Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 8, pp 1097–1102 | Cite as

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

  • Xiaojian He
  • Chuanzhen Hu
  • Kaihua Zhou
  • Qilin Zhai
  • Weifeng Wen
  • Fugen PanEmail author
Trauma Surgery



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.


Gustilo 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.

Ethical approval

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.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Xiaojian He
    • 1
  • Chuanzhen Hu
    • 2
    • 3
  • Kaihua Zhou
    • 1
  • Qilin Zhai
    • 1
  • Weifeng Wen
    • 1
  • Fugen Pan
    • 1
    Email author
  1. 1.Department of Orthopaedics, Qingpu Branch of Zhongshan HospitalFudan UniversityShanghaiPeople’s Republic of China
  2. 2.Department of Orthopaedic SurgeryShanghai Tenth People’s Hospital Affiliated to Tongji UniversityShanghaiChina
  3. 3.Institute of Bone Tumor Affiliated to Tongji University School of MedicineShanghaiChina

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