Percutaneous Plate Research Articles

Evaluation of functional outcome of distal tibial fractures managed with locking compression plate using minimally invasive plate osteosynthesis (MIPPO) technique

Background: Treatment of distal tibial fracture is challenging, because of precarious blood supply leading to poor healing. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But this modalities doesnot give better functional outcome and had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To evaluate clinical, functional and radiological outcomes after minimally invasive plate osteosynthesis using distal tibial locking compression plates. Materials and Methods: In this study, 30 patients with distal third tibial extra articular Metaphyseo diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at Tripura Medical College, between August 2020 to July 2021. Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 6.27 days post- trauma, with an average operative time of 66.25 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 17.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 86.66% cases. Conclusion: It is concluded that locking plate fixation by minimally invasive percutaneous plate osteosynthesis technique (MIPPO), is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.

Evaluation of the management of tibial diaphysial fracture AO Type - 42C with locking compression plate by MIPO technique

Introduction: Fracture involving the diaphysis of the tibia especially due to high energy trauma continues to be a challenging problem in Orthopaedic surgery. Treatment of tibial diaphysial fracture has improved with the evaluation of plate and nailing technologies. Recently locking compression plating have been used with minimally invasive plate osteosynthesis (MIPO) technique with indirect reduction and percutaneous plate insertion, which reported excellent results especially in comminuted tibial shaft fractures (AO Type-42C) where IM nail were contraindicated. The purpose of this study is to analyze and discuss the outcome of comminuted tibial shaft fractures (AO Type-42C) treated with MIPO technique. Methods: This prospective (interventional) study included 19 adult male and 06 adult female patients who had high-energy closed tibial shaft fractures with varying degrees of displacement and comminution. All cases were assessed by clinical examinations and radiographs before and after surgery. Post-operative follow-up was done for a mean time of 06 months and evaluated radiologically and functionally according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system. Results: Most of the fractures 11(44%) united with a mean union time of 19.6±2.53 weeks. ranging from 19-21weeks. Clinical and radiological outcomes according to the ASAMI scoring system showed satisfactory results (excellent and good) in 23 patients, representing 92% of the studied group. There were no persistent limitation of the knee or ankle motions and deep wound infection. Implant failure didn’t 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 plate fixation with locking compression plate is an effective method of stabilization for closed comminuted tibial shaft fractures, yielding good bone alignment with minimal soft tissues injury, leading to higher union rates with good functional outcome.

A prospective study of distal tibial fracture fixation with anatomical osteosyntheses using minimally invasive percutaneous plate osteosynthesis technique

Introduction: Our objective was to evaluate clinical results and functional outcomes of extraarticular distal tibia fracture treated using anatomical osteosyntheses by minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Materials and Methods: 30 patients of closed distal tibial extraarticular fractures operated by MIPPO technique from November 2018 to October 2019 with age from 20 to 60 years with or without fibula fracture upto 5 cm proximal to distal tibiofibular syndesmotic joint were included in the study. Clinical and radiological assessment for fracture union were performed at 3 weeks,12 weeks and 24 weeks interval and results were analysed by using AOFAS Ankle-Hind foot scale. Results: Thirty patients were followed for 6 months with mean fracture healing time was 16 weeks (12-60 weeks). 14 patients had excellent results with AOFAS score with two patients (6.7%) had delayed union and one patient (3.3%) developed superficial infection but fractures united completely. Conclusion: Minimally invasive percutaneous plate osteosynthesis technique is an effective method of treatment for distal tibial fractures, it provides good, stable fixation with minimal complications.

Prospective study of surgical management of proximal tibia fracture with locking compression plate using minimally invasive percutaneous plate osteosynthesis technique

Introduction: The majority of tibial plateau fractures are secondary to high velocity road traffic accidents. Hence the management of high-energy proximal tibial fractures will need very good care of the soft-tissue envelope as the surface of the proximal tibia is covered only with skin and subcutaneous tissues The main goal of surgical treatment of proximal tibial fractures in this study is to restore and preserve normal knee function by using Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) technique. Method: 32 cases of proximal tibial fractures from Chigateri General Hospital and Bapuji Hospital attached to J.J.M Medical College, Davangere during the study period were included in study and cases were followed up for a minimum period of 12 months. At 4, 6, 9, 12, 16 weeks and then two monthly follow up till 12 months. Inability to take part in post operative rehabilitation & those with Open fractures were excluded from the study. Result: Based on Modified Rasmussen criteria for clinical assessment in our study we achieved 71.88% excellent results, 15.62% good results (with overall of 87.% excellent to good results) and 12.5% fair results.

