Functional and radiological outcomes of medial minimally invasive percutaneous plate osteosynthesis in distal tibial pilon fractures: a prospective study

Abstract

Background: Distal tibial fractures represent 5-10% of all tibia fractures, with challenges arising from soft tissue damage and complications like nonunion and infection. Minimally invasive percutaneous plate osteosynthesis (MIPPO) is a biological plating technique for treatment these fractures, aiming to reduce complications by preserving periosteal blood supply and minimizing tissue disruption. This study evaluates the radiological and clinical outcomes of distal tibial fractures treated using biological plating with the radiographic union scale for tibia (RUST) and the American Orthopaedic Foot and Ankle Society (AOFAS) score system. Methods: This prospective study conducted for 18 months involving 22 patients with distal tibial fractures, treated with MIPPO using distal tibial locking compression plates followed up. The inclusion criteria were patients aged above 18 years with fractures of AO classification types 43C, 43B, and 43A. Patients were followed up at 1, 2, 3 and 6 months postoperatively, with radiological assessments based on RUST score for fracture union and functional outcomes using the AOFAS score. Statistical package for the social sciences (SPSS) used for data analysis. Results: The study included patients age averaging 48.4 years and consisted of 72.7% males. The primary cause of injury was road traffic accidents (54.5%). Fracture union was achieved in an average of 15 weeks using RUST score. AOFAS outcomes showed 54.5% of patients with excellent, 31.8% with good, and 13.6% with fair results. Complications such as infection and malalignment were observed in 27.3% of patients. Conclusions: Biological plating using MIPPO technique offers reliable clinical and radiological outcomes for distal tibial fractures, with high union rates and favorable AOFAS scores. Despite few complications, Biological plating remains an effective method for the treatment of distal tibial fractures, particularly in cases requiring soft tissue preservation. Further research into long-term complications and functional outcomes is recommended.