title: Role of Appositional Screw Fixation in Minimally Invasive Plate Osteosynthesis for Distal Tibial Fracture.
abstract: OBJECTIVE
  To determine the effect of interfragmentary appositional (gap-closing) screw fixation in minimally invasive plate osteosynthesis (MIPO) for distal tibial fractures on the clinical and radiologic results.
  
  
  METHODS
  Prospective nonrandomized study.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Sixty patients who were diagnosed as distal metadiaphyseal oblique or spiral tibial fracture without displaced articular fragment.
  
  
  METHODS
  Thirty patients (group A) of the 60 patients were treated with MIPO without appositional screw fixation, and the other 30 (group B) were treated with the screw.
  
  
  METHODS
  Radiologic union, clinical union, clinical functional score [American Orthopaedic Foot and Ankle Society (AOFAS) score], and complications.
  
  
  RESULTS
  The time for initial callus formation and radiologic union was significantly longer in group A than those in group B (76.8 vs. 58.0 days, P = 0.044; 409 vs. 258.7 days, P = 0.002, respectively). The rate of clinical union during 1 year was significantly higher in group B than in group A (P = 0.0063). Four nonunion patients in group A achieved bone union after placement of an additional bone graft. None of the patients in group B diagnosed with delayed union or nonunion (P < 0.001). None of the patients of both groups had malreduction, skin problems, or infection. Overall, the AOFAS score did not significantly differ between groups A and B (85.4 vs. 87.0, P = 0.43).
  
  
  CONCLUSIONS
  The use of additional interfragmentary appositional screw fixation in distal tibia MIPO for the fixation of oblique or spiral fracture promoted callus formation and union rate compared with MIPO without appositional screw fixation.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyu-Hyun
authors.initials: KH
authors.lastname: Yang
authors.forename: Yougun
authors.initials: Y
authors.lastname: Won
authors.forename: Dong-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Jin-Cheol
authors.initials: JC
authors.lastname: Oh
authors.forename: Sung-Jun
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome