Title: The functional outcome of closed fracture proximal third of tibia (Extra- articular) treated by MIPO technique using locking plate

Authors: Dr A.T. M. Rezaul Karim, Dr A. K. M. Harun-Ar-Rashid, Dr Abdur Rahman, Dr Mohammad Shaha Alam, Dr Ayesha Begum, Dr A. H. M.  Azgar Ali Chowdhury

 DOI: https://dx.doi.org/10.18535/jmscr/v9i5.09

Abstract

Objective: In this study our main goal is to evaluate the functional outcome of closed fracture proximal third of tibia (Extra- articular) treated by MIPO technique using locking plate.

Method: This observational study was carried out at Department of Orthopaedic Surgery, Chattogram Medical College Hospital; Chattogram, From January 2012 to June 2013. A total of 26 patients within 18-60 years of age and were admitted in different Orthopaedic units of Chattogram Medical College Hospital with closed fracture in proximal tibia were included in the study.

Results: During the study, 4 patients (17.40%) have additional injuries. Nearly half of them (2 cases) were victims of head injury. Then rest 1 case involving with ipsilateral femur fracture, another 1 case involving with ipsilateral bi-malleolar fracture.21 of the patients were mobilized by active knee bending and quadriceps exercises were initiated after second week. 2 patients associated with other injuries mobilization were delayed.  In 15 cases (65.22%) full range of knee motion at 12 weeks. 6 cases had good results (26.09%), 2 fairs (8.70%). In 18 cases (78.26%) full range of ankle motion at 12 weeks, 3 cases had good results (13.04%), 2 fairs (8.7%). According to patient’s satisfaction 14 patients (60.87%) was pleased, 7 patients (30.43%) was satisfied and two patient 5% is unhappy.          

Conclusion: Proximal tibial fracture is common fracture of the tibia. There are several methods of treating this fracture. In case of proximal tibial fractures, closed reduction and internal fixation with locking plate is a good choice. Most importantly, it is easy to use, it is biological in the sense that the blood circulation to the tibia is not compromised, the plate does not need to be configured and the angular screw fixation ensures a fixed-angle stabilization.

Keywords: Closed fracture proximal third of tibia, MIPO technique, locking plate.

References

  1. Hazarika S, Chakravarthy J, Cooperet al. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia--results in 20 patients.Injury 2006 Sep;37(9):877-87.
  2. Sarmiento A, Latta 450 closed fractures of the distal third of the tibia treated with a functional brace. Clin Orthop Relat Res 2004 Nov;(428):261-71.
  3. Bedi A, Le TT, Karunakar Surgical treatment of nonarticular distal tibia fractures. J Am Acad Orthop Surg 2006 Jul;14(7):406-16.
  4. Anglen JO.Early outcome of hybrid external fixation for fracture of the distal tibia.Journal of Orthopaedic Trauma 1999; 13(2):92-7.
  5. Blachut PA, O’Brien PJ. Meek RN, et al., Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. J Bone Joint Surg 1997;79A:640-6.
  6. Drosos G, Karnezis IA, Bishay M, Miles Initial rotational stability of distal tibial fractures nailed without proximal locking: the importance of fracture type and degree of cortical contact.Injury 2001 Mar; 32(2):137-43.
  7. Babst R, Bavonratanavech S, Pesantez R. Minimally Invasive Plate Osteosynthesis. 2nd ed. Davos (Switzerland): Thieme Medical and Scientific Publishers Private Ltd; 2012. P. 8.
  8. Baumann P, Ebneter L, Giesinger K, Kuster MS. A triangular support screw improves stability for lateral locking plates in proximal tibial fractures with metaphyseal comminution: a biomechanical analysis. Arch Orthop Trauma Surg2011;131:815-21.
  9. Francois J, Vandeputte G, Verheyden F, Nelen G. Percutaneous plate fixation of fractures of the distal tibia. ActaOrthop Belg. 2004 Apr; 70(2):148-54.
  10. Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury. 1997;28 Suppl 1:A7-12.
  11. Collinge CA, Sanders RW. Percutaneous plating in the lower extremity. Am AcadOrthop Surg. 2000 Jul-Aug;8(4):211-6.
  12. Neeraj Mahajan. Minimally Invasive Techniques in Distal Tibial Fractures. JK SCIENCE 10 , April-June 2008.

Corresponding Author

Dr A.T. M. Rezaul Karim

Consultant of Orthopedic Surgery, Parkview Hospital, Chattogram, Bangladesh