COMPARISON OF TWO DIFFERENT PLATE TYPES IN THE MINIMALLY INVASIVE PERCUTANEOUS PLATE OSTEOSYNTHESIS OF DISTAL TIBIA FRACTURES

Nebojsha Nastov; Labinot Bekteshi; Risto Todorov; Pavlina Aleksova; Elizabeta Stojovska Jovanovska

Nebojsha Nastov PHI Clinic for Surgical Diseases "St. Naum Ohridski" - Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Noth Macedonia
Labinot Bekteshi PHI , Special Clinic for Surgical Diseases "St. Naum Ohridski" - Skopje, North Macedonia
Risto Todorov PHI ,Special Clinic for Surgical Diseases "St. Naum Ohridski" - Skopje, North Macedonia
Pavlina Aleksova Clinic for restorative dentistry and endodontics, University Dental Clinical Center "Ss Panteleimon" Skopje, Faculty of Dentistry, Ss.Cyril and Methodius University in Skopje, North Macedonia
Elizabeta Stojovska Jovanovska Institute of Radiology, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia

Abstract

Distal tibia fractures present a unique challenge for the surgeon due to the subcutaneous position of the tibia with a thin soft tissue envelope. The development of the technique for minimally invasive percutaneous plate osteosynthesis (MIPPO) is a well-accepted step towards this direction. In our study we explore the benefits and shortcomings of two different plate types used with this technique: the 3.5 mm anatomically pre-shaped titanium plate, and the 4.5 mm LC-DCP. The study was a prospective â€“ retrospective clinical intervention case control study of 100 patients with closed, unstable, extraarticular and partially articular fractures of the distal tibia and fibula, classified as AO type 43A1, 43A2 and 43Ð3. Patients were divided in two groups of 50 patients. Group A were patients prospectively treated with a 3.5 mm pre-shaped plate, and Group B were patients with retrospectively collected data treated with a 4.5 mm LC-DCP. Patietns age was 38.15 years with 68 male and 32 female patients. Operation duration in Group A was 57.14 Â± 8.30 and 66.67 Â± 5.55, in Group B which was statistically significant. Partial and full weight bearing, as well as time to union in both groups was achieved within a similar timeframe. Functional according to Johner and Wruh's criteria and showed that most patients in both groups (61) had excellent results (Group A: 32, Group B: 29) and 21 had good results (Group A: 10, Group B:11). Rate of complications were comparable between the two groups, in regard to superficial infection, deep infection and ankle stiffness. Only complication parameter which showed a significant difference between the two groups was rate of implant irritation, which was higher in the 4.5 mm LC-DCP group. Both 3.5 mm and 4.5 mm plates are reliable when used with a MIPPO technique. This method is minimally invasive, preserves the periosteal blood supply and ensures optimal conditions for biological repair of distal tibia fractures, regardless of the type of plate used.

Keywords: Distal tibia fractures, MIPPO, Distal Tibia LC-LCP, LC-DCP, AO-classification.

References

1.Schatzker J, Tile M. The Rationale of Operative Fracture Care. 3rd ed. Springer-Verlag Berlin Heidelberg 2005. p. 475-6.
2.Bucholz R, Court-Brown C, Rockwood C. Rockwood and Greenâ€™s Fractures in Adults. New York: Lippincott; 2015. p. 98.
3.Oestern HJ, Tscherne H: Pathophysiology and classification of soft tissue injuries associated with fractures, in Tscherne H, Gotzen L (eds) Fractures with Soft Tissue Injuries. Berlin: Springer-Verlag, 1984, pp 5-7.
4.Borrelli J Jr, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma. 2002 Nov-Dec;16(10):691-5. doi: 10.1097/00005131-200211000-00002. PMID: 12439191.
5.Vidal J. Treatment of articular fractures by â€œligamentotaxisâ€ with external fixation. In: Brooker HS, Edward CC (eds) External Fixation: Current state of the Art. Baltimore: Williams and Wilkins, 1979.
6.Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018 Jan;32 Suppl 1: S1-S170.
7.Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res. 1983 Sep;(178):7-25. PMID: 6883870.
8.Mushtaq A, Shahid R, Asif M, Maqsood M. Distal tibial fracture fixation with locking compression plate (LCP) using the minimally invasive percutaneous osteosynthesis (MIPO) technique. Eur J Trauma Emerg Surg 2009;35:159-64.
9.Ram GG, Kumar D, Phagal VV. Surgical dilemmaâ€™s in treating distal third leg fractures. Int Surg J 2014;1:13-6.
10.Decruz J, Antony Rex RP, Khan SA. Epidemiology of inpatient tibia fractures in Singapore - A single centre experience. Chin J Traumatol. 2019 Apr;22(2):99-102. doi: 10.1016/j.cjtee.2019.01.004. Epub 2019 Feb 27. PMID: 30962125; PMCID: PMC6488744.
11.GÃ¼labi D, Bekler HÄ°, SaÄŸlam F, TaÅŸdemir Z, Ã‡eÃ§en GS, ElmalÄ± N. Surgical treatment of distal tibia fractures: open versus MIPO. Ulus Travma Acil Cerrahi Derg. 2016 Jan;22(1):52-7. doi: 10.5505/tjtes.2015.82026. PMID: 27135079.
12.Yao Q, Ni J, Peng LB, Yu DX, Yuan XM. Locked plating with minimally invasive percutaneous plate osteosynthesis versus intramedullary nailing of distal extra-articular tibial fracture: A retrospective study. Zhonghua Yi Xue Za Zhi 2013;93:3748-51.
13.Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br 2010;92:984-8.
14.Bahari S, Lenehan B, Khan H, McElwain JP. Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg 2007;73:635-40).
15.Redfern DJ, Syed SU, Davies SJ. Fractures of the distal tibia: Minimally invasive plate osteosynthesis. Injury 2004;35:615-20.
16.Li Y, Liu L, Tang X, Pei F, Wang G, Fang Y, et al. Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures. Int Orthop 2012;36:1457-62.