Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis - A prospective series of 50 patients.
Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis - A prospective series of 50 patients.
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DOI：
10.1016/j.jcot.2014.07.010
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发表时间：
2014-09-01
影响因子：
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通讯作者：
Vidyarthi, Kandarp
中科院分区：
文献类型：
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作者：
Paluvadi, Siddhartha Venkata;Lal, Hitesh;Vidyarthi, Kandarp
背景：微创接骨板（MIPO）是一种固定第三胫骨远端骨折的成熟技术。我们的研究旨在通过微创钢板接骨技术治疗远端第三胫骨的关节内和关节外骨折，并进行前瞻性随访。研究了临床和放射学结果，并审查了手术的临床适应症和功效。虽然之前已经进行过很多研究，但这些都是回顾性综述或小系列研究。 方法：2010年5月至2013年5月，对50例闭合性远端胫骨骨折患者采用MIPO技术进行手术，远端胫骨解剖锁定钢板近端有4.5/5个螺孔，远端有3.5/4个螺孔。随访时间为3年。结果：平均骨折愈合时间为21.4周（范围16-32周），平均AOFAS评分为95.06分，满分为100分。末次随访时，5例患者（10%）发生浅表感染；深部感染、种植体失败和畸形愈合各有 1 名患者 (2%)。 结论：MIPO 技术提供了良好的骨愈合，但略有延迟，并降低了不愈合的发生率和骨移植的需要。该技术应用于无法锁钉的远端胫骨骨折，如远端干骺端小碎片骨折、垂直裂口骨折、明显粉碎性骨折以及关节内延伸骨折。
BACKGROUND: Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed. Though many studies on the subject have been done previously, these have been retrospective reviews or small series.METHODS: From May 2010 to May 2013, 50 patients of closed distal tibial fractures were operated by MIPO technique with a distal tibial anatomical locking plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 3 years.RESULTS: The mean fracture healing time was 21.4 weeks (range 16-32 weeks) and average AOFAS score 95.06 was out of a total possible 100 points. At last follow up, superficial infection occurred in 5 patients (10%); deep infection, implant failure and malunion in 1-patient each (2%).CONCLUSION: MIPO technique provides good, though slightly delayed bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension.