Artikel
The impact of lag screw on the healing time of distal tibial fractures managed with Minimally Invasive Plate Osteosynthesis (MIPO): a randomized controlled trial
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Veröffentlicht: | 22. Oktober 2019 |
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Objectives: Minimally Invasive Plate Osteosynthesis (MIPO) is an established technique for the management of distal tibial fractures. This study aims to assess the impact of the lag screw on the healing time of distal tibial fractures managed with MIPO technique.
Methods: Patients undergoing Locking Compression Plate (LCP) osteosynthesis for distal tibial fractures were recruited. Inclusion criteria were: fracture type 43 according to AO/OTA classification system; no history of ankle fractures. Exclusion criteria were: exposed fractures, pathological fractures, surgical management with external fixation or nailing. Patients were divided randomized into two groups, in order to receive an osteosynthesis with lag screw (Group-A) or without lag screw (Group-B). The randomization scheme was generated by the Web site Randomization.com (http://www.randomization.com). Anthropometric data, soft tissue condition and traumatic mechanism were recorded at baseline. All the patients underwent a clinical and radiological follow-up at 6 weeks, 12 weeks and 24 weeks. The American Orthopedic Foot and Ankle Score (AOFAS) was performed at each follow-up; complications and reoperation-rates were also registered. The time interval between surgery and return to full weight bearing (FWB) was assessed. Statistical analysis was performed with SPSS v25.0 (SPSS Inc., Chicago, IL, USA). The Shapiro-Wilk Test was conducted to verify the data normal distribution. Multivariate analysis of variance (MANOVA) with post-hoc tests and Pearson correlation test were performed. The tests were two-tailed with a confidence level of 5%.
Results and conclusion: 42 patients (24 male and 18 female, mean age 49.54 years old, range 25-67) were recruited. 19 patients had a 43-A type fracture; 11 patients a 43-B injury and 12 patients a 43-C type lesion. 22 patients were randomized in Group-A; 20 patients in Group-B. A significantly lower time interval between surgery and return to FWB was observed in Group-A patients (p=0.00342). A significantly better AOFAS score was observed at 24-weeks follow-up in Group-A patients, compared with Group-B.
In this study, the use of lag screw in the management of distal tibial fractures treated with MIPO technique showed a better functional outcome and a faster return to FWB.