PROSPECTIVE STUDY OF BIPLANAR FIXATION FOR TYPE V AND TYPE VI CONDYLAR FRACTURES OF TIBIA BY MIPPO TECHNIQUE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 37
Abstract
BACKGROUND Treating complex Tibial Plateau Fractures has often proved to be a nightmare for the operating surgeon. Treatment has evolved from non-operative treatment previously to relatively rigid internal fixation at present. The primary aim of treatment is to achieve early bony union and to allow early mobilisation of the knee joint, thereby minimising the risks of joint stiffness. Recent interests in the fixation of the fracture have been to provide biological fixation by optimising fracture environment in order to improve fracture healing and to minimise complications. This led to evolution of Indirect Reduction and Minimally Invasive Plate Osteosynthesis (MIPO), illustrating the importance of preservation of bone biology. Locking plate principle has galvanised internal fixation of these fractures with a minimal invasive approach (MIPPO). MATERIALS AND METHODS This is a case series study carried out in KAP Viswanatham Government Medical College/MGM Hospital, Trichy between 2011 and 2014; 40 patients with type V and VI bicondylar fractures of the Tibia satisfying the following criteria were included in our study. X-rays and 3D CT were taken to analyse the fracture morphology. We used proximal tibia locking plate using 4.5/6.5 system on lateral side and 3.5 system on medial side by medial and lateral and distal midline MIPPO (3 cm) incisions (Locking plates were inserted subperiostially). Functional outcome was assessed by HSS (Hospital for Special Surgery) score. RESULTS 36 cases went for good bony union. Three cases went for non-union, of which one subsequently united with bone grafting, one case which was fixed a week after injury ended up with loss of reduction for which re-fixation was performed and still went for nonunion and one case in which bone grafting was done still went for non-union had to be fixed with Ilizarov fixator. One case got infected and implant was removed and external fixation applied. No implant failure was seen in our series. Most patients could start partial weight bearing within 8 - 12 weeks of plating. Average hospital stay of the patients in our studies was 5 - 10 days. The average range of motion in affected knee in most patients was 110 degrees to 130 degrees 2 years after surgery. CONCLUSION From our study, we conclude that MIPPO technique preserves vascularity of the fractured bones and significantly preserves the fracture haematoma (which is proved in many studies is very important for early union), thus aiding biological repair as suggested by BO rules. MIPPO also allows for early mobilisation of the knee, which in turn allows for restoration of good range of motion. It has to be kept in mind that MIPPO signifies “as minimal surgical trauma to the soft tissues as possible and does not effectively mean operating through small incisions.”
Authors and Affiliations
Anbu Srinivasan, Karunanithi Subramanian, Palaniappan Mathivanan
Keywords
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- EP ID EP210987
- DOI 10.14260/Jemds/2017/652
- Views 95
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