• Cory Collinge, Mark Kuper, Kirk Larson, and Robert Protzman.
• Harris Methodist Fort Worth Hospital Orthopedic Trauma Staff, John Peter Smith Orthopedic Surgery Residency, Fort Worth, TX 76104, and Orthopedic Surgery, Texas Tech University, Lubbock, USA. ccollinge@msn.com
• J Orthop Trauma. 2007 Jul 1; 21 (6): 355-61.

ObjectiveThe purpose of this study is to evaluate clinical results and outcomes of a strict cohort of high-energy injuries of the metaphyseal distal tibia with minimal or no intraarticular involvement treated using the minimally invasive plating concept.SettingLevel II trauma center.DesignRetrospective analysis of a consecutive case series with limb-specific and whole-person outcomes measures.InterventionMinimally invasive medial plating for high-energy metaphyseal fractures of the distal tibia with little or no intraarticular involvement.Main Outcome MeasurementClinical and radiographic results were assessed at a minimum of 1 year, and outcomes measures were applied at final follow-up at a minimum of 2 years. Limbs were assessed with the American Orthopaedic Foot and Ankle Surgeons (AOFAS) ankle-hindfoot instrument and the method of Olerud and Molander. Patient outcomes were evaluated with the Short Form-36 (SF-36) and the Musculoskeletal Functional Assessment (MFA).ResultsTwenty-six patients were followed until healed at an average of 36 months (12-56 months). Mean fracture healing time was 35 weeks (12-112 weeks) with acceptable alignment restored (angulation2 years were comparable to normative data of patients with uninjured limbs, whereas MFA results showed functional deficits in 4 of 10 subsections.ConclusionsMinimally invasive medial plating will restore limb alignment and yield successful clinical outcomes for high-energy metaphyseal fractures of the distal tibia. Despite the significant reoperation rate and prolonged time to union, most patients can expect a predictable return of function. Strong consideration should be given to adjunctive measures in at-risk patients, including those with highly comminuted fracture patterns, bone loss, or Type II or III open fractures.

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