Mehmet Atıf Erol AKSEKİLLİ, İsmail ÇELİK, Arslan Kağan ARSLAN, Tuğhan KALKAN, MAHMUT UĞURLU

The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures

Amaç: Çalışmamızın amacı tibia diafiz ve alt uç kırığı nedeniyle minimal invaziv perkütan plakla tespit uygulanan olgularda kaynama süreleri ve komplikasyonların değerlendirilmesi idi. Çalışma planı: Tibia diafiz ve alt uç kırığı nedeniyle 35 olgu (23 erkek, 12 kadın) minimal invaziv perkütan plakla osteosentez (MİPPO) prensipleri ile ameliyat edildi. Kırıkların 28’i kapalı 7’si açık kırık idi. Kırık direkt ya da dolaylı olarak yerine yerleştirildikten sonra kırık hattını açmadan plak distal kesiden submusküler-ekstraperiosteal olarak ilerletildi. Sonrasında, plak proksimal ve distal kesilerden vidalanarak tespit edildi. Ameliyattan sonra 4 ila 6 hafta arayla klinik ve radyolojik kontroller gerçekleştirildi. Açık kırıklara ortalama 14.43 (dağılım: 12-20) haftada, kapalı kırıklara ise ortalama 15.39 (dağılım: 8-32) haftada tam yük verdirildi. Olgularda kaynama süresi ve komplikasyonlar değerlendirildi. Bulgular: Ortalama kaynama süresi açık kırıklarda 20.7 (dağılım: 16-28), kapalı kırıklarda 17.96 (dağılım: 10-36) hafta olarak gerçekleşti. İmplant yetmezliği gelişen bir olgu dışında tüm olgularda kaynama elde edildi. Bir olguda yara yerinde nekroz, bir diğer olguda da enfeksiyon gelişti. Çıkarımlar: Tibia diafiz ve alt uç kırıklarında MİPPO, komplikasyon oranı düşük, kaynama oranı yüksek, etkili bir tedavi seçeneğidir.

Tibia diafiz ve alt uç kırıklarında minimal invaziv perkütan plakla osteosentez (MİPPO) uygulamasının sonuçları

Objective: The aim of this study was to evaluate the time to union and complications in cases of tibial diaphysis and distal tibial fractures fixed with a minimally invasive percutaneous plate. Methods: Thirty-five patients (23 males, 12 females) were operated on using minimally invasive percutaneous plate osteosynthesis (MIPPO) principles for tibial diaphysis and distal tibial fractures. Twenty-eight were closed and seven were open fractures. After direct or indirect fracture reduction, the plate was advanced through a submuscular extraperiosteal tunnel through the distal incision without opening the fracture line. The plate was fixed with screws through the proximal and distal incisions. Clinical and radiological evaluations were made at four to six week intervals after surgery. Full weight-bearing was allowed after an average of 14.43 (range: 12 to 20) weeks and 15.39 (range: 8 to 32) weeks in open and closed fractures, respectively. Duration of the union and complications were analyzed. Results: The mean duration of the union was 20.7 (range: 16 to 28) weeks and 17.96 (range: 10 to 36) weeks in open and closed fractures, respectively. All cases showed union except one who had an implant failure. Necrosis at the wound developed in one case and infection in another. Conclusion: MIPPO is an effective alternative treatment for tibial diaphysis and distal tibia fractures with low complication and high union rates.

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