Limited Open Reduction and Percutaneous Plate Osteosynthesis - Alternative Option to Minimally Invasive Plate Osteosynthesis in Management of Distal Tibia Fractures

Sah, Shambhu Kumar; Bikash, K C; Dangi, Sailoj Jung; Kumar, Rem; Yadav, Roshan

doi:10.31729/jnma.3329

Cited by 3 publications

(4 citation statements)

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“…In retrospect, LORPPO was the ideal fixation for this patient in view of the multi-interdigitated spikes of bone and interposed soft tissue in the displaced fracture site noted at the time of reduction and patient desire to avoid knee pain. LORPPO has shown similar outcomes to MIPPO [ 6 ]. In recent years, there have been many studies demonstrating that the MIPO technique is a safe and effective method of managing such fractures while avoiding some of the complications associated with conventional open-plating methods [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 94%

“…Distal tibia fractures are complex injuries as they are more difficult to reduce, have higher rates of malalignment and knee pain with intramedullary (IM) nailing yet higher rates of wound problems and infection with plate fixation [ 1 - 5 ]. Limited open reduction percutaneous plate osteosynthesis (LORPPO) has shown similar outcomes to minimally invasive percutaneous plate osteosynthesis (MIPPO) [ 6 ]. The literature suggests minimally invasive plate osteosynthesis (MIPO), locking IM nail stabilization and external fixation combined with limited open reduction and absorbable internal fixation techniques are all efficient methods for treating distal tibia fractures [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Double Squeeze Reduction Clamp Technique for Fracture Stabilization: A Case Report

Heck,

Poucke,

Heck

et al. 2024

jocr

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Introduction: The double squeeze technique for fracture stabilization is a technique in which the surgeon uses a second reduction clamp to hold and stabilize a smaller reduction clamp that reduces a fracture or plate yet is too small to hold by itself. This technique greatly assists anatomic fracture reduction and stabilization and allows the surgeon to complete the operation when there is limited reduction instrumentation available, or the surgeon needs more excursion on a small clamp holding a fracture and does not want to change instruments and possibly lose a reduction. We present a case of the double squeeze clamp technique, which to our knowledge has not been reported, to facilitate limited open reduction percutaneous plate stabilization in a distal tibia fracture. Case Report: This case report presents an 18-year-old male with a closed, oblique, displaced right distal tibia fracture following a crush injury to the extremity with a tree while using a chainsaw. He was initially seen in the emergency room and was discharged home in a splint to follow-up with the orthopedic surgeon on call. The family requested follow-up with our practice 3 days later and requested surgery at their rural local hospital secondary to insurance reasons. Patient requested plate fixation to treat his fracture. Due to limited reduction instrumentation in the facility, a double squeeze reduction clamp technique using a pointed reduction clamp on a serrated reduction clamp that was too small to hold the plate on the reduced fracture accomplished stabilization of the plate on the fracture while screws were placed. Conclusion: The double squeeze reduction clamp technique using one reduction clamp on a smaller reduction clamp greatly increases the ability to successfully reduce and stabilize multiple variations of different fractures whether secondary to differences in sizes of the bones, different types of bones, or in our case limited fracture reduction tools available. Keywords: Double squeeze technique, reduction clamp, fracture reduction, fracture stabilization, tibia fracture.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Double Squeeze Reduction Clamp Technique for Fracture Stabilization: A Case Report

Heck,

Poucke,

Heck

et al. 2024

jocr

View full text Add to dashboard Cite

show abstract

“…This procedure minimizes soft tissue injury and produces good clinical results. However, the difficulty with MIPO lies in how to achieve satisfactory fracture reduction and maintain that reduction via indirect reduction techniques to facilitate internal fixation [ 6 , 7 ]. Using the open indirect "biologic" osteosynthesis technique, MIPO was combined with an AO distractor [ 8 , 9 ] or manual reduction and locked compression plating (LCP).To the best of our knowledge, no clinical study has compared the outcomes of AO distractor vs. manual reduction prior to MIPO.…”

Section: Introductionmentioning

confidence: 99%

AO distractor and manual traction reduction techniques repair in distal tibial fractures: a comparative study

