Minimally Invasive Plate Osteosynthesis (MIPO) for Proximal and Distal Fractures of The Tibia: A Biological Approach

Abstract

Introduction: The treatment of fractures of proximal and distal tibia is challenging, because of the limited soft tissue envelope and poor vascularity. The best treatment remains controversial and it depends on the fracture morphology, displacement and comminution. Treatment options vary from closed reduction and cast to open reduction and internal fixation with plate. Open reduction and internal fixation with plate can result in extensive dissection and tissue devitalization. We conducted a study on management of these fractures by biological osteosynthesis using Minimally Invasive Plate Osteosynthesis (MIPO) technique with preservation of osseous and soft tissue vascularity.Methods: We conducted a prospective study on closed reduction and percutaneous plating in 30 cases (mean age 42.7 years; 22 males and 8 females) of closed fractures of tibia. Among them 24 had proximal tibial fractures and 6 had distal tibial fractures. The mean time from injury to surgery was seven days.Results: The mean operative time was 72.6 minutes ( range: 55-90 minutes). Mean time for radiological union was 17 weeks (range: 14-22 weeks). There was one superficial wound infection which resolved with daily dressings and one week of oral antibiotics. One patient developed a nonunion which required a bone grafting procedure.Conclusions: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in periarticular fractures. Biological fixation of complex fractures gives stable as well as optimal internal fixation and complete recovery of limb function at an early stage with minimal risk of complications.

Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: a systematic review and meta-analysis

“…The sample size of the included studies ranged from 25 to 321, and the studies were published between 2010 and 2018. Six studies were conducted in India [9, 10, 18–20], three in China [23, 26, 28], one in the UK [21], and one in Turkey [25] and the USA [24]. Nine studies [9, 10, 18–21, 25, 27] focused on closed or Gustilo patients and most of the studies [10, 19–21, 23–27] followed up participants for more than 12 months.…”

“…Although our study included more RCTs and larger sample size, the results remained similar. Both MIPPO and IMN are regarded as the two most commonly used methods for treating distal tibial fractures, but were associated with the development of complications [20, 28]. MIPPO is a noteworthy technique that manages fractures by avoiding some of the complications, including the union complications, wound complications, and deep infections, that are associated with conventional open plating methods [29, 30].…”

Combined Olecranon Osteotomy and the Posterior Minimal Invasive Plate Osteosynthesis Approach for a Concomitant Injury of the Humeral Shaft and a Distal Intraarticular Humerus Fracture

“…The MIPO technique offers a smaller incision and a procedure with lesser stripping, thus creating a conducive environment for better fracture healing. In the last few years, MIPO has gained popularity for the successful treatment of lower limb fractures [4-5] and has been described for humeral shaft fractures as well as via anterior and lateral approaches. We used a posterior MIPO approach, as described by Galluci et al [6], because there was an associated distal humerus fracture for which we could extend the distal incision for the exposure of the distal humerus via olecranon osteotomy.…”

Comparison of radiological and clinical outcomes of patients treated with plating versus IMIL nailing in distal tibia fractures: A prospective study

“…Additionally, the tibia is subcutaneously oriented, which makes managing the fracture more challenging. Closed comminuted fractures treated non-operatively with casts typically result in issues such as prolonged immobilisation, malunion, shortening, and joint stiffness [1][2][3] . Surgical treatment options include open reduction, intramedullary nailing, external fixation, external fixation with plates, and internal fixation with plates and screws [4] .…”