SLR - August 2011 - R Abram Swensen
Reference: Hess, Florian, Sommer, Christoph (2011). Minimally Invasive Plate Osteosynthesis of the Distal Fibula With the Locking Compression Plate. Journal of Orthopedic Trauma, 25:110-115.
Scientific Literature Review
Reviewed By: R Abram Swensen, DPM
Residency Program: OCPM and University Hospital Richmond Heights MC
Podiatric Relevance:
The aim of this study was to evaluate the clinical feasibility and the possible complications associated with minimally invasive plate osteosyntheses (MIPO) of the distal fibula, particularly as it compares with the other standard fixation techniques for the treatment of complex fractures of the distal fibula.
Methods:
Patients with Orthopedic Trauma Association (OTA) 42,43,44 fractures of the distal tibia requiring plate fixation of the distal fibula were included in this cohort study. Over a 5 year investigational period, 701 patients were admitted requiring internal fixation of these fractures. Of these, 255 required plate fixation of the fibula, but only 20 fulfilled the inclusion criteria for MIPO technique. Of these 20 patients, 10 were male and 10 female with an age range of 18 to 84 years with a mean of 53.7 +/- 28.2 years. Most injuries were caused from falls from a height, sports, and traffic accidents. The mechanism of injury, fracture type, and soft tissue injury were consistent with the OTA 42,43,44 fracture patterns. Fractures were treated with the MIPO technique using angular stable screw-plate system for the fibula. Clinical and radiological outcomes were recorded at 24 months.
Results:
All 20 patients were followed according to protocol with no loss to follow-up. Of the 20 patients, 17 fractures healed without complication at an average of 9 weeks. 3 aseptic non-unions were observed: two with severe closed soft tissue crush injuries and one in an ankle fracture dislocation (OTA 44-C1) with delayed treatment and inadequate reduction of the simple fibula fracture.
Conclusions:
This study concludes that the MIPO technique for the distal fibula can minimize the risk of soft tissue complication in injuries that have a moderate to severe soft tissue injury.