Clinical and radiological outcome of percutaneous plating in extra-articular proximal tibia fractures: a prospective study.

BACKGROUND: Despite various techniques of fixation, proximal tibia fractures are associated with poor outcome and increased rates of complications. Minimal access and rigid fixation are the keys for optimal outcome in such fractures. Therefore, this study was designed to look for the clinical and radiological outcomes of percutaneous locked plating (PLP) in extra-articular proximal tibia fracture.

METHODS: Between April 2008 and September 2010, 47 consecutive patients with 49 proximal third extra-articular tibial fractures (29 closed and 20 open injuries) underwent PLP. The patients were followed up at 6 weeks, 3 months, 6 months and 1 year. The union rate and complications of this fixation were evaluated. The clinico-radiological outcomes were assessed at 1 year of surgery.

RESULTS: Four patients had infection in the postoperative period which needed repeated debridement, gentamycin bead application and prolonged antibiotic therapy. Three of these infective cases ended up with nonunion and needed cancellous bone grafting. All the remaining fractures united. The average time for union was 20 weeks in closed and type I open fracture and 25 weeks in type II and III fractures. No neurovascular injury, hardware failure or loss of fixation was documented till the last follow-up. The mean range of knee joint movement was 119°. The average lower extremity functional score (LEFS) was 59 (74%). There were 10 cases of malunion (20.14%), with six varus/valgus and five procurvatum/recurvatum (one having both sagittal and coronal malunion) angulations. There were no statistical differences between patients with malunion and normal alignment with regard to knee range of motion and LEFS.

CONCLUSION: Minimally invasive osteosynthesis using PLP in extra-articular proximal tibia fractures showed a promising result with minimal complications.