Minimally Invasive Plate Osteosynthesis Research Articles

Different effect of percutaneous plate insertion via anteromedial vs anterolateral approach on intracompartmental pressure of the leg: A cadaveric study

BackgroundCurrently Minimally Invasive Plate Osteosynthesis (MIPO) technique for tibial shaft fracture management has gained wide attention. However, an increased intracompartmental pressure after the plate insertion may result in postoperative acute compartment syndrome. We reported the difference of immediate effect of percutaneous plate insertion using 2 approaches of MIPO technique on anterior compartment pressure of the legs. Materials and methodsEight soft cadaveric legs (one female and three males) without previous history of skeletal trauma or surgery were infused with normal saline to create the sustained intracompartmental pressure of 20mm Hg in all four compartments. The Synthes® 4.5mm 11-hole Narrow Locking Compression Plate was inserted via anteromedial and anterolateral approach. Anterior compartment pressure was measured by portable digital monitoring device through side-port needle (Stryker® Intracompartmental Monitoring Device) before and after plate insertion for each approach. ResultsBy using anteromedial approach, a mean of anterior compartment pressure was increased by 0.375mm Hg after plate insertion (5 of 8 legs had no change in pressure and the remaining 3 resulted in 1mm Hg pressure elevation). For anterolateral plate insertion, all of the 8 legs had an elevation of anterior compartment pressure with a mean of 3.5mmHg (ranged from 2 to 6mm Hg). ConclusionsWhen both approaches were compared to each other, the anterolateral plate insertion resulted in higher intracompartmental pressure elevation of the anterior compartment than the anteromedial approach. Surgeon should be more aware of acute compartment syndrome when considering the anterolateral approach in treating close tibial fracture. However, in patients with suspected acute compartment syndrome, close observation and continuous monitoring of the intracompartmental pressure is still imperative for all healthcare provider.

Effectiveness of Minimally Invasive Plate Osteosynthesis (MIPO) on Comminuted Tibial or Femoral Fractures.

Comminuted fractures happen frequently due to traumas. Fixation without opening the fracture site, known as minimally invasive plate osteosynthesis (MIPO), has recently become prevalent. This study has been designed to assess the outcomes of this treatment for tibial and femoral comminuted fractures. A total of 60 patients with comminuted femoral or tibial fractures were operated with MIPO method in this cross-sectional study at Alzahra university hospital in 2015. Eleven patients were excluded due to lack of adequate follow-ups. Patients'data including union time; infection in the fractured site; hip and knee range of motion; and any malunion or deformities like limb length discrepancy were collected after the surgery in every session. Among 32 femoral and 17 tibial fractures, union was completed in48 patients, while only one patient with femoral fracture had nonunion. The mean union time was 18.57±2.42 weeks. Femur fractures healed faster than tibia (17.76±2.36 compared to 19±2.37 weeks, respectively, P=0.09). None of the patients suffered from infections or fistula. The range of motion in hip and knee remained intact in approximately all patients. Malunion happened in 3 patients; 100 internal rotation in 1 patient; and 1cm limb shortening in 2 patients. According to the result of this study, MIPO is a simple and effective method of fixation with a high rate of union as well as minimal complications for comminuted fractures of long bones. Infection is rare, and malunion or any deformity is infrequent. MIPO appears to be a promising and safe treatment alternative for comminuted fractures.

Treatment of 5th Metatarsal Shaft Fracture using MIPO (Minimally Invasive Plate Osteosynthesis) Technique

