Minimal invasive percutaneous plate osteosynthesis (MIPPO) in treatment of distal tibial fractures: A prospective study of 50 cases

Background: The limited soft tissue, subcutaneous location of large portion of tibia and precarious blood supply renders the treatment of distal tibial fracture very challenging. The main treatment of this type of fracture is reinstatement of the normal alignment and articular congruity. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed Reduction and MIPO with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia, maintains fracture haematoma and provides biomechanically stable construct, early mobilization, less complications and relatively higher rates of union. The aim of this study was to evaluate the functional and clinical outcomes of distal tibia fracture of patients, treated by internal fixation by minimally invasive plating osteosynthesis (MIPPO) technique with locking compression plate (LCP). Methods: 50 patients with distal tibia fracture with or without intra articular extension were treated in our department at Guru Gobind singh Medical College and Hospital, Faridkot by MIPPO with LCP and were prospectively followed for average duration of 6 months. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) score. Results: There were 50 patients in the study including 36 males and 14 female of mean age 38.4 years. The mean follow up period of our patients was 6 months. All fractures united at an average of 19.13 weeks (range- 16-24 to weeks) except two cases of non-union. There were 12 superficial wound infections which were treated with oral antibiotics and progressed to union and there were no failures of implants. . According to AOFAS score at 6 months, 6 cases had score of 31 to 70 and 44 cases had score of 71 to 100. Conclusions: Minimally invasive plating osteosynthesis (MIPPO) is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incision is technically demanding as it is effective, minimally invasive, optimises the operation time, promotes early healing and reduces the incidence of infections.