Simple articular extension did not affect the excellent results of MIPO in treating distal tibia fractures after 5 years

Minimally invasive plate osteosynthesis (MIPO) becomes popular for treating distal tibia fractures. Intra-articular extension was accused for result deterioration and was considered as an indication for open reduction and internal fixation (ORIF). Our hypothesis was that the simple intra-articular extension can be successfully treated percutaneously, MIPO can be successfully applied, and ORIF is not mandatory. We wanted to determine whether the presence of simple articular extension would change the reported excellent results of MIPO after 5 years follow-up.

As extensive articular affection has different treatment strategies, the inclusion criteria for this prospective clinical series included distal tibia fractures with only simple intra-articular extension (AO/OTA 43-B1, B2, C1, and C2). From 43 patients we treated with MIPO using the AO medial distal tibia anatomical locked plate, 13 patients were excluded as they did not complete the follow-up, and only 30 patients were reported. Only seven fractures were open. The minimum follow-up period was 5 years. The outcome measurements included fracture healing, alignment, nonunion, infection, ankle range of motion (ROM), implant removal, ankle osteoarthritis (OA), unemployment, failure to return to daily activities or sports, and functional assessment as per the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale.

All the fractures united, but with delay in two patients. No articular step-off more than 2 mm could be detected in any patient. At the metaphysis, three patients (10 %) had angular deformities less than 5°, uni-planar in two patients and bi-planar in one patient. Three patients (10 %) developed a superficial infection. These three patients had their implants removed and had reduced ankle ROM. Twenty-eight patients (93.33) returned to their original job. Twenty-four patients (80 %) had returned to their pre-injury daily activity and sports. At the end of follow-up, no patient developed ankle osteoarthritis or had deterioration of his earlier satisfactory clinical and functional results. The mean AOFAS score was 90.8 ± 6 at the end of follow-up.

After 5 years follow-up, MIPO was an excellent option for the challenging distal tibia fractures even with simple articular extension. With absence of OA, high percentage of the patients could keep excellent functional results, job, and activity.