Minimally Invasive Percutaneous Plate Osteosynthesis in Distal Femur Fractures Using Locking Compression Plate (LCP)

Background: Distal femoral fractures are frequently seen in high-velocity road traffic accidents. The introduction of locking compression plates with option of locked screws has provided the means to increase the rigidity of fixation in osteoporotic bone or in the presence of periarticular fractures. Materials and Methods: Fifty patients within the span of 3 years underwent internal fixation of distal end femur by LCP using minimal invasive percutaneous plate osteosynthesis (MIPPO) technique. All the patients were assessed using Modified Neer's criteria which assign points for pain, function, working ability, joint movements, gross, and radiological appearance. Results: Out of 50 patients, 48 patients (96%) showed radiological union within 20 weeks. Average time for union was 16.4 weeks. Average knee flexion was 120° with more than 60% of patients having knee range of motion more than 115°. Modified Neer's score was excellent in 32 (64%), good in 12 (24%), fair in 4 (8%), and poor in 2 (4%). There had been one patient each who developed nonunion, deep infection, and valgus malalignment. Conclusion: Locking compression plate used through MIPPO technique is an optimal tool for distal fractures of femur. It provides rigid fixation, where a widening canal, thin cortices, and frequently poor bone stock make fixation difficult.

A comparative study of locking plate by minimally invasive percutaneous plate osteosynthesis versus closed interlocking intramedullary nail in extra-articular distal tibia fractures

<p><strong>Background</strong>: To compare functional outcome between minimally invasive percutaneous plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMIL) in the distal one-third extra-articular tibia fracture.</p><p><strong>Methods</strong>: We retrospectively analysed 32 patients with closed distal tibia extra-articular fractures who underwent IMIL nail and locking plate MIPO technique in 16 patients each. All patients were followed for at least one year with assessment of clinico-radiological union and functional outcome scoring.</p><p><strong>Results</strong>: There was comparable functional outcomes, time to union and surgical time both in IMIL nail and MIPO fixation of closed distal extra-articular tibia fractures with similar complication rate. </p><p><strong>Conclusions</strong>: Our study suggests that both IMIL nail and MIPO fixation could be used for closed distal extra-articular tibia fractures as per surgeon’s preference. However, due to small sample size in our study, we cannot draw any definitive conclusions from our preliminary results but consider them as valuable basis for future studies.</p>

Surgical outcome of tibial condyle fracture with MIPPO technique

Background: Tibial condylar fractures are very common in road traffic accidents; however, sports injury, fall and other trivial trauma can frequently produce these fractures. These are unstable fractures and quite challenging to manage. This study was undertaken to evaluate locking compression plate (LCP) fixation in proximal intra articular tibia fractures by MIPPO (minimally invasive percutaneous plate osteosynthesis) technique. Materials and Methods: The study was conducted from 0ctober 2016 to 2018. 20 cases who had sustained tibial plateau fractures (Schatzker type 1- VI) and operated with LCP fixation using MIPPO technique were included in this study after obtaining informed consent. Follow-up was done at 6 weeks, 12 weeks, 18 weeks and 24 weeks after the surgery and they were evaluated in accordance with modified Rasmussen knee scoring system. Results: Modified Rasmussen functional knee scoring system and modified Rasmussen criteria for radiological assessment was used to analyse the functional outcome among the cases. After evaluation it was observed that 90% of the patients had good to excellent performance. Conclusion: MIPPO technique enables soft tissue stripping via a small surgical incision and provides a rigid fracture reduction. There is also a reduced chance of post traumatic soft tissue injury. Proximal Tibial locking plate is a good device to stabilize the fractures of Tibial plateau (intra articular), especially when used in conjunction with meticulous intraoperative handling of the soft tissues and active participation of the patients in the rehabilitation programme is ensured. Keywords: Proximal tibia, MIPPO, Intra – articular, Tibia plateau, Locking compression plate.

