COMPARISON STUDY ON TWO OPERATIONS FOR TREATMENT OF EXTRA-ARTICULAR DISTAL TIBIAL FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QI Haotian ¹ , LI Weikang ¹ , ZHAO Yongjie ¹ , ZHANG Yinguang ² , LIU Zhaojie ² , JIA Jian ²

1The Graduate College of Tianjin Medical University, Tianjin, 300200, P.R.China;;
2Area III of Traumatic Orthopedic Department, Tianjin Hospital. Corresponding author: JIA Jian, E-mail: jiajian@126.com;

Corresponding author：

Keywords：

Extra-articular distal tibial fractures; Minimally invasive plate osteosynthesis; Open reduction and internal fixation

DOI：

10.7507/1002-1892.20130281

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Objective To compare the effectiveness between minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) for treatment of extra-articular distal tibial fracture. Methods Between March 2009 and March 2012, 57 patients with extra-articular distal tibial fractures were treated, and the clinical data were retrospectively analyzed. Of 57 cases, 31 were treated with MIPO (MIPO group), and 26 with ORIF (ORIF group). There was no significant difference in gender, age, cause of injury, type of fractures, complication, and time from injury to operation between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were compared between 2 groups. Results There was no significant difference in operation time and intraoperative blood loss between 2 groups (P gt; 0.05). Wound infection occurred in 5 cases [2 in MIPO group (6.5%) and 3 in ORIF group (11.5%)], showing no significant difference (χ2=0.651, P=0.499). The other wound obtained healing by first intention. All cases were followed up 13-24 months (mean, 15 months). No significant difference was found in the average healing time between 2 groups and between patients with types A and B by AO classification (P gt; 0.05); in patients with type C, the healing time in MIPO group was significantly shorter than that in ORIF group (t= — 2.277, P=0.033). Delayed union was observed in 3 cases of MIPO group (9.7%) and in 4 cases of ORIF group (15.4%), showing no significant difference (χ2=0.428, P=0.691). Mal-union occurred in 4 cases of MIPO group (12.9%) and in 1 case of ORIF group (3.8%), showing no significant difference (χ2=1.449, P=0.362). No significant difference was found in Mazur score between 2 groups (t=0.480, P=0.633). The excellent and good rate was 93.5% in MIPO group (excellent in 24 cases, good in 5 cases, fair in 1 case, and poor in 1 case) and was 92.3% in ORIF group (excellent in 18 cases, good in 6 cases, and poor in 2 cases), and the difference was not significant (Z= — 0.687, P=0.492). Conclusion Both MIPO and ORIF have good results in treating extra-articular distal tibial fractures. MIPO is superior to ORIF for treating complex and communited fractures.

Citation： QI Haotian,LI Weikang,ZHAO Yongjie,ZHANG Yinguang,LIU Zhaojie,JIA Jian. COMPARISON STUDY ON TWO OPERATIONS FOR TREATMENT OF EXTRA-ARTICULAR DISTAL TIBIAL FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(11): 1286-1290. doi: 10.7507/1002-1892.20130281 Copy

