Does Malrotation After Minimally Invasive Plate Osteosynthesis Treatment of Distal Tibia Metaphyseal Fractures Effect the Functional Results of the Ankle and Knee Joints?

OBJECTIVESTo investigate whether rotational malalignment of tibia, after fracture management with minimally invasive plate osteosynthesis technique (MIPO), leads to impaired results in knee and ankle joint functional scores. DESIGNProspectively collected data were retrospectively analyzed for this study. SETTINGLevel III academic trauma center. PATIENTS/PARTICIPANTSSixty-five consecutive patients who applied between October 2010 and January 2014 with a unilateral distal tibia fracture and had full bone union at their last visit were analyzed. Patients were excluded if they had a pathologic fracture, Gustilo-Anderson type II or III open fracture, additional ligamentous trauma, were pregnant, or had any deformity. A total of 27 patients were accepted into the study. INTERVENTIONAll patients were treated with a MIPO technique after a mean of 2.8 days. The fibular fracture, when present, was fixed first. MAIN OUTCOME MEASUREMENTSThe main outcome of this study was the relation between tibial malrotation after a MIPO procedure, and Lower Extremity Functional Scale, American Orthopedic Foot and Ankle Society, KOOS scores, and range of motions of adjacent joints. RESULTSFourteen patients (51.8%) had a rotation higher than 10 degrees. The mean malrotation angle was 14.6 degrees. Concomitant fibular fractures were present in 13 patients, which did not seem to have a significant influence on malrotation. There was no significant difference between groups regarding functional scores and range of motions of the knee and ankle joints. CONCLUSIONSDespite high rates of malrotation after tibial metaphyseal-diaphyseal fractures treated with MIPO technique, this finding does not seem to have a significantly negative effect on knee and ankle joint functions. Meticulous intraoperative evaluation, through a range of different techniques, should be performed to avoid malrotation. LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.