Outcome of Minimally Invasive Percutaneous Plate Osteosynthesis Technique for Management of Extra Articular Distal Tibial Fractures

Objective: To assess the outcome of the minimally invasive percutaneous plate osteosynthesis (MIPPO) method applied for the management of extra-articular distal tibial fractures.Materials and Methods: This quasi-experimental study was conducted at the Department of Orthopaedic Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan. Total 57 patients have included extra-articular type A distal tibial fracture, duration of injury <1 week, and competent neurological and vascular status of the fractured site. All the patients were treated with MIPPO Technique by using the distal tibial medial locking plate and the outcome of all patients was assessed radiologically in terms of union and functionally by using the Ovadia-Beals clinical scoring system. Data were analysed by using SPSS v. 21. Results: As per sample size calculation, 57 patients were included with a mean age of 37.19 ± 9.22 years. There were 45 (78.94%) male patients and 12 (21.05%) female patients. According to AO classification; the most common type was 43A1 with 31 patients (54.38%) whereas 18 (31.57%) were in Type 43A2 and 8 (14.03%) in Type 43A3. In our study, fracture union was achieved in a mean duration of 19.6 ± 3.45 weeks. When the functional outcome was analyzed, 41 (71.92%) patients had excellent outcome, 8 (14.03%) had good results, 5 (8.77%) had fair and 3 (5.26%) had poor outcome based on the subjective result and 44 (77.19%) patients had excellent, 7 (12.28%) had good, 3 (5.26%) had fair and 3 (5.26%) had poor result based on an objective result of Ovadia-Beals clinical scoring system. Conclusion: Thus MIPPO can be highly successful in achieving good to excellent outcomes in the maximum number of patients presented with a distal tibia fracture. So in the future, we can rely on this technique for such types of fractures.

Functional outcome of extra-articular proximal tibia fractures treated by MIPPO

Introduction: Increased incidence of road traffic accidents, natural disasters, and industrial accidents claim most of human mortality and morbidity. These injuries commonly involve long bones, especially the tibia due to its subcutaneous location. Tibial diaphyseal fractures are the most common, followed by proximal tibial fractures. The treatment of proximal tibial fractures changed dramatically in 1969 following the study by Reudi and Ailgower (1) where 75% patients after internal fixation of tibia fractures were pain free and had good functional outcome at 4 years follow up. The following widespread use of internal fixation led to an increase in major complications like malunions (42%), superficial infections (20%), nonunion (18%), and osteomyelitis (17%). This led to a search for newer techniques which led to lesser soft tissue damage and yielded better results. Amongst these techniques was biological minimally invasive percutaneous plate osteosynthesis (MIPPO). In the 1990’s Krettek et al popularized the Minimally Invasive Percuntaneous Plate Osteosynthesis (MIPPO) technique in which conventional plates were placed through a small incision and slid through a subcutaneous tunnel. Biologically friendly plating and minimally invasive plating continues to remain popular today. This study compares MIPPO in extra articular proximal tibia fractures, in terms of functional outcome, union rate and time and the various complications associated with each group. Aims and objectives 1. To evaluate the clinical and functional outcome in Extra-articular Proximal tibial fracture treated with Minimally Invasive percutaneous plate osteosynthesis. 2. To study range of motion at the knee joint postoperatively. 3. To study the complications, if any with Proximal tibia fracture fixation. Inclusion criteria 1. Patients with closed extra-articular proximal tibia fractures with age of more than 18 years. 2. Both male and female patients. The exclusion criteria 1. Fracture associated with knee dislocation 2. Pathological fractures 3. More than 6 weeks Old untreated fractures 4. No other associated lower limb fracture 5. Age more than 80 years Results and observation: In this study we have taken follow up data of 30 patients with 25 males and 5 females. Most patients were males between 31-50 years of age. RTA was the highest reason for incidence of these fractures. Majority of patients were discharged within 10 post-operative days. Five patients developed infections which increased their hospital stay upto 16 days. On 6 weeks follow up there was only one case of nonunion out of the 30 patients, all of the 29 other fractures united within 6 weeks radiologically and clinically. Total 30 patients were evaluated postoperatively thoroughly for functional outcome using The Knee. Society Score which showed 24 patients (80%) had excellent and 6 patients (20%) had good objective knee society score. 23 patients (76.6%) had excellent, 5 patients (16.66%) had good and 2 patient (6.66%) were each of poor and fair functional knee society score. Conclusion: In this study, we found that extra-articular proximal tibia fractures treated with MIPPO plating gave an excellent functional outcome with minimal soft tissue stripping and better healing of the surgical site wound. There was only one case of delayed union and this directly tells us how superior a MIPPO plating technique is in comparison to long incisions.

Minimally invasive percutaneous plate osteosynthesis for lateral malleolus fractures

Background Lateral malleolus fracture is one of the most common fractures that may occur as a part of ankle joint trauma. Open reduction and internal fixation is considered as the state of the art for displaced lateral malleolar fractures in order to obtain congruent ankle mortise. But in certain conditions, soft-tissue status together with patient comorbidities may impede this technique. Minimally invasive percutaneous plate osteosynthesis (MIPPO) for lateral malleolus may be a suitable solution for ankle fractures with soft-tissue problems. Patients and methods Through the period between May 2012 and May 2016 in Ain Shams University hospitals, a prospective study on 51 patients with displaced lateral malleolus fractures as a part of ankle trauma with bad soft-tissue condition has been managed through the MIPPO approach. All patients have been evaluated as regards the grade of soft-tissue injury, timing of surgery from trauma, duration of the procedure, time to union, postoperative ankle function, and reported superficial peroneal nerve injury. Open fractures, associated pilon fractures, and established Charcot neuropathic joints had been excluded from the study. Results The minimum follow-up for all the patients was 12 months and maximum was 25 months with a mean of 13.7 months postoperatively. Thirty patients (58.8%) were grade III according to Tscherne classification of closed soft-tissue injury. Mean time of surgery from trauma was 45.9 h (12 h to 6 days). The average procedure time was 56 min (20–80 min). The average time to union was within 7 weeks (5–10 weeks), all patients had good-to-excellent ankle function with a mean of 89.9 according to the American Orthopedic Foot and Ankle Score, and no superficial peroneal nerve injury was documented. Conclusion MIPPO for lateral malleolus is an effective and safe technique, provided that ankle mortise congruity is obtained.

A prospective study on functional outcome of distal tibia fracture treated with minimally invasive technique using locking compression plate

Background and Aim: Distal third tibia fractures accounts for about 7-9% of all lower extremity fractures. The treatment of distal tibia fractures is challenging, because of limited soft tissue coverage and poor vascularity. In the present study our aim is to assess the clinical and functional outcome of distal third tibia fractures treated by Minimally invasive percutaneous plate osteosynthesis. Materials and Methods: A total of 40 patients with distal tibia fracture was treated in this study from December 2018 to January 2020. TWS Scoring system was used to evaluated the functional outcome. Results: Majority of the study population (21, 52.5%) were belonging to the excellent outcome category, followed by good category among (14, 35.0%). Discussion: MIPPO technique offers biological advantage by preserving periosteal blood supply and it provides good stability to fracture site. Complication rate is less compared to other procedure.

“A prospective study of minimally invasive percutaneous plate osteosynthesis using LCP for surgical management of distal tibia fracture”

Background: Management of distal tibia fracture is challenging because of wound infections and poor wound healing due to precarious blood supply. Various methods of surgical treatment had been tried, such as closed intramedullary nailing, open reduction and internal fixation with conventional plate osteosynthesis and external fixation however most of them have a high complication rate than a good functional outcome. The newer technique of distal tibia fractures fixation using MIPPO involves less soft tissue handling and minimal periosteal stripping resulting in a lower infection rate and faster healing. Materials and Methods: In this study, 25 patients with distal tibia extra articular fractures and intra articular fractures with or without associated fibula fractures were treated with MIPPO using medial LCP. The present study was conducted in the department of Orthopaedics at a tertiary care hospital and followed up for a period of 2 years. Results: The mean follow up period ranged from 6 weeks to 2 years. All the fractures were united at an average of 16 weeks and mean AOFAS score at the end of 1 year was 85.64. There were two superficial wound infections which were treated with oral antibiotics and there was one deep infection and another with persistent ankle pain. Conclusion: Minimally invasive percutaneous plate osteosynthesis is a reliable method of fixation not only extra articular, but also intra articular fractures of distal tibia. MIPPO technique for the distal tibia fractures offers a biological advantage by preserving the blood supply and decreases chances of delayed or non-union. Patients treated by MIPPO technique have a much lesser rate of deep infection and excellent radiological union. MIPPO technique helps in initiating early mobilization and reduces the risk of ankle stiffness.

Minimally invasive percutaneous plate internal fixation through anterolateral single incision for the treatment of open distal tibiofibula fractures

To investigate therapeutic effect of minimally invasive percutaneous plate internal fixation (MIPPO) through a single incision in treating open distal tibiofibula fractures. From March 2015 to February 2019, 10 patients with open distal tibiofibula fractures were treated with MIPPO technique through single anterolateral incision, including 8 males and 2 females, aged from 31 to 68 years old. According to Gustilo classification, 6 patients were typeⅠ, 3 patients were typeⅡand 1 patient was type ⅢA. Operative time, intraoperative blood loss and fracture healing were observed, Mazur ankle joint scoring was used to evaluate clinical effect. All patients were followed up from 9 to 24 months. Operative time ranged from 85 to 120 min, intraoperative blood loss ranged from 80 to 200 ml, fracture healing time ranged from 18 to 30 weeks. Nine patients with Gustilo typeⅠandⅡachieved satisfactory healing wound, original wound of 1 patient with Gustilo type ⅢA was poor, and healed by skin flap transplantation at stageⅡ. No steel exposed and infection occurred. According to Mazur ankle scoring at the final following-up, total score was from 61 to 97, and 8 patients got excellent result, 1 good and 1 poor. MIPPO technique through anterolateral single incision for the treatment of open distal tibiofibula fractures could protect original medial wound in opertaion, avoid plate exposed through anterolateral extensor tendon to cover internal fixation, and MIPPO technique could protect fracture end blood flow to improve fracture healing rate, and it is a kind of choice.

Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humeral shaft fractures.

The objective of this study was to evaluate the feasibility and safety of a minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure for proximal humeral shaft fractures using lateral minimal proximal and distal approaches and lateral bridge plating with primary radial nerve control, and to assess its clinical and radiographic outcomes. A retrospective review was done for the medical records of adult patients admitted for fracture of the proximal humeral shaft without associated injury to the ipsilateral upper limb and who consented to undergo a novel MIPPO technique herein reported. Patients were reviewed at regular follow-up periods and assessed at a final follow-up for evaluation of Constant, normalized Constant, and QuickDASH scores. There were 21 adult patients with mean age of 56years. Three patients were lost from early follow-up; one of them had post-operative radial nerve paralysis. Eighteen patients were reviewed for the purpose of this study at a mean of 20months of final follow-up; among them, one patient developed post-operative radial nerve paralysis with complete recovery after three months. Bone healing was achieved without any malalignment in 17 patients at a mean of 15weeks, and one patient developed nonunion. At final assessment (mean, 20months), the mean values of Constant, normalized Constant, and QuickDASH scores were 84 (range, 59 to 100), 95 (range, 73 to 100), and 5 (range, 0 to 18.2) respectively. Compared to pre-reported methods of MIPPO, this technique of lateral proximal and distal mini-approaches with lateral bridge plating after primary control of the radial nerve seems safe and feasible for proximal humeral shaft fractures. It gives good clinical and radiographic results with excellent restoration of upper limb function, very low incidence of post-operative radial nerve injury, and high rate of bone union in good alignment.