1.	Bucholz R, Heckman J, Court-Brown C. Rockwood and Green’s fractures in adults. 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2006: 103-118.
2.	Casstevens C, Le T, Archdeacon MT, et al. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg, 2012, 20(11): 675-683.
3.	Zelle BA, Bhandari M, Espiritu M, et al. Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma, 2006, 20(1): 76-79.
4.	Sitnik AA, Beletsky AV. Minimally invasive percutaneous plate fixation of tibia fractures: results in 80 patients. Clin Orthop Relat Res, 2013, 471(9): 2783-2789.
5.	Aksekili MA, Celik I, Arslan AK, et al. The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures. Acta Orthop Traumatol Turc, 2012, 46(3): 161-167.
6.	Rijal L, Sagar G, Mani K, et al. Minimizing radiation and incision in minimally invasive percutaneous plate osteosynthesis (MIPPO) of distal tibial fractures. Eur J Orthop Surg Traumatol, 2013, 23(3): 361-365.
7.	Tanwar YS, Habib M, Jaiswal A, et al. Minimally invasive plate osteosynthesis of distal tibial fracture using a posterolateral approach a cadaveric study and preliminary report. Int Orthop, 2013, 37(5): 989-990.
8.	Ali AA, Gregory JJ, Ockenden M, et al. Anatomic description of the distal tibia implications for internal fixation. J Foot Ankle Surg, 2012, 51(3): 296-298.
9.	Kopp FJ, Banks MA, Marcus RE. Clinical outcome of tibiotalar arthrodesis utilizing the chevron technique. Foot Ankle Int, 2004, 25(4): 225-230.
10.	Gupta RK, Rohilla RK, Sangwan K, et al. Locking plate fixation in distal metaphyseal tibial fractures series of 79 patients. Int Orthop, 2010, 34(8): 1285-1290.
11.	Newman SD, Mauffrey CP, Krikler S. Distal metadiaphyseal tibial fractures. Injury, 2011, 42(10): 975-984.
12.	Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia results in 20 patients. Injury, 2006, 37(9): 877-887.
13.	Ristiniemi J, Flinkkilä T, Hyvönen P, et al. Two-ring hybrid external fixation of distal tibial fractures: a review of 47 cases. J Trauma, 2007, 62(1): 174-183.
14.	Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma, 2008, 22(5): 307-311.
15.	Moshieff R, Safran O, Segal D, et al. The unreamed tibial nail in the treatment of distal metaphyseal fractures. Injury, 1999, 30(2): 83-90.
16.	Batten RL, Donaldson LJ, Aldridge MJ. Experience with the AO method in the treatment of 142 cases of fresh fracture of the tibial shaft treated in the UK. Injury, 1978, 10(2): 108-114.
17.	Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients. Int Orthop, 2007, 31(5): 709-714.
18.	Pai V, Coulter G, Pai V. Minimally invasive plate fixation of the tibia. Int Orthop, 2007, 31(4): 491-496.
19.	Helfet DL, Shonnard PY, Levine D, et al. Minimally invasive plate osteosynthesis of the distal tibia. Injury, 1997, 28 Suppl 1: A42-48.
20.	Farouk O, Krettek C, Miclau T, et al. The topography of the perforating vessels of the deep femoral artery. Clin Orthop Relat Res, 1999, (368): 255-259.
21.	Borrelli J Jr, Prickett W, Song E, et al. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma, 2002, 16(10): 691-695.
22.	Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury, 2007, 38(3): 365-370.
23.	Khoury A, Liebergall M, London E, et al. Percutaneous plating of distal tibial fractures. Foot Ankle Int, 2002, 23(9): 818-824.
24.	Zou J, Zhang W, Zhang CQ. Comparison of minimally invasive percutaneous plate osteosynthesis with open reduction and internal fixation for treatment of extra-articular distal tibia fractures. Injury, 2013, 44(8): 1102-1106.
25.	Cheng W, Li Y, Manyi W. Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation. Int Orthop, 2011, 35(5): 737-742.
26.	Lau TW, Leung F, Chan CF, et al. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop, 2008, 32(5): 697-703.
27.	Ozsoy MH, Tuccar E, Demiryuek D, et al. Minimally invasive plating of the distal tibia: do we really sacrifice saphenous vein and nerve? A cadaver study. J Orthop Trauma, 2009, 23(2): 132-138.
28.	Rouhani A, Elmi A, Akbari Aghdam H, et al. The role of fibular fixation in the treatment of tibia diaphysis distal third fractures. Orthop Traumatol Surg Res, 2012, 98(8): 868-872.
29.	Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma, 2011, 25(12): 736-741.
30.	Egol KA, Weisz R, Hiebert R, et al. Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures. J Orthop Trauma, 2006, 20(2): 94-103.
31.	Boraiah S, Gardner MJ, Helfet DL, et al. High association of posterior malleolus fractures with spiral distal tibial fractures. Clin Orthop Relat Res, 2008, 466(7): 1692-1698.

