OBJECTIVETo compare clinical outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treating distal tibial comminuted fractures at early and delayed stage.

METHODSFrom January 2006 to January 2012,66 patients with distal tibial comminuted fractures were treated by MIPPO. All patients were divided into primary group and delayed group according to operation time. There were 31 patients in primary group, including 18 males and 13 females aged 21 to 57 years old with an average of (39.0 +/- 17.8), treated by MIPPO at primary stage,according to Tscherne soft tissue injury, 18 cases were grade I ,12 cases were grade II and 1 case were grade III. Thirty-five patients were treated by MIPPO at delayed stage, including 16 males and 19 females aged 24 to 55 years old with an average of (39.5 +/- 15.2), according to Tscherne soft tissue injury, 6 cases were grade I, 26 cases were grade II and 3 cases were grade III. Operation time, blood loss, hospital stay, fracture healing time and complications of two groups were recorded and observed, Lowa scoring of ankle joint were used to evaluated therapeutic effects at final following and AP and lateral X-rays were used to evaluated fracture reduction and alignment.

RESULTSAll patients were followed up, the time of following-up of primary group was (13.5 +/- 3.5) months, (15.2 +/- 3.8) months in delayed group, there was no significant meaning between two groups (t = 1.882, P = 0.064). There was no significant differences between two groups in operation time and blood loss (P > 0.05), but hospital stay in primary group was shorter than that of delayed group(P<0.05). There was no significant meaning between primary group (5.5 +/- 2.8) and delayed group (6.2 +/- 3.1) in fracture healing time (t = 0.958, P = 0.342); there was no significant meaning between primary group (87.6 +/- 6.8) and delayed group (89.6 +/- 5.2) in Lowa scores at final following-up (t = 1.351, P = 0.182). Two cases occurred postoperative superficial inflammatory reaction around fibular incision in primary group, 1 case occurred postoperative superficial inflammatory reaction around fibular incision and 1 case occurred delayed deep incision infection in delayed group at four months after operation. There was no significant differences in incidence of postoperative soft tissue complications between primary group (6.5%) and delayed group (5.7%) (t = 0.016, P = 0.900).

CONCLUSIONFor distal tibial comminuted fractures with grade I and II of Tscherne soft tissue injury, MIPPO at primary stage can not increase incidence of soft tissue complications, also can obtain the same clinical outcomes just like delayed MIPPO.