Title : Functional outcomes of Distal Tibia Fractures (DTFs) treated With Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO)
Abstract:
Background: Distal tibial fractures (DTFs) are relatively uncommon but pose significant management challenges due to poor vascularity and associated soft tissue injury. Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) has emerged as a promising technique to address these issues by preserving fracture biology while ensuring stable fixation.
Objective: To evaluate the functional outcomes and complication rates of closed DTFs treated with MIPPO in adult patients and to assess the influence of patient demographics, mechanism of injury, and fracture classification on outcomes.
Methods: A retrospective study was conducted at Sheikh Zayed Medical College Rahim Yar Khan, Pakistan, between January and December 2022, involving 70 patients aged 18–60 years with closed or Gustilo-Anderson grade I distal tibial fractures. Functional outcomes were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score at 6 weeks, 3 months, and 6 months postoperatively. Data were analyzed using chi-square and t-tests, with p ≤ 0.05 considered statistically significant.
Results: The mean age was 34.04 ± 9.66 years, with males comprising 78.8% of cases. Road traffic accidents accounted for 71.4% of injuries. Fracture types included A1 (30%), A2 (45.7%), and A3 (24.3%). Union occurred most commonly within 12–16 weeks (41.4%). At final follow-up, 30% had excellent, 52.9% satisfactory, 12.9% fair, and 4.3% poor outcomes. Postoperative complications occurred in 12.86% of patients, including malunion (5.7%), infection (4.3%), and ankle stiffness (2.9%). No significant associations were found between functional outcomes and age, gender, or mechanism of injury.
Conclusion: MIPPO is an effective surgical technique for DTFs, offering high rates of excellent and satisfactory functional outcomes with low complication rates. Its minimally invasive nature helps preserve soft tissue integrity and fracture vascularity, making it a valuable option for managing these complex fractures.
Keywords: distal tibia fracture, MIPPO, minimally invasive surgery, functional outcome, orthopaedics
