T S Müller1, C Sommer. 1. Department Chirurgie, Kantonsspital Graubünden, Loestr. 170, 7000, Chur, Schweiz. thomas.mueller@ksgr.ch
Abstract
OBJECTIVE: Minimally invasive plate osteosynthesis of distal metaphyseal and/or diaphyseal tibial fractures. INDICATIONS: Extraarticular tibial fractures or distal tibial fractures with simple intraarticular components (AO 42 A-C + AO 43 A, C1, C2) of the distal tibia shaft. Closed or open soft tissue conditions, most suitable for closed soft tissue damage Oestern-Tscherne grade I-II. CONTRAINDICATIONS: High degree open fractures, where the plate would not be covered by soft tissue. Comminuted Pilon fractures. SURGICAL TECHNIQUE: Closed reduction manually, over the plate or the external fixator/large distractor. Short incision on the medial malleolus. Epiperosteal insertion of the plate anteromedial. Improve reduction stepwise and insertion of screws on each main fragment. Relative stability is achieved by using bridging techniques. Fibula fixation in special cases. POSTOPERATIVE MANAGEMENT: Mobilization after 1-3 days with toe-touch weight bearing. Full weight bearing after 8-10 weeks. Implant removal optional after 1-2 years in cases of soft tissue irritation. RESULTS: Uneventful healing with good function was observed in 85% of patients within 4 months. Delayed unions were observed in 5-10% of cases and nonunions or malalignment were observed in 5% of patients. All patients were satisfied with function at the 2-year follow-up.
OBJECTIVE: Minimally invasive plate osteosynthesis of distal metaphyseal and/or diaphyseal tibial fractures. INDICATIONS: Extraarticular tibial fractures or distal tibial fractures with simple intraarticular components (AO 42 A-C + AO 43 A, C1, C2) of the distal tibia shaft. Closed or open soft tissue conditions, most suitable for closed soft tissue damage Oestern-Tscherne grade I-II. CONTRAINDICATIONS: High degree open fractures, where the plate would not be covered by soft tissue. Comminuted Pilon fractures. SURGICAL TECHNIQUE: Closed reduction manually, over the plate or the external fixator/large distractor. Short incision on the medial malleolus. Epiperosteal insertion of the plate anteromedial. Improve reduction stepwise and insertion of screws on each main fragment. Relative stability is achieved by using bridging techniques. Fibula fixation in special cases. POSTOPERATIVE MANAGEMENT: Mobilization after 1-3 days with toe-touch weight bearing. Full weight bearing after 8-10 weeks. Implant removal optional after 1-2 years in cases of soft tissue irritation. RESULTS: Uneventful healing with good function was observed in 85% of patients within 4 months. Delayed unions were observed in 5-10% of cases and nonunions or malalignment were observed in 5% of patients. All patients were satisfied with function at the 2-year follow-up.