Juxtra Articular Compound Fractures of the Tibia Managed by Percutaneous Anatomical Locked Plating-Feasibility in Indian Rural Population

Introduction: Compound fracture of the tibia is the one of the most common injury encountered by orthopaedic surgeon these days. Diaphyseal compound fractures are well managed by primary interlocking nails with good to excellent results. Metaphyseal juxtraarticular and intraarticular compound fractures of upper and lower end of tibia are not good indication for intramedullary nails due to limitation of short proximal and distal fragment and marked communition at these areas, also mostly intra articular extensions. Till now these fractures were mostly managed by External fixators or rind fixators. Primary conventional open plating in compound fracture is not a preferred method of management till now due to fear of infection and soft tissue complications and risk of plate exposure. We managed these fractures by minimally invasive plating using locked plate and result evaluated. Material and Method: In this study we have taken compound metaphyseal fractures of the tibia for primary plating using locked anatomical plate using minimally invasive technique. Ninety four (94) cases of tibia out of which 50 cases of proximal tibia and 44 cases of distal tibia compound fracture up to grade IIIA were taken for study. In all cases primary skeleton traction were applied followed by wound management using through irrigation using low pressure pulse levage and debridement. Plating was done using MIPPO method within 7 days of injury. Cases were followed up at regular interval and functional outcome assessed by using knee society score for proximal fractures and foot and ankle score for distal tibia fractures. Results: Primary bone was achieved in 88 of 94 cases within usual duration. Low grade infection at fracture site seen in 8 cases and out of these 8 cases union achieved in 5 cases by continuation of same primary fixation. 3 cases required revision surgery with removal of implant and antibiotics cement beads followed by other method of fixation to achieve union. Good to excellent outcome achieved according to knee society score in 93.8% of proximal cases and again good functional outcome achieved according to Foot and ankle score in 85% of distal tibia cases. None of these cases showed any serious complications like amputation or severe life threatening infection. Conclusion: With our study we can concluded that compound fractures of proximal and distal tibia can also be well managed by primary plating using minimally invasive technique. This is single staged procedure with minimal financial burden of rural population. One has to take care in proper selection of cases, avoid further soft tissue damage and care should be taken not to leave bone and plate exposed to environment. Wound can be closed by other secondary procedure within next few days without any negative consequences.