Surgical treatment of distal tibia fractures: Open versus MIPO?

Introduction
Treatment of the distal tibial fractures are challenging due to the limited soft tissue, the

subcutaneous location and poor vascularity. In this control-matched study, we aim to compare

the traditional open reduction and internal fixation with minimal invasive plating(MIPO). We

hypothesized that superior results may be achieved with MIPO technique.

Materials and Methods
22 patients treated with traditional open reduction and internal fixation were matched

with 22 patients treated with closed reduction and MIPO on the basis of age (±3), gender, and

fracture pattern (AO classification). Evaluation was assed according to the wound problems,

the American Orthopaedic Foot and Ankle surgery (AOFAS) scoring [14], radiological

union, malunion, delayed union, hospitalisation time, time from injury to surgery, and

operation time.

Results

There was no significant difference in the distribution of AO/OTA classification, age,

gender, AOFAS score, time from injury to operation, follow-up, bone union time, delayed

union, malunion and infection (p>0.05). The operation time was significantly longer in the

open group than in the MIPO group. 69.59±7.21 min. for the ORIF, and 61.14±5.61 for the

MIPO group (p< 0.01).The hospitalisation time was significantly longer in the open group

than in the MIPO group. 7.64±4.71 days for the MIPO, and 10.18±4.32 days for the ORIF

group (p< 0.05).

Conclusions

In conclusion, MIPO technique can be beneficial for the treatment of distal tibia AO/OTA

A and B type fractures with reduced hospital stay, cost-effectiveness, infection rate.

Key words: MIPO, Distal tibia, malunion, fracture.

Distal Tibia Kýrýklarýnda Cerrahi Tedavi: Açýk veya MIPO?

Distal tibia kýrýklarýnýn cerrahi tedavisi: Acik veya MIPO?

GÝRÝÞ
Yetersiz cilt örtusu, hemen cilt altinda olmasý ve zayýf kan dolaþýmý nedeniyle distal tibia kýrýklarýn cerrahi tedavisi tartýþmalýdýr. Bu vaka-kontrol çalýþmasinda geleneksel yerine oturtma, içerden tespit ile minimal invazif(MIPO) plaklama yöntemini karþýlaþtýrmayý amaçladýk.Hipotezimiz ise MIPO yöntemiyle daha iyi sonuçlarýn elde edilebileceðiydi.
MATERYAL VE METOD,
Yaþ(+3), cinsiyet ve kýrýk paterni(AO sýnýflamas) esas alýnarak; geleneksel yerine oturtma ve içerden tespit uygulanan 22 hasta, MIPO kullanýlarak tedavi edilen 22 hasta ile kýyaslanmýþtýr. Yara sorunlarý, Amerkan ayak ve ayak bileði cerrahi skorlamasý(AOFAS), radyolojik kaynama, kötü kaynama, gecikmiþ kaynama, hastanedeyatissuresi, travmadanameliyatakadarbeklemesuresi ve operasyon süresi deðerlendirme kriterleri olarak kullanilmistir.
SONUCLAR
Gruplar arasýnda AO/OTA kýrýk tipi, yaþ, cinsiyet, AOFAS skoru, travmadan ameliyata kadar geçen süre,takip süresi, kaynama süresi, gecikmiþ kaynama, kötö kaynama ve enfeksiyon açýsýndan istatiksel olarak anlamlý fark saptanmamýþtýr. Operasyon süresi açýk grupta MIPO grubuna kýyasla anlamlý þekilde uzun olduðu gözlendi.Hastanede yatýþ süresi açýk cerrahi grubunda MIPO grubuna göre anlamlý þekilde uzun olduðu gözlendi.
ÇIKARIMLAR
Sonuç olarak, MIPO;kýsalmýþ hastane kalýþ süresi, azalmýþ enfeksiyon oraný ve düþük maliyet nedeniyle distal tibia AO/OTA A ve B tip kýrýklarda; daha baþarýlý olduðunu söyleyebiliriz.