Minimally Invasive Percutaneous Plate Osteosynthesis Research Articles

3D printing assisted MIPO for treatment of complex middle-proximal humeral shaft fractures

BackgroundThis study was designed to explore the clinical efficacy of 3-dimensional (3D) printing assisted minimally invasive percutaneous plate osteosynthesis (MIPO) technique by comparing the clinical outcomes with traditional open reduction and internal plating fixation (ORIF) for treating complex middle-proximal humerus fractures (AO 12C fracture type).Materials and methodsThe data of 42 participants who received a complicated middle-proximal humerus fracture from the beginning of 2018 to the end of 2022 were retrospectively analyzed. All patients were assigned to two groups: MIPO with detailed preoperative planning assisted by 3D printing technique (MIPO group), and traditional ORIF (ORIF group).ResultsThis study included 21 patients in the ORIF group and 21 patients in the MIPO group. All patients were followed-up for at least one year (mean: 16.12 ± 4.13 months), and no difference was observed in the range of shoulder joint motion (ROM), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores and Constant scores between the two groups. However, the occurrence of complications (surgical incision site infection, implant loosening, bone nonunion and radial nerve palsy) in ORIF group was remarkably higher compared to the MIPO group. All the cases achieved bone union within the MIPO group. Significant differences were found in surgical time, intraoperative blood loss and fracture healing time between the two groups.ConclusionPreoperative 3D printing assisted MIPO technique exhibits obvious advantages in high operational efficiency and low occurrence of complications, which is worthy of clinical application for treating complex middle-proximal humeral shaft fractures.

A novel technology integrating robotics and 3D printing for closed reduction of tibia shaft fracture with MIPPO:A proof-of-concept study

Less invasive fixation techniques, such as intramedullary nailing (IMN) and minimally invasive percutaneous plate osteosynthesis (MIPPO), are now the preferred choices for treating tibia shaft fractures (TSFs). However, malreduction and radiation exposure are the main deficiencies associated with less invasive fixation techniques, especially when assessing rotation around the shaft axis intra-operatively. The purpose of this study was to investigate the feasibility and reduction accuracy of an innovative technology that integrates robotics and 3D printing for achieving anatomical reduction of TSFs with MIPPO. The surgical workflow from a standardized CT protocol, via 3D reconstruction, 3D printing tibia model, pre-contouring plate, 3D scanning plate, 3D planning of the trajectories of the robot, and use of a commercial surgical robot, robot-assisted screw hole drilling, to automatic fracture reduction through precise installation of the plate was described. The reduction accuracy was evaluated by an optical tracking system. The mean variations of 1.95 ± 1.36mm in length, 1.63 ± 0.92 mm in apposition, 2.78 ± 1.69° in alignment, and 1.99 ± 1.81° in rotation. The interoperator reliabilities were almost perfect, with values of 0.91, 0.93, 0.92, and 0.90, respectively. The proposed technology achieved anatomic reduction on phantom bones.

Comparing Minimally Invasive Percutaneous Plate Osteosynthesis With Interlocking Intramedullary Nail Fixation for the Management of Adult Extra-Articular Distal Tibial Fractures: A Comprehensive Systematic Review and Meta-Analysis.

