DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20214178

Functional and clinical outcome of MIPPO anterolateral plating for proximal tibia fracture both proximal one third and coronal intrarticular fracture

Dinesh Kumar Meena, Raghvendra Choubisa, Johney Juneja, Anamendra Sharma

Abstract


Background: The proximal tibial fractures are one of the commonest intraarticular fractures. Generally these injuries fall into two broad categories, high energy fractures and low energy fractures. The tibial plateau fractures are mostly due to high velocity road traffic accidents and fall from height, where fractures result from direct axial compression, usually with a valgus (more common) or varus moment and indirect shear forces.

Methods: This is a prospective study and includes operations by MIPPO technique that were undertaken between January 2020 till June 2021 in RNT government hospital; Udaipur. The total number of cases studied were 25 with the youngest being 25 years old and oldest 70 years old. Intraoperative complications were noted. Functional outcome was assessed using Modified Rasmussen’s Criteria.

Results: Patients with fracture in our study occurred between the age of 25 to 70 years with maximum incidence involving the productive age group of 21-30 years (90%). Majority of the patients was males- 90%.

Conclusions: From the minimally invasive percutaneous plate osteosynthesis of proximal tibial fracture there is an increase in the complexity of proximal tibial fractures with increasing road traffic accident. As most of the patients sustained these fractures belong to physically highly active and productive age group, they need optimal treatment to get back to their previous work capacity and avoid long term complications like osteoarthritis. We treated all fractures in our study with MIPPO technique and found rapid healing by secondary fracture union and hence achieving strong bone union across the fracture site due to inherent benefits of less tissue damage and minimal disturbance of fracture site biology. We operated 20 proximal tibial fractures with MIPPO technique and observed rapid healing and good functional recovery.


Keywords


MIPPO, LCP, ACL, Proximal tibia

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References


Perry CR. Fractures of tibial plateau. Instr Course Lect. 1994;43:119-26.

George A, Brown, Spraque. Cast bracetreatment for plateau and bicondylar fracture of tibia. Clin Orthop. 1976;119:184.

Bennett WF, Browner B. Tibial Plateau Fractures: A Study of Associated Soft Tissue Injuries. J Orthop Trauma. 1994;8:183-8.

Apley A. Fractures of the lateral tibial condyle treated by skeletal traction and early mobilization. J Bone Joint Surg. 1956;38:699-708.

Wagner M. General principles for the clinical use of the LCP. Injury. 2003;34(2):B31-42.

Westmoreland GL, Mclaurin TM, Hutton WC. Screw pullout strength: A biomechanical comparison of large fragment and small fragment fixation in tibial plateau. J Orthop Trauma. 2002;16:178-81.

Ali AM, el Shafie M, Willet KM. Failure of fixation of tibial plateau fracture. J Orthop Trauma. 2002;16:323-9.

Mallik AR, Covall DJ, Whitelaw GP. Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev. 1992;21:1433-6.

Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma. 1987;1:97-119.

Sommer C, Gautier E, Muller M. For clinical application of the LCP. Injury. 2003;34(2):B43-54.

Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma. 2005;19:73-8.

Stannard JP, Wilson TC, Volgas DA, Alonso JE. The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma. 2004;18:552–8.

Bucholz RW, Brumback RJ. Fractures of the Shaft of the Femur, In: Rockwood and Green’s Fractures in Adults, C.A. Rockwood Jr, D.P. Green, R.W. Bucholz, J.D. Heckman (Ed.). Lippincott-Raven Publishers, Philadelphia, New York. 1996;1827-910.

Krettek C, Schandelmaier P, Miclau T, Tscherne H. Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury. 1997;28(2):A20-30.

Wenda K, Runkel M, Degreif J, Rudig L. Minimally invasive plate fixation in femoral shaft fractures. Injury. 1997;28(1):A13-9.

Krettek C, Schandelmaier P, Miclau T, Bertram R, Holmes W, Tscherne H. Transarticular joint reconstruction and indirect plate osteosynthesis for complex distal supracondylar femoral fractures. Injury. 1997;28(1):A31-41.

Krettek C, Gerich FT, Miclau TH. A minimally invasive medial approach for proximal tibia. Injury. 2001;32(1):4-13.

Sirbu P, Mihaila R, Ghionoiu G, Bruja R, Asaftei R. Minimally invasive plate osteosynthesis (MIPPO) in proximal and distal fractures of tibia. Proceedings of 7th European Trauma Congress. 2006;49-54.

Cole PA, Zlowodzki M, Kregor PJ. Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma. 2004;18:528-35.

Stoffel K, Dietaru. Biomechanical testing of the LCP how can stability in locked internal fixator be controlled. Injury. 2003;34(2):B11-9.

