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BACKGROUNDIncidence of fracture of the proximal tibia are increasing regularly due to RTA. Being one of the major weight bearing joint of the body fracture around it will be of paramount importance. The recent development of LCP has revolutionised the treatment by overcoming the few drawbacks of conventional buttress plate. The LCP is an internal fixation system, which is a hybrid of LC-DCP and LISS. The LCP can be applied in three different ways: (a) As compression plate, (b) As combining compression and bridge plating, and (c) As pure internal fixation (bridge plating).

BACKGROUNDThe aim of this study is to compare clinical and radiological outcomes of distal metaphyseal tibial fractures using locking compression plates by open reduction technique or minimally invasive percutaneous plate osteosynthesis (MIPPO) technique or closed reduction and IMIL nailing.Settings and Design -This is a prospective study of 23 patients with distal tibial fractures who are presenting to our hospital from July 2013 to September 2015, who are treated with ORIF with locking plate or IMIL. MATERIALS AND METHODSThe study material includes data collection, clinical examination and investigations of 23 patients who underwent either ORIF/MIPPO with distal tibial LCP/IMIL for fractures of lower-third tibia admitted to NRI General Hospital, Chinakakani, attached to NRI Medical College, Chinakakani, had taken for this study after obtaining their informed, valid written consent. Of 23 patients, 14 patients underwent fixation with LCP both ORIF/MIPPO and 9 patients underwent fixation with IMIL. All surgeries done under Carm and followed regularly at 4 weeks, 8 weeks, 12 weeks, 6 months and annually thereafter. Clinical and functional results were assessed at followup. RESULTSBoth these techniques provided adequate and comparable stability, fracture union and allowed early motion in distal tibial fractures. LCP is effective in extra-articular fractures occurring within 5 cm of joint where IMIL nails offend and do not provide adequate stability and where external fixators usually applied for primary stabilisation until soft tissue oedema get subsided, which delays the return to work with fixators. The intramedullary nailing is a safe, feasible and simple method of stabilisation of these fractures. This method is definitely a better alternative to external fixator and plating techniques in the management of open distal tibial fractures. Using fracture table to get satisfactory reduction, which can be maintained till completion of nailing and use of multiple distal locking screws in different plane to give stable fixation for early mobilisation and ambulation can minimise the complications. Impacting the unreamed nail till the subchondral bone of the distal tibia enhances the stabilisation. CONCLUSIONThese techniques had resulted in effective stabilisation of lower-third tibial fractures. Both techniques provided adequate and comparable stability, fracture union and allowed early motion; should be used according to clinical situation and surgeon's experience. Financial or Other, Competing Interest: None. Submission 06-01-2016, Peer Review 29-01-2016, Acceptance 05-02-2016, Published 05-12-2016. Corresponding Author: Dr. Satya Kumar Koduru, Flat 101, Kanchukota N. K. Habitate, Gayatri Nagar, Vijayawada-520008, Andhra Pradesh. E-mail: kodurusk@gmail.com DOI: 10.14260/jemds/2016/1614 BACKGROUND Fractures of the distal third shaft and distal metaphysis of tibia are one of the difficult and challenging problems faced by orthopaedic surgeons. The problems associated with these fractures are due to t...

Objectives: The objectives of the study were to describe the surgical technique of our modification of isolated medial patellofemoral ligament (MPFL) reconstruction, in patients with patellar instability. As per literature, isolated MPFL reconstruction is advocated if tibial tubercle-trochlear groove (TTTG) <20 mm. Our study proposes isolated MPFL reconstruction in patients with TT-TG <25 mm and aims to determine any predisposing anatomic variants to aid in the treatment algorithm. Materials and Methods: A retrospective analysis of 52 patients with patellar instability (TT-TG <25 mm), who underwent isolated MPFL reconstruction was undertaken. The study population was divided into two groups; TT-TG <20 mm and TT-TG = 20–24 mm. Both groups were assessed radiologically and on the basis of clinical and functional outcome (KUJALA score), over 5-year follow-up period. Results: The mean age of the study population was 21.98 years, with a female (63.5%) majority. Among the 52 patients included in the study, 39 patients (75%) had TT-TG <20 mm and 13 patients (25%) had TT-TG = 20–24 mm. We noticed statistically significant improvement in both groups with respect to clinical and functional outcome, with no reported complications. None of the patients had patella alta or high grades of trochlear dysplasia. Conclusion: MPFL reconstruction without concomitant bony procedures can be safely performed in patients with a TT-TG <25 mm, in the absence of patella alta or high-grade trochlear dysplasia. Our modification of isolated MPFL reconstruction has shown excellent long-term results. In addition, our technique uses only a single interference screw, thereby reducing cost of surgery and implant hardware.