Clinical and radiological outcome of Gustilo type III open distal tibial and tibial shaft fractures after staged treatment with posterolateral minimally invasive plate osteosynthesis (MIPO) technique
- 83 Downloads
To evaluate the methods and the outcomes of Gustilo type III open distal tibial and tibial shaft fractures with severe anterior and medial soft-tissue injuries, treated with posterolateral minimally invasive plate osteosynthesis (MIPO) technique.
From May 2015 to May 2016, 10 patients with Gustilo type III open distal tibial and tibial shaft fractures with severe anterior and medial soft-tissue injuries (Gustilo–Anderson classification IIIA, 6; IIIB, 4) were treated with staged protocol using posterolateral minimally invasive plate osteosynthesis (MIPO) technique. The initial wound lavage, debridement, and application of a spanning external fixator were performed within 24 h and the mean interval from injury to definitive surgical treatment was 12.8 (range 4–21) days. An additional bone graft was performed in two patients when definitive internal fixation was performed. All patients were followed to union. Postoperative radiographs, postoperative complications, bone union, ankle joint motion, and limb functional outcome information of AOFAS ankle–hindfoot score were recorded.
The mean follow-up period was 17.8 (range 12–26) months. The mean interval to bony union was 25.8 (range 20–40) weeks. Bone union was achieved in all cases. There were no complications, such as incision breakdown, deep infection, or impingement of the flexor hallucis longus tendon. The average AOFAS score was 90 (range 83–96). In ten patients, two patients had a superficial wound infection and another one patient showed a 6° varus deformity.
Staged treatment using MIPO technique through a posterolateral approach is a reasonable and safe treatment option for open distal tibial and tibial shaft fractures, especially Gustilo type III with severe anterior and medial soft-tissue injuries. However, it should have a higher level of research evidence in more patients to confirm the safety of the clinical application of this technique.
KeywordsGustilo type III Open tibial fracture Posterolateral approach minimally invasive plate osteosynthesis Staged treatment
This study was supported by the Grants from Key Project of Shanghai Health Bureau for Kkeletal Trauma (ZK2015B27).
Compliance with ethical standards
Conflict of interest
All authors have no conflict of interest regarding this paper.
This study was conducted in accordance with the Declaration of Helsinki. This study was conducted with approval from the Ethics Committee of the Qingpu Branch of Zhongshan Hospital. Written informed consent was obtained from all participants.
- 4.Shon OJ, Park CH (2012) Minimally invasive plate osteosynthesis of distal tibial fractures: a comparison of medial and lateral plating. J Orthop Sci 17:562–566. https://doi.org/10.1007/s00776-012-0241-9
- 11.Milner SA (1997) A more accurate method of measurement of angulation after fractures of the tibia. J Bone Jt Surg Br 79:972–974Google Scholar
- 13.Thakore RV, Francois EL, Nwosu SK, Attum B, Whiting PS, Siuta MA, Benvenuti MA, Smith AK, Shen MS, Mousavi I, Obremskey WT, Sethi MK (2017) The Gustilo–Anderson classification system as predictor of nonunion and infection in open tibia fractures. Eur J Trauma Emerg Surg 43:651–656. https://doi.org/10.1007/s00068-016-0725-y CrossRefPubMedGoogle Scholar
- 20.Golubovic Z, Stojiljkovic P, Macukanovic-Golubovic L, Milic D, Milenkovic S, Kadija M, Matovic Z, Turkovic G, Radenkovic M, Visnjic A, Golubovic I, Stojanovic S, Vidic G, Mitkovic M (2008) External fixation in the treatment of open tibial shaft fractures. Vojnosanitetski Pregled 65:343–348CrossRefPubMedGoogle Scholar
- 23.Hasenboehler E, Rikli D, Babst R (2007) Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Inj Int J Care Inj 38:365–370. https://doi.org/10.1016/j.injury.2006.10.024
- 24.Hazarika S, Chakravarthy J, Cooper J (2006) Minimally invasive locking plate osteosynthesis for fractures of the distal tibia–results in 20 patients. Inj Int J Care Inj 37:877–887. https://doi.org/10.1016/j.injury.2006.06.002