title: Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis - A prospective series of 50 patients.
abstract: BACKGROUND
  Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed. Though many studies on the subject have been done previously, these have been retrospective reviews or small series.
  
  
  METHODS
  From May 2010 to May 2013, 50 patients of closed distal tibial fractures were operated by MIPO technique with a distal tibial anatomical locking plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 3 years.
  
  
  RESULTS
  The mean fracture healing time was 21.4 weeks (range 16-32 weeks) and average AOFAS score 95.06 was out of a total possible 100 points. At last follow up, superficial infection occurred in 5 patients (10%); deep infection, implant failure and malunion in 1-patient each (2%).
  
  
  CONCLUSIONS
  MIPO technique provides good, though slightly delayed bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension.
authors.affiliation: Senior Resident, Department of Orthopaedics, PGIMER & Dr. RML Hospital, New Delhi 110001, India.
authors.forename: Siddhartha Venkata
authors.initials: SV
authors.lastname: Paluvadi
authors.affiliation: Consultant and Assistant Professor, Department of Orthopaedics, PGIMER & Dr. RML Hospital, New Delhi 110001, India.
authors.forename: Hitesh
authors.initials: H
authors.lastname: Lal
authors.affiliation: Consultant, Professor and Head of the Department, Department of Orthopaedics, PGIMER & Dr. RML Hospital, New Delhi 110001, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Mittal
authors.affiliation: Consultant Orthopaedic Surgeon, Gurgaon, India.
authors.forename: Kandarp
authors.initials: K
authors.lastname: Vidyarthi
keywords: Distal tibia fracture; Locking compression plate (LCP); Percutaneous plating; Pilon fracture