Background: The most notable change in the treatment of fractures has been the shift from the mechanical aspects of internal fixation with absolute stability and primary bone union as the goal, to the biological aspects of internal fixation with relative stability and healing with callus as the preferred method with great emphasis on preservation of the blood supply of bone and soft tissue to ensure the continued vitality of the individual fragments to improve fracture healing. Percutaneous plate fixation minimizes soft tissue compromise with decreased incidence of wound breakdown and deep infection. It also preserves the vascularity of the bone fragments so, shortens the time for union, decreases the need for bone grafting even in comminuted fractures and also decreases the incidence of non-union that needs a second major open intervention.
Aim of the work: to evaluate the outcome of MIPO for treatment of high-energy tibial shaft (upper and middle thirds) fractures in adults using conventional non-locked plates through the medial approach.
Patients and Methods: This prospective study included 16 adult, male patients who had high-energy closed tibial shaft fractures (upper and middle thirds) with varying degrees of displacement and comminution. All patients were evaluated clinically and radiologically before and after surgery, followed up for a mean time of 14 months post-operatively and evaluated radiologically and functionally according to the ASAMI scoring system. All cases were treated using conventional non-locked plates inserted percutaneously on the medial surface of the tibia.
Results: All the fractures united with a mean union time of 16.2 weeks ranging from 13 to 36 weeks. Clinical and radiological outcome according to the ASAMI scoring system in this study showed excellent results in 14 cases representing 87.5 % of the studied group and good results in 2 cases representing 12.5 % of the studied group. No neurovascular complications, no persistent limitation of the knee or ankle motions, no deep wound infection, no implant failure occurred in any case till the last follow-up and no cases required second major open intervention.
Conclusion: minimally invasive Percutaneous plate fixation technique is an effective method of stabilization for closed tibial shaft fractures achieving good bone alignment and protecting soft tissues, leading to higher union rates with good functional outcome. Conventional non-locked plates applied through the medial approach decreases the surgical time and the risk of post-operative compartmental syndrome. |
