Functional Outcome Following Fixation of Extra Articular Distal Tibial Fracture with Locking Compression Plate Using Minimally Invasive Percutaneous Technique

Abstract

Background:Distal tibia fractures are challenging injuries. They are often caused by high energy axial compressive, direct bending or low energy rotation forces. These fractures constitute less than 10% of all tibial fractures.Locking plates provide excellent stability compared to a conventional plate and better protection against loss of reduction and minimization of bone contact. Preservation of vascularity of fracture fragments, fracture hematoma and minimal soft tissue damage favors minimally invasive percutaneous plating osteosynthesis for distal tibia fractures.

Aim of the study:The aim of this study was to improve the outcome of surgical treatment of extra articular distal tibial fracture.

Patient and methods: Eighteen patients with distal tibial extra articular fractures were included in this nonrandomized controlled clinical study. This study was conducted in zagazig university hospital in period between April 2020 to April 2021. The cases were classified using the method of AO classification.Patients admitted to hospital with distal tibia fractures after meeting the inclusion and exclusion criteria, the underwent full history general, local, radiological examination were done and the laboratory investigations. In this study two different shapes of precountred anatomical locked distal tibial plates were used for technique of surgery was MIPP (minimally invasive percutaneous plate osteosynthesis).After operation follow up was done 2, 6, 12 weeks by clinical and radiological assessment.

Results: mean age was 36.72±9.71, 72.2% were males and 27.8% were females, 9 patients 50.0% were smokers. 33.3% had associated injury, 55.6% were left and 44.4% were right, majority were A1 with 77.8% and 50% were accidental and 50% fall from height. mean time since operation was 4.22±1.35 days, mean operation time was 108.33±26.12 minutes. Mean hospital stay was 3.50±0.85 days. AOAFS scores were 35.55±6.15, 45.61±4.0, 9.16±1.91 respectively regarding pain, ROM and alignment and mean total AOAFS was 90.33±10.87. Mean union time was 16.94±3.33 weeks and mean time of full weight bearing was 20.83±3.48 weeks. Eleven patients (61.1%) were excellent, four patients (22.2%) were good, two patients 11.1% were fair and one patient (5.55%) was poor. F our patients 22.2%had Superficial infection one case (5.55%) had stuffiness, two cases (11.1%) were delayed union.

Conclusion:Minimally invasive plate osteosynthesis by locking plate have shown a reliable method of fixation for distal tibial fractures