Retrospective analysis of minimal invasive plating versus intramedullary nailing for treatment of extra-articular distal tibia fracture

<p class="abstract"><strong>Background:</strong> The volume of cases of distal tibia fractures at trauma care centre are quite high in Indian scenario. These type of fracture often creates a dilemma for the orthopaedic surgeons over the choice of the implant for the management. The aim of our study was to compare intramedullary interlocking nail (IMILN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) on the basis of various parameters.</p><p class="abstract"><strong>Methods:</strong> We collected data of 40 patients with extra-articular distal tibial fractures (within 2 muller square from tibial plafond). Patients were divided into two groups: IMILN and MIPPO. We compared the 2 groups for demographic variables, union time, complication rate and functional score.<strong></strong></p><p class="abstract"><strong>Results:</strong> There was no statistical difference of union time, complication rate, functional outcome and other demographic variables among the groups. Only 2 patients developed non-union and two patients had infection. Overall 38 patients obtained excellent or good result (95%) and two patient had fair outcome (5%).</p><p class="abstract"><strong>Conclusions:</strong> The overall analysis suggested that both MIPPO and IMILN treatment option are comparable with consideration of all the parameters. Detailed results indicate a superiority of MIPPO over IMILN in terms of better anatomical reductions of the fracture with less incidence of malalignment while IMILN is better in terms of having lower rates of infections.</p><p> </p>

Distal tibial fractures treated by minimally invasive percutaneous plate osteosynthesis

Objective: To analyse the functional and radiological outcomes of treating distal tibia fractures with minimally invasive percutaneous plate osteosynthesis.Methods: A prospective study was performed on Thirty adult patients who underwent locking compression plate using MIPPO technique for closed fracture of distal tibial in the Department of Orthopaedics from May 2017 to April 2018 and were followed for one year. The functional outcome was measured using AOFAS (American Orthopaedic Foot and Ankle Society score) and was then graded as excellent/ good/ fair and poor. Radiological outcomes assessed to look for cortical union by taking anteroposterior and lateral view x-ray of affected limb.Results: Majority of the patient were male (60%) belonging to the age group of 36 to 40 years (26%). AOFAS score depicts excellent result in the majority of the patients (70%). Duration of cortical union is less than 16 weeks in almost 50% of patients. Complication resulted in 22% of patients.Conclusion: minimally invasive percutaneous plate osteosynthesis technique for the treatment of distal tibia fracture provides good healing and excellent functional results in most of the patients with few complications.

Management of distal tibial metaphyseal fracture by expert tibial nail using suprapatellar approach

Background: Distal tibial metaphyseal fractures are common lower limb injuries and results in extensive musculoskeletal damage due to paucity of soft tissue coverage. Fixation methods include open reduction and internal fixation (ORIF) with plates, minimally invasive percutaneous plate osteosynthesis (MIPPO) and intrameduallary nailing. Extensive exposure for ORIF leads to wound complications,nonunion and infection. Intramedullary nailing is the preferred for diaphyseal tibial fracture however conventional nailing is less suited for distal tibial metaphysis due to diameter mismatch between the nail and the bone leading to very little nail effect and impaired stability. Expert tibial nail with multiplanar locking options at the proximal and distal end allows for secure stabilization of the metaphyseal fragments. Infrapatellar approach is traditionally used for tibial nailing however suprapatellar approach is emerging as an alternative as semi-extended positioning makes it technically easier to nail the proximal and distal fractures. Materials and Methods: This is a prospective study conducted from February 2019 to February 2020. 14 patients fulfilling the inclusion criteria underwent intramedullary nailing using the suprapatellar approach. The functional outcomes were measured at 6 months using the Lysholm knee score and the SF-36 physical and mental score. The obtained data was analyzed using SPSSv16. Result: The average time of fracture union was 17.8 weeks. The mean SF-36 physical and mental score were 42.4 and 44.5 respectively. The average Lysholm score was 84. The mean arc of motion in the involved knee was 110ᵒ. Secondary procedure in the form of dynamization was done in 2 cases. Anterior knee pain was observed in 3 patients.Conclusion: Expert tibial nailing using suprapatellar approach appears to be a suitable fixation method for distal tibial metaphyseal injuries as it provides good functional and clinical outcome at the same time minimizing the violation of delicate soft tissue structures.

