Management of distal tibial fractures with minimally invasive plate osteosynthesis (MIPPO) technique. A retrospective series

The fractures of the distal tibia represent 7-10% of all tibial fractures and they usually are the result of high energy injuries as such as traffic accidents or fall from a height; in these cases the axial compression causes complex articular fractures characterized by metaphysis break and bone loss. Better prognosis are given in case of low energy traumas.The study evaluates the results of the surgical treatment of distal tibia fractures, using minimally invasive plateosteosynthesis (MIPPO) technique. We treated in our unit 30 patients with distal tibia fractures with the MIPPO technique.The fractures, intra-articular or extra-articular, were classified according to the AO classification. The cases studied did not involve open fractures or cutaneous lesions and we excluded the C3 and B2,B3 fractures, for which traditional osteosynthesis is preferable. We had one case of superficial wound infection in a diabetic patient with the dehiscence of the surgical wound than solved with the correct consolidation of the fractures; a malunion with more than 5 degrees of varus, one case of asymptomatic breaking of the distal screws. On the whole the outcomes were positive, thanks to a correct clinical indication. In conclusion we think that two are the elements that direct the choice regarding the type of approach and the type of device for the synthesis. The first is the condition of the skin, as far as its integrity is concerned, and the second is the articular condition, as far as the comminution and the number of fragments are concerned. Therefore we need to choose a synthesis that can guarantee a good outcome and can avoid dreadful complications and MIPPO is a valid technique when used correctly and by experts.