Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures

Abstract

Objective: Evaluation of clinical results and outcomes of low metaphyseal distal tibia fractures with minimal or no intra-articular involvement. These were treated using the minimally invasive plate osteosynthesis concept with a 3.5-mm locked medial tibial plafond plate and hybrid (locking and nonlocking) screw construct.

Setting: Level II regional trauma center.

Design: Consecutive case series of clinical outcomes using limb-specific and whole-person measures.

Intervention: Minimally invasive medial plating using hybrid locking and nonlocking techniques.

Main outcome measurement: The following were applied at a minimum of 2 years: limb assessment--Olerud and Molander's ankle rating scale and the American Orthopaedic Foot and Ankle Surgeon's (AOFAS) ankle-hindfoot instrument, whole-person assessment--the Short Form 36 (SF-36).

Results: Thirty-eight patients were followed an average of 32 months (range, 12-48 months). Mean fracture healing time was 21 weeks (range, 9-60 weeks). Acceptable alignment and length were restored (angulation <or=5 degrees or shortening <or=1 cm) in all but one case. One patient (3%) had loss of fixation and two (5%) underwent secondary surgeries to achieve union. In 30 patients at >2 years, the AOFAS and the Olerud and Molander ankles scores averaged good-excellent. SF-36 outcomes scores were lower than that of normative data in patients with uninjured limbs but only significantly diminished in physical function.

Conclusions: Minimally invasive medial plating using a hybrid locking plate technique in metaphyseal fractures of the distal tibia predictably restored limb alignment with a 5% reoperation rate and yielded mostly good-excellent ankle scores. There were residual impairments seen on whole-body outcomes measures.