Two Stage Minimally Invasive Method with Locking Plate Application on Distal Tibia Fractures - Our Experience

Ilir Hasani; Igor Kaftandziev; Slavco Stojmenski; Simon Trpeski; Hristijan Kostov; Ljupcho Nikolov; Oliver Arsovski; Saliamet Emini

doi:10.3889/oamjms.2017.099

Authors

Ilir Hasani University Clinic of Traumatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Igor Kaftandziev University Clinic of Traumatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Slavco Stojmenski University Clinic of Traumatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Simon Trpeski University Clinic of Traumatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Hristijan Kostov University Clinic of Traumatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Ljupcho Nikolov University Clinic of Traumatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Oliver Arsovski University Clinic of Traumatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Saliamet Emini University Clinic of Traumatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje

DOI:

https://doi.org/10.3889/oamjms.2017.099

Keywords:

distal tibia, minimally invasive approach, locking plate, functional results, anatomic pre-shaped locking plate

Abstract

INTRODUCTION: In the past distal tibia fractures, including intraarticular fractures, frequently led to poor functional outcomes. The Ruedi-Allgower four steps open method, and later the Patterson and Sirkin recommendations for delayed operative treatment has made a drastic advancement in the treatment of these fractures. The two-stage minimally-invasive protocol using locking plate fixation proved a historical turning point, improving functional results to the highest levels compared to all other methods.

AIM: To present the superior results of the two-stage minimally-invasive method using locking plate fixation, making this a historic step forward in treating distal tibia fractures.

MATERIAL AND METHODS: A prospective longitudinal study, collecting data from Traumatology-Clinic in the 2014-2016 periods, available for nine-month follow-up. Twenty-three patients were finally included in the study.

RESULTS: In analysing the data collected, we focused our attention on the final functional outcomes as indicated by dorsiflexion nine months after injury and also according to the AOFAS Ankle-Hindfoot Scale. Results were excellent with no or minimal consequences. Where complications were present, these were benign and did not require further surgery.

CONCLUSION: We believe this modern method for the treatment of distal tibia fractures should be applied routinely and considered as the gold standard in this domain.

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References

Grgurev M, Bakota B. Minimalno invazivna osteosinteza ploÄom (MIPO) â€“ danaÅ¡nja saznanja i kliniÄka primjena clinical implications. Med Flum. 2013;49(3):243-259.

Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury. 1997;28 Suppl 1(1):A7-A12.

Ahmad MA, Sivaraman A, Zia A, Rai A, Patel AD. Percutaneous Locking Plates for Fractures of the Distal Tibia: Our Experience and a Review of the Literature. J Trauma Inj Infect Crit Care. 2010;72(2):1.

Ruedi T, Allgower M. The operativen treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop Relat Res. 1979;138:105-110. PMid:376196

RÃ¼edi TP, AllgÃ¶wer M. The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop Relat Res. 1979;(138):105-110. PMid:376196

Patterson MJ, Cole D. Two-Staged Delayed Open Reduction and Internal Fixation of Severe Pilon Fractures. J Orthop Trauma. 1999;13(2):85-91. https://doi.org/10.1097/00005131-199902000-00003

Tomas-Hernandez J. High-energy pilon fractures management: State of the art. EFORT Open Rev. 2016;1(10):354-361. https://doi.org/10.1302/2058-5241.1.000016 PMid:28461913 PMCid:PMC5367607

Michael S, Roy S, DiPasquale T, Herscovici DJ. A Staged Protocol for Soft Tissue Management in the Treatment of Complex Pilon Fractures. J Orthop Trauma. 2004;18(8):32-38.

Roberts CS, Pape H, Jones AL, Malkani AL, Rodriguez JL, Peter V. Damage Control Orthopaedics. JBJS. 2005;87:434-449. https://doi.org/10.2106/00004623-200502000-00030

Liporace F a, Yoon RS. Decisions and staging leading to definitive open management of pilon fractures: where have we come from and where are we now? J Orthop Trauma. 2012;26(8):488-498. https://doi.org/10.1097/BOT.0b013e31822fbdbe PMid:22357091

Beytemur O, Baris A, Albay C, Yuksel S, Caglar S, Alag??z E. Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2). Acta Orthop Traumatol Turc. 2017;51(1):12-16. https://doi.org/10.1016/j.aott.2016.07.010 PMid:27825761

Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma. 2007;21(6):355-361. https://doi.org/10.1097/BOT.0b013e3180ca83c7 PMid:17620992

Calori GM, Tagliabue L, Mazza E, et al. Tibial pilon fractures: Which method of treatment? Injury. 2010;41(11):1183-1190. https://doi.org/10.1016/j.injury.2010.08.041 PMid:20870227

Hoegel FW, Hoffmann S, Weninger P, BÃ¼hren V, Augat P. Biomechanical comparison of locked plate osteosynthesis, reamed and unreamed nailing in conventional interlocking technique, and unreamed angle stable nailing in distal tibia fractures. J Trauma Acute Care Surg. 2012;73(4):933-938. https://doi.org/10.1097/TA.0b013e318251683f PMid:22710777

Muzaffar N, Bhat R, Yasin M. Complications of Minimally Invasive Percutaneous Plating for Distal Tibial Fractures. TraumaMon. 2016;21(3):22131. https://doi.org/10.5812/traumamon.22131 PMid:28182170 PMCid:PMC5282934

Gabriel A. Akra, Stefanos. Lazarides AMN. Early Results of Minimally Invasive Percutaneous Plate Osteosynthesis for Fractures of the Distal Tibia: A Retrospective Case Series and Review of the Literature. Clin Med Insights Arthritis Musculoskelet Disord. 2017;10: 1â€“7(NA):1-7.