DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20214189

Lateral distal tibial locking compression plate fixation through single lateral incision technique is biologically superior and mechanically equivalent alternative to medial plate fixation for lower third tibia-fibula fractures

Amrut Borade, Gitkumar Hajgude

Abstract


Background: A number of surgical options for management of distal tibia fractures makes scenario confusing and available techniques are associated with complications. Recently lateral plating of tibia has shown good promise. To compare results between medial and lateral distal tibial locking compression plate for treatment of distal third tibia fractures

Methods: Prospective clinical study was carried out among 24 patients presenting with distal third tibia fractures. Patients were randomized into two groups of 12 each. One group was allocated into medial distal tibial LCP and second group was allocated into lateral distal tibial LCP. In first group, approach taken was medial or anteromedial while in second group, approach taken was lateral. Follow up was done for six months after surgery.

Results: There were 10 cases in medical group and eight cases in lateral group which had fracture due to road traffic accidents. All cases in medical group had concomitant fibula fracture while such cases were 10 in lateral group. One case in each group developed infection after surgery. There was one case of superficial skin dehiscence and one case of hardware problem in medial group compared to none in lateral group. Two cases from medial group required removal of implant compared to none from medial group.

Conclusions: Lateral distal tibial LCP seems to provide biological advantage than medial distal tibial LCP without difference in biomechanical properties of implants. Single lateral incision technique is an ingenious, biologically sound, and cosmetically superior for fixation of both lower third tibia & fibula fractures together.


Keywords


Tibia, Treatment, Fractures, Medial, Lateral

Full Text:

PDF

References


Song P, Pu LLQ. The Soleus Muscle Flap: An Overview of Its Clinical Applications for Lower Extremity Reconstruction. Ann Plast Surg. 2018;81(1):S109-16.

Bezstarosti H, Van Lieshout EMM, Voskamp LW, Kortram K, Obremskey W, McNally MA et al. Insights into treatment and outcome of fracture-related infection: a systematic literature review. Arch Orthop Trauma Surg. 2019;139(1):61-72.

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;31:709-14.

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 Ortho Trauma. 2008;22:307-11.

Jensen JS, Hansen FW, Johansen J. Tibial shaft fractures. A comparison of conservative treatment and internal fixation with conventional plates or AO compression plates. Acta Orthop Scand. 1977;48:204-12.

Maffulli N, Toms AD, McMurtie A. Percutaneous plating of distal tibial fractures. Int Orthop. 2004; 28:159-62

Pai V, Coulter G, Pai V. Minimally invasive plate fixation of the tibia. Int Orthop. 2007;31:491-6.

Shantharam SS, Naeni F, Wilson EP. Single-incision technique for internal fixation of distal tibia and fibula fractures. Orthopedics. 2000;23:429-31.

Saini R, Verma RK, Gupta SP, Jangir R, Bairwa RK. Comparative study between medial and lateral distal tibial locking compression plates for distal third tibial fractures. Int J Sci Res. 2021;10(4):1-4

Shingati MH, Ratnam S, Suresh I. A comparative study of distal tibia fractures treated with intramedullary nailing versus plating by mippo. J Evidence Based Med Healthcare. 2019;6(47):2983-2988.

Hooper GJ, Keddell RG, Penny ID. Conservative management or closed nailing for tibial shaft fractures. A randomized prospective trial. J Bone Joint Surg Br. 1991;73(1):83-5.

Yenna ZC, Bhadra AK, Ojike N, ShahulHameed AS, Burden RL, Voor J et al. Anterolateral and medial locking plate stiffness in distal tibial fracture model. Foot Ankle Int. 2011;32(6):630-7.

Manninen MJ, Lindahl J, Kankare J, Hirvensalo E. Lateral approach for fixation of the fractures of the distal tibia. Outcome of 20 patients. Technical note. Arch Orthop Trauma Surg. 2007;127(5):349-53.

Lee YS, Chen SH, Lin JC, Chen YO, Huang CR, Cheng CY et al. Surgical treatment of distal tibia fractures: a comparison of medial and lateral plating. Orthopedics. 2009;32(3):163.