Outcome of treatment of proximal tibial plateau fractures by minimally invasive percutaneous plating osteosynthesis technique

Abstract

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Fractures of the proximal tibia are accompanied by a wide range of severity which may include stable undisplaced fractures with minimal soft tissue injury to highly comminuted unstable fractures, and severe soft tissue involvement. With the better understanding of fracture healing biology and biomechanics of fracture fixation and healing, the trend of treatment is towards biological fixation, which can be accomplished by Minimally Invasive Percutaneous Plating Osteosynthesis (MIPPO) technique.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong><span lang="EN-US"> Demographic data of patients were recorded on admission and thorough history and clinical examination was done. The fractures were assessed for soft tissue injuries and followed by radiological assessment of fracture with schatzkers classification. The surgeries included anterolateral and anteromedial approaches for all patients with ‘inverted hockey stick incision’ and were treated with MIPPO. They were regularly followed up at 6-8 weeks interval till complete fracture union. A clinical and radiological evaluation was carried out using the modified Rasmussen clinical and radiological criteria.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>Out of the 20 patients treated, most of them were males and belonged to the age group of 20-40 years (75%). Unilateral fractures were more common than bilateral fractures and were of the type 4 and type 5 of Schatzkers classification which was usually associated with high velocity RTA. One patient each had infection, varus deformity and knee joint stiffness. 10 fractures gave excellent result, 7 fractures healed with good results. Only 2 of the patients showed fair results and 1 had poor result. </p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>All the fractures treated with MIPPO technique was found to be rapidly healing by secondary fracture union and hence achieving strong bone union across the fracture site due to inherent benefits of less tissue damage and minimal disturbance of fracture site biology.</p>

Evaluation of results of surgical management of lateral tibial condyle fractures using locking compression plate

“…In 5 (14.70%) cases knee stiffness was observed. The average time for union of fractures was 19 weeks in Kancherla et al 15 series ranging from 16 to 24 weeks and an average of 121º knee joint range of motion was achieved. In J. Praneeth Kumar Reddy et al 16 study, most of these fractures were united by an average of 13.75 weeks ranging from 12 to 20 weeks and average range of motion was 114 degrees with only 1 patient (3.3%) had knee flexion of 90 degrees.…”

Management of Proximal Tibial Fractures by Locking Compression Plate

“…Additionally, the management of high energy proximal tibia fractures is a challenging task, as they are often associated with a number of complications. Amongst the complications observed in the study of Kancherla NR et al 13 , 1 patient (5%) developed infection within 2 weeks postoperatively. Our results were comparable to the studies conducted by Egol KA et al 15 who reported no infection, Stannard JP et al 21 who reported 5.9% rate of infection and Cole PA et al 22 with infection rate of 4%.…”

“…ORIF technique was used in 23 (76.7%) patients while MIPPO was used in 7 (23.3%) patients. Kancherla NR et al 13 did a prospective study on 20 patients with proximal tibial fractures. Most of the patients belonged to the age group of 20-40 years (75%), which were highly active and mobile age similarly in our study only 7 (23.3%) were treated with MIPPO technique.…”

“…The patients in the study by Kumar Reddy JP et al 9 had an average union time of 13.75 weeks with range of 12 to 20 weeks. Kancherla NR et al 13 observed that the average time for union of fractures was 19 weeks ranging from 16 to 24 weeks. An average of 120 degrees knee joint range of motion was achieved.…”

“…Twenty six (86.7%) patients had excellent results with full, pain-free function and 4 (13.3%) patients had good result. Kancherla NR et al 13 concluded that based on modified Rasmussen criteria excellent clinical and radiological outcome was noted in 50% of the cases and in 35% of the cases, it was good. In one (5%) patient, the result was poor.…”