Category: Lesser Toes, Trauma Introduction/Purpose: The standard treatment of 5th metatarsal shaft fracture is still not determined yet. Conservative treatment using cast immobilization can be applied for shaft fractures without displacement, but there are reports that open reduction is indicated for displacement more than 3 mm, rotational displacement, and angular displacement more than 30 degrees. In this study, we report the result of 5th metatarsal shaft fracture using MIPO technique, which can shorten recovery period by reducing soft tissue damage with minimal incision. Methods: This study consists of 25 patients who had undergone surgery for displaced 5th metatarsal shaft fracture from March 2013 to December 2015; 8 males and 17 females. Mean age at the time of surgery was 47.4(29~69) and mean follow period was 15.0(8~25) months. 11 cases were simple oblique fracture and 14 cases were comminuted fracture with fracture fragments. Mean fracture gap was 4.4(3.1~7.6)mm. MIPO technique with LCP Compact Hand Locking Condylar Plate 2.0(Depuy-Synthes, Zuchwil, Switzerland) was used for all cases. Partial weight bearing was allowed until 4th week post-op, then full weight bearing was allowed until 6th week post-op. Clinical and radiological follow-up was made at post-op week 2, 6, 12, 24. Clinical results were obtained using Visual Analogue Scale(VAS) and American Orthopedic Foot and Ankle Society(AOFAS) score. Results: VAS of 24 weeks post-op was decreased from 5.6 ± 0.8 (4~7) preoperatively to 1.2 ± 1.3 (0~4), and AOFAS score of 24 weeks post-op was increased from 42.0 ± 12.8 (24~54) preoperatively to 86.4 ± 7.7 (74~95), both showed significant difference. Anatomic reduction and complete bone union was noted in all cases. Mean union period obtained from follow-up radiograph was 6.0 week post-op. For 15 cases, plate removal was performed at 9.5(7~25) months post-op. Conclusion: Plate fixation can be the preferred option for 5th metatarsal shaft fracture, because 5th metatarsal shaft is surgically easily accessible and more stable fixation can be applied. Since it results complete bone union without any complications and enables early weight bearing, MIPO techinque for displaced 5th metatarsal shaft fracture can be considered as useful surgery technique.

Treatment of 5th metatarsal shaft fracture using MIPO (Minimally Invasive Plate Osteosynthesis)

Treatment of 5th metatarsal shaft fracture using MIPO (Minimally Invasive Plate Osteosynthesis)

Minimally invasive plate osteosynthesis of lower end of femur fractures using locking compression plating: a prospective study

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The treatment of distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Pre-contoured Locking compression plates (LCPs) have shown to give best results in terms of recovery, fracture union, return to work and functional outcome. Advent of MIPO technique has reduced the amount of soft tissue injury, delayed healing, tissue necrosis and infections.</span>The objective was <span lang="EN-IN">to study the functional result of fracture distal femur treated by closed reduction with LCP by minimally invasive plate osteosynthesis (MIPO).</span></p><p class="abstract"><strong>Methods:</strong> 20 cases of fracture distal end of femur were treated by closed reduction and internal fixation using LCP by MIPO between 1st October 2013 to 30th September 2015 at our centre. The patients were evaluated clinically and radiologically for functional outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’s score.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">8 of my patients were male and 12 were female. All of them were closed injuries and fresh cases. The mean age was 51.8 years (21-68 yrs). 13 patients sustained RTA and 7 patients had accidental fall. 8 patients had right sided distal femur fracture and 12 had left sided injury. According to NEER’s score 50% had excellent results, 35% had good results and 15% had fair results. Gait and weight bearing after union was satisfactory. Range of motion of knee joint in majority of patients was within acceptable limits. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Closed reduction and internal fixation of fracture lower end of femur by MIPO using LCP is one of the best modalities of treatment for good results.</span></p>

Minimally Invasive Plate Osteosynthesis Using Locking Plates for AO 43-Type Fractures: Lessons Learnt From a Prospective Study.

