Comparison of Open Reduction and Internal Fixation With Minimally Invasive Plating in the Treatment of Distal Tibial Fractures: A Retrospective Study

Mehmet Akdemir; Ahmet Cemil Turan; Mehmet Aykut Türken; Çağdaş Biçen; Ali Ihsan Kilic

doi:10.7759/cureus.23144

Comparison of Open Reduction and Internal Fixation With Minimally Invasive Plating in the Treatment of Distal Tibial Fractures: A Retrospective Study

Cureus. 2022 Mar 14;14(3):e23144. doi: 10.7759/cureus.23144. eCollection 2022 Mar.

Authors

Mehmet Akdemir¹, Ahmet Cemil Turan², Mehmet Aykut Türken³, Çağdaş Biçen⁴, Ali Ihsan Kilic⁵

Affiliations

¹ Orthopedics, Izmir Ekol Hospital, Izmir, TUR.
² Orthopedics and Traumatology, Private Clinic, Izmir, TUR.
³ Orthopedics and Traumatology, Izmir University of Economics Medicalpark Hospital, Izmir, TUR.
⁴ Orthopedics and Traumatology, Izmir University of Economics Medical Park Hospital, Izmir, TUR.
⁵ Orthopedics and Traumatology, Dokuz Eylul University, Izmir, TUR.

Abstract

Introduction Treatment of distal tibial fractures may be problematic due to their close proximity to the ankle joint and poor skin coverage, resulting in skin problems, deep infection, and malunion. To address these problems, minimally invasive plating methods have been described. In this study, we aimed to compare the clinical findings, radiological findings, and complication rates of patients treated with open reduction or minimally invasive plating. Methods A total of 44 patients with distal tibial fractures with a mean follow-up period of 20.73 (12-50) months were included in this study retrospectively. The patients were divided into two groups, those who underwent open reduction and internal fixation and those treated with minimally invasive plates. The two groups were statistically compared in terms of radiological and clinical scores and complication rates (p=0.05). Comparative analysis was also performed for three fracture types in both groups. Results Twenty patients were treated with a minimally invasive approach and 24 patients were treated with the open reduction method. Age, gender, fracture type, and follow-up times were similar between the two groups (p>0.05). There was no statistically significant difference between postop American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), anterior distal tibial angle (ADTA), or lateral distal tibial angle (LDTA) values between both groups. There was also no difference in union times or nonunion rates (p>0.05). There was no statistically significant difference in rates of superficial skin problems or deep infections between the two groups (p>0.05). In comparison regarding fracture types, patients with type C fractures seemed to have better outcomes with minimal invasive plating. Conclusion Minimally invasive plating is a good approach in the treatment of distal tibial fractures. The technique seems to be advisable, especially for patients with type C fractures. However, the rates of skin problems and deep infections are similar to those seen with the open reduction method.

Keywords: distal tibia fracture; infection; minimal invasive plate; open reduction and internal fixation; skin necrosis.