Background
Distal radius fractures following high-energy trauma are common injuries, usually associated with metaphysio-diaphyseal comminution with marked soft tissue injury making effective treatment a real challenge with high risk of complications. Minimally invasive percutaneous plate osteosynthesis (MIPPO) is a fixation technique giving priority for soft tissues and vascularity of the bone fragments achieving a relatively stable fracture construct while preserving a biological environment insuring rapid bone healing. This study aims to evaluate the outcomes of the MIPPO technique for the treatment of distal radius fractures with metaphysio-diaphyseal comminution.
Patients and methods
This prospective, case series study comprised 11 cases of closed distal radial fractures with varying degrees of displacement and metaphysio-diaphyseal comminution following high-energy trauma. All fractures were treated by the MIPPO technique through two volar longitudinal incisions using a volar locking plate bridging the comminuted segment. The patients were followed up clinically and radiologically and the functional outcome was evaluated according to the Dienst wrist scoring system.
Results
All fractures united with a mean union time of 12.5±1.6 weeks (range, 11–16 weeks) with no reported loss of fixation with secondary displacement, implant failure, or deep wound infection. No cases needed any secondary surgical intervention to achieve union. The follow-up period extended for a mean duration of 16.7±3.2 months with satisfactory (excellent and good) clinical and radiological results compared with the other side achieved in all cases. The radiological results (radial inclination, radial height, and volar tilt) were excellent in eight cases and were good in three cases, but the clinical results (range of motion of the wrist and grip strength) were excellent in all the 11 studied cases.
Conclusion
The results are very satisfactory. MIPPO minimizes soft tissue compromise with preservation of vascularity of the comminuted fracture fragments, thus improving the healing rate, shortening the time for union with no need for initial or delayed bone grafting for such comminuted fractures with few potential complications.