Managing fractures of distal tibia is still a subject of debate for orthopaedic surgeons in terms of both, reduction and fixation. Subcutaneous location and soft tissue anatomy predisposes it to angular and rotational instability as well as other bony and soft tissue complexities. Minimally invasive plating offers many advantages over conventional open techniques. It causes minimal soft tissue dissection and surgical trauma to the bone. Minimally invasive plate osteosynthesis(MIPO) maintains biological configuration of distal tibia and fracture hematoma and also provides a construct, which is biomechanically more stable. Evaluation of results of MIPO in management of distal tibia fractures considering radiological union, ankle function restoration, and complications. In our study, 25 closed distal one-third tibia fracture with/without articular extension were taken, fulfilling the inclusion criteria (AO classification: 10, 43A1; 3, 43A2; 2, 43B1; 4, 43B2; and 6, 43C1). MIPO with locking plates was the treatment undertaken. Patients were followed up for 18 months prospectively. Average injury-hospital interval was 11.16 hours and average injury-operation interval was 2.44 days. All fractures showed radiological union at an average duration of 20.5 weeks (14-28 weeks). Olerud and Molander score was used for evaluation at 3, 6, and 18 months. One patient had union with valgus angulation >5° but there was no nonunion. There was 1 superficial postoperative wound infection. Our study shows that plating with MIPO is an effective treatment for closed distal one-third tibia fractures, considering union time and complications rate. Younger age promotes early union and functional recovery. Therapeutic, Level II: Prospective.

Interventions for humeral shaft fractures: mixed treatment comparisons of clinical trials.

Nowadays, five main therapeutic options are used in treating humeral shaft fractures: external fixation, open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), dynamic compression plate (DCP), and intramedullary nail (IMN). Aiming to provide reliable evidence for clinical selection, we designed a network meta-analysis (NMA) to evaluate the efficacy of these treatments. NMA was conducted on Bayesian framework with software R 3.3.2 and STATA 13.0. Nonunion rate, radial nerve palsy rate, union time, complication rate, and infection rate were considered as primary outcomes. Mean operation time was the secondary outcome. The outcomes were measured by odds ratio (OR) value and corresponding 95% credible intervals (CrIs) or mean difference (MD) with 95% CrIs. Surface under cumulative ranking curve (SUCRA) was calculated to show the ranking probability of each treatment. Our results indicated that ORPO had a higher risk of radial nerve palsy than MIPO (OR=2.83, 95% CrIs=1.28-6.23), and DCP had a better performance in preventing complications than IMN (OR=0.31, 95% CrIs=0.11-0.84); no other significant difference were observed. According to the SUCRA results, MIPO had a high-ranking probability in almost all outcomes, while external fixation had lowest values in the majority of outcomes. We recommended MIPO as the optimal treatment for humeral shaft fractures after taking all outcomes into consideration; IMN was also recommended for its relatively good performance, but its complication still needed to be noticed.

Comparison between antegrade intramedullary nailing (IMN), open reduction plate osteosynthesis (ORPO) and minimally invasive plate osteosynthesis (MIPO) in treatment of humerus diaphyseal fractures

IntroductionThe three currently used methods of treatment: namely open reduction plate osteosynthesis (ORPO), Minimally invasive plate osteosynthesis (MIPO), antegrade intramedullary nailing(IMN) are all reported as satisfactory procedures for treatment of humeral shaft fractures. However none of the published reports have a comparison of superiority of one procedure over the other. We evaluated the clinical, radiological and functional outcome of the three procedures. Materials and methodsWe studied adult patients with humerus shaft fractures over a period of 2 years from May 2014 to May 2016 in a level 1 trauma center. Forty-four were treated with IMN, 34 treated with ORPO, and 34 with MIPO. The null hypothesis tested in this study is that there is no difference between IMN, ORPO, MIPO with respect to union time, surgical time, complication rate, non-union rate and functional outcome. Functional outcome was studied by comparing the UCLA shoulder and MEP scores in the three groups. Results112 patients were studied consisting of 83 males and 29 females with mean age of 39 years (range 18-70). IMN group showed early union with mean of 12.73 weeks compared to MIPO (14.45 weeks) and ORPO(13.58 weeks), (p<0.05). MIPO had no events of non-union, as compared to ORPO (5 non-unions) and IMN (10 non-unions), (p=0.04).The range of movement at the shoulder with the UCLA score was significantly better with a score of 32.26 in MIPO as compared to 27.54 in IMN and 28.82 in ORPO (p<0.05). The difference in MEPS score in the three groups was not significant (p=0.31). IMN required a mean of 117.95 minutes intraoperatively as compared to 131 and 150.58 mins in MIPO, ORPO respectively. ConclusionMIPO is overall better with respect to non-union, functional outcome and complications rate. The surgical time depends on the surgeons’ skill and learning curve. Thus considering the advantages and risks involved in the various procedure and surgical acumen, each case should be individualized to have a good outcome. We advocate that MIPO can be safely used as an alternative in treating these fractures.

