Distal Tibia Fracture in Adult Age Group in Lumbini Province of Nepal: Outcome with Minimally Invasive Percutaneous Plate Osteosynthesis

Abstract

Introduction: Management of distal tibia fracture is challenging for many orthopaedic surgeons. The definitive treatment remains controversial. Various treatment options are used for the management of distal tibia fractures. MIPPO for distal tibia fractures are widely accepted by various surgeons as these methods of treatment have advantages like less soft tissue dissection, fracture biology is preserved and provides stable bony construct. Methods: This was a prospective interventional study done from February 2019 to January 2021 at Rapti Academy of Health Sciences, Ghorahi, Dang with displaced distal tibia fracture with or without articular involvement which was treated with MIPPO and assessed for one year. Ethical approval and informed written consent were taken from all patients. The outcome was assessed by American Orthopaedic Foot and Ankle surgery (AOFAS) scoring system. Results: The mean time of fracture union was 21.23±9.066 weeks. At the final follow-up, the mean AOFAS score was 92.59± 5.297. Two patients developed superficial wound infection which resolved with oral antibiotics and regular dressing. One patient had delayed union of the fibula with posterior angulation of the tibia less than 5° which was managed with percutaneous bone marrow injection. Two patients developed ankle stiffness which after extensive physiotherapy regained movement at final follow-up. Conclusion: MIPPO with locking compression plate for distal tibia fracture not only preserve the endosteal blood supply but also preserves the periosteal blood supply which results in early fracture union with excellent to good functional outcome compared to other methods of fixation.