Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, 35365 Daejeon, Republic of Korea.
Department of Orthopedic Surgery, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, 35015 Daejeon, Republic of Korea.
Orthop Traumatol Surg Res. 2024 Apr;110(2):103770. doi: 10.1016/j.otsr.2023.103770. Epub 2023 Nov 17.
Indirect reduction of minimally invasive plate osteosynthesis (MIPO) can often result in delayed union in tibia fractures. This study evaluated several factors in MIPO in relation to bone union.
We hypothesized that the fracture gap, plate - tibia distance, or working length would have a substantial effect on the tibia union rate.
Forty-one patients with simple diaphyseal or distal metaphyseal tibia fractures who underwent internal fixation surgery using the MIPO technique were divided into two groups: patients with delayed union and patients without delayed union. Non-actionable factors involving AO/OTA classification, fibula fracture and actionable factors including postoperative fracture gap, plate - tibia distance, working length in relation to parameters of bone union were compared between the two groups. Also cumulative rates of bone union and risk factors of delayed union according to variables of interest were investigated.
AO/OTA classification, site of fibula fracture, postoperative fracture gap, working length, and bone union rate of the two groups significantly differed (p<0.05). The cumulative rate of bone union during 1-year follow-up according to 43A tibia fracture, distal fibula fracture, fracture gap, and working length significantly differed between the two groups (p<0.05). By univariate Cox proportional hazards model, 43A tibia fracture, distal fibula fracture, facture gap, and short working length were risk factors for delayed union (p<0.05).
Non-actionable factors involving AO/OTA classification, distal fibula fracture and actionable factors including postoperative fracture gap, working length were significant factors affecting bone union after MIPO. The present study indicated that small fracture gap and long working length during MIPO might facilitate bone healing in tibia fracture.
IV; single-center retrospective cohort study.
微创钢板接骨术（MIPO）的间接复位往往会导致胫骨骨折延迟愈合。本研究评估了 MIPO 中与骨愈合相关的几个因素。
我们假设骨折间隙、钢板-胫骨距离或工作长度会对胫骨愈合率有显著影响。
41 例单纯骨干或远端干骺端胫骨骨折患者采用 MIPO 技术行内固定手术，将其分为两组：延迟愈合组和无延迟愈合组。比较两组间非操作性因素（涉及 AO/OTA 分类、腓骨骨折）和操作性因素（包括术后骨折间隙、钢板-胫骨距离、工作长度与骨愈合参数的关系）。还根据感兴趣的变量调查了骨愈合的累积率和延迟愈合的危险因素。
AO/OTA 分类、腓骨骨折部位、术后骨折间隙、工作长度和骨愈合率两组间差异有统计学意义（p<0.05）。43A 胫骨骨折、腓骨远端骨折、骨折间隙和工作长度在两组间 1 年随访期间的骨愈合累积率差异有统计学意义（p<0.05）。单因素 Cox 比例风险模型显示，43A 胫骨骨折、腓骨远端骨折、骨折间隙和工作长度短是延迟愈合的危险因素（p<0.05）。
涉及 AO/OTA 分类、腓骨远端骨折的非操作性因素和包括术后骨折间隙、工作长度在内的操作性因素是影响 MIPO 后骨愈合的重要因素。本研究表明，MIPO 中较小的骨折间隙和较长的工作长度可能有助于胫骨骨折愈合。
IV；单中心回顾性队列研究。