Treatment of periprosthetic femoral fractures following hip arthroplasty utilizing locking compression plates

Objective To evaluate the clinical outcomes of periprosthetic femoral fractures (PFF) following hip arthroplasty utilizing locking compression plates (LCP) in regard to tips and tricks on the construction of LCP augmented with locking attachment plate (LAP) and titanium cables (TC). Methods A total of 41 cases of PFF follow hip arthroplasty (THA 3, Hemi-arthroplasty 2) between May 2008 to April 2016 have been retrospectively analyzed. There were 13 males and 28 females with an average age of 70.5±8.6 years, including 11 case of Unified Classification System (UCS) type IV.3B1.1, 21 cases of B2.1 and 9 cases of type C. All were closed fractures caused by simple fall in terms of low-energy injury. Surgical options depended on individual configuration of the fractures with the combination of LCP and LAP or TC. In respect of reduction techniques, minimally invasive plate osteosynthesis (MIPO) was used in 5 cases for type B1.1 and 8 cases for type C, Mini-open in 6 cases for type B1.1 and 1 case for type C. Posterolateral approach with open reduction internal fixation were selected for type B2.1. The patients were followed up periodically. Harris score, Mukundan criteria and complications were recorded. Results Five cases died of the comorbidities (heart failure 3, pulmonary infection 1, multiple organs failure 1) within 1 year postoperatively. The follow-up rate was 78.0% (32 out of 41 cases) and the average follow-up time was 41 months (ranging 11 to 71 months). No malunion, no reduction lost, no hardware failure, no hip dislocation and revision surgery following PFF care found. All cases showed the signs of fracture healing from 8 to 12 (average 10 weeks) postoperatively except 2 cases of delay union. The postoperative complications shown in 11 cases, including 2 cases of superficial infection of the wound, 6 cases of deep vein thrombosis (popliteal vein 2, intramural gastrocnemius vein 4) and 3 cases of the prosthetic loosening. Harris score at the latest follow-up were 91.5±2.1 for group B1.1, 77.5±4.2 for group B2.1 and 83.5±3.8 for group C. The LCP lengths were 248.9±24.3 mm, 258.6±25.2 mm, 280.4±24.0 mm for group B1.1, B2.1 and C respectively. The LCP length of group B1.1 was short than that of group C (P 0.05). Conclusion Utilizing LCP for PFF following hip arthroplasty can achieve satisfactory short and mid-term clinical outcomes with the prerequisites of precise and individualized preoperative planning. LCP augmented by LAP and TC is a reliable option with low complication rate. However, type C PFF needs longer plate with more screws at distal fragment and more titanium cables. Key words: Femur; Periprosthetic fractures; Arthroplasty, replacement, hip; Fracture fixation, internal

Clavicle reductor homeopathic traction and minimally invasive plate osteosynthesis for treatment of displaced midshaft clavicular fractures

