A Comparative Study between Minimally Invasive Plate Osteosynthesis versus Open Reduction and Internal Fixation for Distal Third Tibia Fractures
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Abstract
Background: Despite the array of surgical and non-surgical approaches available for treating distal tibia fractures, managing unstable fractures continues to pose a challenge. This study compares the advantages and clinical outcomes of minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) in managing distal third tibia fractures.
Methods: Our study focused on 60 cases selected based on age and fracture type. A comparative analysis was performed between two groups, examining factors such as age, gender, AO Foundation and Orthopedic Trauma Association (AO/OTA) fracture type, length of hospital stays, surgical duration, complication rates, time to return to daily routines, and adherence to the criteria set by the American Orthopedic Foot and Ankle Society (AOFAS).
Results: The blood loss during surgery was significantly more in the ORIF group (142 ± 56.83 ml versus 81.83 ± 37.63 ml) (P < 0.05). The rate of complications was significantly higher in the ORIF group compared to the MIPO group (P < 0.05). Time for back to routines was significantly shorter in the MIPO group (17.63 ± 7.86 weeks versus 22.36 ± 8.81 weeks) (P < 0.05). No significant differences were found in surgery duration, hospitalization time,, time of hospitalization, and AOFAS score between the MIPO and ORIF groups.
Conclusion: The optimal method for managing distal tibia fractures remains uncertain due to discrepancies between the outcomes of MIPO and ORIF. We favor MIPO due to its potential for early bone union, quicker return to normal activities, and reduced risk of wound complications.
1. Sreen S, Sahni G, Kumar S, Kumar Jain AK, Behl T. Comparative study of functional outcome of minimally invasive plate Osteosynthesis versus open reduction and internal fixation with locking compression plate in distal 1/3rd shaft tibia fractures (Extraarticular). Int J Orthop Sci. 2019;5(4):149-52. doi: 10.22271/ortho.2019.v5.i4c.1664.
2. Wang B, Zhao Y, Wang Q, Hu B, Sun L, Ren C, et al. Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: A systematic review and meta-analysis. J Orthop Surg Res. 2019;14(1):456. doi: 10.1186/s13018-019-1479-0. [PubMed: 31864398]. [PubMed Central: PMC6925456].
3. Vicenti G, Bizzoca D, Nappi VS, Carrozzo M, Delmedico M, Solarino G, et al. The impact of lag screw in the healing time of distal tibia fractures treated with minimally invasive plate osteosynthesis: A randomized clinical trial. Injury. 2020;51(Suppl 3):S80-S85. doi: 10.1016/j.injury.2020.02.042. [PubMed: 32070556].
4. Gupta P, Tiwari A, Thora A, Gandhi JK, Jog VP. Minimally Invasive Plate Osteosynthesis (MIPO) for proximal and distal fractures of the tibia: A biological approach. Malays Orthop J. 2016;10(1):29-37. doi: 10.5704/MOJ.1603.006. [PubMed: 28435544]. [PubMed Central: PMC5333700].
5. Subash Y, Prabhu Manickam S, Ravikrishna R, Priyadarshini S, Naidu GK. An evaluation of functional outcome following minimally invasive plate osteosynthesis in fractures of the distal tibia. Int J Res Orthop. 2017;3(6):1136-40. doi: 10.18203/issn.2455-4510.IntJResOrthop20174696.
6. Dutta A, Sipani AK, Khan I. Radiological and clinical outcome of minimally invasive percutaneous plate osteosynthesis for diaphyseal fractures of humerus. Int J Orthop Sci. 2020;6(2):208-211. doi: 10.22271/ortho.2020.v6.i2d.2039.
7. Lai TC, Fleming JJ. Minimally Invasive Plate Osteosynthesis for Distal Tibia Fractures. Clin Podiatr Med Surg. 2018;35(2):223-32. doi: 10.1016/j.cpm.2017.12.005. [PubMed: 29482791].
8. Fang JH, Wu YS, Guo XS, Sun LJ. Comparison of 3 minimally invasive methods for distal tibia fractures. Orthopedics. 2016;39(4):e627-e633. doi: 10.3928/01477447-20160606-01. [PubMed: 27286045].