Functional outcome of tibial condylar fractures (Schatzker type V, VI) managed surgically with mippo technique

Introduction: Fractures involving proximal tibia & extending into the knee joint, are known as tibial plateau fractures. They comprise of 1% of all fractures and 8% of the fractures in elderly. Lateral condyle fractures are most common (55-70%). Medial condyle fractures (10 to 23%), bicondylar fractures (10-30%). Most common mechanism of injury is direct axial compression, with a valgus or varus moment and indirect sheer forces. AIM: This study was conducted to observe the functional outcome of surgical management in schatzker type V, VI tibial plateau fractures with proximal locking compression plate. Materials and Methods: 30 cases of Schatzker type V and VI Tibial plateau fractures were taken up for this prospective study. Patients were followed up for a minimum period of 6 months. First follow up was at 6th week, and second follow up was done at 3 months. Both radiological and clinical evaluation was done at both the times. The anatomic and functional evaluation was done using the modified Rasmussen clinical and radiological criteria. Results: In our study, we found that most cases were between 5th-6th decade. Males were affected more than females (80% & 20%). Majority of the patients showed involvement of right tibia (21/30), as compared to left (9/30). RTA was the most common mode of injury, accounting to 77% of the cases followed by self-fall-23%. Conclusion: MIPPO (minimally invasive percutaneous plate osteosynthesis) technique minimizes the size of the surgical incision and avoids soft tissue injury, in turn reducing post-operative complications, leading to better wound healing.

A Comparative Study of Intramedullary Nailing and Minimally Invasive Percutaneous Plate Osteosynthesis for Type A Tibial Fracture Healing

Objective This study aimed to retrospectively compare the efficacy of intramedullary nailing and minimally invasive percutaneous plate osteosynthesis (MIPPO) on the fracture healing of patients with type A tibial fractures. Methods Patients who had been diagnosed with type A tibial fracture (AO classification method) and treated with minimally invasive surgery in our hospital from January 2016 to January 2019 were included in the study. There were 21 patients in the MIPPO group and 27 patients in the intramedullary nailing group. The operation time, intraoperative blood loss, surgical incision length, callus formation time, and fracture healing time of the two groups were analyzed and compared. Results In the intramedullary nailing group, the callus formation time and the fracture healing time were shorter than those in the MIPPO group (P<0.005). Their operation time, intraoperative blood loss, and the surgical incision length were comparable between the two groups. Conclusions For patients with type A tibial fracture and poor wound tissue conditions, intramedullary nailing fixation treatment may be a better choice than MIPPO. Because in patients receiving intramedullary nailing treatment, the callus formation time and fracture healing time are short, and functional exercises can be performed soon after the surgery, which can reduce the occurrence of related complications.

Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall

To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3.3 intertrochanteric fracture with incomplete lateral wall. The clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed. According to different surgical methods, the patients were divided into group A (24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation) and group B (30 cases with Intertan intramedullary nail fixation by closed reduction only). There was no significant difference between the two groups ( P>0.05) in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The operation time, intraoperative blood loss, time to weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. The tip apex distance (TAD) was measured at 2 days, 2 months, and 1 year after operation. At 12 months after operation, the hip joint function was evaluated according to Harris scoring standard, and the rate of conformity (Harris score were more than 70) was calculated. The wounds of the two groups healed by first intention, without infection, skin deformity, and other incision complications. The operation time and intraoperative blood loss of group A were significantly more than those of group B, and the time to weight-bearing and fracture healing were significantly shorter than those of group B ( P<0.05). The patients were followed up 9-20 months (mean, 14.7 months) in group A and 9-19 months (mean, 13.8 months) in group B. There was no significant difference in TAD values at 2 days, 2 months, and 1 year after operation between the two groups ( P<0.05), and there was also no significant difference in TAD values between the postoperative time points ( P>0.05). There was 1 case of infection, 1 case of screw withdrawal, 2 cases of screw removal, and 1 case of bone nonunion in group B, the incidence of complications was 16.7%; there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A, the incidence of complications was 4.2%; there was no significant difference between the two groups ( χ 2=2.109, P=0.146). At 12 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B ( P<0.05). The rate of conformity of group A was 95.83% (23/24) and 76.67% (23/30) in group B, and the difference between the two groups was significant ( χ 2=3.881, P=0.049). For the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall, compared with the closed reduction Intertan intramedullary nail fixation, the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower, the time to weight-bearing was earlier, and the postoperative function was better.