Minimally invasive plating of high-energy metaphyseal distal tibia fractures.
OBJECTIVE
The purpose of this study is to evaluate clinical results and outcomes of a strict cohort of high-energy injuries of the metaphyseal distal tibia with minimal or no intraarticular involvement treated using the minimally invasive plating concept.


METHODS
Level II trauma center.


METHODS
Retrospective analysis of a consecutive case series with limb-specific and whole-person outcomes measures.


METHODS
Minimally invasive medial plating for high-energy metaphyseal fractures of the distal tibia with little or no intraarticular involvement.


METHODS
Clinical and radiographic results were assessed at a minimum of 1 year, and outcomes measures were applied at final follow-up at a minimum of 2 years. Limbs were assessed with the American Orthopaedic Foot and Ankle Surgeons (AOFAS) ankle-hindfoot instrument and the method of Olerud and Molander. Patient outcomes were evaluated with the Short Form-36 (SF-36) and the Musculoskeletal Functional Assessment (MFA).


RESULTS
Twenty-six patients were followed until healed at an average of 36 months (12-56 months). Mean fracture healing time was 35 weeks (12-112 weeks) with acceptable alignment restored (angulation<or=5 degrees or shortening<or=1 cm) in all but 1 case. Two patients (7%) had loss of fixation and 9 (35%) underwent secondary surgeries to achieve union. Risk factors for healing problems included high grades of fracture comminution, bone loss, and high-grade open injuries (P<0.05). SF-36 outcomes scores in 21 patients at >2 years were comparable to normative data of patients with uninjured limbs, whereas MFA results showed functional deficits in 4 of 10 subsections.


CONCLUSIONS
Minimally invasive medial plating will restore limb alignment and yield successful clinical outcomes for high-energy metaphyseal fractures of the distal tibia. Despite the significant reoperation rate and prolonged time to union, most patients can expect a predictable return of function. Strong consideration should be given to adjunctive measures in at-risk patients, including those with highly comminuted fracture patterns, bone loss, or Type II or III open fractures.
Collinge
Cory
C
Harris Methodist Fort Worth Hospital Orthopedic Trauma Staff, John Peter Smith Orthopedic Surgery Residency, Fort Worth, TX 76104, and Orthopedic Surgery, Texas Tech University, Lubbock, USA. ccollinge@msn.com
Kuper
Mark
M
Larson
Kirk
K
Protzman
Robert
R
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D016348:Osseointegration / Q000502:physiology; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome