation in these 10 cats resulted in tibial valgus deformation. Consideration of plate and/or intramedullary rod selection and application should be given to avoid a plate strain environment that exceeds the yield point of the plate.

Antibiotic Intramedullary Nail in the Management of Infected Ununited Tibial Fractures - Case Report, Technique and Review of Literature

Antibiotic Intramedullary Nail in the Management of Infected Ununited Tibial Fractures - Case Report, Technique and Review of Literature

Management of tibial diaphyseal fractures with linear external skeletal fixators using carbon connecting rods in dogs

Dogs (12) with unstable tibial diaphyseal fractures, selected for this study, were stabilized with bilateral uniplanar Type II external skeletal fixators using stainless steel positive profile centrally threaded transfixation full pins, 2- way AO clamps and indigenously designed carbon fiber rods. Clinical lameness evaluation and radiographic evaluation for fixator stability, fragment alignment and callus formation were studied. Post-operatively, no breakage or bending of the carbon fiber rods was seen throughout the fixation period. Fixator staged disassembly and complete removal was done on an average 4–9 weeks in all cases which showed grade I lameness after removal. Complications like pin tract infection, wound at suture site due to wound dehiscence and wound at pin-skin interface were seen, which subsided later without any affect on bone healing. Lameness grading, pain score and radiographic evaluation of healing were estimated in all the cases throughout the fixation period. ESF using carbon fiber connecting rod appears as a practicable method for repair of tibial diaphyseal fractures with minimum risk of fixator destabilization. Fixator staged disassembly at 4 weeks accelerated bone healing and promoted earlier limb function.

Study of surgical management of proximal tibial fractures using locking compression plate

Introduction: Ever since the advents of high velocity transport system, there is an alarming increase in road traffic accident (RTA) with increased orthopaedic related morbidity and mortality. Proximal tibia being involved in body weight transmission through knee joint and leg, it plays a vital role in knee function and stability. The aim of surgical treatment of proximal tibial fractures is to restore and preserve normal knee function, which can be accomplished by anatomical restoration of articular surfaces, maintaining mechanical axis, restoring ligamentous stability and preserving a functional pain free range of motion of knee. Treatment of these injuries using minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques may minimize soft tissue injuries and damage to vascular integrity of fracture fragments. Materials and Methods: This study was a hospital based prospective study centered in department of orthopedics at R.L. Jalappa Hospital and Research Centre attached to Sri Devaraj Urs Medical College, Kolar, from December 2013 to May 2015 in which 30 patients with proximal tibia fractures were treated with locking compression plate (LCP). Results: The assessment of clinical outcome was made according to Rasmussen’s functional grading system. End results showed excellent outcome in 26 cases and good outcome in 4 cases. On subjective evaluation, 4 patients had superficial wound infection, 1 patient had deep vein thrombosis and 4 patients had extensor lag of 10 0 -15 0 at the end of final follow-up. Conclusion: Surgical management of proximal tibial fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, help to facilitate early mobilization and reducing post-traumatic osteoarthritis and hence to achieve optimal knee function. LCP remains a good choice in comminuted or more severe patterns of fractures.

Increased risk of adverse events in management of femur and tibial shaft fractures with plating: An analysis of NSQIP data.

The management of femoral and tibial shaft fractures has long been among the simplest in orthopaedic trauma. Little data exist on the predictors of complications associated with these fractures. The evolving healthcare system is creating a focus on quality metrics and changing payment models. It is critical that traumatologists develop a better understanding of complication rates associated with these injuries so that they may continue to improve patient care while also reducing overall medical costs. Using the ACS-NSQIP database, we evaluated patient demographics, comorbidities and 30-day complications of femoral and tibial fractures. A bivariate analysis was then used to compare rates of minor and major post-operative complications within 30 days. A multivariate logistic regression was performed, assessing the odds of developing a minor and/or major complication up to 30 days post-surgery. 2891 patients were identified. For femoral fractures, intramedullary nailing (IMN) demonstrated an overall complication rate of 14.9% (n=151) whereas open reduction and internal fixation (ORIF) with plating showed an overall complication rate of 15.6% (n=70). Patients undergoing plating of the femur or tibia were 2 times more likely than the IMN patients to demonstrate postoperative complications. Our study is the first to demonstrate that plating of femoral and tibial fractures doubles the odds of developing a complication. As our healthcare system shifts to bundled payment plans, it is impertinent for the orthopaedic surgeon to understand the risk factors associated with fracture treatments in order to assess the best treatment plan.