Intramedullary nailing (IMN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) fixation are both viable approaches for managing distal tibia fractures. IM nailing offers advantages in terms of shorter operation time, faster union, and reduced infection rates, yet it may lead to alignment issues and residual knee pain. Conversely, MIPPO fixation provides better alignment and minimizes knee discomfort but comes with a higher risk of soft-tissue complications and hardware irritation. Notably, this review reveals that MIPPO is associated with a greater risk of both superficial (15% vs. 7% for IMN) and deep infections (14% vs. 6.3% for IMN). This study aims to comprehensively assess the optimal surgical approaches for distal tibia fractures by comparing clinical and functional outcomes between MIPPOand interlocking IMNtechniques in treating extra-articular distal tibial fractures. Key outcome parameters include operation duration, union time, non-union occurrence, malunion cases, infection rates, secondary surgical interventions, and functional results, as indicated by quality of life and ankle scores. Regarding union complications, it is notable that IMN demonstrates a higher incidence of malunion, affecting 14.7% of patients compared to 8.8% in the MIPPO fixation group. Interestingly, both treatment methods exhibit a similar incidence of non-union, occurring in 3.5% of patients in both groups. Furthermore, when assessing the union time, IMN fixation notably achieves significantly shorter union times, especially evident in AO 43A fracture types and closed fractures. The mean time for union is 18 weeks with IMN compared to 20 weeks with MIPPO fixation. In our analysis of nine studies involving 813 patients, the reported operation times revealed an overall weighted mean operation time of 74.1 minutes (ranging from 56.4 to 124 minutes) for IMN and 85.4 minutes (ranging from 51.4 to 124 minutes) for MIPPO fixation. Notably, the operation time for IMN was significantly shorter compared to MIPPO, showing a weighted mean difference (WMD) of -11.24 minutes, with a 95% confidence interval (CI) ranging from -15.44 to -7.05 (P<0.05). This difference exhibited significant moderate heterogeneity (I2 = 68%). In light of this comprehensive study, both MIPPO and IMN emerge as equally effective therapeutic options for addressing functional outcomes in distal tibial extra-articular fractures. While IMN offers several advantages, including lower infection rates, reduced implant irritation, shorter operation time, and earlier weight-bearing and union, it is associated with a heightened risk of malunion and anterior knee pain. Consequently, the choice of implant should be tailored on a case-by-case basis. Patients at elevated infection risk, stemming from factors, such as advanced age, comorbidities, smoking, or severe soft tissue injuries, are better suited for nail treatment. Conversely, MIPPO fixation may present a more advantageous choice for young, active, and healthy patients, given its ability to mitigate the risk of knee pain and malunion.

Comparative Study of Intramedullary Interlocking Nailing and Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibia Extra-Articular Fractures

Management of distal tibial extra-articular fractures presents a significant challenge in orthopedic practice due to their complex anatomical features and variable fracture patterns. Surgical intervention plays a crucial role in achieving stable fixation and optimal functional outcomes. This study aimed to compare the effectiveness between minimally invasive percutaneous plate osteosynthesis and intramedullary nailing for the management of distal tibial extra-articular fractures. This was a prospective observational study that was conducted in the Department of Orthopedics, Bangabandhu Sheikh Mujib Medical College, Hospital (BSMMCH), Faridpur, Bangladesh from January 2021 to December 2022. Total 24 patients having a fracture of the distal third of the tibia were enrolled in this study as the study subjects. Total patients were divided into two groups. In group A, 12 patients underwent minimally invasive percutaneous plate osteosynthesis (MIPPO) and in group B, 12 patients underwent intramedullary nailing (IMN). A random selection method was used in sample selection. According to Olerud Molander’s score, Excellent, Good and Fair results were found in 50%, 50%, and 0% of the group A patients respectively. On the other hand, those results were found in 42%, 50% and 8% of group B patients respectively. Although both minimally invasive percutaneous plate osteosynthesis and intramedullary nailing procedures are effective in managing distal tibial extra-articular fractures, considering excellent union rate, low blood loss and remarkable Olerud Molander’s score, MIPPO may be considered as the better option. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(2):92-96.

Comparison of clinical efficacy between closed reduction combined with semi-circular external fixator and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of middle and distal tibia fractures

To compare the clinical efficacy between closed reduction combined with semi-circular external fixator and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of middle anddistal tibia fractures. The clinical data of sixty patients with middle and distal tibia fractures admitted between January 2019 and November 2022, were retrospectively analyzed. These patients were categorized into external fixation group (n=30) and internal fixation group (n=30). There were 18 males and 12 females in the external fixation group, with an average age of (49.29±2.35) years old. Among them, 14 patients presented with fractures on the left side, and 16 patients presented with fractures on the right side. Closed reduction, arched wire, and semi-circular external fixator were used for treatment. There were 20 males and 10 females in the internal fixation group, with an average age of (48.96±1.87) years old. Among them, 15 patients presented with fractures on the left side, and 15 patients presented with fractures on the right side. MIPPO technique was used for the treatment. Perioperative parameters, including time injury to surgery, surgical duration, incision length, intraoperative bleeding, time to active activity, and incision healing level, were compared between the two groups. Clinical outcomes were also assessed, including Johner-Wruhs scores, time to minimum pain-adapted full weight-bearing, visual analog scale (VAS), SF-36 scale, and complications. The external fixation group exhibited a significantly shorter incision length (1.36±0.86) cm and lower intraoperative bleeding (10.83±5.73) ml compared to the internal fixation group (12.74±3.12) cm and (86.47±8.90) ml, respectively(P<0.05). The postoperative active activity time (1.50±0.54) days and minimum pain-adapted full weight-bearing activity time(108.87±3.43) days in the external fixation group were slightly delayed than the internal fixation group(1.15±0.98) days and (105.27±3.68) days, respectively(P<0.05). Over a mean postoperative follow-up duration of (6.23±1.89) months, both groups showed improved VAS and SF-36 scale scores. There were no statistically significant differences in VAS and SF-36 scale scores 1, 3, 6 months post-operatively between the two groups(P>0.05). The intraoperative surgical time in the external fixation group (35.42±9.31) minutes was shorter than that in the internal fixation group(74.22±7.81) minutes (P<0.05). There was no intraoperative vascular or nerve injury, nor postoperative skin necrosis in the external fixation group. However, skin necrosis was observed in 6 patientsin the internal fixation group, representing a statistically significant difference (P<0.05). Both external fixation and plate internal fixation are effective methods for the treatment of middle and distal tibia fractures. External fixation exhibits the advantage of less surgical trauma and a lower incidence of complications.

