A comparison of minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in the management of tibial pilon fractures: A prospective randomized study.

Introduction: The aim of this study was to compare two surgical procedures for the treatment of tibial pilon fractures, i.e. minimally invasive plate osteosynthesis (MIPO) vs. open reduction and internal fixation (ORIF), in terms of wound healing time, ankle swelling, change in pain, functional outcomes and complications.

Hypothesis: We hypothesized that MIPO treatment would induce a faster healing process and lower complications rates.

Patients and methods: This monocentric, comparative, prospective and randomized study was based on the enrollment of 54 patients between November 2017 and May 2023. Patients hospitalized for a tibial pilon fracture with closed or open fracture (Cauchoix or Gustilo type I) received randomly ORIF or MIPO treatment using distal tibial locking compression plates of 3.5 mm. Data collection included demographics, wound dressing wear time, ankle circumference ratio, pain scores, AOFAS, FADI and MAZUR functional scores, and complications. Data were monitored from the intervention day until 12 months of follow-up, with different intermediate follow-up visits. They were then compared between minimally invasive and open surgery groups.

Results: We found similar dressing wear times in both groups with a mean of 21.55 ± 14.91 days in the ORIF group and 18.0 ± 6.44 days in the MIPO group (p = 0.312). VAS pain scores and ankle circumference ratio did not reveal a significant difference between the two techniques. The infection rate was identical in both groups (15.4%; 4/26). Wound complication rates in the ORIF group (11.5%; 3/26) and the MIPO group (7.7%; 2/26) were not statistically different (p = 0.334). The analysis of the functional scores showed ameliorated results in the ORIF group at 3 months follow-up with higher AOFAS, FADI and MAZUR scores, but at further monitoring visits there was no evidence of the superiority of one technique over another.

Conclusion: The MIPO technique was not distinctively superior to ORIF method in the treatment of tibial pilon fractures.

Level of evidence: I, prospective randomized controlled trial.