Comparison of 3 Minimally Invasive Methods for Distal Tibia Fractures.
This study compared the results of external fixation combined with limited open reduction and internal fixation (EF + LORIF), minimally invasive percutaneous plate osteosynthesis (MIPPO), and intramedullary nailing (IMN) for distal tibia fractures. A total of 84 patients with distal tibia shaft fractures were randomized to operative stabilization using EF + LORIF (28 cases), MIPPO (28 cases), or IMN (28 cases). The 3 groups were comparable with respect to patient demographics. Data were collected on operative time and radiation time, union time, complications, time of recovery to work, secondary operations, and measured joint function using the American Orthopaedic Foot and Ankle Society (AOFAS) score. There was no significant difference in time to union, incidence of union status, time of recovery to work, and AOFAS scores among the 3 groups (P>.05). Mean operative time and radiation time in the MIPPO group were longer than those in the IMN or EF + LORIF groups (P<.05). Wound complications after MIPPO were more common compared with IMN or EF + LORIF (P<.05). Anterior knee pain occurred frequently after IMN (32.1%), and irritation symptoms were encountered more frequently after MIPPO (46.4%). Although EF + LORIF was associated with fewer secondary procedures vs MIPPO or IMN, it was related with more pin-tract infections (14.3%). Findings indicated that EF + LORIF, MIPPO, and IMN all achieved similar good functional results. However, EF + LORIF had some advantages over MIPPO and IMN in reducing operative and radiation times, postoperative complications, and reoperation rate. [Orthopedics. 2016; 39(4):e627-e633.].
Jun-Hao
JH
Fang
Yao-Sen
YS
Wu
Xiao-Shan
XS
Guo
Liao-Jun
LJ
Sun
D000328:Adult; D018771:Arthralgia / Q000209:etiology; D001858:Bone Nails / Q000009:adverse effects; D001860:Bone Plates / Q000009:adverse effects; D018483:Diaphyses / Q000293:injuries / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D000070799:Open Fracture Reduction / Q000379:methods*; D061646:Operative Time; D000069079:Radiation Exposure; D012086:Reoperation; D013530:Surgical Wound Infection / Q000209:etiology*; D013977:Tibia / Q000293:injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors