• Kyu-Hyun Yang, Yougun Won, Dong-Hyun Kang, Jin-Cheol Oh, and Sung-Jun Kim.
• Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
• J Orthop Trauma. 2015 Sep 1; 29 (9): e331-5.

ObjectivesTo determine the effect of interfragmentary appositional (gap-closing) screw fixation in minimally invasive plate osteosynthesis (MIPO) for distal tibial fractures on the clinical and radiologic results.DesignProspective nonrandomized study.SettingLevel I trauma center.PatientsSixty patients who were diagnosed as distal metadiaphyseal oblique or spiral tibial fracture without displaced articular fragment.InterventionThirty patients (group A) of the 60 patients were treated with MIPO without appositional screw fixation, and the other 30 (group B) were treated with the screw.Main Outcome MeasurementsRadiologic union, clinical union, clinical functional score [American Orthopaedic Foot and Ankle Society (AOFAS) score], and complications.ResultsThe time for initial callus formation and radiologic union was significantly longer in group A than those in group B (76.8 vs. 58.0 days, P = 0.044; 409 vs. 258.7 days, P = 0.002, respectively). The rate of clinical union during 1 year was significantly higher in group B than in group A (P = 0.0063). Four nonunion patients in group A achieved bone union after placement of an additional bone graft. None of the patients in group B diagnosed with delayed union or nonunion (P < 0.001). None of the patients of both groups had malreduction, skin problems, or infection. Overall, the AOFAS score did not significantly differ between groups A and B (85.4 vs. 87.0, P = 0.43).ConclusionsThe use of additional interfragmentary appositional screw fixation in distal tibia MIPO for the fixation of oblique or spiral fracture promoted callus formation and union rate compared with MIPO without appositional screw fixation.Level Of EvidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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