A Study of Functional Outcome of Distal Tibial Fractures Treated by Minnmally Invasive Percutaneous Plate Osteosynthesis

The distal part of tibia is more superficial in nature. The soft tissue coverage and the blood supply to the bone in this area is comparatively less. Injuries to the distal end of tibia produce more morbidity due to the compromised blood supply, variable involvement of the articular surface and soft tissue damage. Intra-articular fractures of the distal tibia are additionally called 'pilon fractures' or 'tibial plafond fractures'. With the recent increase in high velocity injuries, treatment of these have become demanding. Fracture pattern, soft tissue injury, and bone quality critically influence the selection of fixation technique. Various methods of treatment like external fixation, intramedullary nailing, and locking plates have been considered. Among these, intramedullary nailing is not feasible in this region due to the distal nature of the injury because of which the distal screws cannot be placed and to the possibility of rotational misalignment during the course of fracture healing. External fixators can lead to inaccurate reduction, malunion, non-union and pin tract infection. Intramedullary nailing is considered standard for surgically managing tibial fractures, but the distal tibia poses concerns regarding the stability of fixation, the risks of secondary displacement of the fracture on insertion of the nail, breakage of nails and locking screws, and final alignment of the tibia. Classic open reduction and internal plate fixation require extensive soft tissue dissection and periosteal stripping even in expert hands, with high rates of complications, including infection, delayed union, and nonunion. Minimally invasive techniques offer fixation in the biological manner with preservation of the bone's vascularity, soft tissue envelope and containment of the fracture hematoma.