What is tibial fracture plate internal fixation treatment? What are the complications?

Author: Wang Qiwei, attending physician at Peking University First Hospital

Reviewer: Li Jun, deputy chief physician, Peking University First Hospital

The tibia is an important weight-bearing bone. If the fracture is not handled properly, complications such as infection, delayed healing or non-healing may occur, and even serious consequences such as amputation may occur. Therefore, it should be actively treated and handled.

Today we will learn about the internal fixation treatment of tibial fractures with bone plates.

Plate internal fixation treatment of tibial fracture refers to a treatment method that uses a steel plate with holes as a fixation device, and screws are screwed into the bone through these holes to achieve fixation. This operation process is called plate internal fixation technology.

Figure 1 Original copyright image, no permission to reprint

There are two types of surgical methods for bone plate internal fixation treatment.

One method is complete incision, which is mainly used for severe fractures within the articular surface. The fracture ends are completely cut open to expose them, and they are precisely aligned under direct vision with a relatively large exposure range. After the fracture is reduced, the steel plate is placed on one side of the fracture, and the screws are screwed in, and the operation is completed.

The second method is limited incision, which is semi-open. The bridging method is used. The fracture ends do not need to be cut open and reduction is performed under imaging fluoroscopy. This requires that the fracture site cannot be within the joint, but in the epiphysis of the tibia or close to the tibial shaft. An incision is made at the head and tail ends of the plate, and the plate is inserted deep into the skin and muscles and attached around the fracture. Some plates are equipped with special extracorporeal devices, through which a small incision can be made in the skin and the screws can be screwed in percutaneously. This minimally invasive plate fixation method can ensure that the blood supply to the fracture end is not affected to the greatest extent.

Tibial metaphysis fractures or fractures close to the articular surface are suitable for plate fixation. Metaphysis fractures are not suitable for intramedullary nail fixation because the medullary cavity in this area is relatively short and wide. If the fracture line is particularly long, the plate is an eccentric fixation with a relatively long span, which will have a certain impact on stability. The surgical injury and exposure range will be large, otherwise the plate cannot be put in. Therefore, for fracture lines that are particularly long, the use of plate fixation should be more cautious. Measurements must be made before and during surgery to select a plate of appropriate length that can completely cover the fracture ends. This is safe and effective.

The biggest advantage of plate fixation is that it can assist in the reduction of fractures. Compared with plate fixation, intramedullary nail fixation is superior in terms of stability and surgical invasiveness, and has fewer complications. However, current clinical data statistics show that there is no significant statistical difference between the two in terms of healing time.

The most common complication of tibial fracture plate internal fixation is nonunion. For limited incisions, because the fracture ends are not exposed, the fracture ends may not be well aligned, or the fracture reduction may not achieve satisfactory results, resulting in delayed union, nonunion, or malunion. For open incisions, due to the large incision range and large damage, the chance of infection will increase, such as incision infection and osteomyelitis. When the fracture ends are cut and exposed, the surrounding important blood vessels and nerves may be damaged.

In addition, if the steel plate is not selected properly, such as the fixation range is too long, the steel plate is too short, the number of screws is insufficient, and the screw distribution is not scientific and reasonable, resulting in non-union of the fracture, the steel plate will break.

If the internal fixation of the bone plate is not properly reduced, it needs to be re-reduced. At this time, it is necessary to completely cut open. In most cases, the original fixed steel plate needs to be removed and re-reduced. If infection occurs, the steel plate must also be removed and an external fixator is used. After the infection is completely eliminated, the steel plate can be used for fixation. If the steel plate is broken, it needs to be taken out and effectively fixed again.

The following aspects should be noted in postoperative care for tibial fracture plate internal fixation treatment:

First, change the dressing on local wounds in time and replace the dressing if there is bleeding.

Second, after waking up from anesthesia after surgery, do muscle contraction and adjacent joint and limb activity training as soon as possible if you can tolerate the pain.

Third, if the pain can be tolerated, patients are encouraged to get up with crutches as soon as possible and gradually bear weight.

Fourth, one or two months after the operation, if X-rays show that the fracture has signs of stable healing, or the signs of healing are getting better and better, try to remove the crutches as soon as possible and perform weight-bearing exercises after the crutches are completely removed.

Finally, whether the built-in plate needs to be removed after the fracture heals depends on the specific situation. For example, for young and middle-aged patients, in order to avoid the potential risk of osteoporosis; or when local screws cause compression symptoms, the plate should be removed after the fracture heals. In general, there is no need to remove the plate.