Submuscular Plating of Tibial Fractures
A 14-year-old male sustained a displaced closed left distal tibia fracture while playing rugby. Closed reduction was attempted and a long leg cast was applied. An acceptable reduction was achieved intraoperatively, but loss of alignment was noted at 1-week follow-up. Treatment options included cast wedging, elastic intramedullary nailing (ESIN), external fixation or open reduction, and plating. Definitive management consisted of submuscular plate fixation with manual closed reduction to preserve the periosteal blood supply. This technique does not interfere with the fracture site and thus provides excellent angular stability with improved healing potential. The fracture healed uneventfully in 10 weeks. Percutaneous plating is one of several options in the management of tibia fractures in skeletally immature patients. Because of its biologic advantages and stable fixation that allows early mobilization, percutaneous plating is a reasonable treatment option for older children and adolescents with complex-unstable fractures of the tibia.