Percutaneous clamp reduction technique using plate as a position template during minimally invasive plate osteosynthesis for the treatment of tibial shaft fractures

Abstract

Background: Minimally invasive plate osteosynthesis (MIPO) has become an effective option for tibial shaft fracture surgery owing to its protection of the osteogenic microenvironment. However, the nonexposure of the fracture site also makes satisfactory reduction challenging. In this study, we designed a strategy of percutaneous clamping reduction assisted by the implanted plate as a template. Method: A retrospective analysis of patients with tibial shaft fractures who underwent percutaneous clamping reduction using a plate as a template was performed. From March 2017 to April 2022, a total of 110 patients (mean age: 30.3 years) were included. The reduction time, intraoperative blood loss, the effect of reduction, and postoperative radiographs were recorded and evaluated. The healing time, recovery of limb function, and complications were also assessed. Results: The average reduction time was 8.3 ± 5.8 min. The average intraoperative bleeding was 20.6 ± 5.9 ml. The radiographs after reduction showed most patients achieved near-perfect alignment with the average coronal varus or valgus angulation of 1.8° ± 0.7° and the average sagittal anterior/posterior angulation of 2.9° ± 0.9°, and one (0.9%) patient had malreduction due to improper plate shaping. Bone healing was achieved in all patients, with an average fracture healing time of 3.8 ± 1.4 months. Complications included one case of bone nonunion (0.9%) and one case of postoperative infection (0.9%), both of which achieved bone union after secondary treatment. Additionally, there was one patient with extensor hallucis longus tendon contracture and one patient with flexor hallucis longus tendon contracture. Both cases had minimal functional impact. Importantly, there were no neurovascular injuries or hematomas. Conclusions: By using the plate, which can perfectly match the anatomical structure, as a positional template to assist the percutaneous clamp reduction, a more accurate and reliable reduction was achieved with minimal surgical disturbance. It is a key advancement in clinical practice with promising applications for more complex fractures and diverse anatomical locations. Level of evidence Therapeutic level III.