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(A, B) A 53-year-old male patient sustained type III-B open proximal tibial fracture. (C, D) Primary minimal invasive plate osteosynthesis was performed and followed by rotational gastrocnemius muscle flap.
Source publication
Relatively few studies have addressed plate osteosynthesis for open proximal tibial fractures by now. The purpose of this study was to assess the results of minimally invasive plate osteosynthesis (MIPO) for open fractures of the proximal tibia.
Thirty-four patients with an open proximal tibial fracture were treated by MIPO. Thirty of these, who fo...
Context in source publication
Context 1
... the open wound did not involve the lateral side of proximal tibia or the soft tissue or flap was consid- ered sufficient ( Figs. 1 and 2), we performed simultane- ous plate fixation with a soft tissue procedure, defined as primary MIPO. However, in cases with inadequate soft tissue coverage, given the need for a brief operation due to general medical condition, and the presence of a severely contaminated wound, patients were treated by staged MIPO. ...Similar publications
Background
Open pilon fractures combined with sizeable segmental bone defects are rare, difficult to treat, and often result in the loss of ankle joint function. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures and sizeable segmental bone defects treated by limited ORIF combined with an Ilizarov ext...
Background:
Non-union is a serious complication of open tibial fractures. This case series investigates the efficiency of the induced membrane technique in patients with tibial exposed non-union.
Methods:
Eleven consecutive male patients with non-union after an open tibia fracture were enrolled into the study. The mean age of the patients was 40...
The tibial shaft is one of the most common sites of open fractures of all the open fractures, 63% are seen in the tibia alone. Ramon Gustilo has laid down the foundations of open fracture management; thorough debridement and irrigation, fracture stabilization, early soft tissue coverage and rehabilitation. The optimum treatment for open fractures o...
Aims
Several studies have reported that patients presenting during the evening or weekend have poorer quality healthcare. Our objective was to examine how timely surgery for patients with severe open tibial fracture varies by day and time of presentation and by type of hospital. This cohort study included patients with severe open tibial fractures...
Despite advances in Masquelet techniques of bone transfer, complex lower extremity trauma reconstruction remains a challenge. Herein, we present the use of a modified version of the Acute Masquelet technique to treat Grade III open fractures of the lower extremity. This modification can reduce the treatment period and complications of external fixa...
Citations
... Kim et al 23 Plating for open tibial shaft fractures remains an uncommon fracture fixation technique. There are a few studies proposing noninferiority to IMN. ...
Tibial shaft fractures are one of the most common orthopaedic injuries. Open tibial shaft fractures are relatively common because of the paucity of soft tissue surrounding the bone. Despite the prevalence of these injuries, the optimal fixation strategy is still a topic of debate. The purpose of this article was to review the current literature on open tibial shaft fracture fixation strategies including intramedullary nailing, external fixation, and plating.
... Owing to the rarity of these fractures resulting from high-energy mechanisms, gold standard for surgery is not available, and soft tissue conditions must be carefully considered. In the case of plate fixation, complications of FRI and nonunion may be high [2], and there may be technical difficulties to fixate multiple levels [3][4][5][6]. However, the minimally invasive plate osteosynthesis (MIPO) technique has evolved, and favorable clinical results have been reported [3][4][5][6]. ...
... In the case of plate fixation, complications of FRI and nonunion may be high [2], and there may be technical difficulties to fixate multiple levels [3][4][5][6]. However, the minimally invasive plate osteosynthesis (MIPO) technique has evolved, and favorable clinical results have been reported [3][4][5][6]. ...
... There is only one study by Kubiak et al. [1] on the clinical results of combined tibial plateau and shaft fractures that reported an average tibial plateau union time of 12 weeks and an average shaft union time of 29 weeks with combined IM nailing and plate fixation. In previous studies, the time to bone union for tibial plateau fractures was 12.5-16 weeks [39][40][41][42], and in tibial shaft fractures, including open fractures, the bone union time was 18.3-20.1 weeks in MIPO [3,5,6,43,44] and 17-27.6 weeks in IM nail [43,[45][46][47]. In our study, the union time of the plateau was 3.36 ± 1.28 months in the plate group and 3.53 ± 1.23 months in the IM nail group, tibial shaft union time was 7.99 ± 4.07 months and 7.70 ± 3.89 months in the plate and IM nail group. ...
Purpose
To compare union rate, union time, alignment, and complication rate in ipsilateral tibia plateau and shaft fractures treated via suprapatellar intramedullary nailing with screw fixation and minimally invasive locking plate fixation.
