Minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in the treatment of distal fibula Danis-Weber types B and C fractures

Abstract

Background Minimally invasive plate osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) in the treatment of different long bone fractures. Nevertheless, in distal fibula fractures, the evidence of MIPO remains scarce. The aim of this retrospective study was to compare the clinical and radiological outcomes of the minimally invasive techniques applied to the distal fibula with open reduction and internal fixation within a 12 months follow-up. Methods A consecutive series of patients who underwent surgery using either ORIF or MIPO for the treatment of distal fibula fractures between 2010 and 2014 were retrospectively analyzed. All distal fibular fractures requiring an operative treatment (Danis-Weber type B ≙ AO type 44 B1, 2, 3 and Danis-Weber type C ≙ AO type 44 C1, 2) were included (ORIF n = 35, MIPO n = 35). Patients were assessed for postoperative pain using a visual analog scale (VAS) for pain (ranging from 0 to 10) and classified into 4 groups: “no pain” for VAS = 0, “low” for VAS = 1–3, “moderate” for VAS = 3–5, and “severe” for VAS = 5–10. In addition, complications of postoperative fracture-related infection, wound healing disorders, vascular and nerve injury and development of nonunion were evaluated and analyzed. Radiologic outcome measures assessing the talocrural angle, lateral and medial clear space, tibiofibular overlap, and talar tilt angle were evaluated postoperatively. Results The overall complication rate showed to be lower in the MIPO group compared to the ORIF group (14% vs. 37%, p = 0.029). Even though not statistically significant, specific surgery-related complications such as skin necrosis (3% vs. 9%, p = 0.275), nonunion (0% vs. 6%, p = 0.139), infections and wound healing disorders (9% vs. 20%, p = 0.141), as well as postoperative pain (17% vs. 26%, p = 0.5) were found more frequently in the ORIF group. The tibiofibular overlap demonstrated to be significantly lower in the ORIF group (3.3 mm vs. 2.7 mm, p = 0.033). The talocrural angle, talar tilt angle, and lateral and medial clear space showed to be equivalent in both groups. Conclusion In this retrospective single-center consecutive series, MIPO was superior to ORIF in the surgical treatment of distal fibula fractures with respect to the overall complication rate. Trial registration EKNZ Project-ID: 2019-02310, registered on the 20th of December 2019 with swissethics

Limb Fractures Treated With the Novel Plate Osteosynthesis Application Technique: Second to Minimally Invasive Plates osteosynthesis

“…This approach can minimize surgical trauma, alleviate postoperative pain, expedite the recovery process, and provide better cosmetic outcomes. 12 , 21 , 22 Indeed, research has shown that closed reduction is the greatest challenge in the MIPO technique. In addition, radiation exposure during the procedure is another factor that young orthopaedic physicians consider when opting for open reduction and internal fixation (ORIF) instead.…”

“…MIPO technique, developed in the past 30 years, is considered because it most closely aligns with the concept of biologic internal fixation for fracture treatment, and it has found widespread application in treating fractures in various sites throughout the body, including the tibia, fibula, ulna, radius, humerus, clavicle, and scapula, among others. [9][10][11][12][13][14][15][16][17] The advantages of this technique include reducing iatrogenic damage to the soft tissues surrounding the fracture site and minimizing postoperative scar formation, thereby meeting patients' aesthetic requirements. 18,19 However, there are also some drawbacks associated with the MIPO technique in practical clinical operations.…”

Biomechanical Basis of Bone Fracture and Fracture Osteosynthesis in Small Animals

“…Malunion or delayed union are infrequent complications when using this type of implant in MIPO. Regarding infection rates, when MIPO and ORIF are compared, there is a lack of evidence in veterinary studies, but in the human side, evidence showed lower infection rates when MIPO techniques are used in long bone fractures [29,[60][61][62].…”

Lower Limb Malrotation following Minimally Invasive Plating in Distal Tibia Fractures

“…This allows secondary fracture healing with callus formation and preservation of the bone’s native blood supply and minimises wound related complications. MIPOtechniques have been shown to be superior to conventional osteosynthesis in the tibia and/or fibula, having lower rates of soft tissue related complications 5 . However, one of the challenges of MIPO is difficulty in assessing rotational profile of the limb during fixation.…”