Goyal KS, Shalak AS, Marcus RE. Analysis of anatomic periarticular tibial plate fit on normal adults. Clin Orthop Rel Res. 2007;461:245-57.

Matityahu A, Krettek C, Miclau T III. Evolving concepts in plate fixation. In: Stannard JP, Schmidt AH, Kregor PJ, eds. Surgical treatment of orthopedic trauma. Philadelphia. Thieme Medical Publishers. 2007;58-64.

Palmer I. Compression fracture of lateral tibial condyle and their treatment. J Bone & Joint Surg. 1939;2(AM):674.

Apley Graham A., Pyrford, England, Fractures Of The Lateral Tibial Condyle Treated By Skeletal Traction And Early Mobilisation. 1956;38(3):699-708.

Lansinger O, Bergman B, Korner L. Tibial condylar fractures. A twenty-year follow-up. J Bone Joint Surg Am. 1986;68:13-19.

Moore TM, Patzakis MJ, Harvey JP: Tibial plateau fractures: Definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma. 1987;1:97-119.

Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am. 1973;55:1331-50.

Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res. 1979;1973;94-104.

Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res. 1993;87-100.

Lachiewicz MP, Lachiewicz PF. Are the Relative Indications for Revision Total Knee Arthroplasty Changing? J Surg Orthop Adv. 2009;18(2):74-6.

Houben PF, van der Linden ES, van den Wildenberg FA, Stapert JW. Functional and radiological outcome after intra-articular tibial plateau fractures, Injury (impact factor: 1.98). 1997;28(7):459-62.

Waddell JP, Johnston DW, Neidre A. Fractures of the tibial plateau: a review of ninety-five patients and comparison of treatment methods. J Trauma. 1981;21(5):376-81.

Schatzker J, Schulak DJ. Pseudarthrosis of a tibial plateau fracture: Report of a case. Clin Orthop. 1979;145:146-9.

Shrestha BK, Bijukachhe B, Rajbhandary T, Uprety S, Banskota AK. Tibial plateau fractures: four years review at B & B Hospital, Kathmandu Univ Med J (KUMJ). 2004;2(4):315-23.

Volpin G, Dowd GS, Stein H, Bentley G. Degenerative arthritis after intra-articular fractures of the knee. Long-term results. Journal of Bone and Joint Surgery. 1990;72(4):634-8.

Honkonen SE. Degenerative arthritis after tibial plateau fractures. J Orthop Trauma. 1995;9:273-77.

Duwelius PJ, Rangitschm MR, Colville MR, Woll TS. Treatment of Tibial Fractures by Limited Internal Fixation. Clin Orthop. 1997;339:47-57.

Gausewitz S, Hohl M. The significance of early motion in the treatment of tibial plateau fractures. Clin Orthop. 1986;202:135-8.

Gualtieri G, Hendriks M, Gualtieri I, Prosperi P, Fracture of the tibial plateau: results of surgical treatment. Chir Organi Mov. 1989;74(1-2):13-20.

Barei DP, Nork SE, Mills WJ. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am. 2006;88:1713-21.

Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma. 2005;19(2):73-8.

Wang SQ, Gao YS, Wang JQ, Zhang CQ, Mei J, Rao ZT. Surgical approach for high-energy posterior tibial plateau fractures, Indian J Orthop. 2011;45(2):125-31.

Barei DP, O’Mara TJ, Taitsman LA, Dunbar RP, Nork SE. Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma. 2008;22:176-83.

Oestern HJ, Tscherne H. Pathophysiology and classification of soft tissue injuries associated with fractures. In: Fracture with soft tissue injuries. Tscherne H, Gotzen L, editors. New York: Springer. 1984;6.

Mikulak SA, Gold SM, Zinar DM. Small wire external fixation of high energy tibial plateau fractures. Clin Orthop. 1998;(356):230-8.

Egol KA, Capla EL, Wolinsky PL. Bridging External Fixation for High Energy Proximal Tibia Fractures: Results of a Prospective Protocol. In: O.T.A. annual meeting, 2003, Salt Lake City, UT.

Ryan KJ, Malkani AL, Roberts CS, Seligson D, Crawford CH, Smith L. Treatment of bicondylar tibia plateau fractures using locked plating versus external fixation, Orthopedics. 2009;32(8).

Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994;23(2):149-54.

Ballmer FT, Hertel R, Nötzli HP. Treatment of tibial plateau fractures with small fragment internal fixation: a preliminary Report. J Orthop Trauma. 2000;14(7):467-74.

Westmoreland GL, McLaurin TM, Hutton WC. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau, J Orthop Trauma. 2002;16(3):178-81.