Distal Tibial Fractures – Surgical Outcome Following Minimally Invasive Percutaneous Plate Osteosynthesis

Objectives With preservation of the vascularity of the bone, preservation of the soft tissue envelope and containment of the fracture haematoma, minimally invasive procedures provide fixation in a biologically sound manner. With these in view, this study was conducted to evaluate the technique of surgical management in distal tibial fractures treated by internal fixation with locking compression plate (LCP) and screws through the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Material and Methods In this cohort study, 21 patients with distal tibial fractures who were admitted to the hospital between November 2014 and August 2016 were tracked for at least 10 weeks and up to 39 weeks. Adults who were fit enough for surgery, both male and female, participated in the study. MIPPO procedures were followed for every case. In this investigation, a total of 21 cases were examined. Results 86% of cases with proper bone union were able to bear their full weight at or before the 18-week mark. Complete weight bearing was permitted for the final three patients (14%) at or before 39 weeks. Ninety per cent of patients had fracture union rates that were satisfactory to excellent at 23 weeks. Also, delayed unions were noted in three individuals; two cases experienced ankle stiffness, one as a result of prolonged immobilization and the other as a result of an intra-articular fracture. There were no infections or wound breakdowns during this trial. Conclusion The MIPPO technique with LCP plates is a good choice when intramedullary nailing is inadequate for metaphyseal and distal tibia shaft fractures. Also, early fracture union is easily accomplished using the MIPPO technique and careful application of these plates.

Minimally Invasive Percutaneous Plate Osteosynthesis versus Interlocking Intramedullary Nail Fixation in Treating Extra-Articular Distal Tibial Fractures in Adults. A Systematic Review

Background IM nailing and MIPPO fixation remain viable options for management of distal tibia fractures. IM nailing provides superior operation time, union time, and time to full weight-bearing as well as a lower incidence of superficial and deep infection, but may provide inferior alignment and is associated with residual knee pain. MIPPO fixation provides superior alignment and avoids knee pain, but it has a higher rate of soft-tissue complications and hardware irritation. This review revealed that MIPPO has a higher risk of both superficial and deep infection among patients treated with MIPPO compared to IMN. In the MIPPO technique, 15% developed a superficial infection, compared to 7% after IMN, and 14% developed a deep infection, compared to 6.3% after IMN. Aim of the Work to provide a complete overview of the optimal surgical treatment of distal tibia fractures by evaluating and comparing the clinical and functional outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs Interlocking intramedullary nail (IMN) for treating extra-articular distal tibial fractures. Outcomes of interest include operation time, time to union, non-union, mal-union, infection, secondary operations, and functional outcomes (quality of life scores and ankle scores). Patients and Methods In terms of union complication, IMN has a higher incidence of malunion which occurred in 14.7% of the patients after IMN compared to 8.8% after MIPPO fixation. The incidence of non-union was similar in both treatment methods, it occurred in 3.5% of patients. In addition to union rate, the union time was significantly shorter after IMN fixation compared to the MIPPO technique especially in AO 43A fracture type and the closed fractures. The mean time for union was 18 weeks in IMN compared to 20 weeks in MIPPO. Results Nine studies including 813 patients reported on operation time with an overall weighted mean operation time of 74.1 minutes (range 56.4 – 124 minutes) in IMN and 85.4 minutes (range 51.4 – 124 minutes) in MIPPO. The operation time in the IMN was significantly shorter compared to MIPPO (WMD -11.24 minutes, 95% CI -15.44 to -7.05, P &amp;lt; 0.05) with significant moderate heterogeneity (I2 = 68%). Conclusion Based on this study, both MIPPO and IMN have similar therapeutic efficacy regarding the functional outcome and can be used safely in distal tibial extra-articular fractures. Although IMN is advantageous over MIPPO with a lower incidence of infection and implant irritation symptoms, shorter operation time, earlier weight-bearing, and earlier union, it leads to a higher rate of mal-union and anterior knee pain. Overall, choosing an implant based on the findings of this meta-analysis is difficult and should be done on a caseby-case basis. Patients who have a high risk for infection (due to high age, comorbidities, smoking, or severe soft tissue injury) should preferably be treated with a nail. MIPPO fixation may be more beneficial to young, active, and healthy patients who are less prone to infection because it reduces the risk of knee pain and mal-union.