9. Sreejith Thampy J, Nagakumar JS, Manohar PV, Reddy PK. Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) in distal tibia fractures-retrospective functional and radiological outcome analysis among rural population. Int J Orthop Sci. 2018;4(2):596-600. doi: 10.22271/ortho.2018.v4.i2i.89.
10. Onta PR, Ranjeet N, Wahegaonkar K, Sapkota K, Thapa P, Thapa UJ. Study of unstable fracture of Distal Tibia and its outcome managed with Minimally Invasive Plate Osteosynthesis (MIPO). Asian Journal of Medical Sciences. 2018;9(5):73-6. doi: 10.3126/ajms.v9i5.20330Width1.
11. Hofmann V, Diepold J, Moursy M, Birke MT, Deininger C, Wichlas F. Minimally invasive plate osteosynthesis (MIPO) for distal humeral fractures: a cadaveric study and first clinical application. BMC Musculoskelet Disord. 2023;24(1):206. doi: 10.1186/s12891-023-06189-0. [PubMed: 36934262]. [PubMed Central: PMC10024368].
12. Bade D, More D, Parmar D. Functional outcome following anatomical locking compression plate by open technique and Minimal Invasive Percutaneous Osteosynthesis (MIPO) technique in mid shaft clavicle fracture. International Journal of Medical and Biomedical Studies. 2019;3(10):86-90. doi: 10.32553/ijmbs.v3i10.612.
13. Marazzi C, Wittauer M, Hirschmann MT, Testa EA. Minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in the treatment of distal fibula Danis-Weber types B and C fractures. J Orthop Surg Res. 2020;15(1):491. doi: 10.1186/s13018-020-02018-5. [PubMed: 33092616]. [PubMed Central: PMC7583231],
14. Zehir S, Sahin E, Songur M, Altunkilic T, OZdemir G. Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) vs. open plating in superior plating of midshaft clavicle fractures. Acta Orthop Belg. 2018;84(4):491-6. [PubMed: 30879455].
15. Jabshetty A, Kazmi SSH. Functional outcome following fixation of distal tibial fracture (Extra articular) with locking compression plate (LCP) using the minimally invasive percutaneous osteosynthesis (MIPO) technique. Int J Orthop Sci. 2020;6(1):687-691. doi: 10.22271/ortho.2020.v6.i1l.1945.
16. Redfern DJ, Syed SU, Davies SJ. Fractures of the distal tibia: Minimally invasive plate osteosynthesis. Injury. 2004;35(6):615- 20. doi: 10.1016/j.injury.2003.09.005. [PubMed: 15135282].
17. Lefaivre KA, Guy P, Chan H, Blachut PA. Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma. 2008;22(8):525-9. doi: 10.1097/BOT.0b013e318180e646. [PubMed: 18758282].
18. Gulabi D, Bekler HI, Saglam F, Tasdemir Z, Cecen GS, Elmali N. Surgical treatment of distal tibia fractures: Open versus MIPO. Ulus Travma Acil Cerrahi Derg. 2016;22(1):52-7. doi: 10.5505/tjtes.2015.82026. [PubMed: 27135079].
19. Cheng W, Li Y, Manyi W. Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation. Int Orthop. 2011;35(5):737-42. doi: 10.1007/s00264-010-1052-2. [PubMed: 20517695]. [PubMed Central: PMC3080491].
20. Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia-- results in 20 patients. Injury. 2006;37(9):877-87. doi: 10.1016/j.injury.2006.06.002. [PubMed: 16895727].
21. Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: A retrospective study of 32 patients. Injury. 2007;38(3):365-70. doi: 10.1016/j.injury.2006.10.024. [PubMed: 17241634].
22. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92(7):984-8. doi: 10.1302/0301-620X.92B7.22959. [PubMed: 20595119].
23. LiY,LiuL,TangX,PeiF,WangG,FangY,etal.Comparisonof low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures. Int Orthop. 2012;36(7):1457-62. doi: 10.1007/s00264-012-1494-9. [PubMed: 22310971]. [PubMed Central: PMC3385886].
