Abstract
Background
Distal tibial metaphyseal fractures pose many complexities. This study assessed the outcomes of distal tibial fractures treated with percutaneously inserted medial locking plates.
Methods
Eighteen patients were selected based on the fracture pattern and classified using the AO classification and stabilised with an AO medial tibial locking plate. Time to fracture union, complications and outcomes were assessed with the American Orthopaedic Foot and Ankle Society ankle score at 12 months.
Results
Sixteen of the 18 patients achieved fracture union, with 1 patient lost to follow up. Twelve fractures united within 24 weeks, with an average union time of 23.1 weeks. Three delayed unions, two at 28 weeks and one at 56 weeks. The average time to union was 32 weeks in the smokers and 15.3 weeks in the non-smokers. Five of the 18 patients (27%) developed complications. One superficial wound infection and one chronic wound infection, resulting in non-union at 56 weeks, requiring revision. Two patients required plate removal, one after sustaining an open fracture at the proximal end of the plate 6 months after surgery (post fracture union) and the other for painful hardware. One patient had implant failure of three proximal diaphyseal locking screws at the screw head/neck junction, but successful fracture union. The average AOFAS ankle score was 88.8 overall, and 92.1 in fractures that united within 24 weeks.
Conclusions
Distal tibial locking plates have high fracture union rates, minimum soft tissue complications, and good functional outcomes. The literature shows similar fracture union and complication rates in locking and non-locking plates.