Objective To investigate the effect of displaced midshaft clavicular fractures treated by clavicle reductor homeopathic traction and minimally invasive plate osteosynthesis (MIPO). Methods A prospective case control study was made on 84 cases of unilateral displaced midshaft clavicular fractures admitted from January 2014 to June 2014. According to the random number table, the patients were allocated to experiment group (43 cases) and control group (41 cases). Subjects in experiment group were treated by homeopathic traction using the self-designed clavicle reductor and MIPO, including 36 male and seven female cases aged 32(24.0, 47.0) years. In contrast, control group were treated by traditional open reduction and internal fixation, including 37 male and four female cases aged 32(26.0, 44. 5)years. According to the OTA classification, 22 cases were type 15-B1, 13 type 15-B2 and eight type 15-B3 in experiment group, while 22 type 15-B1, 12 type 15-B2 and seven 15-B3 in control group. Operation duration, fluoroscopy time, complications and bone healing was recorded. Constant-Murley score was employed to test the functional outcomes. Results Operation duration was 45(36.0, 54.0)min in experiment group and 49 (40.0, 67.5)min in control group (P 0.05). Conclusion MIPO technique assisted with clavicle reductor homeopathic traction in treatment of displaced midshaft clavicular fractures has similar efficacy with the traditional open reduction and internal fixation, but the former technique is associated with relatively shorter operation time and smaller wound. Key words: Clavicle; Fractures, bone; Surgical procedures, minimally invasive

Effectiveness of sonography assisted minimal invasive plate osteosynthesis (MIPO) compare with fluoroscope assisted in femoral shaft fracture: A cadaveric study

IntroductionA minimal invasive plate osteosynthesis (MIPO) has an advantage of biological soft tissue preservation that consists of preserving bony blood supply, fracture hematoma and less soft tissue damage which leads to decreasing of infection rate and rapid bone healing. However, the radiation exposure is still a disadvantage of this technique. A sonography that provides dynamic real time imaging may be used as an alternative technique for assisting MIPO. The aim of this study was to compare the effectiveness of MIPO in femoral shaft fracture between the sonography assisted and the fluoroscopy assisted. MethodsTwenty-eight cadaveric limbs were subjected to create femoral shaft fracture. Then, sonography assisted reduction with temporary external fixation and MIPO were performed. Images of the sonography and the fluoroscopy were recorded including before reduction, after reduction and after MIPO in order to identify fracture displacements in anteroposterior and mediolateral directions. Moreover, the anterior and posterior distances from edge of the bone to the plate were measured to confirm plate position. The effectiveness of this technique was defined as the proper plate position and acceptable alignment after fixation. All distances from the sonography and the fluoroscopy were also analyzed and compared using Pearson correlation and Bland-Altman method to assess the agreements between two tests. ResultAll of the subjects were met the criteria for acceptable alignment. We found only three femoral shaft fracture (11%) operated with MIPO by sonography assisted that showed slipped plate off femoral bones. According to Pearson correlation, there were good to excellent agreements in term of measuring fracture displacement before (Pearson Correlation >0.7) and after reduction (Pearson Correlation >0.7) between these two tests. There was moderate agreement regarding to evaluation of plate position (Pearson Correlation 03.–0.7). When we compared two methods of measurement using Bland-Altman plot, there were no statistical significant difference (P<0.05). ConclusionImages from the sonography could provide visualization of the fracture during reduction and MIPO as accurately as the radiography. Thus, the sonography assisted MIPO in femoral shaft fracture can be done effectively comparing with radiographic assisted.

Soft tissue complications in distal tibial fractures managed with medial locking plates: A myth or reality?