Double segmental tibial fractures—an unusual fracture pattern

AbstractA case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis technique with a pleasing outcome.

Surgical Management of Postero-Medial Tibial Plateau Fracture: Is Plate Osteosynthesis Mandatory?

Postero-medial tibial plateau fracture (Moore type 1) is challenging. Since several years a posterior approach has been described in order to use a butteress plate. In our opinion, it is possible to fix accurately this kind of fracture with 2 to 5 antero-posterior 6.5 mm cancellous screws through an anterior approach. The aim of this work was to present anatomical results and return to sport of 15 patients operated on for Moore type 1 tibial plateau fracture. We observed no pseudarthrosis or secondary varus displacement. 87% of patients resumed back to their sporting activities. The anteromedial incision has a dual advantage of anatomical postero-medial fragment reduction and tibial spine fixation (in 80% of our cases).

Management of segmental tibial fractures by an Ilizarov external fixator

Objectives This study aimed to evaluate the treatment of patients with segmental tibial fractures using an Ilizarov external fixator. Background Segmental fractures of the tibial shaft often occur after a high-energy direct trauma with consecutive severe soft-tissue injury and a high rate of open fractures. The blood supply of the intermediate bone fragment can be severely disturbed, and therefore operative treatment is demanding. Materials and methods This prospective study included 30 patients with segmental tibial fractures. All were fixed by an Ilizarov external fixator. Results The bone results were excellent in 15 patients (50%), good in six patients (20%), fair in seven patients (23.4%), and poor in two patients (6.6%). The functional results were excellent in 15 patients (50%), good in 10 patients (33.4%), fair in three patients (10%), and poor in two patients (6.6%). Conclusion Ilizarov external fixator is a successful method in the acute management of segmental tibial fractures. This method allows for control of complications by decreasing the need for new operations even in the presence of infection.

Arthroscopic management of tibial spine fracture with development of arthrofibrosis: A case report with review of literature

Being intra-articular nature and disruption of anterior cruciate ligament complex, tibial spine fracture, it is mandatory to fix the displaced fracture of tibial spine in order to maintain the knee kinematics. Fixation of the fracture has shifted from open to arthroscopic assisted. The deficit of a few degrees of movement is a noted complication due to arthrofibrosis which require arthrolysis. We are presenting a case report of a 12 year male patient with type III tibial spine fracture that was fixed using a 7 mm cannulated cancellous screw. Functional outcome was excellent.

Multiple Fractures in Tibia Bone of Dog: A Case Study

Tibial fractures are one of the most common type of fracture encountered in canines. This is due to the fact that tibia is covered with minimal muscles, which prones it to fracture. The fracture of tibial bone is quite common in dogs. The tibial diaphysis is a good site to utilize the principals of biologic fracture repair. The principles of biologic fracture repair are to preserve the vascular envelope by being minimally invasive or by not opening the fracture site at all. The clinical case of left tibial fracture of dog was successfully managed surgically and by proper post-surgical therapeutic management. The present report deals with successful management of tibial fracture in dog.

Comparative study of the results of compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators

PurposeIlizarov ring fixator and limb reconstruction system (LRS) fixators have been used in the management of complex tibial fractures with severe soft tissue injuries, compound tibial fractures, and infected tibial nonunion for which conventional internal fixation cannot be contemplated. Fracture union and distraction osteogenesis can be done simultaneously with these external fixators, allowing early weight bearing. Several previous studies have shown almost equal results of rail and ring fixators for the compound tibial shaft fractures. Thus we performed a prospective study to evaluate the union rate, functional outcome and amount of limb lengthening after the treatment of compound tibial shaft fractures with or without infected nonunion by ring or LRS fixators. MethodsThis prospective study was done at Sarojini Naidu Medical College and Hospital, Agra, India and included 32 patients of compound tibial shaft fractures with or without infected nonunion. There were 26 males and 6 females and the average age was 40 years. Patients were randomly divided into two groups (n = 16 for each): one underwent Ilizarov fixation and the other received LRS fixation. Cases were followed up for 3–24 months, 6 months on average from September 2012 to October 2014. Functional and radiological outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria for both rail and ring fixators. ResultsUnion was achieved in all cases. Radiological outcome was found excellent in 68.75%, good in 18.75% and fair in 12.50% of cases treated by rail fixators whereas it was excellent in 56.25%, good in 18.75%, fair in 12.50% and poor in 12.50% of cases treated by ring fixators. Functional result was satisfactory in 75.00% of cases treated by rail fixator and 68.75% of cases treated by ring fixators whereas the corresponding rate of unsatisfactory was 25.00% vs. 31.25%. ConclusionIn our short-term assessment, LRS fixators show a better result than Ilizarov fixators in terms of fracture union and functional outcome with soft tissue care and limb length.

