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Minimally Invasive Locked Plating of Distal Tibia Fractures is Safe and Effective

  • Symposium: Recent Advances in Foot and Ankle Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Distal tibial fractures are difficult to manage. Limited soft tissue and poor vascularity impose limitations for traditional plating techniques that require large exposures. The nature of the limitations for traditional plating techniques is intrinsic to the large exposure required to approach distal tibia, a bone characterized by limited soft tissue coverage and poor vascularity. The locking plate (LP) is a new device for treatment of fractures. We assessed the bone union rate, deformity, leg-length discrepancy, ankle range of motion, return to preinjury activities, infection, and complication rate in 21 selected patients who underwent minimally invasive osteosynthesis of closed distal tibia fractures with an LP. According to the AO classification, there were 12 Type A, 5 Type B, and 4 Type C fractures. The minimum followup was 2 years (average, 2.8 years; range, 2–4 years). Two patients were lost to followup. Union was achieved in all but one patient by the 24th postoperative week. Four patients had angular deformity less than 7°. No patient had a leg-length discrepancy more than 1.1 cm. Five patients had ankle range of motion less than 20° compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. We judge the LP a reasonable device for treating distal tibia fractures. The level of physical activities appears permanently reduced in most patients.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Fig. 1A–C
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Fig. 3A–B

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Acknowledgments

We thank Stefano Turino, MD, for his assistance in preparing the pictures.

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Correspondence to Nicola Maffulli MD, PhD, MS, FRCS(Orth).

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital—275 Bancroft Road, London E1 4DG, United Kingdom.

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Ronga, M., Longo, U.G. & Maffulli, N. Minimally Invasive Locked Plating of Distal Tibia Fractures is Safe and Effective. Clin Orthop Relat Res 468, 975–982 (2010). https://doi.org/10.1007/s11999-009-0991-7

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  • DOI: https://doi.org/10.1007/s11999-009-0991-7

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