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Archives of Orthopaedic and Trauma Surgery

Erschienen in:

10.05.2018 | Trauma Surgery

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

verfasst von: Xiaojian He, Chuanzhen Hu, Kaihua Zhou, Qilin Zhai, Weifeng Wen, Fugen Pan

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 8/2018

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Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Lua J, Tan VH, Sivasubramanian H, Kwek E (2017) Complications of open tibial fracture management: risk factors and treatment. Malays Orthop J 11:18–22. https://doi.org/10.5704/MOJ.1703.006 CrossRefPubMedPubMedCentral

Penn-Barwell JG, Myatt RW, Bennett PM, Sargeant ID (2015) Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation. Inj Int J Care Inj 46:288–291. https://doi.org/10.1016/j.injury.2014.12.004 CrossRef

Sheean AJ, Krueger CA, Napierala MA, Stinner DJ, Hsu JR (2014) Evaluation of the mangled extremity severity score in combat-related type III open tibia fracture. J Orthop Trauma 28:523–526. https://doi.org/10.1097/BOT.0000000000000054 CrossRefPubMed

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

Vidovic D, Matejcic A, Ivica M, Jurisic D, Elabjer E, Bakota B (2015) Minimally-invasive plate osteosynthesis in distal tibial fractures: Results and complications. Inj Int J Care Inj 46(Suppl 6):S96–S99. https://doi.org/10.1016/j.injury.2015.10.067 CrossRef

Mushtaq A, Shahid R, Asif M, Maqsood M (2009) Distal tibial fracture fixation with locking compression plate (LCP) using the minimally invasive percutaneous osteosynthesis (MIPO) technique. Eur J Trauma Emerg Surg 35:159–164. https://doi.org/10.1007/s00068-008-8049-1 CrossRefPubMed

Beale BS, McCally R (2012) Minimally invasive plate osteosynthesis: tibia and fibula. Vet Clin North Am Small Anim Pract 42:1023–1044. https://doi.org/10.1016/j.cvsm.08.001 CrossRefPubMed

Borens O, Kloen P, Richmond J, Roederer G, Levine DS, Helfet DL (2009) Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases. Arch Orthop Trauma Surg 129:649–659. https://doi.org/10.1007/s00402-006-0219-1 CrossRefPubMed

Kritsaneephaiboon A, Vaseenon T, Tangtrakulwanich B (2013) Minimally invasive plate osteosynthesis of distal tibial fracture using a posterolateral approach: a cadaveric study and preliminary report. Int Orthop 37:105–111. https://doi.org/10.1007/s00264-012-1712-5 CrossRefPubMed

10.

Yamamoto N, Ogawa K, Terada C, Okazaki Y, Munetomo K, Noda T, Ozaki T (2016) Minimally invasive plate osteosynthesis using posterolateral approach for distal tibial and tibial shaft fractures. Inj Int J Care Inj 47:1862–1866. https://doi.org/10.1016/j.injury.2016.06.017 CrossRef

11.

Milner SA (1997) A more accurate method of measurement of angulation after fractures of the tibia. J Bone Jt Surg Br 79:972–974

12.

Muhlhausser J, Winkler J, Babst R, Beeres F (2017) Infected tibia defect fractures treated with the Masquelet technique. Medicine (Baltimore) 96:e6948. https://doi.org/10.1097/MD.0000000000006948 CrossRef

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 CrossRefPubMed

14.

Kellam JF, Waddell JP (1979) Fractures of the distal tibial metaphysis with intra-articular extension–the distal tibial explosion fracture. J Trauma 19:593–601CrossRef

15.

Dillin L, Slabaugh P (1986) Delayed wound healing, infection, and nonunion following open reduction and internal fixation of tibial plafond fractures. J Trauma 26:1116–1119CrossRef

16.

De Giacomo AF, Tornetta PR (2016) Alignment after intramedullary nailing of distal tibia fractures without fibula fixation. J Orthop Trauma 30:561–567. https://doi.org/10.1097/BOT.0000000000000637 CrossRefPubMed

17.

Vallier HA, Cureton BA, Patterson BM (2011) Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma 25:736–741. https://doi.org/10.1097/BOT.0b013e318213f709 CrossRefPubMed

18.

Vallier HA, Cureton BA, Patterson BM (2012) Factors influencing functional outcomes after distal tibia shaft fractures. J Orthop Trauma 26:178–183. https://doi.org/10.1097/BOT.0b013e31823924df CrossRefPubMed

19.

Sun LJ, Yu XB, Dai CQ, Hu W, Guo XS, Chen H (2014) A randomised prospective study of two different combined internal and external fixation techniques for distal tibia shaft fractures. Inj Int J Care Inj 45:1990–1995. https://doi.org/10.1016/j.injury.2014.10.044 CrossRef

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 65:343–348CrossRef

21.

Beltsios M, Savvidou O, Kovanis J, Alexandropoulos P, Papagelopoulos P (2009) External fixation as a primary and definitive treatment for tibial diaphyseal fractures. Strateg Trauma Limb Reconstr 4:81–87. https://doi.org/10.1007/s11751-009-0062-3 CrossRef

22.

Collinge C, Kuper M, Larson K, Protzman R (2007) Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma 21:355–361. https://doi.org/10.1097/BOT.0b013e3180ca83c7 CrossRefPubMed

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

25.

Unlu S, Catma MF, Bilgetekin YG, Altay M, Ates Y, Bozkurt M, Kapicioglu MI (2015) Minimally invasive plate osteosynthesis of distal tibia and fibular fractures through a single distal anterolateral incision. J Foot Ankle Surg 54:1081-1084. https://doi.org/10.1053/j.jfas06.009 CrossRef

26.

Howard JL, Agel J, Barei DP, Benirschke SK, Nork SE (2008) A prospective study evaluating incision placement and wound healing for tibial plafond fractures. J Orthop Trauma 22:299–305. https://doi.org/10.1097/BOT.0b013e318172c811 (discussion 305-6)CrossRefPubMed

Titel: 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
verfasst von: Xiaojian He
Chuanzhen Hu
Kaihua Zhou
Qilin Zhai
Weifeng Wen
Fugen Pan
Publikationsdatum: 10.05.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 8/2018
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-2950-9

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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

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Objectives

Methods

Results

Conclusions

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