Minimally Invasive Percutaneous Plate Osteosynthesis Technique Research Articles

A Study of Minimally Invasive Percutaneous Plate Osteosynthesis with Locking Compression Plate for Distal Tibial Fractures

Introduction: Distal tibial fractures present a serious challenge, often requiring operative treatment but are very difficult to deal with. Fixation with locking compression plate (LCP) by minimally invasive percutaneous plate Osteosynthesis (MIPPO) technique has emerged as an alternative treatment option because it respects biology of distal tibia and fracture hematoma and also provides biomechanically sound fixation. The aim of this study was to find out the results of MIPPO with LCP for distal tibial fractures in our set up. Method: Twenty nine patients were treated by minimally invasive technique (MIPPO with LCP) for distal tibial fracture, only 24 patients were having proper follow-up. These 24 patients-(AO classification: 14 type A, 5 type B & 5 type C) were prospectively followed up. Twenty two male and two female patients with a mean age of 35 years were included. Results: In our study 17 (70.83%) patients had excellent results, 6(25%) patients had good results & 1(4.17 %) patient was having poor result. One patient had delayed union & required bone grafting. Malleolar skin irritation and pain due to prominent hardware was observed in two patients. One patient had hardware failure due to non-compliance. Another patient had infection in fibular fixation site that required hardware removal. Conclusion: The MIPPO technique for distal tibia has shown good results with many additional advantages over the conventional methods. It appears to be a reliable & effective method of stabilisation for these fractures. Rigid fixation allows the patient to be mobilized earlier & complications like displacement, contractures & stiffness can be avoided.

Is risk-free minimally invasive humeral shaft osteosynthesis possible? A cadaver study (technique and anatomy)

Purpose To determine the feasibility of using minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of humeral shaft fractures and analyze the anatomical relations of the different bodily structures with the fixation plate. Introduction Humeral shaft fractures account for 1.6% of all surgical fractures. Open reduction and compression plate fixation is a universally accepted method, but since it requires an extended dissection it could cause a lesion to the radial nerve. Another alternative is to use intramedullary nails, but the percentage of complications associated to them is similar. Materials and methods We conducted a study of 5 cadavers. At the proximal level, we carried out a deltopectoral mini approach; the distal incision was performed at about 5 centimeters proximally to the elbow flexure in the inferomedial region of the arm. Once the two mini approaches were completed, a blunt instrument was used to drive an anterior extraperiosteal sub-brachial tunnel on the anterior aspect of the humerus through which a 10-hole straight narrow plate was introduced from proximal to distal. Results Once the osteosynthesis was completed, we identified the relationship of the different anatomical structures with the plate, extending both incisions without finding any significant anatomical structure on the anterior aspect of the humerus that could be damaged. Conclusions Even if technically challenging, the MIPPO technique described herein is less invasive or traumatic than open reduction and plate fixation, and it is not associated with any special risks of injury to the radial or musculocutaneous nerves.

¿Es posible la osteosíntesis mínimamente invasiva de la diáfisis del húmero sin riesgos? Estudio en el cadáver (técnica y anatomía)

Purpose To determine the feasibility of using minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of humeral shaft fractures and analyze the anatomical relations of the different bodily structures with the fixation plate. Introduction Humeral shaft fractures account for 1.6% of all surgical fractures. Open reduction and compression plate fixation is a universally accepted method, but since it requires an extended dissection it could cause a lesion to the radial nerve. Another alternative is to use intramedullary nails, but the percentage of complications associated to them is similar. Materials and methods We conducted a study of 5 cadavers. At the proximal level, we carried out a deltopectoral mini approach; the distal incision was performed at about 5 centimeters proximally to the elbow flexure in the inferomedial region of the arm. Once the two mini approaches were completed, a blunt instrument was used to drive an anterior extraperiosteal subbrachial tunnel on the anterior aspect of the humerus through which a 10-hole straight narrow plate was introduced from proximal to distal. Results Once the osteosynthesis was completed, we identified the relationship of the different anatomical structures with the plate, extending both incisions without finding any significant anatomical structure on the anterior aspect of the humerus that could be damaged. Conclusions Even if technically challenging, the MIPPO technique described herein is less invasive or traumatic than open reduction and plate fixation, and it is not associated with any special risks of injury to the radial or musculocutaneous nerves.

Minimally invasive percutaneous plate osteosynthesis to fracutures of the proximal tibia

目的 探讨经皮微创钢板固定治疗胫骨近端骨折的临床疗效.方法 2001年2月至2004年2月,采用经皮微创钢板固定法治疗16例胫骨近端骨折.结果按Johner-Wruhs评价标准,优10例,良5例,中1例.1例出现浅表伤口感染,1例患者侧方成角10°.结论经皮微创钢板固定法手术创伤小,固定可靠。

MIPPO Technique using DCS in Comminuted Fracture of the Distal Femur

Purpose: To evaluate the advantages of transarticular reconstruction and fixation by MIPPO (Minimally Invasive Percutaneous Plate Osteosynthesis) using DCS in comminuted fractures of the distal femur. Materials and Methods: From February, 1998 to August, 2000, we experienced 23 cases of comminuted fractures of the distal femur, which were treated by MIPPO and lateral parapatellar arthrotomy in most cases. The follow up period was minimally 12 months. Clinical results were evaluated using Neer scores, radiographic results and the presence of clinical complications. Results: According to the Neer scores, 18 cases (78.3%) showed satisfactory results and 5 cases (21.7%) unsatisfactory results. The average period until radiographic union was 16 weeks (range 11-20 weeks). As for alignment measured using the tibiofemoral angle, 2 cases showed valgus deformity and no posterior angulation was present over . As for complications, 1 case showed a leg length discrepancy of 2 cm and 5 cases showed delayed union, which showed a gap radiographically between the bone fragment at the site of the fracture, and callus formation on ultrasound, but which did not need a bone graft. The radiographic union was achieved at the final follow-up. Conclusion: In the case of comminuted fractures of the distal femur, transarticular reconstruction and fixation by the MIPPO technique using DCS could reduce complications including non-union and infection.