Treatment of distal tibial fractures using locked plates | ||
| The Egyptian Orthopaedic Journal | ||
| Volume 55, Issue 3, July 2020, Pages 172-177 PDF (2.1 M) | ||
| DOI: 10.4103/eoj.eoj_49_21 | ||
| Author | ||
| Mohamed Y. Ali | ||
| Abstract | ||
| Background Distal tibial fracture accounts for approximately three per 10 000 women/year plus 28 per 10 000 men/year. Conservative treatment often results in malunion, nonunion, and ankle stiffness. Moreover, surgery faces challenge of difficult rigid fixation of the relatively short distal fragment, plus poor soft tissues and blood supply at the distal tibia. New modalities for overcoming these problems have recently been developed, including locked plates technology, which allows buttressing of the distal fragment by multiple locked screws, which are introduced by fixed different angles creating fixed-angle stability. Aim To evaluate the outcome of using distal tibial locked plate in fixation of closed extraarticular distal tibial fractures through minimally invasive plate osteosynthesis (MIPO) technique. Patients and methods A prospective study was conducted on 30 patients with distal tibial fracture fixed by distal tibial locked plate in Cairo University Hospital from January 2013 to September 2015. The mean age in the study was 39.7 years. Overall, 40% were females, whereas 60% were males. This study included 18 (60%) cases of type AO 43-A1, with mean healing time of 3.2 months; seven (23%) cases of AO 43-A2, with mean healing time of 6.75 months (one of them revised by another locked plate and grafting, so healed after 11 months); and five (17%) cases AO 43-A3, with mean healing time 3.6 months. One case was not united, and seven cases showed delayed union after 4–6 months. Two cases showed superficial infection, which resolved with antibiotics; one case developed deep infection, which necessitated serial surgical debridement for four times, with removal of plate in the last one and rotational flab coverage; and five cases showed angulations (four of them showed 5° angulation in anteroposterior plane, where one of the them showed in addition 10° posterior angulation, which was considered unacceptable, but the patient refused revision, whereas the fifth case had pure posterior angulation of 5°). Results Ankle range of motion (ROM) evaluation according to Ovadia score was as follows: 67% of cases were excellent, 13% of them were good, and 20% were fair; with mean ankle ROM being restored 70% of the normal side. Conclusion Locked plate is a comparable modality for distal tibial fractures to the new nailing systems and is superior to the convention ones in the rates of union and good alignment. Although concurrent fibular fixation did not prevent lateral angulations in some cases, fixation of the distal tibia alone with locked plate prevented angulation in others. | ||
| Keywords | ||
| fracture distal tibia; locked plate osteosynthesis; MIPO locked plate; osteosynthesis MIPO | ||
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