Treatment of distal tibial comminuted fractures with minimally invasive percutaneous plate osteosynthesis

Objective: To explore the outcomes of the treatment of distal tibial comminuted fractures with minimally invasive percutaneous plate osteosynthesis. Methods: Forty two patients suffered from distal tibial comminuted fractures between March 2010 and July 2012were treated by minimally invasive percutaneous plate osteosynthesis protocol. According to AO classification,there were 21 cases type A,12 type B,9 type C. A few cases had been combined with the treatment of proper external fixation at the same time. They would be permit active and passive motion of ankle joint without weight- bearing after 1 ～ 2 weeks postoperative when local swelling up of the ankle and the lower limb had been faded away. The outcomes of both the treatment and the function of the ankle joint involved were graded into the excellent,the good,the fair and the poor according to Johner- Wruhs scoring system. Results: The incision of all the cases had achieved healing. Out of the 42 cases,the recovering of wound delayed in 3 cases,and 2 cases were diabetic patients. All the patients had been followed up from 8 months to 3. 2 years( averaged 1. 6 years). The mean time of bone union was 3. 4 months. The radiographic healing was 14 weeks. Fracture reduction was anatomical or nearly anatomical without angular displacement in all cases. No infection,delayed union,nonunion or malunion had happened to in this series. No patient complained of knee and ankle symptoms related to the surgery. According to Johner- Wruhs scoring system,of the 42 cases,there were 21 cases belonging to the excellent,15 the good,4 the fair and 2the poor. The rate of the excellent and the good was 85. 71%( 36 /42). Conclusion: minimally invasive percutaneous plate osteosynthesis protocol should be a safe and effective technique in the treatment of distal tibial comminuted fractures.