Minimally invasive plate osteosynthesis in type B fibular fractures versus open surgery

In traumatology, the search for better surgical access points has led to the increased use of the minimally invasive plate osteosynthesis (MIPO) technique. Locking head screws are used, giving good stability, especially in osteoporotic bone1-2, and complete respect for the periosteum. The literature contains many works on the MIPO technique for fractures of the humerus3 (proximal and shaft), femur3-6 (proximal, distal and shaft), tibia3, 7-11 (proximal, distal and shaft), with good results. However, there are few studies on the treatment of distal fibular fractures with MIPO. LCP for distal fibular fractures is generally applied after open reduction, but may involve complications to the surgical wound, as reported in the literature12-14, especially in elderly patients with critical soft tissue condition, because at this level the bone is not covered with muscle and soft tissue coverage is thin. Siegel and Tornetta15 reported a series of 31 unstable comminuted pronation-abduction ankle fractures. A direct lateral incision with extraperiosteal dissection was used to preserve the soft-tissue sleeve surrounding the fracture. All fibula fractures healed within 10 weeks. Hess and Sommer16 reported 20 distal fibula fractures with critical soft tissue conditions treated with the MIPO technique. Seventeen fractures healed without complications in an average time of 9 weeks. Krenk et al. 17 reported 19 ankle injures treated with the MIPO technique. All fractures healed without skin complications in an average time of 8.3 weeks. In this study, we compared two groups of patients receiving either ORIF or MIPO, in order to analyse the advantages and disadvantages of the two techniques.