Minimally Invasive Plate Osteosynthesis (MIPO) for Proximal and Distal Fractures of The Tibia: A Biological Approach

Introduction: The treatment of fractures of proximal and distal tibia is challenging, because of the limited soft tissue envelope and poor vascularity. The best treatment remains controversial and it depends on the fracture morphology, displacement and comminution. Treatment options vary from closed reduction and cast to open reduction and internal fixation with plate. Open reduction and internal fixation with plate can result in extensive dissection and tissue devitalization. We conducted a study on management of these fractures by biological osteosynthesis using Minimally Invasive Plate Osteosynthesis (MIPO) technique with preservation of osseous and soft tissue vascularity. Methods: We conducted a prospective study on closed reduction and percutaneous plating in 30 cases (mean age 42.7 years; 22 males and 8 females) of closed fractures of tibia. Among them 24 had proximal tibial fractures and 6 had distal tibial fractures. The mean time from injury to surgery was seven days. Results: The mean operative time was 72.6 minutes (range: 55-90 minutes). Mean time for radiological union was 17 weeks (range: 14-22 weeks). There was one superficial wound infection which resolved with daily dressings and one week of oral antibiotics. One patient developed a nonunion which required a bone grafting procedure. Conclusions: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in periarticular fractures. Biological fixation of complex fractures gives stable as well as optimal internal fixation and complete recovery of limb function at an early stage with minimal risk of complications.