Materials and methods
A retrospective study was conducted on 48 patients who underwent minimally invasive plate fixation (n = 35) or suprapatellar intramedullary nailing with screw fixation (n = 13), for the treatment of ipsilateral tibial plateau and shaft fractures with at least 1-year follow-up. Union rate, union time, radiologic alignment, and complication rate such as malalignment, nonunion, and fracture-related infection (FRI) were investigated.
Results
Demographic data were not different between the two groups. Coronal plane alignment was 0.17 ± 4.23 in the plate group and −0.48 ± 4.17 in the intramedullary nail group (p = 0.637). Sagittal plane alignment was −0.13 ± 5.20 in the plate group and −1.50 ± 4.01 in the suprapatellar intramedullary nail group (p = 0.313). Coronal and sagittal malalignment recorded equal results: (p > 0.99), FRI (p = 0.602), nonunion and union times recorded (p = 0.656) and (p = 0.683, 0.829), respectively, and showed no significant difference between the two groups.
Conclusion
Suprapatellar intramedullary nailing with screw fixation had similar surgical outcomes with minimally invasive locking plate fixation in ipsilateral tibial plateau and shaft fractures in terms of union rate, union time, alignment, and complication rate. Thus, frequent use of intramedullary nailing combined with screw fixation is anticipated in patients with ipsilateral tibial plateau and shaft fractures when the soft tissue condition is not desirable.
Level of evidence
Level III
... Usually, disunion and excessive pain in the knee region is observed in the case of nailing. The nailing treatment is only suitable for the fractures in the proximal region but beyond this line, this nailing method is more complicated [17][18][19] . The function of the ankle was assessed by the criteria of Merchant and Dietz. ...
Background: As the highest number of complications are associated with the distal tibia fracture it is one of the most challenging condition to treat. Minimally invasive plate osteosynthesis techniques are more feasible. As the disappointing results were obtained from the traditional techniques therefore this method was gradually evolved. Study design: It is a prospective study conducted in Pakistan Railway General Hospital, Rawalpindi for the duration of one year from January 2022 to December 2022. Material and Methods: The study comprised of 49 patients who fulfilled the inclusion criteria. Among 49 patients there were 23 males and 26 female patients. The patients that were not fulfilling the inclusion criteria were excluded from the study. Results: 40% of the patients had problem in the right leg and 60% had it in their left side. There were 24 patients that reported about fibula plating the remaining 52% had no fibula plating experienced. The mean time of surgery was 7 days ranging from 3 to 8 days. Based on the classification of fracture, 72% patients were included in the 43A category and 43B included 28% patients. Conclusion: For distal tibia fractures, minimally invasive plate osteosynthesis has better radiological and functional outcomes and is quite better than other treatment methods. The invasive method can cure these fractures with fewer complications and in a short union time. Keywords: distal tibia fractures and soft tissue.
... It reflects that outdoor population, which is predominantly male in India, were more prone for the proximal tibial fractures. Even similar was the distribution from western studies, when Stannard., et al. [12] studied 52 patients out of which 41 were male and 11 were female and 24 males out of 30 patients in Kim., et al. study [13]. The mode of trauma was predominantly (63%) Road traffic accident in our study and correlated with others (Stannard-65%, Kim-80%). ...
... Open reduction and internal fixation with plates can easily cause secondary damage to soft tissues, so it has often resulted in complications such as delayed unions or nonunions, infections, and implant failures (Thompson et al., 2021). To reduce irritation and damage to soft tissue, minimally invasive plate osteosynthesis was developed and reported to have several advantages in union, alignment, and low infection rates (Gupta et al., 2016;Kim et al., 2012). The external fixation cannot achieve higher repositioning and force line maintenance requirements, and postoperative care is complex and prone to complications such as nail tract infection and deformative healing (Pairon et al., 2015). ...
Purpose: The extra-articular proximal tibial fractures continue to have high malunion rates despite development in intramedullary nailing (IMN) technology. Combined plate and IMN fixation can increase mechanical stability. The purpose of this study was to investigate combined plate and IMN for the treatment of extra-articular proximal tibial fracture using a biomechanical model.
Methods: A 10-mm defective osteotomy was created in the fourth-generation composite tibia to simulate extra-articular proximal tibial fractures (AO/OTA 41A2). The fractures were stabilized with IMN alone (IMN group), IMN with supplementary medial plate (M-IMN group), and IMN with supplementary lateral plate (L-IMN group). The biomechanical properties of each specimen were tested under axial compression loading, bending stress, and cyclic loading. The maximum displacement of the fragments and implant-bone construct failure was recorded.
