FUNCTIONAL AND RADIOLOGICAL OUTCOME OF LOCKING COMPRESSION PLATE FORDISTAL TIBIA FRACTURES USING MIPPO TECHNIQUE – A PROSPECTIVE STUDY

Abstract

Background: Distal Tibia fracture is one of the most substantial therapeutic challenges that confronts an orthopaedic surgeon. Numerous features are responsible for this, but perhaps none are as difficult as the accompanying soft tissue injury that is frequently present. They are only 1-10% of all lower extremity fractures. Plating has been the conventional management strategy for such fractures. However, restoration of the osseous anatomy while ignoring the oftentraumatized soft tissue envelope, frequently led to poor postoperative outcomes and high complication rates. This prompted for more research into the treatment strategies. The conventional plating techniques are thus rapidly being replaced by low profile Locking Compression Plates (LCP). They give higher degree of stability and provide better protection against primary and secondary loss of reduction. Since open reduction in lower end tibial fractures often jeopardizes vascularity of the fracture fragments, minimally invasive percutaneous plate osteosynthesis (MIPPO) is slowly becoming the best possible option permitting adequate fixation in a biological manner. Materials And Methods: This is a prospective study for a period of 2 years from 1ST June 2015 to 31st May 2017 done under the guidance of the ethical committee of the hospital. It includes 36 cases of fractures of lower end tibia in adults. Patients were evaluated as per the history, mode of injury and clinical findings pre-operatively, duration of surgery, time for fracture union, complications, and functional outcome post-operatively. Clinical and radiological follow-ups were taken at intervals of three weeks. OLERUD-MOLANDER scoring system was used to analyse functional outcome at the end of 6 months. According to OLERUD-MOLANDER scoring system, at the end of 6 months, 28 out of 36 patients Results: (78%) had excellent outcome, 5 (14%) had good results, 1 (3%) patient had fair outcome and 2 (5%) patients had poor results. The average duration of surgery was 77 minutes. Average time of fracture healing was 12 weeks with three cases of delayed union i.e., 20 weeks. There were no intra-operative complications. Post-operatively 3 patients had superficial wound infection and 6 patients had ankle stiffness. The present case series concludes that MIPPO wi Conclusion: th LCP is an effective treatment modality in terms of union time and complication rate for distal third tibia fractures. The outcome is evidently better than the open reduction and internal fixation technique with conventional plates.

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