Distal Tibial Fractures Treated with Locking Plates Using the MIPPO Technique: A Prospective Functional Outcome Study

Abstract

Background: Distal tibial fractures represent a formidable challenge in orthopedic surgery owing to the subcutaneous location of the bone, poor vascularity, and inadequate soft tissue envelope. Minimally invasive percutaneous plate osteosynthesis (MIPPO) using locking compression plates (LCP) has emerged as a biologically sound and mechanically reliable fixation strategy. This prospective study evaluates the clinical, radiological, and functional outcomes of 100 consecutive patients with distal tibial fractures treated with locking plates using the MIPPO technique.

Methods: One hundred adult patients with distal tibial fractures (AO/OTA types 43-A and 43-B) were prospectively enrolled and treated with anatomical distal tibial locking compression plates via the MIPPO technique. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Radiological union, complications, and operative parameters were systematically recorded.

Results: The mean patient age was 42.6 years, with a male predominance of 72%. Road traffic accidents were the most common mechanism of injury (68%). The mean operative time was 78.4 minutes and the mean hospital stay was 7.4 days. The mean time to radiological union was 18.6 weeks. The mean AOFAS score at 12 months was 87.4. Excellent or good outcomes were achieved in 88% of patients. Complications included superficial wound infection in 6 patients (6%), delayed union in 8 patients (8%), ankle stiffness in 5 patients (5%), and malunion in 3 patients (3%). No deep infections, implant failures, or non-unions were recorded.

Conclusion: MIPPO with locking compression plates is a safe, effective, and biologically advantageous technique for the management of distal tibial fractures, offering reliable union, early mobilization, and excellent functional outcomes with an acceptable complication profile.