Application of bridge-link type combined fixation system in the treatment of trifocal femoral fractures.

Ipsilateral combined fractures of the proximal femur, femoral shaft, and distal femur, though uncommon, present significant treatment challenges for orthopaedic surgeons. This retrospective study aims to investigate the intraoperative and long-term postoperative outcomes of this combination fracture when treated using a bridge-link type combined fixation system (BCFS). Four individuals received treatment at a level 1 trauma centre between January 2013 and December 2017 for combined fractures of the proximal femur, femoral shaft, and distal femur. The medical records of these patients were retrospectively examined. In addition to minimally invasive percutaneous plate osteosynthesis (MIO), all patients underwent BCFS. The median follow-up period for each patient was 28.5 months. The median duration of the surgical procedure was 176.0 min, with intraoperative haemorrhage measured at 470.0 ml. Among the cases, three patients showed firm union of the femoral shaft fractures. However, one patient experienced nonunion 12 months after the procedure, while another patient suffered from refracture of the femoral shaft and postoperative avascular necrosis of the femoral head. At the time of the last follow-up, the Friedman-Wyman functional scores were excellent in one case, good in two cases, and fair in one case. Trifocal femoral fractures lack a widely approved therapeutic strategy. Nonetheless, BCFS may present itself as a viable alternative for treating this type of fracture, offering positive clinical outcomes.

Medial minimally invasive percutaneous plate osteosynthesis for humeral shaft fractures: a case series and novel technique description.

Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) is increasingly favored for treating humeral shaft fractures (HSFs). However, conventional MIPPO techniques pose challenges in fixing fractures near fossa olecranon and carry a risk of iatrogenic radial nerve palsy. A novel technique using a medial MIPPO for treating humeral shaft fractures (HSFs) is described. Results of clinical follow-up are presented. This study is a retrospective case series study. Twenty-one patients (mean age 43.9 ± 17.66 [22‒81] years) with HSFs were treated with the novel MIPPO fixation method. Clinical outcomes including time for radiographic consolidation, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and complications were assessed at the last follow-up. The mean follow-up was 26 ± 17.12 (range 12-67) months. All patients had a bony union at a mean of 15.76 ± 6.74 (range 8-40) weeks based on X-ray with an early and aggressive range of motion. The complication rate was 0. The mean DASH score was3.29 ± 4.09 (range 0-14.17) at the time of the last follow-up. The mean screw density was 0.49 ± 0.1 (range 0.2-0.65). This novel surgical technique for HSFs is a viable alternative to previously described methods with the advantage of being less prone to nerve injury and easy to fix distal extra-articular HSFs. The learning curve is short. IV.

Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) for Distal Tibial Metaphyseal Fracture: A Better Option

Objective: The objective of this study was to evaluate the radiological and functional outcomes in of treatment of fracture distal tibial metaphysis fixed with pre-contoured anatomical locking compression plate using minimally invasive percutaneous plate osteosynthesis (MIPO) technique. Methods: This was a prospective study conducted at Department of Orthopedic Surgery, Services Hospital Lahore. Total of 58 closed distal tibial metaphyseal fractures (AO classification 43A) included in the study. All patients were operated using anatomical LCP with MIPO technique. The functional outcome was assessed by Tenny &amp; Wiss criteria at 6 weekly intervals with final scoring at 24th week. Functional outcome was graded as excellent, good, fair and poor. Similarly, radiological outcome was also assessed at 6 week intervals using Hammer et al criteria and grade 3 labelled as union. Results: We observed excellent functional outcome in 48 patients (82.6%) and good outcome in 6(10.34%) at last follow-up. Radiological union was achieved in 100% (58) patients at 24th week. The average time of union was 16.5 weeks with a range of 12 to 23 weeks. Total 03 patients (5.17%) developed superficial wound infection which was successfully managed with antibiotic therapy and no surgical site deep infection reported. Conclusion: Results of this study advocate that treatment of distal tibial metaphyseal fractures with LCP by MIPPO technique is an effective modality resulting in low complication rate, high union rates and good functional outcome.

A retrospective comparison of double-hooked locking plates versus non-locking plates in minimally invasive percutaneous plate osteosynthesis for the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures

BackgroundSurgical approach and fixation material are crucial in the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures. This study compared the efficacy of double-hooked locking plates and anatomic plates in minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures.MethodsClinical data were collected from 96 patients diagnosed with comminuted distal fibular fractures accompanied by tibial Pilon fractures who had undergone MIPPO. Patients in the study group (n = 48) received double-hooked locking plate fixations and the control group (n = 48) received anatomical plate fixations. The operating time, intraoperative bleeding, length of hospital stays, full weight-bearing time, fracture healing time and complication rates in the two groups were compared. The quality of fracture reduction was evaluated using the Burwell–Chamley imaging scoring system; the ankle function was assessed based on the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score.ResultsPatients in the study group had shorter operating time, less bleeding, significantly shorter hospital stays, and shorter time to full weight-bearing as well as fracture healing compared to the control group (P < 0.05). Additionally, the post-operative complication rates were significantly lower in the study group (6.16% vs. 22.92%) (P < 0.05), but there was no significant difference in the fracture reduction rate between the two groups (P > 0.05). Patients in the study group experienced better ankle recovery than those in the control group (93.75% vs. 75.00%) (P < 0.05).ConclusionDouble-hooked locking plates have advantages in the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures during MIPPO due to their shorter operating time and less intraoperative bleeding, as well as shorter hospital stays, full weight-bearing time and fracture healing time, fewer complications and better ankle recovery. Therefore, double-hooked locking plates are worthy of clinical application.

FUNCTIONAL AND RADIOLOGICAL OUTCOME OF LOWER THIRD TIBIAL FRACTURES IN ADULTS TREATED BY MIPPO WITH LOCKING COMPRESSION PLATE - A PROSPECTIVE STUDY

Background: Treating distal tibia fractures can be challenging because of the limited soft tissue available at this region, the subcutaneous location of the bone , precarious blood supply and its close proximity to ankle joint. Treatment for fractures of distal tibia remains a controversial subject despite an ample amount of advances in both non-surgical (conservative) and operative care. This is a prospective study Material And Methods: to analyse the functional and radiological outcome of xing the distal third of tibia treated with Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO). 30 patients were treated for extra articular dista Results: l third tibia fracture with MIPPO. In our study all 30 patients achieved radiological union at a mean time of 15.6 weeks. 94% had excellent to good objective results based on AOFAS criteria and 97% had excellent subjective criteria. We observed ankle joint stiffness in 2 patients and 3 had supercial infection. Treating the closed distal Conclusion: third tibial fractures with LCP with MIPPO technique provides an early union and excellent to good functional outcome

Is an anteromedial minimally invasive approach for middle and distal third humeral fractures feasible? A cadaveric study and clinical case series

