The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures

Abstract

Objective: The aim of this study was to evaluate the time to union and complications in cases of tibial diaphysis and distal tibial fractures fixed with a minimally invasive percutaneous plate.

Methods: Thirty-five patients (23 males, 12 females) were operated on using minimally invasive percutaneous plate osteosynthesis (MIPPO) principles for tibial diaphysis and distal tibial fractures. Twenty-eight were closed and seven were open fractures. After direct or indirect fracture reduction, the plate was advanced through a submuscular extraperiosteal tunnel through the distal incision without opening the fracture line. The plate was fixed with screws through the proximal and distal incisions. Clinical and radiological evaluations were made at four to six week intervals after surgery. Full weight-bearing was allowed after an average of 14.43 (range: 12 to 20) weeks and 15.39 (range: 8 to 32) weeks in open and closed fractures, respectively. Duration of the union and complications were analyzed.

Results: The mean duration of the union was 20.7 (range: 16 to 28) weeks and 17.96 (range: 10 to 36) weeks in open and closed fractures, respectively. All cases showed union except one who had an implant failure. Necrosis at the wound developed in one case and infection in another.

Conclusion: MIPPO is an effective alternative treatment for tibial diaphysis and distal tibia fractures with low complication and high union rates.