BackgroundDistal tibial fractures are common injuries that are prone to complications and require careful management. The use of medial periarticular locking plates is an established modality in the treatment if these fractures. These plates are inserted using the minimally invasive plate osteosynthesis (MIPO) or open technique. Our study looks at the soft tissue complications associated with the use of medial locking plates in the management of these fractures. MethodsThis was a retrospective study carried out at a tertiary care university hospital in an urban setting. Forty four patients with distal tibia fractures treated with periarticular locking plates during a three year period were included in the study. Both closed and open fractures were included while those with an established non-union were excluded. Patient data related to inpatient stay, outpatient visits as well as readmissions was extracted from hospital records and analysed. Spanning external fixation was done if necessary and definitive fixation was done using medial locking plates with either MIPO technique or open reduction and internal fixation (ORIF) with biological technique. The sub cohort of patients with soft tissue complications was compared to the parent group. ResultsThe study group included 44 patients (28M:16F) with 45 fractures with a median age of 42.6 years (range 18–65 years) followed up for a mean of 9.2 months (range 5–20 months). Domestic falls were the cause of injury in 61.4% (n=27) of the fractures. The average time to union was 26.2 weeks (range 12–66 weeks). Out of these 45 fractures, soft tissue complications were seen in 22.2% of cases (n=10) with road side accidents seen in 60% (n=6) of cases. In four patients, there was difficulty in achieving primary wound closure and in five other cases wound dehiscence with exposure of implant was seen within 12 to 30 days of surgery. One patient required secondary suturing after readjustment for malreduction. No statistically significant difference was found in the parent cohort and the sub cohort with soft tissue complications with respect to the use of spanning external fixator, MIPO/ORIF technique or fibular fixation. ConclusionThe incidence of soft tissue complications with the use of medial locking plates in distal tibial fractures may be more than what is currently reported in literature and further studies are required to shed more light on this subject.

Outcome of minimally invasive plate osteosynthesis (MIPO) technique in distal tibial fracture

Background: Distal tibial fractures including tibial pilon present a challenge due to subcutaneous location of tibia and precarious blood supply of distal leg. MIPO (Minimal invasive plating osteosynthesis) has evolved as a newer concept to treat distal tibial fractures with minimal articular comminution and minimal soft tissue damage Method: A prospective study for the management of distal tibial fractures by MIPO technique by using LCP (locking compression plate) was done, in 20 patients. Patients were followed and scored according to TEENY and WISS scoring criteria. Result: Among 20 patients, there were 16 males and 4 females with a mean age of 41.4 yrs (range from 20-76yrs). High energy trauma (road traffic accident) predominated causing 11 fractures. Superficial wound infections were seen in 02 cases, surgical wound breakdown with implant exposure in 01 case. 15 patients had excellent, 3 patients had good outcome and 02 patients had fair outcome. Conclusion: We conclude that MIPO is an effective technique for the management of distal tibial fractures.

Study of results of “operative management of intra-articular fractures of upper end tibia”

Intra- Articular Fracture of upper end of Tibia occurring with increased frequency because of high velocity injuries as a result of growth of no. of vehicles & increased speed on expressways. Management of such high velocity trauma to joint is still a challenge to Orthopaedic surgeons. This study carried out to analyze various Operative methods of treatment of tibial plateau fractures. This is a prospective study of 22 cases of Tibial Plateau fractures treated operatively. Patients were followed from 6 months to 2 years. All fractures were classified with Schatzgar classification and treated with various operative methods like close reduction & percutaneous fixation, Open reduction & Internal Fixation (ORIF) or Minimally Invasive Plate Osteosynthesis (MIPO). All patients were assessed with Lansinger Criteria. Results suggests of operative treatment in displaced fractures of Tibial Plateau. Aim is Anatomical reduction, stable fixation & soft tissue preservation. MIPO technique is favored in fractures where closed reduction method achieves near anatomical reduction of fracture fragments. Open reduction is preferred in displaced and depressed Tibia Plateau fractures.

Application of Minimally Invasive Plate Osteosynthesis to Tibial Shaft Fractures in Dogs

The objective of this study was to evaluate the effectiveness of the minimally invasive plate osteosynthesis (MIPO) method for treatment of tibial shaft fractures in dogs by comparing MIPO radiographic and fracture healing time results with those from the popular open reduction and internal fixation (ORIF) technique. In this clinical study at the Royal Animal Medical Center, five consecutive dogs with diagnoses of comminuted tibial shaft fractures were treated with the MIPO surgical approach. For comparison, an additional five breed-, age-, and weight-matched dogs with comminuted tibial shaft fractures were treated with the ORIF technique. Mean healing time was 75.6 ± 12.5 days in the MIPO group and 131.8 ± 18.6 days in the ORIF group (p < 0.01). The mean surgery time in the MIPO group (36.4 ± 3.5 minutes) was significantly shorter (p < 0.01) than that for the ORIF group (47.0 ± 2.2 minutes). Based on the short surgical and healing times, the MIPO approach is clinically superior to the ORIF approach and should be the preferred approach in tibial fracture cases.

