Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) Versus Intramedullary Interlocking Nailing (IMILN) in...

Area of Science:

• Orthopedic surgery
• Traumatology
• Bone fracture repair

Background:

• Extra-articular proximal tibia fractures present surgical challenges due to muscle forces and soft tissue compromise.
• Optimal treatment for these AO/OTA 41A2 fractures remains debated, especially comparing minimally invasive percutaneous plate osteosynthesis (MIPPO) and intramedullary interlocking nailing (IMILN).

Purpose of the Study:

• To compare the effectiveness of MIPPO versus IMILN for treating extra-articular proximal tibia fractures.
• To evaluate radiological union, functional outcomes, and complication rates between the two surgical techniques.

Main Methods:

• A prospective, comparative study allocated 52 adult patients with AO/OTA 41A2 fractures to either MIPPO (n=26) or IMILN (n=26).
• Primary outcomes included time to union and 12-month functional scores (KSS, LEFS, Johner and Wruhs).
• Statistical analysis used independent-samples t-tests and chi-square/Fisher's exact tests.

Main Results:

• Comparable union rates (95.8% MIPPO vs. 95.5% IMILN) and functional scores (KSS, LEFS) were observed at 12 months.
• IMILN allowed significantly earlier partial weight-bearing (p < 0.001) but required more intraoperative adjuncts (p=0.005) and was linked to anterior knee pain.
• MIPPO was associated with less knee morbidity but a more gradual rehabilitation.

Conclusions:

• MIPPO and IMILN demonstrate comparable union rates and functional outcomes for AO/OTA 41A2 tibia fractures.
• IMILN offers earlier mobilization benefits, while MIPPO minimizes knee-related complications.
• Treatment selection should consider fracture pattern, soft tissue status, and available resources.