Chen

et al. 2022

BMC Musculoskelet Disord

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Background Minimally invasive plate osteosynthesis (MIPO) via percutaneous plate placement on the distal medial tibia can be performed with minimizes soft tissue injury and produces good clinical results. However, the difficulty with MIPO lies in how to achieve satisfactory fracture reduction and maintain that reduction via indirect reduction techniques to facilitate internal fixation. The purpose of this study was to compare the effects of AO distractor and manual traction reduction techniques combined with MIPO in the treatment of distal tibia fractures. Methods Between January 2013 and December 2019, 58 patients with a distal tibia fracture were treated using MIPO. Patients were divided into two groups according to the indirect reduction method that was used: 26 patients were reduced with manual traction(group M), and 32 were reduced with an AO distractor (group A).Time until union and clinical outcomes including AOFAS ankle-rating score and ankle range of ankle motion at final follow-up were compared. Mean operative time, incision length, blood loss and postoperative complications were recorded via chart review. Radiographic results at final follow-up were assessed for tibial angulation and shortening by a blinded reader. Results Mean operative time, incision length, and blood loss in group A were significantly lower than in group M(p = 0.019, 0.018 and 0.016, respectively).Radiographic evidence of bony union was seen in all cases, and mean time until union was equivalent between the two groups (p = 0.384).Skin irritation was noted in one case(3.1%) in group A and three cases(11.5%)in group M, but the symptoms were not severe and the plate was removed after bony union. There was no statistically significant difference in postoperative complications between the two groups(p = 0.461). Mean AOFAS score and range of ankle motion were equivalent between the two groups, as were varus deformity, valgus deformity, anterior angulation and posterior angulation. No patients had gross angular deformity. Mean tibial shortening was not significantly different between the two groups, and no patients had tibial shortening > 10 mm. Conclusion Both an AO distractor and manual traction reduction techniques prior to MIPO in the treatment of distal tibial fractures permit a high fracture healing rate and satisfying functional outcomes with few wound healing complications. An AO distractor is an excellent indirect reduction method that may improve operative efficiency and reduce the risk of soft tissue injury.

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“…This procedure minimizes soft tissue injury and produces good clinical results. However, the di culty with MIPO lies in how to achieve satisfactory fracture reduction and maintain that reduction via indirect reduction techniques to facilitate internal xation [6][7]. Using the open indirect "biologic" osteosynthesis technique, MIPO was combined with an AO distractor [8][9] or manual reduction and locked compression plating (LCP).To the best of our knowledge, no clinical study has compared the outcomes of AO distractor vs. manual reduction prior to MIPO.…”

Section: Introductionmentioning

confidence: 99%

AO distractor and manual traction reduction techniques repair in distal tibial fractures: a comparative study

Chen

et al. 2022

Preprint

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Background: Minimally invasive plate osteosynthesis (MIPO) via percutaneous plate placement on the distal medial tibia can be performed with minimizes soft tissue injury and produces good clinical results. However, the difficulty with MIPO lies in how to achieve satisfactory fracture reduction and maintain that reduction via indirect reduction techniques to facilitate internal fixation.The purpose of this study was to compare the effects of AO distractor and manual traction reduction techniques combined with MIPO in the treatment of distal tibia fractures. Methods: Between January 2013 and December 2019, 58 patients with a distal tibia fracture were treated using MIPO. Patients were divided into two groups according to the indirect reduction method that was used: 26 patients were reduced with manual traction(group M), and 32 were reduced with an AO distractor (group A).Time until union and clinical outcomes including AOFAS ankle-rating score and ankle range of ankle motion at final follow-up were compared. Mean operative time, incision length, blood loss and postoperative complications were recorded via chart review. Radiographic results at final follow-up were assessed for tibial angulation and shortening by a blinded reader.Results: Mean operative time, incision length, and blood loss in group A were significantly lower than in group M(p=0.019, 0.018 and0.016, respectively).Radiographic evidence of bony union was seen in all cases, and mean time until union was equivalent between the two groups (p=0.384).Skin irritation was noted in one case(3.1%) in group A and three cases(11.5%)in group M, but the symptoms were not severe and the plate was removed after bony union. There was no statistically significant difference in postoperative complications between the two groups(p=0.461). Mean AOFAS score and range of ankle motion were equivalent between the two groups, as were varus deformity, valgus deformity, anterior angulation and posterior angulation. No patients had gross angular deformity. Mean tibial shortening was not significantly different between the two groups, and no patients had tibial shortening >10 mm.Conclusion: Both an AO distractor and manual traction reduction techniques prior to MIPO in the treatment of distal tibial fractures permit a high fracture healing rate and satisfying functional outcomes with few wound healing complications. An AO distractor is an excellent indirect reduction method that may improve operative efficiency and reduce the risk of soft tissue injury.

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Limited Open Reduction and Percutaneous Plate Osteosynthesis - Alternative Option to Minimally Invasive Plate Osteosynthesis in Management of Distal Tibia Fractures

Cited by 3 publications

References 0 publications

Double Squeeze Reduction Clamp Technique for Fracture Stabilization: A Case Report

Double Squeeze Reduction Clamp Technique for Fracture Stabilization: A Case Report

AO distractor and manual traction reduction techniques repair in distal tibial fractures: a comparative study

AO distractor and manual traction reduction techniques repair in distal tibial fractures: a comparative study

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