Minimally Invasive Plate Osteosynthesis (MIPO) for Proximal and Distal Fractures of the Tibia

ABSTRACT

Introduction: The treatment of fractures of proximal and distaltibia is challenging, because of the possibility of soft tissuecomplications. The treatment of choice remains controversialand it depends on the fracture morphology, displacement andpresence of comminution. Options for the management ofthese fractures vary from closed reduction and cast applicationto open reduction and fixation with plate. Open reduction andplate osteosynthesis is associated with extensive dissectionand soft tissue complications in post-operative period. Weconducted a case series on management of these fractures byusing Minimally Invasive Plate Osteosynthesis (MIPO)technique, which has the advantage of preservation of osseousand soft tissue vascularity.Methods: We conducted a prospective study on closedreduction and percutaneous plating by MIPO technique in 30cases (mean age 42.5 years; 23 males and 7 females) ofclosed fractures of tibia. 22 cases had proximal tibial fracturesand eight had distal tibial fractures. The mean time from injuryto surgery was 7.6 days.Results: Mean time for radiological union was 18 weeks(range 14-24 weeks). Two patients had superficial operativesite infections, which were managed with oral antibiotics andregular dressings. One patient with proximal tibia fracturedeveloped a non-union, which was treated with bone grafting.Conclusions: In closed peri-articular fractures of the tibia,favourable results can be achieved by MIPO technique.Principles of MIPO technique like minimal soft tissuedissection, closed and indirect reduction, biological fixation andearly mobilization have to be followed for a favourablefunctional outcome.