Osteosíntesis mini-invasiva con placas bloqueadas en fracturas metafisarias distales de tibia: Resultados clínico-funcionales

• Autores: Juan Manuel Yañez Arauz, Ignacio Ricardo Arzac Ulla, Javier Del Vecchio, Andres Eksarho, Leandro Civetta, Rodrigo Pérez Dávila
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 80, Nº. 3, 2015, págs. 185-195
• Idioma: español
• DOI: 10.15417/341
• Títulos paralelos:
  • Minimally invasive plate osteosynthesis in distal metaphyseal fractures of tibia: Comparison of results between fractures AO 43A and AO 43C
• Enlaces
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• Resumen
  • español

    IntroducciónLas fracturas distales de tibia son un desafío para el tratamiento debido a la escasa cobertura y particular vascularización. Los objetivos del presente estudio son analizar los resultados clínicos y funcionales de los pacientes con fractura de tibia distal; tratados con técnica MIPO (minimally invasive plate osteosynthesis) con placas bloqueadas; comparar los resultados del grupo de fracturas tipo AO 43A con las tipo AO 43C1-C2; y comparar los resultados MIPO con el tratamiento abierto convencional. Material y métodosEntre 2004 y 2012, se evaluaron 32 fracturas de tibia distal tratadas con técnica MIPO. 20 varones y 12 mujeres. Edad promedio: 40,1 años. El 59,4% presentó fracturas tipo AO 43A; y el 40,6% AO 43C. Tiempo trauma/cirugía: 6,8 días promedio. 24 casos presentaron fractura de peroné. Estadía hospitalaria: 1,5 días promedio. Seguimiento promedio: 39,6 meses, mediante score AOFAS y radiología. Se consignaron complicaciones. Se compararon resultados de grupos  tipo AO A y los tipo AO C. ResultadosIncremento del score AOFAS entre pre y post-operatorio: 73,3 puntos promedio. El grupo AO tipo A: media de 95,89 puntos AOFAS PO. El grupo AO tipo C1-2: media de 92,15 puntos PO. Carga del peso corporal: a las 8,7 semanas promedio. Comparando A= 43A y AO 43C: p: 0,46 (no significativa). Retorno a actividad previa a la lesión:9.3 meses promedio. Comparando tipo A y tipo C: p=0,16 (no significativa). Hubo 18,75% de complicaciones y retiro de osteosíntesis en 14 casos. Conclusiones La osteosíntesis mínimamente invasiva con placa y tornillos, es una buena opción para las fracturas de tibia distal; con buena evolución clínico-funcional, y escasas complicaciones comparadas a la cirugía abierta. Las fracturas 43A presentan menos complicaciones mayores que las 43C, tratadas con técnica MIPO.

  • English

    IntroductionDistal tibial fractures are a challenge for treatment due to the limited coverage and specific vascularization. The aims of this study are to analyze the clinical outcome and functional results in patients with tibial fracture treated with MIPO technique with locked plates. As well comparing  AO 43A with AO 43C1-C2 fractures and comparing  conventional with MIPO techniques.Material and MethodsBetween 2004 and 2012 we evaluated 32 distal tibial fractures treated with MIPO technique. 20 males and 12 female. Average age: 40.1 years old. 59.4% were fracture AO 43A; and the other 40.6% AO 43C. The mean time between the trauma and the surgery was 6.8 days. 24 cases with fibula fracture. Mean hospital stay: 1.5 days. Mean follow up: 39.6 month, with AOFAS Score and X-Ray. We compare results with AO A and AO C fractures.ResultsAOFAS score improve average 73.3 points in POP.  The mean POP- AOFAS score in AO A fracture was 95.89 points, and 92.15 in AO C1-2. The mean time of weight bearing was 8.7 weeks. The mean time to return to activity was 9.3 months. We had 18.75% complications and 14 cases of hardware removal.ConclusionsTibial distal fracture has shown to have better outcome, less complications with MIPO technique in comparission to ORIF. AO 43 A have less complications than AO 43C with this technique. 

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