Percutaneous osteosynthesis of distal tibial fractures using locking plates

Surgical fixation of distal tibia fractures can be difficult, and requires careful preoperative planning. Fracture pattern, soft tissue injury, and bone quality critically influence the selection of fixation technique.¹ Several surgical methods have been described for the treatment of these fractures, including external fixation, intramedullary nailing, and plate fixation. Classical open reduction and internal plate fixation requires extensive soft tissue dissection and periosteal stripping, with high rates of complications, including infection, delayed and non-unions.^2,3 Moreover, the surgical dissection required to achieve anatomic reduction evacuates the osteogenic fracture ematoma. Several minimally invasive plate osteosynthesis techniques have been developed, with good results at medium term follow-up.^4-6 These techniques aim to reduce surgical trauma and to maintain a more biologically favorable environment for fracture healing.