1. Bucholz R, Heckman J, Court-Brown C. Rockwood and Green’s fractures in adults. 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2006: 103-118.
2. Casstevens C, Le T, Archdeacon MT, et al. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg, 2012, 20(11): 675-683.
3. Zelle BA, Bhandari M, Espiritu M, et al. Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma, 2006, 20(1): 76-79.
4. Sitnik AA, Beletsky AV. Minimally invasive percutaneous plate fixation of tibia fractures: results in 80 patients. Clin Orthop Relat Res, 2013, 471(9): 2783-2789.
5. Aksekili MA, Celik I, Arslan AK, et al. The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures. Acta Orthop Traumatol Turc, 2012, 46(3): 161-167.
6. Rijal L, Sagar G, Mani K, et al. Minimizing radiation and incision in minimally invasive percutaneous plate osteosynthesis (MIPPO) of distal tibial fractures. Eur J Orthop Surg Traumatol, 2013, 23(3): 361-365.
7. Tanwar YS, Habib M, Jaiswal A, et al. Minimally invasive plate osteosynthesis of distal tibial fracture using a posterolateral approach a cadaveric study and preliminary report. Int Orthop, 2013, 37(5): 989-990.
8. Ali AA, Gregory JJ, Ockenden M, et al. Anatomic description of the distal tibia implications for internal fixation. J Foot Ankle Surg, 2012, 51(3): 296-298.
9. Kopp FJ, Banks MA, Marcus RE. Clinical outcome of tibiotalar arthrodesis utilizing the chevron technique. Foot Ankle Int, 2004, 25(4): 225-230.
10. Gupta RK, Rohilla RK, Sangwan K, et al. Locking plate fixation in distal metaphyseal tibial fractures series of 79 patients. Int Orthop, 2010, 34(8): 1285-1290.
11. Newman SD, Mauffrey CP, Krikler S. Distal metadiaphyseal tibial fractures. Injury, 2011, 42(10): 975-984.
12. Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia results in 20 patients. Injury, 2006, 37(9): 877-887.
13. Ristiniemi J, Flinkkilä T, Hyvönen P, et al. Two-ring hybrid external fixation of distal tibial fractures: a review of 47 cases. J Trauma, 2007, 62(1): 174-183.
14. Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma, 2008, 22(5): 307-311.
15. Moshieff R, Safran O, Segal D, et al. The unreamed tibial nail in the treatment of distal metaphyseal fractures. Injury, 1999, 30(2): 83-90.
16. Batten RL, Donaldson LJ, Aldridge MJ. Experience with the AO method in the treatment of 142 cases of fresh fracture of the tibial shaft treated in the UK. Injury, 1978, 10(2): 108-114.
17. Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients. Int Orthop, 2007, 31(5): 709-714.
18. Pai V, Coulter G, Pai V. Minimally invasive plate fixation of the tibia. Int Orthop, 2007, 31(4): 491-496.
19. Helfet DL, Shonnard PY, Levine D, et al. Minimally invasive plate osteosynthesis of the distal tibia. Injury, 1997, 28 Suppl 1: A42-48.
20. Farouk O, Krettek C, Miclau T, et al. The topography of the perforating vessels of the deep femoral artery. Clin Orthop Relat Res, 1999, (368): 255-259.
21. Borrelli J Jr, Prickett W, Song E, et al. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma, 2002, 16(10): 691-695.
22. Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury, 2007, 38(3): 365-370.
23. Khoury A, Liebergall M, London E, et al. Percutaneous plating of distal tibial fractures. Foot Ankle Int, 2002, 23(9): 818-824.
24. Zou J, Zhang W, Zhang CQ. Comparison of minimally invasive percutaneous plate osteosynthesis with open reduction and internal fixation for treatment of extra-articular distal tibia fractures. Injury, 2013, 44(8): 1102-1106.
25. Cheng W, Li Y, Manyi W. Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation. Int Orthop, 2011, 35(5): 737-742.
26. Lau TW, Leung F, Chan CF, et al. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop, 2008, 32(5): 697-703.
27. Ozsoy MH, Tuccar E, Demiryuek D, et al. Minimally invasive plating of the distal tibia: do we really sacrifice saphenous vein and nerve? A cadaver study. J Orthop Trauma, 2009, 23(2): 132-138.
28. Rouhani A, Elmi A, Akbari Aghdam H, et al. The role of fibular fixation in the treatment of tibia diaphysis distal third fractures. Orthop Traumatol Surg Res, 2012, 98(8): 868-872.
29. Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma, 2011, 25(12): 736-741.
30. Egol KA, Weisz R, Hiebert R, et al. Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures. J Orthop Trauma, 2006, 20(2): 94-103.
31. Boraiah S, Gardner MJ, Helfet DL, et al. High association of posterior malleolus fractures with spiral distal tibial fractures. Clin Orthop Relat Res, 2008, 466(7): 1692-1698.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON STUDY ON TWO OPERATIONS FOR TREATMENT OF EXTRA-ARTICULAR DISTAL TIBIAL FRACTURE

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