title: Minimally invasive locked plating of distal tibia fractures is safe and effective.
abstract: Distal tibial fractures are difficult to manage. Limited soft tissue and poor vascularity impose limitations for traditional plating techniques that require large exposures. The nature of the limitations for traditional plating techniques is intrinsic to the large exposure required to approach distal tibia, a bone characterized by limited soft tissue coverage and poor vascularity. The locking plate (LP) is a new device for treatment of fractures. We assessed the bone union rate, deformity, leg-length discrepancy, ankle range of motion, return to preinjury activities, infection, and complication rate in 21 selected patients who underwent minimally invasive osteosynthesis of closed distal tibia fractures with an LP. According to the AO classification, there were 12 Type A, 5 Type B, and 4 Type C fractures. The minimum followup was 2 years (average, 2.8 years; range, 2-4 years). Two patients were lost to followup. Union was achieved in all but one patient by the 24th postoperative week. Four patients had angular deformity less than 7 degrees . No patient had a leg-length discrepancy more than 1.1 cm. Five patients had ankle range of motion less than 20 degrees compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. We judge the LP a reasonable device for treating distal tibia fractures. The level of physical activities appears permanently reduced in most patients.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics and Traumatology, University of Insubria, Varese, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Ronga
authors.forename: Umile Giuseppe
authors.initials: UG
authors.lastname: Longo
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*