Primary plate osteosynthesis in compound fractures of proximal and distal tibia by locked anatomical plate using minimally invasive technique: Our experience of 94 cases

Introduction: Juxta-articular or intra-articular compound proximal tibia fractures presents a great therapeutic challenge to an orthopaedic surgeon. The treatment of this kind of fractures is often complicated either by the patient's compromised general conditions, or by soft tissue damage. The development of biological techniques in plate fixation and the design of implants which cause the least possible interference with the periosteal blood supply have enhanced the use of plates and screws for stabilisation of open proximal tibia fractures. The primary aim of this study is to assess the role of biological plate fixation in compound proximal and distal tibia fractures. Material and Method: We selected 94 patients of compound proximal and distal tibia fractures including Gustilo and Anderson type 1,2 and 3A. Our protocol included debridement, irrigation, and splint casting in emergency room with definitive stabilization with the biological plate through minimally invasive surgical techniques if the soft tissue injury and wound allowed. Patients were followed up for at least two years. Outcome were measured using knee society clinical rating score for proximal tibia fracture cases and Modified American Orthopaedic Foot and Ankle Society score (AOFAS) for distal tibia fracture cases. Results: Further, final outcome of these patients was assessed after 2 years of follow-up using Knee society score. Excellent results were seen in 35(73%) cases and good result in 10 (20.8%) cases. Three cases show fair to poor score and all these cases were from compound Grade III group. one case required early plate removal and external fixation and showed poor result. Functional outcome of distal tibia fracture cases was assessed with the modified AOFAS ankle-hind foot score at final follow-up. Out of the 40 cases, 20(50%) shown excellent result. Out of the 40 cases, 14 (35%) shown good result. Overall good to excellent result was seen in 34 (85%) cases. Two cases showed fair result and poor result was seen in 4 (10%) cases. Discussion: The biological plate presents another good option in the treatment of open fractures in open proximal and distal tibial fractures. The combination of minimal soft tissue dissection, small surgical approaches, and plates that do not compress the bone, yield an implant that would be expected to yield a lower rate of infection than other alternative methods in treatment of open proximal tibial fracture.