Outcome of Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) in closed fractures of distal tibia
Abstract
The limited soft tissue, subcutaneous location and poor vascularity render the dista tibial fractures very challenging. Treatment of distal tibial fractures using minimally invasive percutaneous plate osteosynthesis (MIPPO) technique may minimise damage to soft tissues and vascular integrity of bony fragments, leaving comminuted fragments out of the mechanical construct, preserving soft tissues with limited operative exposure. The aim of this study is to assess the outcome of patients treated with MIPPO technique for closed distal tibial fractures. The study included total of 30 patients (24males and 6females) with close distal tibia fracture, which were treated with distal tibia locking plate using MIPPO technique. The mean ages of the patient were 44.23 years (30 to58 years). Patients were followed up at 2 weeks, 6weeks, 12weeks, 24weeks and 1 year after the operation and evaluated clinically and radiologically. Among 30 pateints, all fractures went to union. The mean AOFAS was 89.23% (SD-3.92). There was 2case of super! cial infection and 3 case of plate impingement with no intraoperative complication and mortality rates.MIPPO is an effective technique for the management of distal tibial fractures. It is minimally invasive, though technically demanding, but preserves the biological environment by preserving the soft tissue with better outcome in terms of radiological union and functional outcome.Keywords: Minimally invasive percutaneous plate osteosynthesis (MIPPO), Distal tibia fracture, open reduction and internal ! xation (ORIF).References
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2. Teeny SM, Wiss DA. Open reduction and internal ! xation of tibial plafond fractures; variables contributing to poor results and complications. Clin Orthop 1993;292:108–17.
3. Ronga M, Longo UG, Maffulli N. Minimally invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat Res 2010 Apr;468(4):975–82.
10 -14 Mishra AK...Outcome of MIPPO
13JSSN Journal of Society of Surgeons of Nepal
JSSN 2013; 16 (1)
4. Konrat G, Moed BR, Watson JT, Kaneshiro S, Karges DE, Cramer KE. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. J Orthop Trauma 1997;1:200–5.
5. Salton HL, Rush S, Schuberth J. Tibial plafond fractures: Limited incision reduction with percutaneous ! xation. J Foot Ankle Surg 2007;46(4):261–9.
6. Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M, Evidence based Orthopaedic Trauma working group. Treatment of distal tibia fractures without articular involvement :a systemic review of 1125 fractures. J Orthop Trauma 2006;(1):76–9.
7. Othman M, Strzelczyk P. Results of conservative treatment of “pilon” fractures. Ortop Traumatol Rehabil 2003;5:787–94
8. Digby JM, Holloway GM, Webb JK. A study of function after tibial cast bracing. Injury 1983;14:432–9.
9. Anglen JO. Early outcome of hybrid external ! xation for fracture of the distal tibia. J Orthop Trauma 1999;13:92–97
10. Anglen JO. Early outcome of hybrid external ! xation for fracture of the distal tibia. J Orthop Trauma 1999;13:92–7.
11. Ruedi T, Webb JK. Experience with the dynamic compression plate in 418 recent fractures of the tibia. Injury 1976;7:252.
12. Olerud S, Karlstrom G. Tibial fractures treated by AO compression osteosynthesis. Experiences from a ! ve year material. Acta Orthop Scand Suppl 1972;140(1):1–104.
13. Chandler Robert W. Principles of internal ! xation. Rockwood and Greene’s fractures in adults, 4th edition. 1996;1:159–217.
14. Mockford BJ, Ogonda L, Warnock D, Barr RJ, Andrews C. The early management of severe tibial pilon fractures using a temporary ring ! xator. Surgeon 2003 ; 1 :104-107.
15. Rammelt S, Endres T, Grass R, Zwipp H. The role of external ! xation in acute ankle trauma. Foot Ankle Clin 2004 ; 9 : 455-474.
16. Konrath G. Moed BR,Watson JT, Kaneshiro S,
Karges DE, Cramer KE. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. J Orthop Trauma 1997 ; 11 : 200-205.
17. Piper Kj,Won HY, Ellis AM. Hybrid external ! xation in complex tibial plateau and plafond fractures : An Autralian audit of outcomes. Injury 2005 ; 36 : 178-184.
18. Blauth M. Bastian L. Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon Fractures. A study of three techniques. J Orthop Trauma 2001 ; 15 : 153-160.
19. Bonar SK, Marsh JL. Tibial plafond fractures : Changing principles of treatment. J Am Acad Orthop Surg 1994 ; 2 :297-305.
20. Bone LB. Fractures of the tibial plafond. Orthop Clin North Am 1987 ; 18 : 95-104.
21. Borg T. Larsson S. Lindsjo U. Percutaneous plating of distal tibia fractures. Preliminary results in 21 patients. Injury 2004 ; 35 : 608-614.
22. Helfet D. Shonnard P. Levine D. Borelli J. Minimally invasive plate osteosynthesis of distal fractures of the tibia.Injury 1997 ; 28 : Suppl 1 : A42-48.
23. Helfet DL, Koval K, Pappas J, Sanders RW, Di Pasquale T. Intraarticular ”pilon” fracture of the tibia. Clin Orthop 1994 ; 298 : 221-228.