Biomechanical assessment and 3D finite element analysis of the treatment of tibial fractures using minimally invasive percutaneous plates.

The aim of the present study was to investigate the biomechanical effects of varying the length of a limited contact-dynamic compression plate (LC-DCP) and the number and position of screws on middle tibial fractures, and to provide biomechanical evidence regarding minimally invasive plate osteosynthesis (MIPO). For biomechanical testing, 60 tibias from cadavers (age at mortality, 20-40 years) were used to create middle and diagonal fracture models without defects. Tibias were randomly grouped and analyzed by biomechanic and three-dimensional (3D) finite element analysis. The differences among LC-DCPs of different lengths (6-, 10- and 14-hole) with 6 screws, 14-hole LC-DCPs with different numbers of screws (6, 10 and 14), and 14-hole LC-DCPs with 6 screws at different positions with regard to mechanical characteristics, including compressing, torsion and bending, were examined. The 6-hole LC-DCP had greater vertical compression strain compared with the 10- and 14-hole LC-DCPs (P<0.01), and the 14-hole LC-DCP had greater lateral strain than the 6- and 10-hole LC-DCPs (P<0.01). Furthermore, significant differences in torque were observed among the LC-DPs of different lengths (P<0.01). For 14-hole LC-DCPs with different numbers of screws, no significant differences in vertical strain, lateral strain or torque were detected (P>0.05). However, plates with 14 screws had greater vertical strain compared with those fixed with 6 or 10 screws (P<0.01). For 4-hole LC-DCPs with screws at different positions, vertical compression strain values were lowest for plates with screws at positions 1, 4, 7, 8, 11 and 14 (P<0.01). The lateral strain values and vertical strain values for plates with screws at positions 1, 3, 6, 9, 12 and 14 were significantly lower compared with those at the other positions (P<0.01), and torque values were also low. Thus, the 14-hole LC-DCP was the most stable against vertical compression, torsion and bending, and the 6-hole LC-DCP was the least stable. However, the use of 14 screws with a 14-hole LC-DCP provided less stability against bending than did 6 or 10 screws. Furthermore, fixation with distributed screws, in which some screws were close to the fracture line, provided good stability against compression and torsion, while fixation with screws at the ends of the LC-DCP provided poor stability against bending, compressing and torsion.

Antero-lateral minimally invasive plate osteosynthesis (MIPO) with the radial nerve exploration for extra-articular distal-third diaphyseal fractures of the humerus.

Traditional open reduction and internal fixation (ORIF) of extra-articular distal humerus fractures has a risk of iatrogenic radial nerve injury, extensive soft tissue stripping, and long incision scar. We performed an antero-lateral minimally invasive plate osteosynthesis (MIPO) technique with the radial nerve exploration for distal-third diaphyseal fractures of the humerus and evaluated clinical and radiographic outcomes through this respective study. From April 2010 to June 2016, 28 cases of extra-articular distal-third diaphyseal fractures were treated with an antero-lateral MIPO procedure. Patient demographics, Disabilities of the Arm, Shoulder and Hand (DASH) Score, Mayo Elbow Performance (MEP) Score, elbow range of motion, scars and post-operative complications were recorded and analyzed. All fractures were united with a mean time of 3.5months. One patient exhibited delayed union (3.6%). The mean DASH Score was 6.6, and all patients had excellent or good MEP Score values. The average scar length was 6.8cm, and the shortest was 4.5cm. The MIPO technique via an antero-lateral approach for extra-articular distal-third diaphyseal fractures of the humerus results in satisfactory clinical outcomes. Level IV, case series, treatment study.

