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The authors are from the Department of Orthopedics, Ningbo No. 6 Hospital, Ningbo, Zhejiang Province, China.
The authors have no relevant financial relationships to disclose.
Open reduction and internal fixation for distal tibial fractures can achieve anatomical reduction but may result in delayed union, nonunion, or soft tissue complications. Minimally invasive plate osteosynthesis (MIPO), which involves insertion of the plate through a limited incision, placement of screws through stab incisions, and using the principles of biologic fixation with indirect reduction techniques to reduce the fracture, is believed to decrease the rates of non-union and lower soft tissue complications because of the undisrupted local fracture environment and limited skin incisions.1 As a result, percutaneous plate fixation of distal tibial fractures has gained prevalence as a minimally invasive technique.
A locking plate, such as the less invasive stabilization system (LISS) plate (Synthes, Paoli, Pennsylvania), is advocated as an internal-external fixator given its angular stable screw fixation. These properties make it a good candidate for external plate fixation. Recently, the novel application of a locking plate used as an external fixator was introduced for the management of open fractures and infected nonunions and even as an adjunct in distraction osteogenesis.2â[euro]"4 Analogous to so-called submuscular plating, this technique is called supercutaneous plating.5 However, to date, the supercutaneous plating technique is still not widely accepted and used.
The purpose of this control-matched study was to compare the MIPO technique with the supercutaneous plating technique in the treatment of distal tibial fractures.
<bold>Materials and Methods</bold>
From January 2010 to January 2012, one hundred fifty-eight cases of distal tibial fracture with or without fibular fractures were enrolled in the study with complete follow-up details. Eligible patients were aged from 18 to 60 years and were diagnosed as having a closed distal tibial AO/OTA classification type 42 fracture with or without fibular fracture. Patients were excluded if they had an open distal tibial fracture, pathologic fracture, multiple fractures or injury, or brain trauma. In addition, patients were excluded if they had existing disorders having an effect on the healing process and function, such as multiple sclerosis, paraplegia or other relevant neurologic disorder, or polytrauma with an Injury Severity Score higher than 16. Among them, 24 patients treated with closed reduction and minimally invasive...