title: Percutaneous locking plates for fractures of the distal tibia: our experience and a review of the literature.
abstract: BACKGROUND
  Distal tibial metaphyseal fractures pose many complexities. This study assessed the outcomes of distal tibial fractures treated with medial locking plates.
  
  
  METHODS
  Eighteen patients were selected based on the fracture pattern and classified using the AO classification and stabilized with an AO medial tibial locking plate. Time to fracture union, complications, and outcomes were assessed with the American Orthopedic Foot and Ankle Society Ankle score at 12 months.
  
  
  RESULTS
  Sixteen of the 18 patients achieved fracture union, with 1 patient lost to follow-up. Twelve fractures united within 24 weeks, with an average union time of 23.1 weeks. Three delayed unions, two at 28 weeks and one at 56 weeks. The average time to union was 32 weeks in the smokers and 15.3 weeks in the nonsmokers. Five of the 18 patients (27%) developed complications. One superficial wound infection, and one chronic wound infection, resulting in nonunion at 56 weeks, requiring revision. Two patients required plate removal, one after sustaining an open fracture at the proximal end of the plate 6 months after surgery (postfracture union)and the other for painful hardware. One patient had implant failure of three proximal diaphyseal locking screws at the screwhead/neck junction, but successful fracture union. The average American Orthopedic Foot and Ankle Society ankle score was 88.8 overall, and 92.1 in fractures that united within 24 weeks.
  
  
  CONCLUSIONS
  Distal tibial locking plates have high fracture union rates, minimum soft tissue complications, and good functional outcomes. The literature shows similar fracture union and complication rates in locking and nonlocking plates.
authors.affiliation: Department of Trauma & Orthopaedics, Epsom and St Helier Hospital, Epsom, Surrey, UK. mudussarahmad@hotmail.com
authors.forename: Mudussar Abrar
authors.initials: MA
authors.lastname: Ahmad
authors.forename: Alagappan
authors.initials: A
authors.lastname: Sivaraman
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zia
authors.forename: Amarjit
authors.initials: A
authors.lastname: Rai
authors.forename: Amratlal D
authors.initials: AD
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000145:classification / Q000601:surgery*; D016896:Treatment Outcome