Strategies in Trauma and Limb Reconstruction

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VOLUME 8 , ISSUE 2 ( August, 2013 ) > List of Articles

Original Article

Minimally invasive osteosynthesis of adult tibia fractures by means of rigid fixation with anatomic locked plates

Melih Güven, Emrah Ceviz, Murat Demirel, Turhan Özler, Onur Kocadal, Ayberk Önal

Keywords : Tibia fracture, Minimally invasive, Osteosynthesis, Biological, Locked plate, Screw

Citation Information : Güven M, Ceviz E, Demirel M, Özler T, Kocadal O, Önal A. Minimally invasive osteosynthesis of adult tibia fractures by means of rigid fixation with anatomic locked plates. 2013; 8 (2):103-109.

DOI: 10.1007/s11751-013-0164-9

License: CC BY-NC-SA 4.0

Published Online: 01-06-2017

Copyright Statement:  Copyright © 2013; The Author(s).


Main principle of biological fixation by minimally invasive locked plate osteosynthesis (MILPO) in lower extremity long bone fractures is relative stability which is provided by using long plate with limited number of screws. Some biomechanical studies have been reported about this issue. However, clinical studies are still missing. The aims of this retrospective extended case series were to evaluate the clinical and radiological results of adult tibia fractures treated by MILPO and the effect of plate length and screw density on complication rates. Twenty tibia fractures in 19 patients (mean age 42.3 years) operated by MILPO were reviewed. According to the AO classification, diaphyseal and metaphyseal fractures without intraarticular extensions were simple and wedge-type fractures, whereas all intraarticular fractures were comminuted. Number of screws, cortices and empty screw holes proximal and distal to the fracture, plate-span ratio (plate length divided by overall fracture length), plate-screw density (number of inserted screws divided by number of plate holes), fixation failures, delayed or nonunion, malalignment and leg length discrepancy were documented. Mean follow-up was 16 (range 12–26) months. On average, 4 screws with 6 cortices were used both proximally and distally in all fractures. Only in diaphyseal fractures, one screw hole close to the fracture was omitted. Average plate-screw density and plate-span ratio were 0.68 and 4, respectively. Mean union time was 3 months. There were no cases of delayed or nonunion on the final follow-up. Plate bending was observed in one patient who had fair result. The remaining 18 (94.8 %) patients showed good and excellent results. Satisfactory results can be achieved despite low plate-span ratio and high plate-screw density in simple and wedge-type diaphyseal fractures of the tibia. Additionally, plate-screw density can be higher at metaphysis in intraarticular fractures, in which essential point is a perfectly stable fixation that provides early motion.

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  1. Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H (1997) Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury 28(Suppl 1):7-12
  2. Strauss EJ, Schwarzkopf R, Kummer F, Egol KA (2008) The current status of locked plating: the good, the bad and the ugly. J Orthop Trauma 22:479-486
  3. Oh CW, Kyung HS, Park IH, Kim PT, Ihn JC (2003) Distal tibia metaphyseal fractures treated by percutaneous plate osteosynthesis. Clin Orthop Relat Res 408:286-291
  4. Hasenboehler E, Rikli D, Babst R (2007) Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury 38:365-370
  5. Hazarika S, Chakravarthy J, Cooper J (2006) Minimally invasive locking plate osteosynthesis for fractures of the distal tibia. Results in 20 patients. Injury 37:877-887
  6. Gupta RK, Rohilla RK, Sangwan K, Singh V, Walia S (2010) Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients. Int Orthop 34(8):1285-1290
  7. Wenda K, Runkel M, Degreif J, Rudig L (1997) Minimally invasive plate fixation in femoral shaft fractures. Injury 28(Suppl 1):13-19
  8. Redfern DJ, Syed SU, Davies SJM (2004) Fractures of the distal tibia: minimally invasive plate osteosynthesis. Injury 35:615-620
  9. Kesemenli C, Subasi M, Necmioglu S, Kapukaya A (2002) Treatment of multifragmentary fractures of the femur by indirect reduction (biological) and plate fixation. Injury 33:691-699
  10. Gautier E, Sommer C (2003) Guidelines for the clinical application of the LCP. Injury 34(Suppl 2):63-76
  11. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ (2004) Biomechanics of locked plates and screws. J Orthop Trauma 18:488-493
  12. Stoffel K, Dieter U, Stachowiak G, Gachter A, Kuster MS (2003) Biomechanical testing of the LCP—how can stability in locked internal fixators be controlled? Injury 34(Suppl 2):11-19
  13. Fulkerson E, Egol KA, Kubiak EN, Liporace F, Kummer FJ, Koval KJ (2006) Fixation of diaphyseal fractures with a segmental defect: a biomechanical comparison of locked and conventional plating techniques. J Trauma 60:830-835
  14. Orthopaedic Trauma Association Committee for Coding and Classification (1996) Fracture and dislocation compendium. J Orthop Trauma 10:1-153
  15. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am 58:453-458
  16. Güven M, Unay K, Çakýcý H, Ozturan EK, Ozkan NK (2008) A new screw fixation technique for minimally invasive percutaneous plate osteosynthesis. Acta Orthop Belg 74:846-850
  17. Ricci WM, Rudzki JR, Borrelli J (2004) Treatment of complex proximal tibia fractures with the less invasive skeletal stabilization system. J Orthop Trauma 18:521-527
  18. Johner R, Wruhs O (1983) Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res 178:7-25
  19. Hertel R, Eijer H, Meisser A, Hauke C, Perren SM (2001) Biomechanical and biological considerations relating to the clinical use of the Point Contact-Fixator-evaluation of the device handling test in the treatment of diaphyseal fractures of the radius and/or ulna. Injury 32(Suppl 2):10-14
  20. Sommer C, Gautier E, Muller M, Helfet DL, Wagner M (2003) First clinical results of the locking compression plate (LCP). Injury 34(Suppl 2):43-54
  21. Helfet DL, Shonnard PY, Levine D, Borrelli J (1997) Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury 28(Suppl 1):42-48
  22. Collinge C, Sanders R, DiPasquale T (2000) Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop Relat Res 375:69-77
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