24. Ozsoy MH, Tuccar E, Demiryurek D, Bayramoglu A, Hayran M, Cavusoglu AT, et al. Minimally invasive plating of the distal tibia: Do we really sacrifice saphenous vein and nerve? A cadaver study. J Orthop Trauma. 2009;23(2):132-8. doi: 10.1097/BOT.0b013e3181969993. [PubMed: 19169106].
25. CollingeC,KuperM,LarsonK,ProtzmanR.Minimallyinvasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma. 2007;21(6):355-61. doi: 10.1097/BOT.0b013e3180ca83c7. [PubMed: 17620992].
2. Wang B, Zhao Y, Wang Q, Hu B, Sun L, Ren C, et al. Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: A systematic review and meta-analysis. J Orthop Surg Res. 2019;14(1):456. doi: 10.1186/s13018-019-1479-0. [PubMed: 31864398]. [PubMed Central: PMC6925456].
3. Vicenti G, Bizzoca D, Nappi VS, Carrozzo M, Delmedico M, Solarino G, et al. The impact of lag screw in the healing time of distal tibia fractures treated with minimally invasive plate osteosynthesis: A randomized clinical trial. Injury. 2020;51(Suppl 3):S80-S85. doi: 10.1016/j.injury.2020.02.042. [PubMed: 32070556].
4. Gupta P, Tiwari A, Thora A, Gandhi JK, Jog VP. Minimally Invasive Plate Osteosynthesis (MIPO) for proximal and distal fractures of the tibia: A biological approach. Malays Orthop J. 2016;10(1):29-37. doi: 10.5704/MOJ.1603.006. [PubMed: 28435544]. [PubMed Central: PMC5333700].
5. Subash Y, Prabhu Manickam S, Ravikrishna R, Priyadarshini S, Naidu GK. An evaluation of functional outcome following minimally invasive plate osteosynthesis in fractures of the distal tibia. Int J Res Orthop. 2017;3(6):1136-40. doi: 10.18203/issn.2455-4510.IntJResOrthop20174696.
6. Dutta A, Sipani AK, Khan I. Radiological and clinical outcome of minimally invasive percutaneous plate osteosynthesis for diaphyseal fractures of humerus. Int J Orthop Sci. 2020;6(2):208-211. doi: 10.22271/ortho.2020.v6.i2d.2039.
7. Lai TC, Fleming JJ. Minimally Invasive Plate Osteosynthesis for Distal Tibia Fractures. Clin Podiatr Med Surg. 2018;35(2):223-32. doi: 10.1016/j.cpm.2017.12.005. [PubMed: 29482791].
8. Fang JH, Wu YS, Guo XS, Sun LJ. Comparison of 3 minimally invasive methods for distal tibia fractures. Orthopedics. 2016;39(4):e627-e633. doi: 10.3928/01477447-20160606-01. [PubMed: 27286045].
9. Sreejith Thampy J, Nagakumar JS, Manohar PV, Reddy PK. Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) in distal tibia fractures-retrospective functional and radiological outcome analysis among rural population. Int J Orthop Sci. 2018;4(2):596-600. doi: 10.22271/ortho.2018.v4.i2i.89.
10. Onta PR, Ranjeet N, Wahegaonkar K, Sapkota K, Thapa P, Thapa UJ. Study of unstable fracture of Distal Tibia and its outcome managed with Minimally Invasive Plate Osteosynthesis (MIPO). Asian Journal of Medical Sciences. 2018;9(5):73-6. doi: 10.3126/ajms.v9i5.20330Width1.
11. Hofmann V, Diepold J, Moursy M, Birke MT, Deininger C, Wichlas F. Minimally invasive plate osteosynthesis (MIPO) for distal humeral fractures: a cadaveric study and first clinical application. BMC Musculoskelet Disord. 2023;24(1):206. doi: 10.1186/s12891-023-06189-0. [PubMed: 36934262]. [PubMed Central: PMC10024368].
