Fractures of the distal third of the adult tibia pose a management problem. Conservative treatment often results in delayed and non-union, mal union or sub optimal functional results in terms of joint motion. Closed reduction and intramedullary fixation may not be possible where the fracture line traverses or lies distal to the level of the locking screws and open reduction and internal fixation at this level has a high soft tissue complication rate. Percutaneous plating provides a safe and minimally invasive procedure for fixation of these fractures.

In our unit, over an eighteen month period from September 1999 to March 2001, fourteen patients (ten male and four female) with an average age of forty five (range sixteen to sixty nine years) with fractures of the distal third of the tibia underwent percutaneous plating. Thirteen cases were isolated limb injuries and one occurred in a polytrauma patient with bilateral lower limb injuries. Eight were A1.2, four A1.3 and two B1.3 fractures according to the OTA classification. Only one injury was compound.

All patients had a general anaesthetic and antibiotic prophylaxis. The procedure was carried out under tourniquet control and fluoroscopy. Except for the polytrauma patient, all procedures were carried out within seventy two hours of the injury. All fractures were reduced closed and fixed percutaneously with either a semi tubular or DCP plate. The average tourniquet time was 50 minutes. A below knee plaster slab was used in the initial postoperative period and patients were mobilised non weight bearing in a below knee cast at forty eight hours.

Patients were followed up in the out patients at two weeks for suture removal and cast change. The average period of non weight bearing was ten weeks. There were no cases of wound infection and union was achieved in all cases with an average time to union of fourteen weeks.

After union, three patients underwent a further procedure to remove symptomatic metalwork.

On clinical review, all patients had an excellent range of knee and ankle motion. One patient with an associated subtalar dislocation developed marked stiffness at that joint.

Percutaneous plating is a quick and relatively easy way of achieving biological fixation of distal tibial fractures. In our study, there was a very low complication rate with predictable union and excellent functional results.