Clin Orthop Surg.  2011 Mar;3(1):69-76. 10.4055/cios.2011.3.1.69.

Staged Protocol in Treatment of Open Distal Tibia Fracture: Using Lateral MIPO

• Sohn OJ
• Kang DH

• KMID: 999463
• DOI: http://doi.org/10.4055/cios.2011.3.1.69

Abstract

BACKGROUND
To evaluate the radiological, clinical results in patients with open distal tibia factures, who were treated with a staged treatment protocol using the lateral minimally invasive plate osteosynthesis (MIPO) technique.
METHODS
From January 2007 to June 2009, 10 patients with open distal tibia fractures (Gustilo-Anderson classification II, 3; IIIA, 1; IIIB, 6) were treated using a staged treatment protocol. The initial debridement and application of an external fixator were performed within 24 hours and the mean interval from injury to definitive surgical treatment was 15 days (range, 6 to 52 days). Eight weeks later, an additional bone graft was performed in 3 patients. The follow-up duration was more than 1 year.
RESULTS
The mean fracture healing time was 21 weeks (range, 17 to 28 weeks), and the average Iowa ankle rating score was 84.5 points. At the last follow-up, there was no non-union, angular deformity > 5degrees, shortening > 10 mm or infection. In 10 patients, 2 patients had a superficial wound infection, and another 2 patients showed limitation of ankle joint motion.
CONCLUSIONS
This staged treatment protocol using a lateral MIPO technique is a useful alternative method for achieving high functional recovery with good healing and low complication rates in patients with an open distal tibia fracture.

Keyword

Open distal tibia fracture; Staged protocol; Minimally invasive plate osteosynthes; Lateral plate fixation

MeSH Terms

Adult
Aged
Aged, 80 and over
Ankle Injuries/*surgery
Bone Transplantation
Clinical Protocols
Debridement
External Fixators
Female
Fracture Fixation, Internal/*methods
Fractures, Open/*surgery
Humans
Male
Middle Aged
Negative-Pressure Wound Therapy
Therapeutic Irrigation
Tibial Fractures/*surgery
Treatment Outcome

Figure

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  Fig. 1 (A) Mono frame. (B) Delta frame.

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  Fig. 2 Skin incision & plate insertion in lateral minimally invasive plate osteosynthesis.

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  Fig. 3 (A) A 65-year-old woman sustained a right open distal tibia fracture (AO/OTA type A2, Gustilo-Anderson classification IIIB). (B) Stage 1, irrigation & debridement was performed and ankle-spanning bridge external fixator was applied. (C) Stage 2, after 6 weeks, lateral plate fixation of the distal tibia using the minimally invasive plate osteosynthesis (MIPO) technique was performed and anterolateral. rotator free flap and skin graft were applied. (D) The last follow-up, 13 months postoperatively. AO/OTA: AO/Orthopaedic Trauma Association.

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  Fig. 4 (A) A 29-year-old woman sustained a right open distal tibia fracture (AO/OTA type A3, Gustilo-Anderson classification IIIB). (B) Stage 1, irrigation & debridement was performed and ankle-spanning bridge external fixator was applied. (C) Stage 2, after 8 weeks, lateral plate fixation of the distal tibia using the minimally invasive plate osteosynthesis (MIPO) technique was performed and a skin graft was applied. (D) Stage 3, 8 weeks after open reduction and internal fixation, a bone graft was performed using autogenous iliac bone. (E) Last follow-up, 21 months postoperatively. AO/OTA: AO/Orthopaedic Trauma Association.

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