Advertisement

Percutaneous Plating of Ankle Fractures

  • Mario Ronga
  • Chezhiyan Shanmugam
  • Francesco Oliva
  • Nicola Maffulli

Abstract

The management of distal tibial fractures can be ­difficult, and requires careful preoperative planning. Fracture pattern, soft tissue injury, and bone quality critically influence the selection of fixation technique.1 Several surgical methods have been described for the management of these fractures, including external fixation, intramedullary nailing, and plate fixation. External fixation may result in inaccurate reduction, malunion or nonunion, and pin tract infection.2 Intramedullary nailing is considered the standard method to manage operatively diaphyseal fractures of the tibia, but the distal tibia poses concerns regarding the stability of fixation, the risk of secondary displacement of the fracture on insertion of the nail, breakage of nails and locking screws, and final alignment of the tibia.

Keywords

Soft Tissue Injury Distal Tibia Ankle Fracture Axial Stiffness Torsional Rigidity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of Interest Statement

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the ­submitted work.

References

  1. 1.
    Bedi A, Le TT, Karunakar MA. Surgical treatment of nonarticular distal tibia fractures. J Am Acad Orthop Surg. 2006;14(7):406-416.PubMedGoogle Scholar
  2. 2.
    Rammelt S, Endres T, Grass R, Zwipp H. The role of external fixation in acute ankle trauma. Foot Ankle Clin. 2004;9(3):455-474. vii-viii.PubMedCrossRefGoogle Scholar
  3. 3.
    Boenisch UW, de Boer PG, Journeaux SF. Unreamed intramedullary tibial nailing – fatigue of locking bolts. Injury. 1996;27(4):265-270.PubMedCrossRefGoogle Scholar
  4. 4.
    Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma. 2008;22(5):307-311.PubMedCrossRefGoogle Scholar
  5. 5.
    Fisher WD, Hamblen DL. Problems and pitfalls of compression fixation of long bone fractures: a review of results and complications. Injury. 1978;10(2):99-107.PubMedCrossRefGoogle Scholar
  6. 6.
    Olerud S, Karlstrom G. Tibial fractures treated by AO ­compression osteosynthesis. Experiences from a five year material. Acta Orthop Scand Suppl. 1972;140:1-104.PubMedGoogle Scholar
  7. 7.
    Francois J, Vandeputte G, Verheyden F, Nelen G. Percutaneous plate fixation of fractures of the distal tibia. Acta Orthop Belg. 2004;70(2):148-154.PubMedGoogle Scholar
  8. 8.
    Helfet DL, Shonnard PY, Levine D, Borrelli J Jr. Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury. 1997;28(Suppl 1):A42-A47. discussion A47-8.PubMedCrossRefGoogle Scholar
  9. 9.
    Maffulli N, Toms AD, McMurtie A, Oliva F. Percutaneous plating of distal tibial fractures. Int Orthop. 2004;28(3):159-162.PubMedCrossRefGoogle Scholar
  10. 10.
    Stoffel K, Dieter U, Stachowiak G, et al. Biomechanical testing of the LCP—how can stability in locked internal fixators be controlled? Injury. 2003;34(Suppl 2):B11-B19.PubMedCrossRefGoogle Scholar
  11. 11.
    Frigg R. Development of the locking compression plate. Injury. 2003;34(Suppl 2):B6-B10.PubMedCrossRefGoogle Scholar
  12. 12.
    Frigg R. Locking compression plate (LCP). An osteosynthesis plate based on the dynamic compression plate and the point contact fixator (PC-Fix). Injury. 2001;32(Suppl 2):63-66.PubMedCrossRefGoogle Scholar
  13. 13.
    Collinge C, Sanders R, DiPasquale T. Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop Relat Res. 2000;375:69-77.PubMedCrossRefGoogle Scholar
  14. 14.
    Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury. 2007;38(3):365-370.PubMedCrossRefGoogle Scholar
  15. 15.
    Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia – results in 20 patients. Injury. 2006;37(9):877-887.PubMedCrossRefGoogle Scholar
  16. 16.
    Ronga M, Longo UG, Maffulli N. Minimally invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat Res. 2010;468(4):975-982.PubMedCrossRefGoogle Scholar
  17. 17.
    Tull F, Borrelli J Jr. Soft-tissue injury associated with closed fractures: evaluation and management. J Am Acad Orthop Surg. 2003;11(6):431-438.PubMedGoogle Scholar
  18. 18.
    Hintermann B, Regazzoni P, Lampert C, et al. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br. 2000;82(3):345-351.PubMedCrossRefGoogle Scholar
  19. 19.
    Imade S, Takao M, Nishi H, Uchio Y. Arthroscopy-assisted reduction and percutaneous fixation for triplane fracture of the distal tibia. Arthroscopy. 2004;20(10):e123-e128.PubMedCrossRefGoogle Scholar
  20. 20.
    Loren GJ, Ferkel RD. Arthroscopic assessment of occult intra-articular injury in acute ankle fractures. Arthroscopy. 2002;18(4):412-421.PubMedCrossRefGoogle Scholar
  21. 21.
    Ahmad M, Nanda R, Bajwa AS, et al. Biomechanical testing of the locking compression plate: when does the distance between bone and implant significantly reduce construct stability? Injury. 2007;38(3):358-364.PubMedCrossRefGoogle Scholar
  22. 22.
    Shanmugam C, Rahmatalla A, Maffulli N. Percutaneous fixation of distal tibial fractures using locking plates. Tech Orthop. 2007;22:162-166.CrossRefGoogle Scholar
  23. 23.
    Toms AD, McMurtie A, Maffulli N. Percutaneous plating of the distal tibia. J Foot Ankle Surg. 2004;43(3):199-203.PubMedCrossRefGoogle Scholar
  24. 24.
    Borg T, Larsson S, Lindsjo U. Percutaneous plating of distal tibial fractures. Preliminary results in 21 patients. Injury. 2004;35(6):608-614.PubMedCrossRefGoogle Scholar
  25. 25.
    Shanmugam C, Rahmatalla A, Maffulli N. Strain in distal tibial osteotomy stabilized with metaphyseal and distal tibial locking compression plates. Tech Orthop. 2007;22(3):145-150.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Mario Ronga
    • 1
  • Chezhiyan Shanmugam
    • 2
  • Francesco Oliva
    • 3
  • Nicola Maffulli
    • 4
  1. 1.Department of Orthopaedics and TraumatologyUniversity of InsubriaVareseItaly
  2. 2.Department of Trauma and OrthopaedicsUniversity Hospital of North Staffordshire NHS TrustStoke-on-TrentUK
  3. 3.Department of Trauma and Orthopaedic SurgeryUniversity of Rome “Tor Vergata”RomeItaly
  4. 4.Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End HospitalQueen Mary University of LondonLondonUK

Personalised recommendations