title: Minimally-invasive plate osteosynthesis in distal tibial fractures: Results and complications.
abstract: BACKGROUND
  Distal tibial or pilon fractures are usually the result of combined compressive and shear forces, and may result in instability of the metaphysis, with or without articular depression, and injury to the soft tissue. The complexity of injury, lack of muscle cover and poor vascularity make these fractures difficult to treat. Surgical treatment of distal tibial fractures includes several options: external fixation, IM nailing, ORIF and minimally-invasive plate osteosynthesis (MIPO). Management of distal tibial fractures with MIPO enables preservation of soft tissue and remaining blood supply. This is a report of a series of prospectively studied closed distal tibial and pilon fractures treated with MIPO.
  
  
  METHODS
  A total of 21 patients with closed distal tibial or pilon fractures were enrolled in the study between March 2008 and November 2013 and completed follow-up. Demographic characteristics, mechanism of injury, time required for union, ankle range of motion and complications were recorded. Fractures were classified according to the AO/OTA classification. Nineteen patients were initially managed with an ankle-spanning external fixator. When the status of the soft tissue had improved and swelling had subsided enough, a definitive internal fixation with MIPO was performed. Patients were invited for follow-up examinations at 3 and 6 weeks and then at intervals of 6 to 8 weeks until 12 months.
  
  
  RESULTS
  Mean age of the patients was 40.1 years (range 19-67 years). Eighteen cases were the result of high-energy trauma and three were the result of low-energy trauma. According to the AO/OTA classification there were extraarticular and intraarticular fractures, but only simple articular patterns without depression or comminution. The average time for fracture union was 19.7 weeks (range 12-38 weeks). Mean range of motion was 10° of dorsiflexion (range 5-15°) and 28.3° of plantar flexion (range 20-35°). Three cases were metalwork-related complications. Two patients underwent plate removal at 24 weeks because of plate impingement. There was one case of wound breakdown at 11 weeks. One patient had fracture union with tibial recurvatum of approximately 10°, without functional impairment. Two patients had delayed union.
  
  
  CONCLUSIONS
  MIPO is a reliable method of treatment for distal tibial fractures; it provides a high union rate and good functional outcome with minimal soft tissue complications. Skin impingement remains a common complication with MIPO, but this can be solved by timely plate removal.
authors.affiliation: University Hospital "Sisters of Mercy", Department of Trauma and Orthopaedic Reconstructive Surgery, Vinogradska cesta 29, 10000, Zagreb, Croatia. Electronic address: dinko.vidovic@gmail.com.
authors.forename: Dinko
authors.initials: D
authors.lastname: Vidović
authors.affiliation: University Hospital "Sisters of Mercy", Department of Trauma and Orthopaedic Reconstructive Surgery, Vinogradska cesta 29, 10000, Zagreb, Croatia.
authors.forename: Aljoša
authors.initials: A
authors.lastname: Matejčić
authors.affiliation: University Hospital "Sisters of Mercy", Department of Trauma and Orthopaedic Reconstructive Surgery, Vinogradska cesta 29, 10000, Zagreb, Croatia.
authors.forename: Mihovil
authors.initials: M
authors.lastname: Ivica
authors.affiliation: Department of Surgery, General Hospital "Josip Benčević", Andrije Štampara 42, 35000, Slavonski Brod, Croatia.
authors.forename: Darko
authors.initials: D
authors.lastname: Jurišić
authors.affiliation: University Hospital "Sisters of Mercy", Clinic for Traumatology, Draškovićeva 19, 10000, Zagreb, Croatia.
authors.forename: Esmat
authors.initials: E
authors.lastname: Elabjer
authors.affiliation: Department of Surgery, General Hospital Karlovac, Dr. Andrije Štampara 3, 47000, Karlovac, Croatia.
authors.forename: Bore
authors.initials: B
authors.lastname: Bakota
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000503:physiopathology / Q000601:surgery*; D001860:Bone Plates; D017523:Croatia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D016059:Range of Motion, Articular; D017695:Soft Tissue Injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Distal tibial fractures; External fixation; Internal fixation; MIPO; Pilon; Soft tissue