J Korean Fract Soc.  2011 Jul;24(3):230-236.

Anatomically Percutaneous Wiring Reduction in Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures

• Kim YM
• Kang C
• Hwang DS
• Joo YB
• Lee WY
• Hwang JM

Abstract

PURPOSE
To report the method of anatomical reduction and its maintenance by percutaneous wiring reduction in minimally invasive plate osteosynthesis for distal tibial fractures.
MATERIALS AND METHODS
17 cases that were diagnosed oblique, spiral or transverse fracture of distal tibia from August 2007 to February 2010 and were able to anatomically reduce by the method of percutanous wiring reduction in minimally invasive plate osteosynthesis were included in this study. Mean age was 50, and mean follow up period was 18 months. We investigated the period until bone union was achieved, degree of angulation angle, and complications. For postoperative evaluation, Olerud and Molander ankle score and VAS pain score in daily living were checked.
RESULTS
The mean varus/valgus angulation after bone union on AP radiograph was 0.9 degrees and the mean anterior/posterior angulation on lateral radiograph was 2.0 degrees The mean Olerud and Molander ankle score was 89.4, and mean pain score due to walk adjacent to metal plate was 0 points.
CONCLUSION
By the method of percutaneous wiring reduction in distal tibial fracture, anatomical reduction is easily acquired, and only by wire itself, reduction could be maintained, so that without additional manual reduction, plate could be easily fixed.

Keyword

Distal tibial spiral fracture; Percutaneous wiring reduction; Anatomical reduction; MIPO

MeSH Terms

Animals
Ankle
Follow-Up Studies
Tibia
Tibial Fractures

Figure

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  Fig. 1 (A, B) 33 year old male injured by traffic accident admitted to emergency department. Anteroposterior and lateral radiographs shows spiral distal tibial fracture without involving the tibial plafond.

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  Fig. 2 (A) Two small stab incisions are made at the anteromedial and posteromedial borders of the fracture line. (B) A knot pusher loaded with nonabsorbable suture limb is inserted into the posteromedial incision and advanced along the posterior surface of the tibia. (C) On the anteromedial incision, a hemostat is inserted and advanced along the anterolateral surface of the distal tibia, contact with the knot pusher, and the first string is caught and pulled out through the anteromedial incision by the hemostat. (D) A 18 G wire is then knotted with the unloaded suture limb and it is pulled out so the posterior surface of tibia could be circumferentially surrounded. (E) The knot pusher loaded with nonabsorbable suture limb is inserted into the anteromedial incision and advanced along the anteromedial surface of the tibia. (F) The suture limb is held, and the wire advanced in the anteromedial incision is tied with the unloaded suture limb, and it is pulled out toward the posteromedial incision. (G) The circumferential wire is achieved, and it is confirmed by C-arm intensifier. (H) The periarticular plate is inserted and appropriately positioned, and tensioning of the wire using locking pinch is performed. (I) The displacement is automatically corrected. The reduction state of the fracture is confirmed from the images obtained by C-arm intensifier.

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  Fig. 3 (A, B) Anteroposterior and lateral radiographs after removal of plate. There is no evidence of angulation, shortening, or malalignment, and the patient had no pain of discomfort in daily living.

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