A Clinical Study For Management Of Tibial Diaphyseal Fractures In Adults With Locking Compression Plate Using Mippo Technique

摘要

Background: The tibia is the most commonly fractured bone of all the long bones in the body. In-spite of advances in treatment, fractures of tibia still pose a challenge to the orthopaedic surgeon as to their best method of management. Vulnerability of soft tissues and increased incidence of open fractures further complicates these fractures. Minimally invasive percutaneous plate osteosynthesis is one of the modalities of treatment of tibial diaphyseal fractures which causes minimal disturbance of blood supply and preserves the soft tissues around the fracture site. The aim of our study is to show the results of treatment of tibial diaphyseal fractures using MIPPO technique. Patients and methods: Our study included fifty patients with tibial diaphyseal fractures treated with locking compression plate using MIPPO technique. Fourteen patients had associated skeletal injuries. Ten patients had a type one open fracture. Results: All the fractures united at an average of 22.25 weeks. Forty patients (80%) were pain free, six patients (12%) had occasional pain (no limitation of activities) and four patients (8%) had persistent pain with limitation of daily activities. 46 (88%) had excellent or good results and 4 (8%) had poor results. 4 (8%) patients had delayed union and 1(2%) patient developed superficial skin infection, 6 patients (12%) had a palpable hardware and 3 patients (6%) had ankle stiffness.Conclusion: Minimally invasive plate osteosynthesis is a good and safe technique for treatment of tibial diaphyseal fractures providing fracture healing, rapid functional recovery, with minimal soft tissue damage and preservation of blood supply. It is a reliable approach for the management of tibial diaphyseal fractures with proper indications. Introduction The tibia is the most commonly fractured bone of all the long bones of the body. No fracture in the body arouses more controversy regarding treatment than tibial fracture. Due to their frequency, topography, mode of injury and sometimes type of treatment, they have become source of temporary or permanent disability. Fractures of the tibia still pose a challenge to the orthopaedic surgeon due to certain peculiarities like; tibia is a subcutaneous bone so more chances of open type of fracture, greater tendency of displacement of tibial fractures and increased chances of post-op infection. Due to its poor blood supply and less soft tissue coverage there is an increased incidence of delayed union and non union. Biological plating techniques are those in which blood supply to the fractured fragments is maximally preserved. The objective of biologic fixation is to assist physiological process of bone healing wisely and optimally with minimal amount of operative intervention. Stress is laid on maintaining a precarious balance between devascularisation and mechanical perfection.The first attempts at which is called as biological plating date back some 30 years (Boitzy and Weber), but it has gained popularity in the 1980’s. The development of indirect reduction techniques (Mast et al 1989), the development of wave plate (Brunner and Weber 1981) and the bridging plate (Heitemeyer et al 1985) brought about a basic change to fracture treatment using plates. Biological fixation principles can be summarized as: Repositioning and realigning by manipulation at a distance to fracture site, preserving soft tissues (Indirect reduction techniques). Leaving comminuted fragments out of the mechanical construct, while preserving their blood supply. Using low elastic modulus, biocompatible materials. Limited operative exposure. Minimally invasive plate osteosynthesis (MIPPO) is one such method in which percutaneous inserted plate is fixed at a distance proximal and distal to the fracture site through minimal exposure. Advantages cited for MIPPO: Simpler technique, easy to master. No need of additional expensive instrumentation. Improved rates of union. Decreased infection rate. Decreased need for bone gra