24. Im GI, Tae SK. Distal metaphyseal fractures of tibia : a prospective randomised trial of closed reduction and intramedullary nail versus open reduction and plate and screw ! xation. J Trauma 2005 ; 59 : 1219-1223.
25. Konrath G. Moed BR,Watson JT, Kaneshiro S, Karges DE, Cramer KE. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. J Orthop Trauma 1997 ; 11 : 200-205.
26. Marsh JL, Bonar S, Nepola JV et al. Use of an articulated external ! xator for fractures of the tibial plafond. J Bone Joint Surg 1995 ; 77-A : 1498-1509.
27. Mockford BJ, Ogonda L, Warnock D, Barr RJ, Andrews C. The early management of severe tibial pilon fractures using a temporary ring ! xator. Surgeon 2003 ; 1 :104-107.
10 -14 Mishra AK...Outcome of MIPPO
14JSSN Journal of Society of Surgeons of Nepal
JSSN 2013; 16 (1)
28. Mosheiff R, Safran O, Segal D, Liebergall M. The unreamed tibial nail in the treatment of distal metaphyseal fractures. Injury 1999 ; 30 : 83-90.
29. Pavolini B, Maritato M, Turelli L, D’Arienzo M. The Illizarov ! xator in trauma. A 10-year experience. J Orthop Sci 2000 ; 5 : 108-113.
30. Perren SM. Minimally invasive internal ! xation. History, essence and potential of a new approach. Injury 2001 ; 32 :SA1-3.
31. Piper Kj,Won HY, Ellis AM. Hybrid external ! xation in complex tibial plateau and plafond fractures : An Autralian audit of outcomes. Injury 2005 ; 36 : 178-184.
32. Rammelt S, Endres T, Grass R, Zwipp H. The role of external ! xation in acute ankle trauma. Foot Ankle Clin 2004 ; 9 : 455-474.
33. Redfern DJ, Syed SU, Davies SJM. Fractures of the distal tibia. Minimally invasive plate osteosynthesis. Injury 2004 ; 35 : 615-620.
34. Robinson CM, McLauchlan GJ, McLean IP, Court- Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle : classi! cation and treatment by locked intramedullary nailing. J Bone Joint Surg 1995 ; 77-B : 781-787.
35. Sands A, Grujic L, Byck DC, Agel J, Benirschke S, Swiontkowski MF et al. Clinical and functional outcomes of internal ! xation of displaced pilon fractures. Clin Orthop 1998 ; 347 : 131-137.
36. Sirkin M, Sanders R, DiPasquale T, Herscovici D. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 2004 ; 13 : 78-84.
37. Teeny SM,Wiss DA. Open reduction and internal ! xation of tibial plafond fractures. Clin Orthop 1993 ; 292 : 108- 117.
38. Wyrsch B, McFerran MA, McAndrew M et al. Operative treatment of fractures of the tibial plafond. A randomised, prospective study. J Bone Joint Surg 1996 ;78-A : 1646-1657.Acta Orthopædica
2. Teeny SM, Wiss DA. Open reduction and internal ! xation of tibial plafond fractures; variables contributing to poor results and complications. Clin Orthop 1993;292:108–17.
3. Ronga M, Longo UG, Maffulli N. Minimally invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat Res 2010 Apr;468(4):975–82.
10 -14 Mishra AK...Outcome of MIPPO
13JSSN Journal of Society of Surgeons of Nepal
JSSN 2013; 16 (1)
4. Konrat G, Moed BR, Watson JT, Kaneshiro S, Karges DE, Cramer KE. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. J Orthop Trauma 1997;1:200–5.
5. Salton HL, Rush S, Schuberth J. Tibial plafond fractures: Limited incision reduction with percutaneous ! xation. J Foot Ankle Surg 2007;46(4):261–9.
6. Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M, Evidence based Orthopaedic Trauma working group. Treatment of distal tibia fractures without articular involvement :a systemic review of 1125 fractures. J Orthop Trauma 2006;(1):76–9.
7. Othman M, Strzelczyk P. Results of conservative treatment of “pilon” fractures. Ortop Traumatol Rehabil 2003;5:787–94
8. Digby JM, Holloway GM, Webb JK. A study of function after tibial cast bracing. Injury 1983;14:432–9.
9. Anglen JO. Early outcome of hybrid external ! xation for fracture of the distal tibia. J Orthop Trauma 1999;13:92–97
10. Anglen JO. Early outcome of hybrid external ! xation for fracture of the distal tibia. J Orthop Trauma 1999;13:92–7.
11. Ruedi T, Webb JK. Experience with the dynamic compression plate in 418 recent fractures of the tibia. Injury 1976;7:252.
12. Olerud S, Karlstrom G. Tibial fractures treated by AO compression osteosynthesis. Experiences from a ! ve year material. Acta Orthop Scand Suppl 1972;140(1):1–104.
13. Chandler Robert W. Principles of internal ! xation. Rockwood and Greene’s fractures in adults, 4th edition. 1996;1:159–217.
14. Mockford BJ, Ogonda L, Warnock D, Barr RJ, Andrews C. The early management of severe tibial pilon fractures using a temporary ring ! xator. Surgeon 2003 ; 1 :104-107.
15. Rammelt S, Endres T, Grass R, Zwipp H. The role of external ! xation in acute ankle trauma. Foot Ankle Clin 2004 ; 9 : 455-474.
16. Konrath G. Moed BR,Watson JT, Kaneshiro S,
Karges DE, Cramer KE. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. J Orthop Trauma 1997 ; 11 : 200-205.
17. Piper Kj,Won HY, Ellis AM. Hybrid external ! xation in complex tibial plateau and plafond fractures : An Autralian audit of outcomes. Injury 2005 ; 36 : 178-184.
18. Blauth M. Bastian L. Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon Fractures. A study of three techniques. J Orthop Trauma 2001 ; 15 : 153-160.
19. Bonar SK, Marsh JL. Tibial plafond fractures : Changing principles of treatment. J Am Acad Orthop Surg 1994 ; 2 :297-305.
20. Bone LB. Fractures of the tibial plafond. Orthop Clin North Am 1987 ; 18 : 95-104.
21. Borg T. Larsson S. Lindsjo U. Percutaneous plating of distal tibia fractures. Preliminary results in 21 patients. Injury 2004 ; 35 : 608-614.
22. Helfet D. Shonnard P. Levine D. Borelli J. Minimally invasive plate osteosynthesis of distal fractures of the tibia.Injury 1997 ; 28 : Suppl 1 : A42-48.
23. Helfet DL, Koval K, Pappas J, Sanders RW, Di Pasquale T. Intraarticular ”pilon” fracture of the tibia. Clin Orthop 1994 ; 298 : 221-228.
24. Im GI, Tae SK. Distal metaphyseal fractures of tibia : a prospective randomised trial of closed reduction and intramedullary nail versus open reduction and plate and screw ! xation. J Trauma 2005 ; 59 : 1219-1223.
25. Konrath G. Moed BR,Watson JT, Kaneshiro S, Karges DE, Cramer KE. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. J Orthop Trauma 1997 ; 11 : 200-205.
26. Marsh JL, Bonar S, Nepola JV et al. Use of an articulated external ! xator for fractures of the tibial plafond. J Bone Joint Surg 1995 ; 77-A : 1498-1509.
27. Mockford BJ, Ogonda L, Warnock D, Barr RJ, Andrews C. The early management of severe tibial pilon fractures using a temporary ring ! xator. Surgeon 2003 ; 1 :104-107.
10 -14 Mishra AK...Outcome of MIPPO
14JSSN Journal of Society of Surgeons of Nepal
JSSN 2013; 16 (1)
28. Mosheiff R, Safran O, Segal D, Liebergall M. The unreamed tibial nail in the treatment of distal metaphyseal fractures. Injury 1999 ; 30 : 83-90.
29. Pavolini B, Maritato M, Turelli L, D’Arienzo M. The Illizarov ! xator in trauma. A 10-year experience. J Orthop Sci 2000 ; 5 : 108-113.
30. Perren SM. Minimally invasive internal ! xation. History, essence and potential of a new approach. Injury 2001 ; 32 :SA1-3.
31. Piper Kj,Won HY, Ellis AM. Hybrid external ! xation in complex tibial plateau and plafond fractures : An Autralian audit of outcomes. Injury 2005 ; 36 : 178-184.
32. Rammelt S, Endres T, Grass R, Zwipp H. The role of external ! xation in acute ankle trauma. Foot Ankle Clin 2004 ; 9 : 455-474.
33. Redfern DJ, Syed SU, Davies SJM. Fractures of the distal tibia. Minimally invasive plate osteosynthesis. Injury 2004 ; 35 : 615-620.
34. Robinson CM, McLauchlan GJ, McLean IP, Court- Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle : classi! cation and treatment by locked intramedullary nailing. J Bone Joint Surg 1995 ; 77-B : 781-787.
35. Sands A, Grujic L, Byck DC, Agel J, Benirschke S, Swiontkowski MF et al. Clinical and functional outcomes of internal ! xation of displaced pilon fractures. Clin Orthop 1998 ; 347 : 131-137.
36. Sirkin M, Sanders R, DiPasquale T, Herscovici D. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 2004 ; 13 : 78-84.
37. Teeny SM,Wiss DA. Open reduction and internal ! xation of tibial plafond fractures. Clin Orthop 1993 ; 292 : 108- 117.
38. Wyrsch B, McFerran MA, McAndrew M et al. Operative treatment of fractures of the tibial plafond. A randomised, prospective study. J Bone Joint Surg 1996 ;78-A : 1646-1657.Acta Orthopædica
Published
2015-03-13
How to Cite
ADHIKARI V AND SINGH RP, Mishra AK, Chalise PK, Shah SB,.
Outcome of Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) in closed fractures of distal tibia.
J Soc Surg Nep, [S.l.], v. 16, n. 1, mar. 2015.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=4>. Date accessed: 07 nov. 2024.
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