Amit Yadav, Ali Saify, Dr. Ganesh Yeotiwad, Sagar G. Daliya, Pagadala Manikanta Babu


Background:  The limited soft tissue, subcutaneous location of large portion of tibia and precarious blood supply renders the treatment of distal tibial fracture very challenging. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed Reduction and MIPPO with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia, maintains fracture haematoma and provides biomechanically stable construct, early mobilization, less complications and relatively higher rates of union.

Methods: 30 patients with distal tibia fracture with or without intra articular extension were treated with Closed Reduction and MIPPO with locking compression plate (LCP) Closed Reduction and. The patients were prospectively followed up for the duration of 12 months.

Results: There were 30 patients in the study including 22males and 8 females in the age group of 23 to 62 years (average 42years). The mean follow up period of our patients varied ranging from 6 months to 12 months. All fractures united at an average of 16 weeks (range- 12 to 20 weeks). In our study rate of superficial infection was 16.7% (5 patients), and ankle stiffness 6.7% (2 patients) .There were no cases of deep infection, delayed union, malunion or non union.

Conclusion: MIPPO with LCP is a reliable and effective method of treatment for the distal tibia fractures with or without intra articular extension, preserving most of the osseous vascularity and fracture haematoma and thus providing for a more biological repair. The use of indirect reduction technique and small incision is technically demanding as it is effective, minimally invasive, safe, optimises the operation time, reduces the incidence of infection, allows restoration of limb alignment and provides good clinical and radiological results with low complications and high union rates.


distal tibia fracture, MIPPO, functional outcome, LCP)

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Othman M, Strzelczyk P. Results of conservative treatment of “pilon” fractures. Ortop Traumatol Rehabil. 2003;5:787–94.

Digby JM, Holloway GM, Webb JK. A study of function after tibial cast bracing. Injury. 1983;14:432–9.

Anglen JO. Early outcome of hybrid external fixation for fracture of the distal tibia. J Orthop Trauma. 1999;13:92–7.

McFerran MA, Smith SW, Boulas HJ, Schwartz HS. Complicationsencountered in the treatment of pilon fractures. J Orthop Trauma. 1992;6:195–200.

Ruedi TP, Allgower M. The operative treatment of intra articular fractures of the lower end of tibia. Clin Orthop 1979; 138: 105-110.

Kellam J, Waddell JP. Fractures of the distal tibial metaphysic with intra-articular extension - the distal tibial explosion fracture. J Trauma 1979; 19: 593-601.

Bourne R, Rorabeck C, Macnab J. Intra-articular fractures of the distal tibia: The pilon fracture. J Trauma 1983; 23: 591-596.

Ovadia DN, Beals RK. Fractures of the tibial plafond. J Bone Joint Surg Am. 1986; 68:543-551.

Dillin L, Slabaugh P. Delayed wound healing, infection, and non union following open reduction and internal fixation of tibial plafond fractures. J Trauma 1986; 26: 1116-1119.

Helfet DL, Koval K, Pappas J, Sanders RW, Dipasquale T. Intra articular "pilon" fracture of the tibia. Clin Orthop 1994; 298: 221-228.

Im GI, Tae SK. Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma. 2005 Nov; 59(5):1219-23; discussion 1223.

Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia – Injury.2006 Sep;37(9):877-87.Epub 2006 Aug 8.

Ozakaya U, Parmaksizoglu AS, Gul M, Sokuou S, Kabukcuoglu Y. Minimally invasive treatment of distal tibial fractures with locking and non locking plates. Foot Ankle Int .2009 Dec; 30(12):1161-7

Cory Collinge, MD, Mark Kuper , DO, Kirk Larson , RNFA, and Robert Protzman, MD. Minimally Invasive Plating of High-Energy Metaphyseal Distal Tibial Fractures. J Orthop Trauma 2007; 21:355-361.

Andrew Grose, Michael. J. Garden. Open reduction and internal fixation of tibial pilon fractures using a lateral approach. J. Orhop Trauma 2007; 21:530-537.

Andrew Grose, Michael. J. Garden. Open reduction and internal fixation of tibial pilon fractures using a lateral approach. J. Orhop Trauma 2007; 21:530-537.

Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomized trial comparing closed inramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br.2010 Jul; 92(7): 984-8

Neeraj Mahajan, Minimally invasive techniques in distal tibia fractures, J K Science, Vol. 10 No. 2, April-June 2008

D.J Redfern, S.U Syed, S.J.M Davies, Fractures of the distal tibia: minimally invasive plate osteosynthesis, Injury, Volume 35, Issue 6, June 2004, Pages 615-620

Int Orthop. 2004 Jun;28(3):159-62. Epub 2004 Feb 14.Percutaneous plating of distal tibial fractures.-Maffulli N, Toms AD, McMurtie A, Oliva F.

Muzaffar N, Bhat R, Yasin M. Complications of Minimally Invasive Percutaneous Plating for Distal Tibial Fractures. Trauma Monthly. 2016;21(3):e22131. doi:10.5812/traumamon.22131.

Supe AC, Kinge KV, Badole CM, Wandile KN, Patond KR. Minimally invasive percutaneous plate osteosynthesis in distal tibial fracture: A series of 32 cases. International Journal of Orthopaedics. 2016;2(1):06-9.


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