12. Bade D, More D, Parmar D. Functional outcome following anatomical locking compression plate by open technique and Minimal Invasive Percutaneous Osteosynthesis (MIPO) technique in mid shaft clavicle fracture. International Journal of Medical and Biomedical Studies. 2019;3(10):86-90. doi: 10.32553/ijmbs.v3i10.612.
13. Marazzi C, Wittauer M, Hirschmann MT, Testa EA. Minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in the treatment of distal fibula Danis-Weber types B and C fractures. J Orthop Surg Res. 2020;15(1):491. doi: 10.1186/s13018-020-02018-5. [PubMed: 33092616]. [PubMed Central: PMC7583231],
14. Zehir S, Sahin E, Songur M, Altunkilic T, OZdemir G. Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) vs. open plating in superior plating of midshaft clavicle fractures. Acta Orthop Belg. 2018;84(4):491-6. [PubMed: 30879455].
15. Jabshetty A, Kazmi SSH. Functional outcome following fixation of distal tibial fracture (Extra articular) with locking compression plate (LCP) using the minimally invasive percutaneous osteosynthesis (MIPO) technique. Int J Orthop Sci. 2020;6(1):687-691. doi: 10.22271/ortho.2020.v6.i1l.1945.
16. Redfern DJ, Syed SU, Davies SJ. Fractures of the distal tibia: Minimally invasive plate osteosynthesis. Injury. 2004;35(6):615- 20. doi: 10.1016/j.injury.2003.09.005. [PubMed: 15135282].
17. Lefaivre KA, Guy P, Chan H, Blachut PA. Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma. 2008;22(8):525-9. doi: 10.1097/BOT.0b013e318180e646. [PubMed: 18758282].
18. Gulabi D, Bekler HI, Saglam F, Tasdemir Z, Cecen GS, Elmali N. Surgical treatment of distal tibia fractures: Open versus MIPO. Ulus Travma Acil Cerrahi Derg. 2016;22(1):52-7. doi: 10.5505/tjtes.2015.82026. [PubMed: 27135079].
19. Cheng W, Li Y, Manyi W. Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation. Int Orthop. 2011;35(5):737-42. doi: 10.1007/s00264-010-1052-2. [PubMed: 20517695]. [PubMed Central: PMC3080491].
20. Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia-- results in 20 patients. Injury. 2006;37(9):877-87. doi: 10.1016/j.injury.2006.06.002. [PubMed: 16895727].
21. Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: A retrospective study of 32 patients. Injury. 2007;38(3):365-70. doi: 10.1016/j.injury.2006.10.024. [PubMed: 17241634].
22. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92(7):984-8. doi: 10.1302/0301-620X.92B7.22959. [PubMed: 20595119].
23. LiY,LiuL,TangX,PeiF,WangG,FangY,etal.Comparisonof low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures. Int Orthop. 2012;36(7):1457-62. doi: 10.1007/s00264-012-1494-9. [PubMed: 22310971]. [PubMed Central: PMC3385886].
24. Ozsoy MH, Tuccar E, Demiryurek D, Bayramoglu A, Hayran M, Cavusoglu AT, et al. Minimally invasive plating of the distal tibia: Do we really sacrifice saphenous vein and nerve? A cadaver study. J Orthop Trauma. 2009;23(2):132-8. doi: 10.1097/BOT.0b013e3181969993. [PubMed: 19169106].
25. CollingeC,KuperM,LarsonK,ProtzmanR.Minimallyinvasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma. 2007;21(6):355-61. doi: 10.1097/BOT.0b013e3180ca83c7. [PubMed: 17620992].
| Files | ||
| Issue | Vol 11 No 1 (2025) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v11i1.18007 | |
| Keywords | ||
| Tibia Fractures Minimally Invasive Surgical Procedures | ||
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How to Cite
1.
Zandi R, Talebi S, Mehrvar A, Sheibani S, Ehsani A, Nodehi S. A Comparative Study between Minimally Invasive Plate Osteosynthesis versus Open Reduction and Internal Fixation for Distal Third Tibia Fractures. J Orthop Spine Trauma. 2025;11(1):15-19.
