SURGICAL MANAGEMENT OF DISTAL THIRD TIBIA FRACTURE BY MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS

Abstract

Background- The management of distal tibia fractures is still a subject of debate for orthopaedic surgeons in terms of both, reduction and xation. The subcutaneous location and soft tissue anatomy of the tibia predispose it to angular and rotational instability. The disadvantage of traditional plating techniques is that it requires large exposure to approach distal tibia, a bone characterized by limited soft tissue coverage and poor vascularity. Minimally invasive plating offers many advantages over conventional open techniques. It causes minimal soft tissue dissection and surgical trauma to the bone. Minimally invasive plate osteosynthesis (MIPO) maintains the biological conguration of the distal tibia and fracture hematoma and also provides a biomechanically stable construct, enabling biological healing. Purpose: To study the functional and radiological outcome of patients with distal thirds diaphyseal-metaphyseal tibial fractures treated by minimally invasive plate osteosynthesis and to document major and minor complications associated with this treatment modality. Materials and Methods: A prospective observational study of cases of distal third diaphyseometaphyseal tibial fractures meeting the inclusion criteria who were admitted in Adichunchanagiri institute of medical sciences, Department of Orthopaedics, BG nagara between 01-02- 2021 to 01-07-2022 was carried out. Fractures were classied according to AO classication [1] and minimally invasive plate osteosynthesis was done. After a minimum follow up period of 6 months the functional and radiological outcomes were assessed using Olerud -Molander Ankle scoring system [2] and anterord posterior and lateral radiographs on follow up. Results: A series of 50 cases with distal 1/3 tibia fractures were studied comprising of 30 males and 20 females. The largest contribution came from the age group of 31-40 and 41-50 years (50%). Road trafc accidents was the commonest cause of injury (60%). Most common fracture pattern was AO Type 43 A2. Associated bula rd fracture was present in 24 patients of which 15 patients underwent xation with ORIF with 1/3 tubular plate or CRIF with Rush pin. Majority of patients, time interval between injury and surgery was less than 5 days (36 patients). A total of 5 cases were found to develop complications including supercial (3 cases) and deep infection (2 case). The time to union was between 16-28 weeks. Average time to union was 24 weeks. Olerud and Molander score was used for functional evaluation, post xation. At the end of 6 months excellent functional outcome was achieved in 27 cases, good results in 21 cases and fair result in 2 cases. Conclusion: This single center, medium size population series demonstrated good to excellent results in a majority of the patients after distal tibia fracture xation using minimally invasive plate osteosynthesis, with outcomes and complications comparable to other studies in literature. Our study shows that plating with MIPO is an effective treatment for closed distal onethird tibia fractures, considering union time and complications rate. Low energy trauma had lesser complications. Younger age promotes early union and functional recovery