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

Affiliations
  • 1Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea. cwoh@knu.ac.kr

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.

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

  • 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.

  • 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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Reference

1. Starman JS, Castillo RC, Bosse MJ, MacKenzie EJ. LEAP Study Group. Proximal tibial metaphyseal fractures with severe soft tissue injury: clinical and functional results at 2 years. Clin Orthop Relat Res. 2010. 468(6):1669–1675.
Article
2. Tejwani NC, Achan P. Staged management of high-energy proximal tibia fractures. Bull Hosp Jt Dis. 2004. 62(1-2):62–66.
3. Clancey GJ, Hansen ST Jr. Open fractures of the tibia: a review of one hundred and two cases. J Bone Joint Surg Am. 1978. 60(1):118–122.
4. Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994. 23(2):149–154.
5. Whittle AP, Russell TA, Taylor JC, Lavelle DG. Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming. J Bone Joint Surg Am. 1992. 74(8):1162–1171.
Article
6. Kumar A, Whittle AP. Treatment of complex (Schatzker Type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review. J Orthop Trauma. 2000. 14(5):339–344.
Article
7. Cole PA, Zlowodzki M, Kregor PJ. Less Invasive Stabilization System (LISS) for fractures of the proximal tibia: indications, surgical technique and preliminary results of the UMC Clinical Trial. Injury. 2003. 34:Suppl 1. A16–A29.
Article
8. Collinge C, Sanders R, DiPasquale T. Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop Relat Res. 2000. (375):69–77.
Article
9. Oh CW, Oh JK, Kyung HS, et al. Double plating of unstable proximal tibial fractures using minimally invasive percutaneous osteosynthesis technique. Acta Orthop. 2006. 77(3):524–530.
Article
10. Oh JK, Oh CW, Jeon IH, et al. Percutaneous plate stabilization of proximal tibial fractures. J Trauma. 2005. 59(2):431–437.
Article
11. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989. (248):13–14.
Article
12. Das De S, Bae DS, Waters PM. Displaced humeral lateral condyle fractures in children: should we bury the pins? J Pediatr Orthop. 2012. 32(6):573–578.
13. Bach AW, Hansen ST Jr. Plates versus external fixation in severe open tibial shaft fractures: a randomized trial. Clin Orthop Relat Res. 1989. (241):89–94.
14. Gaudinez RF, Mallik AR, Szporn M. Hybrid external fixation of comminuted tibial plateau fractures. Clin Orthop Relat Res. 1996. (328):203–210.
Article
15. Dendrinos GK, Kontos S, Katsenis D, Dalas A. Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator. J Bone Joint Surg Br. 1996. 78(5):710–717.
Article
16. Henley MB, Chapman JR, Agel J, Harvey EJ, Whorton AM, Swiontkowski MF. Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma. 1998. 12(1):1–7.
Article
17. Xue D, Zheng Q, Li H, Qian S, Zhang B, Pan Z. Reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures: a subgroup analysis of randomised trials. Int Orthop. 2010. 34(8):1307–1313.
Article
18. Lindvall E, Sanders R, Dipasquale T, Herscovici D, Haidukewych G, Sagi C. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: comparison of 56 cases. J Orthop Trauma. 2009. 23(7):485–492.
Article
19. Nork SE, Barei DP, Schildhauer TA, et al. Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma. 2006. 20(8):523–528.
Article
20. Ricci WM, O'Boyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws. J Orthop Trauma. 2001. 15(4):264–270.
Article
21. Stannard JP, Finkemeier CG, Lee J, Kregor PJ. Utilization of the less-invasive stabilization system internal fixator for open fractures of the proximal tibia: a multi-center evaluation. Indian J Orthop. 2008. 42(4):426–430.
Article
22. Haidukewych GJ. Temporary external fixation for the management of complex intra- and periarticular fractures of the lower extremity. J Orthop Trauma. 2002. 16(9):678–685.
Article
23. Ma CH, Wu CH, Yu SW, Yen CY, Tu YK. Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures. Injury. 2010. 41(2):190–196.
Article
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