M. Chandra Sekharam Naidu1, Ch. V. Murali Krishna2, S. Sankara Rao3, V. Dharma Rao4, P. Ashok Kumar5
INTRODUCTION: Distal tibial fractures represent a significant challenge to most of the surgeons even today. They constitute 1-10% of all lower extremity fractures.1 The difficulty in treating the fractures of distal tibial end is exemplified by orthopedists, who in the first half of twentieth century, believed these injuries were so severe and fraught with so many complications, that these fractures were deemed not amenable for surgical reconstruction.2 Conservative treatment by POP cast lead to prolonged immobilization, leading to ankle and knee stiffness affecting quality of life of the patient.3 Operative treatment is indicated for most tibial fractures caused by high energy trauma. Operative treatment allows early motion, and avoids shortening and other complications associated with prolonged immobilization.4 The fundamental goal of treatment of distal tibial fractures is restoration of normal or near normal alignment and articular congruity and finally to obtain a well healed fracture; pain free weight bearing; and functional ROM of ankle joint. For the past decade, plating has been successful in treating complex fractures of the lower extremity especially distal tibia.5 Conventional ORIF have been associated with complications like infection and delayed or non-union due to devitalisation of bony fragments and additional damage to the soft tissues.6 To improve fracture healing, more “biological” methods have been developed in the last decade to lessen the surgical dissection, preserving blood supply to bony fragments and containing at least partially the fracture haematoma.7 Recently, the trend is towards use of a Locking compression plate for treatment of fractures of the distal part of the tibia8. Compared with a conventional plate, a Locking compression plate imparts a higher degree of stability and provides better protection against primary and secondary losses of reduction and minimization of bone contact.9 MIPO promoted by AO group emphasis on indirect reduction, axial alignment and stable fixation without disturbing the fracture environment and thus preserving most of the vascularization and fracture haematoma, containing all necessary growth factors for bony healing. Technique of closed reduction and MIPPO with LCP has emerged as an alternative treatment option for distal dia-metaphyseal tibia fracture. When applied subcutaneously, LCP does not endanger periosteal blood supply, respect fracture heamtoma and also provides biomechanically stable construct. Several clinical studies have established MIPO with LCP as a biologically friendly and technically sound method of fixation for distal meta-diaphyseal tibial fracture.