A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures.

Background:Extraarticular distal tibial fractures are among the most challenging fractures encountered by an orthopedician for treatment because of its subcutaneous location, poor blood supply and decreased muscular cover anteriorly, complications such as delayed union, nonunion, wound infection, and wound dehiscence are often seen as a great challenge to the surgeon. Minimally invasive plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMLN) are two well-accepted and effective methods, but each has been historically related to complications. This study compares clinical and radiological outcome in extraarticular distal tibia fractures treated by intramedullary interlocking nail (IMLN) and minimally invasive plate osteosynthesis (MIPO).Materials and Methods:42 patients included in this study, 21 underwent IMLN and 21 were treated with MIPO who met the inclusion criteria and operated between June 2014 and May 2015. Patients were followed up for clinical and radiological evaluation.Results:In IMLN group, average union time was 18.26 weeks compared to 21.70 weeks in plating group which was significant (P < 0.0001). Average time required for partial and full weight bearing in the nailing group was 4.95 weeks and 10.09 weeks respectively which was significantly less (P < 0.0001) as compared to 6.90 weeks and 13.38 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness, and infection, were seen in interlocking group as compared to plating group. Average functional outcome according to American Orthopedic Foot and Ankle Society score was measured which came out to be 96.67.Conclusion:IMLN group was associated with lesser duration of surgery, earlier weight bearing and union rate, lesser incidence of infection and implant irritation which makes it a preferable choice for fixation of extra-articular distal tibial fractures. However, larger randomized controlled trials are required for confirming the results.

МАЛОИНВАЗИВНЫЙ НАКОСТНЫЙ ОСТЕОСИНТЕЗ ДИСТАЛЬНОГО МЕТАЭПИФИЗА ЛУЧЕВОЙ КОСТИ: ПОКАЗАНИЯ К ПРИМЕНЕНИЮ И ОСОБЕННОСТИ МЕТОДИКИ

МАЛОИНВАЗИВНЫЙ НАКОСТНЫЙ ОСТЕОСИНТЕЗ ДИСТАЛЬНОГО МЕТАЭПИФИЗА ЛУЧЕВОЙ КОСТИ: ПОКАЗАНИЯ К ПРИМЕНЕНИЮ И ОСОБЕННОСТИ МЕТОДИКИ

Minimal invasive percutaneous plate osteosynthesis (MIPPO) through deltoid-pectoralis approach for the treatment of elderly proximal humeral fractures

BackgroundCurrent treatments for proximal humeral fractures include conservative treatment, conventional open reduction internal fixation (ORIF) and MIPPO through deltoid-splitting approach. The aim of this study was to evaluate the clinical outcome of MIPPO versus ORIF via the deltoid-pectoralis approach in elderly patients with proximal humeral fractures.MethodsThirty-six patients with proximal humeral fractures were enrolled in this study. Following the randomized block and single-blinded principle, the patients were assigned to two groups and treated with either conventional ORIF or MIPPO, both through the deltoid-pectoralis approach. Surgical outcomes were evaluated by the NEER score, Constant-Murley score, blood loss, length of operation, radiological imaging and clinical examination. The patients were followed up for 4–24 (mean 10) months.ResultsAccording to Constant-Murley score, the surgical outcome was excellent in 14 cases, satisfactory in 2 cases and unsatisfactory in one case in MIPPO group versus 10, 5 and 4 in conventional ORIF group. MIPPO was significantly advantageous over conventional ORIF in terms of NEER score, Constant-Murley, length of operation and intraoperative blood loss. In addition, MIPPO was also more advantageous in several indexes in patients with BMI > 26.0 and NEER type III fracture.ConclusionThe results of our study have demonstrated that MIPPO through the deltoid-pectoralis approach is an effective alternative for the treatment of proximal humeral fractures in elderly patients.Trial registrationThe trial registration number (TRN): ChiCTR-INR-17011098 (retrospectively registered at 2017-04-09)