A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation

ObjectiveThe anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. For complex fracture patterns a combined anterolateral/anteromedial approach is suitable but a high rate of complication has been reported. In our retrospective study a two-choice strategy adopting a medial tibial approach was proposed for the treatment of pilon fractures with anterior or posterior fragmentation. MethodsBased on an anatomic study of tibial pilon fractures, we retrospectively analyzed the fractures with primary posterior, posterior-lateral or anterior, anterior-lateral (Tillaux-Chaput) involvement of the distal tibia. This retrospective study consisted of 18 patients with a closed tibial plafond fracture. The inclusion criteria were: (1) presence of an anterior/anterolateral type fragment or a posterior (Volkmann) type fragment involving >25% of the articular surface, (2) a minimum follow-up of 12 months, (3) a fibula fracture associated with a medial column fracture of the distal tibia, and (4) soft tissue conditions at the time of operation that did not compromise the choice of surgical access (Tscherne classification for closed fractures: grade 0 and grade 1). Tibial plafond fractures were classified into two groups: one presenting anterior and the other with posterior rim (Volkmann) fragments. ResultsMost patients achieved a good clinical recovery in terms of range of motion and Olerud-Molander scale scores. Only three patients presented a grade 2 osteoarthritis at the 12 month follow-up. ConclusionOur two-choice strategy highlights concepts which have been previously debated and described in the literature. But a new extended protocol for surgical approach to the distal tibia, including more fracture patterns and their association should be further investigated.

Minimally-invasive plate osteosynthesis in distal tibial fractures: Results and complications.

Distal tibial or pilon fractures are usually the result of combined compressive and shear forces, and may result in instability of the metaphysis, with or without articular depression, and injury to the soft tissue. The complexity of injury, lack of muscle cover and poor vascularity make these fractures difficult to treat. Surgical treatment of distal tibial fractures includes several options: external fixation, IM nailing, ORIF and minimally-invasive plate osteosynthesis (MIPO). Management of distal tibial fractures with MIPO enables preservation of soft tissue and remaining blood supply. This is a report of a series of prospectively studied closed distal tibial and pilon fractures treated with MIPO. A total of 21 patients with closed distal tibial or pilon fractures were enrolled in the study between March 2008 and November 2013 and completed follow-up. Demographic characteristics, mechanism of injury, time required for union, ankle range of motion and complications were recorded. Fractures were classified according to the AO/OTA classification. Nineteen patients were initially managed with an ankle-spanning external fixator. When the status of the soft tissue had improved and swelling had subsided enough, a definitive internal fixation with MIPO was performed. Patients were invited for follow-up examinations at 3 and 6 weeks and then at intervals of 6 to 8 weeks until 12 months. Mean age of the patients was 40.1 years (range 19-67 years). Eighteen cases were the result of high-energy trauma and three were the result of low-energy trauma. According to the AO/OTA classification there were extraarticular and intraarticular fractures, but only simple articular patterns without depression or comminution. The average time for fracture union was 19.7 weeks (range 12-38 weeks). Mean range of motion was 10° of dorsiflexion (range 5-15°) and 28.3° of plantar flexion (range 20-35°). Three cases were metalwork-related complications. Two patients underwent plate removal at 24 weeks because of plate impingement. There was one case of wound breakdown at 11 weeks. One patient had fracture union with tibial recurvatum of approximately 10°, without functional impairment. Two patients had delayed union. MIPO is a reliable method of treatment for distal tibial fractures; it provides a high union rate and good functional outcome with minimal soft tissue complications. Skin impingement remains a common complication with MIPO, but this can be solved by timely plate removal.