Outcome of Minimaly Invasive Plate Osteosynthesis (MIPO) Technique with Locking Compression Plate in Distal Tibial Fracture Management

Background: Distal tibial fractures including tibial pilon present a challenge as to their best method of management due to subcutaneous location of larger portion of tibia, paucity of soft tissue coverage and precarious blood supply of distal leg. MIPO (Minimal invasive plating osteosynthesis) has evolved as a newer concept to treat distal tibial fractures with minimal articular comminution and minimal soft tissue damage. It works on Biological fixation principle which assists physiological process of bone healing wisely with minimal operative intervention. Method: A prospective study for the management of distal tibial fractures by MIPO technique by using pre-contoured metaphyseal LCP (locking compression plate) was done, in 20 patients, between January 2012 and October 2013. Fractures were classified as per AO system and patients were followed and scored according to TEENY and WISS clinical scoring criteria. Result: Among 20 patients operated, there were 15 males and 5 females with a mean age of 38.95yrs (range from20-67yrs). 17 patients sustained extra-articular fractures (type A), 02 partial-articular fractures (type-B) and 01 total-articular fracture (typeC). High energy trauma (road traffic accident) predominated causing 13 fractures. Average trauma surgery interval was 12 days (02-22days). Patients were followed minimum for 6 months (range 06-18 months). Superficial wound infections were seen in 02 cases, surgical wound breakdown with implant exposure in 01 case and prominent hardware in 01 case. 17 patients (85%) had excellent/good outcome and 03 cases with complications had fair (02 cases) to poor (01 case) outcome. Conclusion: MIPO is an effective and safe technique for the management of distal tibial fractures without intra-articular comminution and minimum soft tissue damage. It preserves bone biology by maintaining balance between devascularisation and mechanical perfection. Further studies with longer follow-up and large sample size are warranted.