Zeitschrift für Trauma und Behandlung

Minimally Invasive Percutaneous Plate Osteosynthesis (Mippo) in Distal Tibial Fractures – A Prospective Study from Developing Nation

Abstract

Naiyer Asif, Yasir Salam Siddiqui, Jitesh Kumar Jain, Mohd Zahid, Mazhar Abbas, Aamir Bin Sabir and Sohail Ahmed

Background: The management of distal tibial fractures can be challenging because of scarcity of soft tissues, their subcutaneous nature and poor vascularity. Consequently, operative treatment can lead to complications. The surgical treatment of fractures has evolved a great deal since the development of the original “open reduction and internal fixation” technique by the AO group. A mechanically stable fracture-bridging osteosynthesis can be obtained without significant dissection and surgical trauma to the bone and surrounding soft tissues by minimally invasive percutaneous plate osteosynthesis (MIPPO). This technique utilizes indirect reduction and internal fixation with locking compression plates. Our aim was to observe the outcome of the distal tibial fracture fixation (extra-articular and intra-articular) with locking compression plate (LCP) using MIPPO technique. Material and Methods: 26 consecutive patients were prospectively underwent minimally invasive percutaneous plate osteosynthesis for distal tibial fractures between January 2010 and December 2011. Patients were aged between 20 to 65 years with seventeen males and nine females. Both open and closed AO types 43A, 43B and 43C fractures were included. Patients were managed with LCP using MIPPO technique. Postoperative regimen consisted of knee and ankle bending exercises starting on 1st postoperative day. Non weight bearing ambulation started on 3rd post-operative day, progressing to partial weight bearing at 6 to 8 weeks. Full weight bearing ambulation was allowed after clinico radiological union at 12 to 14 weeks. Observation and Results: RTA was the commonest cause of injury. All fractures healed with good functional outcome. Mean union time was 4.5 months (range 3.5–8 months). Mean follow-up was 14.3 months. For all fractures acceptable active range of ankle movement was achieved. Mean AOFAS score was 88. There were 2 cases of superficial infection, treated successfully with antibiotics. No deep infection, wound dehiscence and hardware failure was noted. Conclusion: MIPPO is a well-documented technique that offers biological advantages and appears to be a reasonable treatment option for complex unstable distal tibial or pilon fractures that are not suited for intramedullary nailing. The literature is full of studies from developed nations, but studies from developing nations are lacking. Nevertheless small numbers of patients were involved in our study to draw any definitive conclusions, but our encouraging results will motivate the trauma surgeons from the developing nations to use MIPPO technique in managing distal tibial fractures, in an endeavor to reduce morbidity and associated complications, especially of the soft tissues.