Minimally invasive locking plate osteosynthesis for fractures of the distal tibia - Results in 20 patients

Aims: We report our experiences with minimally invasive locking plate osteosynthesis (MILPO), for distal tibia fractures, with specific reference to fracture union and complications encountered. Patients and methods: Twenty patients underwent MILPO for open and closed distal tibia fractures between March 2003 and December 2004. Fractures were classified according to the AO system. Open fractures were graded using the Gustilo and Anderson classification and closed fractures via the Tscherne classification system. Results: There were 16 mates and 4 females of mean age 44.7 years (range 19-69 years). Thirteen patients had temporary external fixation, prior to definitive fracture fixation. Minimum follow-up was 12 months and average time to full weight bearing in the closed fracture group (12 patients) was 18.1 weeks (range 8-32 weeks) and 19.3 weeks in the open fracture group (8 patients, range 8-44 weeks). Fracture heating was defined as radiological evidence of bridging mature callus combined with pain-free full weight bearing. In the open fracture group, four fractures united within 6 months, one within 6-12 months and one united 12 months after surgery; there were two cases of non-union. In the closed fracture group, seven fractures united within 6 months, three fractures between 6 and 12 months and two after 12 months from surgery. Two of the 20 patients required additional procedures to aid bone heating in the post-operative period. Three of the 20 patients required metalwork removal, for delayed wound breakdown in two cases and wound infection in one case. An uneventful recovery was made following this, in all three cases. There was one case of implant failure due to plate breakage at 32 weeks post-op. The fracture site was opened and re-plated at 32 weeks with a DCP. There were no complications following this. Conclusion: MILPO was used for definitive fixation of high energy, open and closed, peri-articular distal tibia fractures. This approach aims to preserve bone biology and minimise surgical soft tissue trauma. This surgical approach may provide an answer to treating a challenging group of fractures and further research is warranted. (C) 2006 Elsevier Ltd. All rights reserved.