Results: The maximum displacement of the M-IMN group was significantly less than either the L-IMN or IMN group in both axial compression loading and bending stress (p < 0.05 for both comparisons). All specimens in the three groups survived in 10,000 cyclic loading without hardware deformation. The maximum stiffness of failure was similar between the M-IMN and L-IMN groups, but the IMN group was statistically lower than either the L-IMN or the IMN group (p < 0.05).
Conclusion: The results indicated that combined medial plate and IMN fixation could effectively increase the mechanical stability of proximal tibial fractures.
... Fractures of the proximal tibia are the results of high-energy injuries, and because of the lack of soft tissue coverage in this region, it is vulnerable and open fractures are commonly encountered. In such cases, the treatment of damaged soft tissues is of primary concern [1] . The majority of tibial plateau fractures are secondary to high speed velocity accidents and fall from height [2] Fractures result from direct axial compression, usually with a valgus or varus moment and indirect shear forces [3] . ...
... In patients with limited contamination such as GA grades I and II, a minimal invasive technique of locking plate has also been reported [24,25]. However, it is unorthodox, and the removal of the plate is more troublesome than ESIN. ...
Introduction
External fixator (EF) is a popular choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively.
Methods
Patients aged 5–11 years with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF and ESIN groups. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow-up < 24 months or incomplete medical records were also excluded.
Results
In all, 55 patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no statistically significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no case of nonunion and malunion in either group. The angulation at the latest follow-up was higher in the EF group than the ESIN group (P < 0.01). The radiological union was faster in the ESIN group (7.0 ± 0.9 weeks) than those in the EF group (9.0 ± 2.2 weeks) (P < 0.01). Limb length discrepancy (LLD) was more in the EF group (12.1 ± 4.4, mm) than in the ESIN group (7.3 ± 4.3, mm) (P < 0.01).
Conclusion
ESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator. Pin tract infection is the most troublesome complication in the EF group while implant prominence is a nuisance in the ESIN group.
... Fractures of the proximal tibia are the results of high-energy injuries because of the lack of soft tissue coverage in this region, it is usually vulnerable, so commonly open fractures are encountered. In those cases, the treatment of damaged soft tissues is of primary concern [1] . The most of the tibial plateau fractures are secondary to high-speed velocity accidents and the fall from height [2] . ...
... Fractures of the proximal tibia are the results of high-energy injuries because of the lack of soft tissue coverage in this region, it is usually vulnerable, so commonly open fractures are encountered. In those cases, the treatment of damaged soft tissues is of primary concern [1] . The most of the tibial plateau fractures are secondary to high-speed velocity accidents and the fall from height [2] . ...
... 13,14 Joon Woo Kim believed, that majority of fractures occurred in the range of 24-69 years with a mean age of 44.4 years. 15 Gonzalez et al described that the plate (locking) can be used with severe soft tissues damage as the plates tend to preserve the periosteal blood supply and further need for bone grafting. MIPPO enables indirect fracture reduction and percutaneous submuscular implant placement. ...
INTRODUCTION The tibial plateau fractures can be devastating as they affect knee function and stability. 1 They are also known bumper car fractures in literature. 2 Fractures of these variations result from compressive forces, directed axially, most common being valgus or varus directed force and indirect shear. 3 As these are high energy fractures, the usual ORIF(open reduction and internal fixation) can result in wound breakdown and deep infection, which is based on laboratory and clinical studies. 4 Older individuals owing to their poor bone density at the subchondral level, very commonly present with depression fractures and presumed to be weaker to resist any axial load. 5 As MIPPO is a method of bridging the fracture by os-teosynthesis, it can be done without significantly sacrificing the soft tissues, which preserves the reduction of fracture and bone-forming capacity of the fracture hematoma. 6,7 As surgical treatment is the method of choice for the management of proximal tibial fractures, it can be also managed by cast bracing, traction, immobilization as an alternative to surgical intervention. The surgical methods despite being a conventional approach for the management of these fractures had disadvantages such as large surgical scars, wound dehis-cence and intraoperative blood loss. It also had other notable issues such as hardware complications and alignment problems. These shortcomings have been solved by MIPPO to a great extent. ABSTRACT Background: The management of plateau fractures of the tibia with minimally invasive percutaneous plating osteosynthesis has been a revelation. It has avoided many complications such as a large surgical scar, disruption of musculo osseous vascularity. It has significantly enhanced the preservation of soft tissues circulation and biologic fixation mechanism. The management of these fractures patterns can be done with indirect manipulation and effective reduction techniques.
