Clinical and radiographic outcomes after minimally invasive locking plating of distal tibia fractures

Objective: Assess the bone union rate, deformity, leg-length discrepancy, return to pre-injury daily and sports activities and infection rate in a selected group of 21 patients who underwent minimally invasive osteosynthesis of close distal tibia fractures with Locking plate (LP). Material and methods: We prospectively included patients with closed distal tibia and fibula fractures, without any previous or present ipsilateral leg fracture. There were 9 women and 12 men, ranging in age from 25 to 66 yrs. Fractures were classified according to AO classification. There were 12 type A, 5 B, and 4 C fractures. Clinical, functional, and radiographic evaluations were scheduled at 6, 12, 24 weeks, 1 year, and then annually. Results were classified in accordance to criteria developed by the Association for the Study and Application of the Method of Ilizarov (ASAMI). The results were divided into bone and functional results. For bone results four criteria were evaluated: union time, infection, deformity (< 7°), and leg-length discrepancy (< 2.5 cm) at standard long-leg radiographs. The functional results were based on five criteria: limp, equinus rigidity of the ankle, soft-tissue dystrophy, pain, and inactivity (unemployment because of the leg injury or inability to return to daily activities because of the leg injury). Results: The average follow-up was 2.8 years (range, 2 to 4). Two patients were lost to follow-up. Union was achieved in all but one patient. Four patients had angular deformity < 7°. No patient had a leg-length discrepancy ≥ 1.1 cm. Five patients had range of motion of ankle ≤ 20° compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. According to the ASAMI criteria, there were 15 excellent, 3 good and 1 poor “bone results” and 11 excellent, 3 good and 5 fair “functional results”. Conclusions: The high percentage of unions and the low rate of complications show that LP is a suitable device for treatment of distal tibia fractures. The level of physical activities appears permanently reduced in most of patients. The cost of the LP, the technically demanding procedure, and the increased exposure to radiation to perform the procedure should be considered when comparing the efficacy of this device to the normal plates. Only future prospective randomized studies may be able to clarify these issues.