Percutaneous ORIF of Periarticular Distal Tibia Fractures

Abstract

Periarticular fractures of the distal tibia remain among the more challenging of fractures for the orthopedic surgeon. Traditional methods of treatment have included functional bracing, external fixation with or without limited internal fixation (hybrid fixation), intramedullary nailing, and formal open reduction internal fixation (ORIF). Cadaveric studies have previously described the somewhat tenuous vascular supply to the distal metaphysis, which, combined with inherent limitations in the surrounding soft tissue envelope, pose a risk of nonunion and have led to increasing interest in “biologic” fixation techniques.¹

These techniques are based upon the principles of limited soft tissue stripping, maintenance of the osteogenic fracture hematoma, and preservation of vascular supply to the individual fracture fragments while restoring axial and rotational alignment, and providing sufficient stability to allow progression of motion, uncomplicated fracture healing, and eventual return to function. As such, the evolution of percutaneous plating techniques has led to the development of low-profile, precontoured implants specifically intended for subcutaneous/submuscular application in the distal tibia.