Minimal invasive plate osteosynthesis (MIPO) in fracture femur

Abstract

Background The advantage of bridge plating in keeping the vascularity and the fracture healing promotes it to be widely used in comminuted fracture femur; the fracture site is not touched, the plate is inserted beneath the vastus lateralis from proximal and distal incisions away from the fracture itself, screws keep the alignment, and screws are limited only to the proximal and distal fragments. Longitudinal femoral fractures extending right to the trochanteric and or condylar areas are the main indication for minimally invasive plate fixations. Patient and methods This is a prospective study for minimal invasive plate osteosynthesis (MIPO) techniques in the treatment of the fractured femur. The study was carried out in Cairo University Hospitals from May 2009 to December 2014, on 60 patients, for an average follow-up of 3 years including 64% men (48 cases) and 36% women (22 cases), using both fixed angled plates (locked plates) in 34 cases (56%) and conventional dynamic compression plate (DCP) plates (nonlocked plates) in 26 cases (44%). Results Time taken for the union as shown by evidence of radiographic healing of the fracture was defined as the presence of callus around most of the fracture’s circumference. The fracture-healing process ranged from 9 to 40 weeks (median: 16 weeks). One (1.6%) patient suffered from malalignment in the form of varus deformity and two patients (3.3%) from malrotation within acceptable measures. None was the candidate for revision, two (3.3%) patients suffered from the shortening of insignificant value, eight cases (13.3%) suffered from the delayed union, four (6.7%) cases suffered from wound infection, and five (8.3%) cases suffered from decreased range of motion. Implant failure occurred in two cases and periprothetic fracture occurred in one case. Scoring of results according to Tegner and Lysholm was as follows: 27 cases (45%) with excellent outcome, 23 (38.3%) case with good results, 6 (10%) with fair outcome, and 4 (6.7%) with poor outcome. Conclusion The use of MIPO technique in fracture femur provides an easy, safe, and effective method of treatment especially in comminuted diaphyseal fracture with extension to the supracondylar or the subtrochanteric areas.