Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial frac- tures

Objective： To investigate the efficacy of the locking internal fixator （LIF）, which includes the locking compression plate （LCP） and the less invasive stable system （LISS）, in the proximal and distal tibial fractures. Methods： We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the opera- tion with LIF by the minimally invasive plate osteosynthe- sis （MIPO） technique. The data consisted of 43 proximal tibial fractures （type AO41 C3） and 55 distal tibial fractures （type AO43C3）. Results： No complications were observed in all patients after operation. The mean healing time was 8.4 months （range 5-14 months）. Only two cases of delayed union oc- curred at postoperative 10 months. No infections were re- ported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at post- operative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion： Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing.

Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures

Purpose： To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis （MIPPO） of tibial shaft fractures with the use of a distraction support. Methods： Between March 2011 and October 2014, 52 patients with a mean age of 48 years （16-72 years） sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goniometer measurement on preoperative and postoperative images. Results： Preoperative radiographs revealed a mean of 7.6°（1.2°-28°） angulation in coronal plane and a mean of 6.8°（0.5°-19°） angulation in sagittal plane. Postoperative anteroposterior and lateral radio graphs showed a mean of 0.8°（0°-4.0°） and 0.6°00-3.6°） of varusvalgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. Conclusions： This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.

Comparative prospective study between medial and lateral distal tibial locking compression plates for distal third tibial fractures

Purpose： Tibial fracture is the most common long bone fracture. Distal third tibial fractures are chal- lenging though open reduction and plating can result in anatomical reduction and rigid fixation. This paper aimed to evaluate and compare the results of medial and lateral locking compression plates for distal third tibial fractures. Methods： This prospective clinical study involved 36 patients with distal tibial fractures admitted in Department of Orthopaedics, Sawai Mansingh Medical College ＆ Affiliated Hospital, Jaipur, India, from June 2011 to May 2012, including 29 closed fractures and 7 open fractures at the mean age of 38.9 years. Thirty-six patients were divided equally into two groups based on treatment method, including medial plating group （18 patients） and lateral plating group （18 patients）. They were followed up for at least 5 months after discharge. The functional outcomes were evaluated using Tenny and Wiss clinical assess- ment criteria. Results： Malunion was found in 3 cases of medial plating group and in 1 case of lateral plating group. In the medial plating group, there were 5 cases of superficial infections, 1 deep infection, 1 nonunion and 3 wound dehiscence. In the lateral plating group, there was 1 case of superficial infections, 1 deep infection and 1 nonunion, in the lateral plating group, 4 patients reported feeling the plates and screws but none of them asked to remove the hardware. In the medial plating group, 9 patients reported symptomatic hardware problems and 7 asked to remove the hardware. The number of cases graded as excellent/good/ fair was 1/8/7 in the medial plating group and 3/7/7 in the lateral plating group respectively. In the medial plating group, the final range of motion was 17.2° in ankle dorsiflexion and 30.7° in ankle plantar flexion. In the lateral plating group, the final range of motion was 19° in ankle dorsiflexion and 34.2° in ankle plantar flexion. Conclusion： Lateral plating of distal tibia is safe and feasible, which can provide biological fixation and prevent the soft tissue complications associated with medial plating.

Distal tibial fracture： An ideal indication for external fixation using locking plate

Objective： To evaluate the feasibility and efficiency of one-stage external fixation by using locking plate in distal tibial fractures. Methods： In this non-control prospective study, 28 patients with distal tibial fractures were included and underwent one-stage external fixation by using locking plate. There were 21 males and 7 females, with a mean age of 43 years （19-63）. According to AO/OTA fracture classification, there were 9 cases of Type A1, 9 of Type A2, 10 of Type A3 fractures. There were 21 close and 7 open fractures. The locking plate was placed on the anteromedial aspect of the tibia with 4-5 bicortical screws inserted in both distal metaphysis and diaphysis. The radiographic and clinic results were evaluated. Results： All patients were followed up for the average of 16 months （ranging from 12 to 21 months）. The average surgery duration was 38 （25-60） minutes. The mean time to fracture healing were 14.6 ± 2.67, 17.5 ± 3.66, and 18.4±3.37 （p 〈 0.05） weeks in type A1, A2, and A3 fractures respectively. By the end of the follow-ups, the mean AOFAS score were 96.11 ± 2.32, 92.67 ± 1.80 and 92.00± 2.06 （p 〉 0.05） in type A1, A2, and A3 fractures respectively. None of nonunion, deep infection, or breakage of screw or plate were observed. Conclusions： Distal tibial fracture was the ideal indication for external fixation using locking plate. The external plating is characterized by ease of performance, less invasive, fewer soft tissue impingement, improved cosmesis, and convenient for removal.