Minimally Invasive Plate Osteosynthesis in Distal Tibial Fractures: Union Rates and Complications
DOI:
https://doi.org/10.5281/zenodo.22326896Keywords:
Minimally invasive plate osteosynthesis, Distal tibia fracture, Intramedullary nailing, Fracture union, MalunionAbstract
- Background: Distal tibial metaphyseal fractures are difficult to fix because the overlying soft-tissue envelope is thin and poorly
vascularised, predisposing open plating to wound breakdown, infection and delayed union. Minimally invasive plate
osteosynthesis (MIPO) was developed to restore alignment while preserving periosteal blood supply.
Objective: To synthesise published evidence on MIPO for distal tibial fractures, comparing union, malalignment, and
complications against open reduction internal fixation (ORIF) and intramedullary nailing (IMN). Methods: Narrative review of rationale studies, comparative cohorts, randomised trials, meta-analyses and a Cochrane review. Findings: MIPO achieves union in roughly 84-96% of reported series, generally by 18-20 weeks, comparable to IMN and ORIF. IMN shortens operative time and lowers wound infection, but carries higher malunion and anterior knee pain rates. Conclusions: MIPO is a safe, biologically favourable option for selected fractures, with technique choice guided by fracture pattern, soft-tissue status and surgeon experience.
References
Helfet, D.L., Shonnard, P.Y., Levine, D., Borrelli, J. Jr. (1997) Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury, 28(Suppl 1): A42-A48.
Farouk, O., Krettek, C., Miclau, T., Schandelmaier, P., Guy, P., Tscherne, H. (1999) Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? Journal of Orthopaedic Trauma, 13(6): 401-406.
Collinge, C., Sanders, R., DiPasquale, T. (2000) Treatment of complex tibial periarticular fractures using percutaneous techniques. Clinical Orthopaedics and Related Research, 375: 69-77.
Kuo, L.T., Chi, C.C., Chuang, C.H. (2015) Surgical interventions for treating distal tibial metaphyseal fractures in adults. Cochrane Database of Systematic Reviews, 2015(3): CD010261.
Borg, T., Larsson, S., Lindsjö, U. (2004) Percutaneous plating of distal tibial fractures. Preliminary results in 21 patients. Injury, 35(6): 608-614.
Gupta, R.K., Rohilla, R.K., Sangwan, K., Singh, V., Walia, S. (2010) Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients. International Orthopaedics, 34(8): 1285-1290.
Ghera, S., Santori, F.S., Calderaro, M., Giorgini, T.L. (2004) Minimally invasive plate osteosynthesis in distal tibial fractures: pitfalls and surgical guidelines. Orthopedics, 27(9): 903-905.
Maffulli, N., Toms, A.D., McMurtie, A., Oliva, F. (2004) Percutaneous plating of distal tibial fractures. International Orthopaedics, 28(3): 159-162.
Ronga, M., Longo, U.G., Maffulli, N. (2010) Minimally invasive locked plating of distal tibia fractures is safe and effective. Clinical Orthopaedics and Related Research, 468(4): 975-982.
Bahari, S., Lenehan, B., Khan, H., McElwain, J.P. (2007) Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthopaedica Belgica, 73(5): 635-640.
Krackhardt, T., Dilger, J., Flesch, I., Höntzsch, D., Eingartner, C., Weise, K. (2005) Fractures of the distal tibia treated with closed reduction and minimally invasive plating. Archives of Orthopaedic and Trauma Surgery, 125(2): 87-94.
Hasenboehler, E., Rikli, D., Babst, R. (2007) Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury, 38(3): 365-370.
Mioc, M.L., Prejbeanu, R., Deleanu, B., Anglitoiu, B., Haragus, H., Niculescu, M. (2018) Extra-articular distal tibia fractures-controversies regarding treatment options. A single-centre prospective comparative study. International Orthopaedics, 42(4): 915-919.
Li, Y., Jiang, X., Guo, Q., Zhu, L., Ye, T., Chen, A. (2014) Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. International Orthopaedics, 38(6): 1261-1267.
Guo, J.J., Tang, N., Yang, H.L., Tang, T.S. (2010) A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. Journal of Bone and Joint Surgery British Volume, 92-B(7): 984-988.
Goh, E.L., Chidambaram, S., Eigenmann, D., Ma, S., Jones, G.G. (2018) Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for closed distal tibial fractures: a meta-analysis of the clinical outcomes. SICOT-J, 4: 58.
Li, X., Chen, K., Xue, H., Cheng, J., Yu, X. (2024) Efficacy comparison between intramedullary nail fixation and plate fixation in distal tibia fractures: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research, 19(1): 403.
Liu, X.K., Xu, W.N., Xue, Q.Y., Liang, Q.W. (2019) Intramedullary nailing versus minimally invasive plate osteosynthesis for distal tibial fractures: a systematic review and meta-analysis. Orthopaedic Surgery, 11(6): 954-965.
Khalsa, A.S., Toossi, N., Tabb, L.P., Amin, N.H., Donohue, K.W., Cerynik, D.L. (2014) Distal tibia fractures: locked or non-locked plating? A systematic review of outcomes. Acta Orthopaedica, 85(3): 299-304.
Cheng, W., Li, Y., Manyi, W. (2011) Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation. International Orthopaedics, 35(5): 737-742.
Lau, T.W., Leung, F., Chan, C.F., Chow, S.P. (2008) Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. International Orthopaedics, 32(5): 697-703.
Mauffrey, C., McGuinness, K., Parsons, N., Achten, J., Costa, M.L. (2012) A randomised pilot trial of "locking plate" fixation versus intramedullary nailing for extra-articular fractures of the distal tibia. Journal of Bone and Joint Surgery British Volume, 94-B(5): 704-708.
Costa, M.L., Achten, J., Griffin, J., Petrou, S., Pallister, I., Lamb, S.E., Parsons, N.R. (2017) Effect of locking plate fixation vs intramedullary nail fixation on 6-month disability among adults with displaced fracture of the distal tibia: the UK FixDT randomized clinical trial. JAMA, 318(18): 1767-1776.
Polat, A., Kose, O., Canbora, K., Yanik, S., Guler, F. (2015) Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial. Journal of Orthopaedic Science, 20(4): 695-701.
Vallier, H.A., Cureton, B.A., Patterson, B.M. (2011) Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. Journal of Orthopaedic Trauma, 25(12): 736-741.
Collinge, C., Kuper, M., Larson, K., Protzman, R. (2007) Minimally invasive plating of high-energy metaphyseal distal tibia fractures. Journal of Orthopaedic Trauma, 21(6): 355-361.
