Abstract: Introduction: Increased incidence of road traffic accidents, natural disasters, and industrial accidents claim most of human mortality and morbidity. These injuries commonly involve long bones, especially the tibia due to its subcutaneous location. Tibial diaphyseal fractures are the most common, followed by proximal tibial fractures. The treatment of proximal tibial fractures changed dramatically in 1969 following the study by Reudi and Ailgower (1) where 75% patients after internal fixation of tibia fractures were pain free and had good functional outcome at 4 years follow up. The following widespread use of internal fixation led to an increase in major complications like malunions (42%), superficial infections (20%), nonunion (18%), and osteomyelitis (17%). This led to a search for newer techniques which led to lesser soft tissue damage and yielded better results. Amongst these techniques was biological minimally invasive percutaneous plate osteosynthesis (MIPPO). In the 1990’s Krettek et al popularized the Minimally Invasive Percuntaneous Plate Osteosynthesis (MIPPO) technique in which conventional plates were placed through a small incision and slid through a subcutaneous tunnel. Biologically friendly plating and minimally invasive plating continues to remain popular today. This study compares MIPPO in extra articular proximal tibia fractures, in terms of functional outcome, union rate and time and the various complications associated with each group.
Aims and objectives
1. To evaluate the clinical and functional outcome in Extra-articular Proximal tibial fracture treated with Minimally Invasive percutaneous plate osteosynthesis.
2. To study range of motion at the knee joint postoperatively.
3. To study the complications, if any with Proximal tibia fracture fixation.
Inclusion criteria
1. Patients with closed extra-articular proximal tibia fractures with age of more than 18 years.
2. Both male and female patients.
The exclusion criteria
1. Fracture associated with knee dislocation
2. Pathological fractures
3. More than 6 weeks Old untreated fractures
4. No other associated lower limb fracture
5. Age more than 80 years
Results and observation: In this study we have taken follow up data of 30 patients with 25 males and 5 females. Most patients were males between 31-50 years of age. RTA was the highest reason for incidence of these fractures. Majority of patients were discharged within 10 post-operative days. Five patients developed infections which increased their hospital stay upto 16 days. On 6 weeks follow up there was only one case of nonunion out of the 30 patients, all of the 29 other fractures united within 6 weeks radiologically and clinically.
Total 30 patients were evaluated postoperatively thoroughly for functional outcome using The Knee.
Society Score which showed 24 patients (80%) had excellent and 6 patients (20%) had good objective knee society score. 23 patients (76.6%) had excellent, 5 patients (16.66%) had good and 2 patient (6.66%) were each of poor and fair functional knee society score.
Conclusion: In this study, we found that extra-articular proximal tibia fractures treated with MIPPO plating gave an excellent functional outcome with minimal soft tissue stripping and better healing of the surgical site wound. There was only one case of delayed union and this directly tells us how superior a MIPPO plating technique is in comparison to long incisions.
