Posterior MIPO with Reverse Philos Plate in Distal Tibial Fracture
Keywords:
tibial fractures; soft tissue injuries; fracture fixation, internal; treatment outcomeAbstract
Introduction: Distal tibia fractures are difficult to treat. There are several modalities available for treatment, and soft tissue suffering is widely described as one of the most common complications.
Objective: To demonstrate that the minimally invasive plate osteoshyntesis (MIPO) technique with an inverted proximal humeral internal locking system (philos) is effective in repairing distal tibia fractures.
Case presentation: A 60-year-old female patient obese, with hypertension and insulin-dependent diabetes mellitus subject to irregular treatment, suffered a domestic accident that caused a distal fracture of the right tibia, associated with soft tissue injury on the anteromedial face. The distal tibial fracture was treated with the MIPO technique using an inverted philos plate through distal posterolateral and proximal posteromedial approach. At 16 months of follow-up, she exhibited satisfactory functional, radiological, and cosmetic outcomes.
Conclusions: Treatment using MIPO technique with an inverted philos plate is effective and safe surgical option in repairing distal tibial fractures, as it protects the medial soft tissue, reduces postoperative wound complications, allows adequate reduction of tibial fragments, which leads to satisfactory results.
Keywords: tibial fractures; soft tissue injuries; fracture fixation, internal; treatment outcome.
Downloads
References
1. Yamamoto N, Ogawa K, Terada C, Okazaki Y, Munetomo K, Noda T, et al. Minimally invasive plate osteosynthesis using posterolateral approach for distal tibial and tibial shaft fractures. Injury. 2016;47(8):1862-6. DOI: https://doi.org/10.1016/j.injury.2016.06.017
2. Wajnsztejn A, Pires RES, Dos Santos ALG, Labronici PJ, Fernandes HJA, Ferretti M. Minimally invasive posteromedial percutaneous plate osteosynthesis for diaphyseal tibial fractures: technique description. Injury. 2017;48(4):S6-S9. DOI: https://doi.org/10.1016/s0020-1383(17)30768-4
3. Yang X, Zhang X, Liu C, Zhang L, Wu F, Shen Q, et al. Treatment of distal third tibial fractures with anterior soft tissue compromise through the posterolateral approach. The Journal of Foot and Ankle Surgery. 2025 [acceso 15/04/2025];64(2):136-43. Disponible en: https://www.jfas.org/article/S1067251624002151/fulltext
4. Paget LDA, Sierevelt IN, Tol JL, Kerkhoffs GMMJ, Reurink G. The completely patient-reported version of the American Orthopaedic Foot and Ankle Society (AOFAS) score: A valid and reliable measurement for ankle osteoarthritis. J ISAKOS. 2023 [acceso 14/04/2025];8(5):345-51. Disponible en: https://www.sciencedirect.com/science/article/pii/S2059775423005254
5. Malhotra R, Goh A, Gardner A. Posterolateral plating of distal tibial fractures: extending the use of a familiar approach. JOIO. 2021[acceso 14/05/2025];5(2):426-35. DOI: https://doi.org/10.1007/s43465-021-00403-8
6. Osamura N, Ikeda K, Matsubara H. Posterior approach using a proximal humeral internal locking system long plate for open fractures of the distal tibia: A report of three cases. J Orthop Sci. 2016;21(4):552-6. DOI: https://doi.org/10.1016/j.jos.2015.06.002
7. Schloss M, Ghulam Q, Hannan Z, O’Hara N, Napora J, McAlister I, et al. Posterolateral plating is a safe alternative for the treatment of distal tibial fractures. Injury. 2020;51(7):1662-8. DOI: https://doi.org/10.1016/j.injury.2020.03.037
8. Heeran N, Gomaa AR, Mason L, Bond AP. The arterial risk posed by the posterolateral approach: An anatomical cadaveric study of the fibular artery and its variability. Clin Anat. 2024;37(8):840-8. DOI: https://doi.org/10.1002/ca.24108
9. Mahajan NP, Kumar P, Patil T, Pande K, Pawar H. Extra-articular distal tibia fibula fracture managed with single posterolateral approach: a case report. Int J Res Orthop. 2021 [acceso 24/05/2024];7(3):683-5. DOI: https://doi.org/10.18203/issn.2455-4510
10. Kupai K, Kang HL, Pósa A, Csonka Á, Várkonyi T, Valkusz Z. Bone Loss in Diabetes Mellitus: Diaporosis. International Journal of Molecular Sciences. 2024 [acceso 29/05/2025];25(13):7269. DOI: https://doi.org/10.3390/ijms25137269
11. Müller F, Doblinger M, Eckstein C, Füchtmeier B. Die PHILOS-Platte-auch an der distalen Tibia eine Indikation zur Osteosynthese? Unfallchirurg. 2020 [acceso 24/05/2025];123:326-9. DOI: https://doi.org/10.1007/s00113-020-00782-x
12. Hohenberger GM, Schwarz AM, Grechenig G, Schwarz U, Feigl GC, Bakota B. Dorsal minimally invasive plate osteosynthesis of the distal tibia with regard to adjacent anatomical characteristics. Injury. 2020 [acceso 24/05/2024];52:S11-S16. DOI: https://doi.org/10.1016/j.injury.2020.02.047
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Renán Estuardo Vargas Morales
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
