A Prospective Study Of Functional Outcome Of Tibial Pilon Fractures Treated With Locking Compression Plate By Mippo Technique (Minimally Invasive Percutaneous Plate Osteosynthesis

Abstract

INTRODUCTION: Pilon fractures represent a significant challenge to most of the surgeons even today, accounting for 7-10% of all tibial fractures. The challenges are in the form of poor status of the soft tissue envelope, compound fractures and intra articular fractures. In the first half of the last century these fractures were deemed to be non amenable for surgical reconstruction. Conservative treatment by cast application led to prolonged immobilization, ankle and knee stiffness and arthritic changes there by affecting the quality of life. For the past decade, plating using fracture reduction has been successful in treating complex fractures of the lower extremity especially distal tibia. The goal of this technique is to apply stable plate fixation while maintaining fracture biology and minimizing soft tissue problems. In this region MIPPO (minimally invasive percutaneous plate osteosynthesis) technique is maximally indicated, as preservation of soft tissue integrity is critical; it reduces iatrogenic soft tissue injury and damage to bone vascularity as well as preserves the fracture hematoma. The anteromedial tibial cortex is subcutaneous and the soft tissue envelope is thin. Indirect reduction and percutaneous locked plating are useful in the management of XI distal tibia fractures because they do not require extensile exposure for reduction of the articular surface. OBJECTIVE: To study the functional outcome and duration of union in Tibial Pilon fractures treated with Locking Compression Plate by MIPPO technique. METHODS: The study was conducted between the period of December 2014 to January 2016 in Shri. B.M. Patil medical college, hospital and research centre, VIJAYAPUR. 25 patients with diagnosis of tibial pilon fractures were treated with locking compression plate by mippo technique. All fractures classified according to AO/OTA classification in adults aged 18 years and above of either sex were included in the study. All patients were followed up. With each follow up, clinical and radiological examinations were performed at 6 weeks, 3months and 6months. RESULTS: The study included 25 patients, 18 male and 7 female aged from 22 to 85 years with mean age of 42.3 years. The average time for fracture union in our series was 17.6 weeks.Our study had 20 (80%) patients without any complications and 5 (20%) patients had complications like superficial wound infection,deep wound infection,non union and ankle stiffness. Our study yielded excellent to good results in 80% of the cases. CONCLUSION: Tibial pilon fractures are best managed operatively. Optimal functional outcome is achieved by accurate anatomical reduction and secure fixation followed by early mobilisation. XII MIPPO facilitates in early mobilization of the patient which helps in healing of the fracture and prevents joint stiffness. It promotes early union as it does not disturb anatomy and physiology of vascularity at the fracture site. MIPPO with a LCP is an excellent treatment option for tibial pilon fractures in terms of radiological and clinical union.