Minimally invasive osteosynthesis of distal tibial fractures using locking plates

The management of distal tibia fractures can be challenging because of the scarcity of soft tissue, their subcutaneous nature, and poor vascularity. Classic open reduction and internal plate fixation require extensive soft tissue dissection and periosteal stripping, with high rates of complications. Minimally invasive plating techniques reduce iatrogenic soft tissue injury and damage to bone vascularity and preserve the osteogenic fracture hematoma. Locking plates (LPs) have the biomechanical properties of internal and external fixators, with superior holding power because of fixed angular stability through the head of locking screws, independent of friction fit. In this review, the rationale for the use of LPs and a description of the technique of minimally invasive LP osteosynthesis of distal tibia fractures are presented.