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Clinical and Functional Outcome of Distal Tibial Fractures Treated with Minimally Invasive Percutaneous Plate Osteosynthesis Technique using Anatomical Distal Tibial Plate: A Case Series

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Title: Clinical and Functional Outcome of Distal Tibial Fractures Treated with Minimally Invasive Percutaneous Plate Osteosynthesis Technique using Anatomical Distal Tibial Plate: A Case Series
Authors: H Rohit Karthik, Venkata Kiran Pillella, Hemanth Raj, Madhukar Chegu, Vijay Narasimman Reddy, G Puguzhendhi
Source: Journal of Orthopaedic Case Reports, Vol 15, Iss 11, Pp 256-264 (2025)
Publisher Information: Indian Orthopaedic Research Group, 2025.
Publication Year: 2025
Collection: LCC:Orthopedic surgery
LCC:Diseases of the musculoskeletal system
Subject Terms: distal tibial fractures, minimally invasive plate osteosynthesis, anatomical distal tibial locking plate, biological fixation, functional outcomes, american orthopaedic foot and ankle society ankle-hindfoot score, complications in tibial fracture fixation, case series, Orthopedic surgery, RD701-811, Diseases of the musculoskeletal system, RC925-935
Description: Introduction: Distal tibial fractures are difficult to manage due to their complex anatomy, subcutaneous location, and poor vascularity. Conventional open plating often causes soft tissue complications, while intramedullary nailing and external fixation have limitations in alignment and infection control. Minimally invasive percutaneous plate osteosynthesis (MIPPO) with anatomical distal tibial plates preserves periosteal blood supply and provides stable fixation. This study aimed to evaluate clinical and functional outcomes of distal tibial fractures treated by MIPPO. Materials and Methods: A prospective case series was conducted at a tertiary care center from January 2022 to June 2024. Thirty-six patients were treated using MIPPO; 23 with a minimum of 12 months’ follow-up were included. AO type 43-A2, 43-A3, and 43-C3 fractures and Gustilo-Anderson Grade I open fractures were included. Functional recovery was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score and the Foot and Ankle Ability Measure. Radiological union time and complications were also analyzed. Results: The mean patient age was 47.5 years; 65% of injuries were from road traffic accidents. The mean radiological union time was 11.4 weeks (range 5–17). Mean AOFAS scores improved from 39.6 preoperatively to 82.9 at 6 months and 87.7 at 12 months (P < 0.0001), with 90% achieving good-to-excellent outcomes. Complications included delayed union in three cases (13%), one superficial infection (4.3%), and one mild varus malunion (4.3%), all resolving without reoperation. There were no deep infections, implant failures, or non-unions. Discussion: MIPPO with anatomical locking plates provided excellent union rates and functional recovery, with minimal wound complications. Results compare favorably with previous series (union 11–16 weeks) and confirm that limited soft tissue dissection preserves vascularity and enhances healing. While small sample size and single-center design limit generalizability, outcomes reinforce MIPPO as a reliable fixation strategy for distal tibial fractures. Conclusion: MIPPO using anatomical distal tibial plates is a safe, effective, and biologically sound fixation method. It achieves reliable union, early mobilization, and high functional scores with minimal complications. Future multicenter studies with longer follow-up are warranted for long-term validation.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2250-0685
2321-3817
Relation: https://jocr.co.in/wp/2025/11/clinical-and-functional-outcome-of-distal-tibial-fractures-treated-with-minimally-invasive-percutaneous-plate-osteosynthesis-technique-using-anatomical-distal-tibial-plate-a-case-series/; https://doaj.org/toc/2250-0685; https://doaj.org/toc/2321-3817
DOI: 10.13107/jocr.2025.v15.i11.6376
Access URL: https://doaj.org/article/4ccdde0de1df4db2bc06c6ae3bb898d8
Accession Number: edsdoj.4ccdde0de1df4db2bc06c6ae3bb898d8
Database: Directory of Open Access Journals
Description
Abstract:Introduction: Distal tibial fractures are difficult to manage due to their complex anatomy, subcutaneous location, and poor vascularity. Conventional open plating often causes soft tissue complications, while intramedullary nailing and external fixation have limitations in alignment and infection control. Minimally invasive percutaneous plate osteosynthesis (MIPPO) with anatomical distal tibial plates preserves periosteal blood supply and provides stable fixation. This study aimed to evaluate clinical and functional outcomes of distal tibial fractures treated by MIPPO. Materials and Methods: A prospective case series was conducted at a tertiary care center from January 2022 to June 2024. Thirty-six patients were treated using MIPPO; 23 with a minimum of 12 months’ follow-up were included. AO type 43-A2, 43-A3, and 43-C3 fractures and Gustilo-Anderson Grade I open fractures were included. Functional recovery was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score and the Foot and Ankle Ability Measure. Radiological union time and complications were also analyzed. Results: The mean patient age was 47.5 years; 65% of injuries were from road traffic accidents. The mean radiological union time was 11.4 weeks (range 5–17). Mean AOFAS scores improved from 39.6 preoperatively to 82.9 at 6 months and 87.7 at 12 months (P < 0.0001), with 90% achieving good-to-excellent outcomes. Complications included delayed union in three cases (13%), one superficial infection (4.3%), and one mild varus malunion (4.3%), all resolving without reoperation. There were no deep infections, implant failures, or non-unions. Discussion: MIPPO with anatomical locking plates provided excellent union rates and functional recovery, with minimal wound complications. Results compare favorably with previous series (union 11–16 weeks) and confirm that limited soft tissue dissection preserves vascularity and enhances healing. While small sample size and single-center design limit generalizability, outcomes reinforce MIPPO as a reliable fixation strategy for distal tibial fractures. Conclusion: MIPPO using anatomical distal tibial plates is a safe, effective, and biologically sound fixation method. It achieves reliable union, early mobilization, and high functional scores with minimal complications. Future multicenter studies with longer follow-up are warranted for long-term validation.
ISSN:22500685
23213817
DOI:10.13107/jocr.2025.v15.i11.6376