Minimally invasive plate osteosynthesis of distal tibial fractures: a comparison of medial and lateral plating

Abstract

Purpose: The hypothesis of this study was that lateral minimally invasive plate osteosynthesis (MIPO) would be comparable with medial MIPO with regard to clinical and radiographic results. The purpose of this study was to compare the results of medial and lateral MIPO for treatment of distal tibial fractures.

Materials and methods: Between June 2005 and February 2009, 24 patients with a distal tibia fracture were treated using MIPO. Patients were divided into two groups according to the MIPO methods used; 12 patients were fixated by medial MIPO (group M) and the other 12 patients by lateral MIPO (group L). These two groups were compared with regard to time to union. Clinical results were assessed by use of the IOWA ankle-rating system and the range of ankle motion at last follow-up. Mean operation time and postoperative complications were evaluated by chart review. Radiographic results were assessed on the basis of tibial angulation and shortening at last follow-up.

Results: Radiological evidence of bony union was observed for all study subjects. Mean union time was not significantly different between the two groups. Mean IOWA score, range of ankle motion, and operation time were no different between the two groups. No significant difference in angulation and shortening was observed between the groups, and no patient had an angular deformity >5° or tibial shortening >10 mm at the last follow-up. Skin irritation was encountered in one case in group M and limited motion because of entrapment of the tibialis anterior muscle was observed in one patient in group L.

Conclusion: Both medial and lateral MIPO produced good clinical and radiological results for distal tibial fractures. Lateral MIPO may be an effective option when soft tissue condition on the medial side of the distal tibia is poor or when the fracture line is close to the ankle joint.