Union Following Biological and Rigid Fixations of Distal Tibia Extra-articular Fractures

Document Type : RESEARCH PAPER

Authors

Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon

Abstract

Background: Distal tibia fractures are among the most common bony injuries, with a significant rate of nonunion and
delayed union. There are multiple methods for the management of distal tibia fractures. Among the plating methods,
there are bridge plating and compression plating techniques. There is still a lack of evidence about whether one method
has a higher rate of union than the other. The present study aimed to assess the union rate of extra-articular distal tibia
fractures using biological fixation with bridge plating and rigid fixation with compression plating.
Methods: This retrospective analysis was performed on 41 adult patients with distal tibia fractures. The subjects
were divided into two groups based on the fixation method, namely bridge plating and compression plating. Baseline
characteristics, fracture characteristics, and union status were analyzed and compared in this study.
Results: Baseline and fracture characteristics were similar between the groups. Only higher translation in any planes
was noted in the bridge plating group (2.80±3.04 mm; p <0.001). As for union status, the rates of the union during 3
months and delayed/no union were similar between the two groups (P=0.18). During a 6-month follow-up, 92% and
93.8% of the patients achieved union in the bridge plating and compression plating groups, respectively.
Conclusion: Rates of delayed union and nonunion are similar regarding extra-articular distal tibia fractures treated
with either bridge plating or compression plating.
Level of evidence: III

Keywords

Main Subjects


1. Larsen P, Elsoe R, Hansen SH, Graven-Nielsen T,
Laessoe U, Rasmussen S. Incidence and epidemiology
of tibial shaft fractures. Injury. 2015; 46(4):746-50.
2. Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch
EH. Treatment of open fractures of the shaft of the
tibia. J Bone Joint Surg Br. 2001; 83(1):62-8.
3. Piatkowski K, Piekarczyk P, Kwiatkowski K, Przybycien
M, Chwedczuk B. Comparison of different locking
plate fixation methods in distal tibia fractures. Int
Orthop. 2015; 39(11):2245-51.
4. Williams TH, Schenk W. Bridging-minimally invasive
locking plate osteosynthesis (Bridging-MILPO):
technique description with prospective series of 20
tibial fractures. Injury. 2008; 39(10):1198-203.
5. Wagner M. General principles for the clinical use of
the LCP. Injury. 2003; 34(Suppl 2):B31-42.
6. Madadi F, Eajazi A, Madadi F, Daftari Besheli
L, Sadeghian R, Nasri Lari M. Adult tibial shaft
fractures - different patterns, various treatments and
complications. Med Sci Monit. 2011; 17(11):CR640-5.
7. McGrath L, Royston S. Fractures of the tibial shaft
(including acute compartment syndrome). Surgery.
2007; 25(10):439-44.
8. Baumgaertel F, Gotzen L. The “biological” plate
osteosynthesis in multi-fragment fractures of the paraarticular
femur. A prospective study. Unfallchirurg.
1994; 97(2):78-84.
9. Gautier E, Ganz R. The biological plate osteosynthesis.
Zentralbl Chir. 1994; 119(8):564-72.
10. Müller ME, Allgöwer M, Schneider R, Willenegger
H. Manual of INTERNAL FIXATION: techniques
recommended by the AO-ASIF group. Abridg AOManual,
Limit. 3rd ed. Berlin, Heidelberg: Springer
Berlin Heidelberg; 1992.
11. He GC, Wang HS, Wang QF, Chen ZH, Cai XH. Effect 
of minimally invasive percutaneous plates versus
interlocking intramedullary nailing in tibial shaft
treatment for fractures in adults: a meta-analysis.
Clinics (Sao Paulo). 2014; 69(4):234-40.
12. 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):365-70.
13. Fang JH, Wu YS, Guo XS, Sun LJ. Comparison of 3
minimally invasive methods for distal tibia fractures.
Orthopedics. 2016; 39(4):e627-33.
14. Zou J, Zhang W, Zhang CQ. Comparison of minimally
invasive percutaneous plate osteosynthesis with
open reduction and internal fixation for treatment
of extra-articular distal tibia fractures. Injury. 2013;
44(8):1102-6.
15. Fracture and dislocation compendium. Orthopaedic
trauma association committee for coding and
classification. J Orthop Trauma. 1996; 10(Suppl 1):vix,
1-154.
16. Tay WH, de Steiger R, Richardson M, Gruen R, Balogh
ZJ. Health outcomes of delayed union and nonunion
of femoral and tibial shaft fractures. Injury. 2014;
45(10):1653-8.
17. Horn C, Dobele S, Vester H, Schaffler A, Lucke M,
Stockle U. Combination of interfragmentary screws
and locking plates in distal meta-diaphyseal fractures
of the tibia: a retrospective, single-centre pilot study.
Injury. 2011; 42(10):1031-7.
18. Wenger R, Oehme F, Winkler J, Perren SM, Babst R,
Beeres FJ. Absolute or relative stability in minimal
invasive plate osteosynthesis of simple distal
meta or diaphyseal tibia fractures? Injury. 2017;
48(6):1217-23.