Clin Orthop Surg.  2012 Dec;4(4):313-320. 10.4055/cios.2012.4.4.313.

Minimally Invasive Plate Osteosynthesis for Open Fractures of the Proximal Tibia

• Kim JW
• Oh CW
• Jung WJ
• Kim JS

• KMID: 1719300
• DOI: http://doi.org/10.4055/cios.2012.4.4.313

Abstract

BACKGROUND
Relatively few studies have addressed plate osteosynthesis for open proximal tibial fractures by now. The purpose of this study was to assess the results of minimally invasive plate osteosynthesis (MIPO) for open fractures of the proximal tibia.
METHODS
Thirty-four patients with an open proximal tibial fracture were treated by MIPO. Thirty of these, who followed for over 1 year, constituted the subject of this retrospective study. According to the AO Foundation and Orthopaedic Trauma Association (AO-OTA) classification, there were 3 patients of type 41-C, 6 of type 42-A, 8 of type 42-B, and 13 of type 42-C. In terms of the Gustilo and Anderson's open fracture grading system, 11 patients were of grade I, 6 were of grade II, and 13 were of grade III (III-A, 6; III-B, 6; III-C, 1). After thorough debridement and wound cleansing, when necessary, a soft tissue flap was placed. Primary MIPO (simultaneous plate fixation with soft tissue procedures) was performed in 18 patients, and staged MIPO (temporary external fixation followed by soft tissue procedures and subsequent conversion to plate fixation after soft tissue healing) was performed in 12 patients. Results were assessed according to the achievement and time to union, complications (including infections), and function of the knee joint using Knee Society scores. Statistical analysis was performed to identify factors influencing results.
RESULTS
Primary union was achieved by 24 of the 30 study subjects. Early bone grafting was performed in 6 cases with a massive initial bone defect expected to result in non-union. No patient had malalignment greater than 10degrees. The mean Knee Society score was 88.7 at final follow-up visits, 23 patients achieved an excellent result, and 7 a good result. There were 3 superficial and 5 deep infections, but none required early implant removal. Functional results were similar for primary and staged MIPO (p = 0.113). Fracture pattern (p = 0.089) and open fracture grade (p = 0.079) were not found to influence the results.
CONCLUSIONS
If soft tissue coverage is adequately performed, MIPO could be regarded as an acceptable method for the treatment of open proximal tibial fracture.

Keyword

Proximal; Tibia; Open fracture; Minimally invasive surgical procedure; Plate; Osteosynthesis

MeSH Terms

Adult
Aged
Chi-Square Distribution
Female
Fracture Fixation, Internal/adverse effects/*methods
Fractures, Open/*surgery
Humans
Male
Middle Aged
Surgical Procedures, Minimally Invasive/adverse effects/*methods
Tibia/pathology/radiography/surgery
Tibial Fractures/pathology/radiography/*surgery

Figure

• 

  Fig. 1 (A, B) A 53-year-old male patient sustained type III-B open proximal tibial fracture. (C, D) Primary minimal invasive plate osteosynthesis was performed and followed by rotational gastrocnemius muscle flap.

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  Fig. 2 Follow-up radiograph after 1 year shows solid union of fracture (A, B) with an excellent function (C, D).

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  Fig. 3 (A, B) A 51-year-old male patient suffered from type III-A open proximal tibial fracture. (C, D) Knee bridging external fixation was performed after wound debridement and closure on that day.

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  Fig. 4 (A-C) After wound was healed at 13 days, minimal invasive plate osteosynthesis was done. (D) Satisfactory alignment was achieved. (E, F) Follow-up radiograph after 3 years shows complete union of fracture.

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