Abstract:

BACKGROUND: Minimally invasive plate osteosynthesis (MIPO) has become widely used for the treatment of complex fractures of the distal part of the tibia. For relatively small distal tibia fracture fragment, a monoaxial locking plate with fixed-trajectory locking screws sometimes may not provide anticipated fixation stability for the distal fragment.

OBJECTIVE: To evaluate primary clinical outcomes of fractures of the distal tibia with very short metaphyseal fragments treated with polyaxial locking plating.

METHODS: A total of 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia were treated with a polyaxial locking plate. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. There were 9 cases of open fractures. All fractures involved the metaphyseal part of the distal tibia, and in 14 cases the fracture extended distally into the ankle. Of them, 21 patients were treated with MIPO, and 11 with traditional open reduction and internal fixation. The incision and complications were observed. The patients were followed up until fracture healing. The results were evaluated by AOFAS scores.

RESULTS AND CONCLUSION: All fractures healed. The average time to union for all fractures was 14 weeks (range, 10–20 weeks). The average healing time for fractures using the MIPO technique was significantly shorter than traditional technique (P < 0.01). Closed fractures healed rapidly compared with open fractures (P < 0.05). Using the AOFAS ankle-hindfoot scale, the average functional score was 87.3 points (range, 72–98 points). All results demonstrated that the polyaxial locking plate offering more fixation versatility can provide a high degree of angular and axial stability to short articular segments and metaphyseal comminution, with low incidence of complications. Therefore, it can be considered a feasible and worthwhile method of stabilization and recommended for the treatment of these special type fractures of the distal tibia