Fracture involving the diaphysis of the tibia especially due to high energy trauma continues to be a challenging problem in Orthopaedic surgery. Treatment of tibial diaphysial fracture has improved with the evaluation of plate and nailing technologies. Recently locking compression plating have been used with minimally invasive plate osteosynthesis (MIPO) technique with indirect reduction and percutaneous plate insertion, which reported excellent results especially in comminuted tibial shaft fractures (AO Type-42C) where IM nail were contraindicated. The purpose of this study is to analyze and discuss the outcome of comminuted tibial shaft fractures (AO Type-42C) treated with MIPO technique.
Methods: This prospective (interventional) study included 19 adult male and 06 adult female patients who had high-energy closed tibial shaft fractures with varying degrees of displacement and comminution. All cases were assessed by clinical examinations and radiographs before and after surgery. Post-operative follow-up was done for a mean time of 06 months and evaluated radiologically and functionally according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system.
Results: Most of the fractures 11(44%) united with a mean union time of 19.6±2.53 weeks. ranging from 19-21weeks. Clinical and radiological outcomes according to the ASAMI scoring system showed satisfactory results (excellent and good) in 23 patients, representing 92% of the studied group. There were no persistent limitation of the knee or ankle motions and deep wound infection. Implant failure didn’t occurred in any of the patients until the last follow-up, and none of the patients required a second major open intervention.
Conclusion: The minimally invasive plate fixation with locking compression plate is an effective method of stabilization for closed comminuted tibial shaft fractures, yielding good bone alignment with minimal soft tissues injury, leading to higher union rates with good functional outcome.