BackgroundIatrogenic injury to the radial nerve is a risk in surgical treatment for extraarticular fractures of the middle and distal third of the humerus. We aimed to investigate the safety, feasibility and advantages of minimally invasive percutaneous plate osteosynthesis (MIPPO) via an anteromedial approach in the treatment of middle and middle-distal humeral fractures and to evaluate proximity to neurovascular structures.Materials and methodsIn 2016, 13 adult cadaver arms were used to simulate a minimally invasive surgical approach to the anteromedial humerus followed by fixation with a locking compression plate (LCP), and several sets of anatomical data were measured to clarify the possible risk of iatrogenic vascular and nerve injury in this surgical approach. Then, a case series study of 12 patients with humeral fractures who were treated with this surgical approach was conducted between 2017 and 2020.ResultsThe average humeral length was 29.22 ± 1.62 cm, the average width of the medial epicondyle of the humerus was 1.31 ± 0.17 cm, and the average distance from the vertex of the medial epicondyle to the median nerve was 2.96 ± 1.62 cm. Furthermore, the safe area for distal humeral screw placement was 6.28 ± 0.39 cm, and the average distance from the tip of the distal end of the screw in the medial epicondyle to the ulnar nerve was 1.7 ± 1.25 mm. None of the 12 patients had nerve damage or an incisional infection after the operation.ConclusionsThe new approach was performed as described, and no cases of iatrogenic nerve palsy occurred. This approach can be used as an alternative for the treatment of extraarticular fractures of the middle and distal thirds of the humerus.Level of Evidence: Level IV, therapeutic study.

Prospective study of radiological and functional outcomes of humeral mid-shaft fractures by anterior bridge plating technique

Background: The humerus can be considered the most versatile bone in the human body. Can be successfully approached by a variety of methods for fracture fixation including functional bracing, plating (posterior, lateral, and anterior), and intramedullary nailing (antegrade and retrograde). Notably, many humeral fractures can be successfully managed conservatively due to the wide range of acceptability for reduction. Anterior bridge plating (ABP) which utilizes the minimally invasive approach popularly known as the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique can be said to be the latest entrant in this list. The present study was undertaken to evaluate the efficacy of ABP. Methods: The study was carried out from July 2020 to July 2022 in DR. D. Y. Patil medical college and hospital, Nerul, Navi Mumbai, involving 32 patients who met the selection criteria and were operated at the tertiary care centre. Informed consent was obtained from all the patients for use of their clinical and imaging data. Ethical committee approval was taken. The assessment of the patients was done based on functional and radiological outcomes periodically. Results: Majority of patients belongs to age group 18-25 years (46.87%). Majority of side of injury were found right side (65.62%). In most of the cases, the extent of the displacement of fractures were 2-5 cm (71.87). Conclusions: In conclusion ABP is a very good technique in treating mid-shaft humeral fractures with minimal soft tissue dissection, smaller scars, and early return to overhead activities.

Functional outcome of intramedullary interlocking nailing versus minimally invasive percutaneous plate osteosynthesis in distal tibia fracture

Aims: The aim of the study was to compare the functional outcome of patients with extra-articular distal one-third tibia fracture, treated with intramedullary interlocking nailing (IMILN) with those treated by minimally invasive percutaneous plate osteosynthesis (MIPPO). Settings and Design: This is a prospective study and nonprobability sampling technique. Subjects and Methods: In this study, 60 patients with distal third tibia fractures of AO classification Type 43 A1, A2, and A3 were selected, in which 30 of them were treated with IMILN and the remaining 30 were managed with MIPPO. The patients were regularly followed up, and functional outcome was measured at 4, 8, 12, and 24 weeks using a modified Klemm and Borner scoring system. Statistical Analysis Used: The data collected were subjected to data entry in MS Excel. The data were analyzed using SPSS version 20.0 using Chi-square test. Results: In our prospective study, the functional outcome of MIPPO has shown excellent outcome in 13 patients (43.3%) and good outcome in 13 patients (43.3%), fair outcome in three patients (10%), and only one patient had poor outcome (3.3%). However, in the IMILN group, excellent outcome was seen in 7 patients (23.3%) and good outcome in 15 patients (50%), fair in five patients (16.7%), and poor outcome in 3 patients (10%). Alignment of fracture was anatomical in 13 patients of MIPPO and 7 patients of IMILN. Complications such as nonunion and malunion were more in the IMILN group than MIPPO, whereas superficial wound infection and delayed union were comparable in both. Conclusions: Distal tibial fractures can be effectively treated by both intramedullary nailing and MIPPO with minimal soft tissue injury providing good-to-excellent results, whereas in our present study, we observed that MIPPO had excellent functional outcome when compared to IMILN. Although interlocking intramedullary nailing allows early weight-bearing in patients, malunion and nonunion were more frequently seen, which affects the functional outcome. Therefore, we recommend that MIPPO is considered a very effective modality of treatment in distal third tibia fractures.

Clinical analysis of extended PFNA combined with MIPPO plate for reconstruction of lateral wall in treatment of AO-A3.3 intertrochanteric fracture

To compare the clinical efficacy of lengthened proximal femoral nail anti-rotation(PFNA) combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) and common PFNA in the treatment of AO-A3.3 intertrochanteric fracture. The clinical data of 58 patients with AO-A3.3 intertrochanteric fracture treated from January 2015 to April 2020 were retrospectively analyzed. Among them, 27 patients were treated with extended PFNA + MIPPO plate to reconstruct the lateral wall (group A), and 31 patients were treated with closed reduction and PFNA fixation (group B). The bleeding volume, operation time, femoral neck length and tip apex distance(TAD), fracture healing time and postoperative complications were observed and compared between two groups. Harris score was used to evaluate hip joint function 10 months after operation. All patients were followed up for 12 to 28 months. The incision healed well after operation. The bleeding volume and operation time of group A were significantly more than that of group B (P<0.05), and the fracture healing time of group A was significantly less than that of group B(P<0.05). There was no significant difference in the length of femoral neck between two groups at 2 days after operation(P>0.05). The length of femoral neck at 6 months after operation in each group was shorter than that at 2 days after operation(P<0.05), and the shortening of femoral neck at 6 months after operation in group B was significantly shorter than that in group A(P<0.05). There was no significant difference in TAD values between two groups at the same time point(P>0.05) at 2 days and 6 months after operation. There was no significant difference in TAD values between 2 days and 6 months after operation(P>0.05). The incidence of complications in group B was significantly higher than that in group A(P<0.05). The Harris scores of hip joint function in group A were higher than those in group B 10 months after operation (P<0.05). Compared with the treatment of AO-A3 femoral intertrochanteric fracture with closed reduction and PFNA fixation, the lengthened PFNA combined with MIPPO small plate for reconstruction and fixation of the lateral wall can promote the fracture healing, improve the patient's functional recovery, and significantly reduce the complications.

3D mirror printing combined with minimally invasive percutaneous plate osteosynthesis in the treatment of adult median clavicle fracture

To retrospectively analyze clinical effect of 3D mirror printing combining with minimally invasive percutaneous plate osteosynthesis(MIPPO) technology in the treatment of adult clavicle fracture. The clinical data of 32 adult patients with collarbone AllmanⅠdisplacement of fracture who had undergone the combination of 3D mirror printing with MIPPO technology treatment were collected from October 2019 to October 2020. There were 19 males and 13 females, aged from 19 to 55 years old with an average of(34.12±16.42) years old. According to Allman classification, there were 14 cases of AllmanⅠb and 18 cases of AllmanⅠc. Fracture occurred on the left in 17 cases and on the right in 15 cases. Postoperative complications, operation time, incision length, intraoperative blood loss, the number of fluoroscopies, fracture healing time of all patients were retrospectively analyzed, and the curative effect was evaluated by Constant-Murley shoulder joint score before operation, 1 and 6 months after operation. All the 32 patients were followed up for 6 to 8 months, with an average of (6.67±2.13) months. All the patients did not have postoperative complications such as incision infection and skin numbness in the operating area. The operation time was (35.37±4.28) min. The incision length was (3.78±0.45) cm. Intraoperative blood loss was(37.23±4.76) ml. The number of fluoroscopies was(3.12±0.47) times. Fracture healing time was (8.18±2.58) weeks. Constant-Murley shoulder joint score of the affected side at 1 and 6 months after operation was 81.08±3.92 and 98.03±1.05 respectively, which had a significant difference compared with 54.62±5.25 before operation(P<0.05). According to Constant-Murley shoulder function score at 6 months after operation, 30 cases were excellent and 2 cases were good. 3D mirror printing can effectively assist MIPPO technique in the treatment of adult clavicle AllmanⅠdisplaced fracture. It not only has the advantages of less trauma and fewer complications of the MIPPO technique, but also can further shorten the operation time and improve the operation maneuverability. It is a better method in the treatment of adult clavicle AllmanⅠdisplaced fracture.

Humerus cisim kırıklarında minimal invaziv perkütan plak osteosentezi (MIPPO)

Amaç: Kliniğimizde minimal invaziv perkütan plak osteosentezi (MIPPO) ile tedavi edilen humerus cisim kırıklarının radyolojik ve fonksiyonel sonuçlarının değerlendirilmesi amaçlanmıştır.&#x0D; Gereç ve Yöntem: MIPPO ile tedavi edilen 20 hastanın 21 humerus cisim kırığına ait verileri retrospektif olarak değerlendirildi. Hastaların demografik verileri, yaralanma şekilleri, AO sınıflaması ve bölgesine göre kırık sınıflaması, sigara kullanımı, radial sinir yaralanması kaydedildi. Radyografik olarak 6. ayda kaynama durumu ve dizilim değerlendirildi. Hastaların son kontrollerinde omuz ve dirsek hareket açıklığı ile objektif, Amerikan Omuz ve Dirsek Derneği (ASES) skoru, California Üniversitesi Los Angeles (UCLA) skoru, Mayo dirsek performans indeksi (MEPI), Kol Omuz El Engellilik (DASH) skoru ve Constant omuz skoru ile subjektif değerlendirme yapıldı.&#x0D; Bulgular: Hastaların ortalama omuz fleksiyonu 169,5°±26,4°, abdüksiyonu 169,5°±26,4° idi. Ortalama dirsek hareket arkı 131,4°±19,8° bulundu. Ortalama ASES ve UCLA skorları sırasıyla 88,5±16,4 ve 32,1±5,2, MEPI ve DASH skoru sırasıyla 93,1±11,3 ve 11,8±20,0, ortalama Constant skoru 9,1±15,3 bulundu. İki hastada 6. ayda kaynamama gözlendi.&#x0D; Sonuç: MIPPO yöntemi humerus cisim kırıklarının tedavisinde; minimal yumuşak doku hasarı, korunmuş omuz ve dirsek fonksiyonları ile başarılı bir tekniktir.

Functional outcomes of distal tibia fractures treated using the minimally invasive percutaneous plate osteosynthesis technique with a locking compression plate

Background: Distal metaphyseal tibia fractures are difficult to treat owing to their limited blood supply, subcutaneous location, and inadequate soft tissue blanket. Minimally invasive percutaneous plate Osteosynthesis (MIPPO) using a locking compression plate (LCP) is a widely used surgical treatment. It is beneficial for the management of distal tibia fractures. This study aimed to assess the functional outcomes of distal tibia fractures treated with the MIPPO technique with an LCP. Methods: The investigators have conducted this prospective study with thirty patients who presented with distal tibia fractures over 8 months. All patients fulfilling the inclusion criteria and exclusion criteria took part in the study. All the patients were surgically managed by the MIPPO technique with LCP under spinal or general anesthesia. The functional and radiological outcomes were evaluated with the American Orthopedic Foot &amp; Ankle Society (AOFAS) scale. Results: A sizable number of the patients were aged 40–60 years, with a mean age of 49.8 years. Most participants were male (66.67%). The mean duration of surgery was 72.60 ± 5.35minutes. The mean length of hospital stay was 7.22 ± 1.45 days.

Preoperative position and protection of radial nerve by B-ultrasound combined with MIPPO for treatment of middle-inferior humerus fractures

Background and purposeOpen reduction and internal fixation through the posterior approach are standard methods for treating middle-inferior humerus fractures. Given the limited operative field and difficulty in locating the radial nerve, the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique via the posterior approach to treat middle-inferior humerus fractures has rarely been reported. This study aims to evaluate the clinical effect of the preoperative study of the radial nerve position by B-ultrasound and its intraoperative protection combined with MIPPO in managing middle-inferior humerus fractures.MethodsThe data were studied retrospectively involving 64 participants who had surgery for middle-inferior humerus fractures from the start of 2017 to the end of 2020. Participants were divided into two groups, those treated with the MIPPO technique, including newly developed dual procedures and preoperative position and protection of radial nerve by B-ultrasound (group A), and those treated with open reduction and internal plating fixation (group B).ResultsAll the cases were followed up for 12–34 months (an average of 25.6 ± 8.76 months), and there was no significant difference in the mean operative duration, surgical incision infection, range of motion (ROM) and MEPS (Mayo elbow performance score) for groups A and B. However, the occurrence of complications (radial nerve palsy, bone nonunion and flexible internal fixation or ruptures) in group B was significantly higher than the group A. A statistically significant difference was observed in the intraoperative blood loss, hospital stay and fracture nonunion time between the two groups. All the cases gained bone union within the MIPPO group.ConclusionMIPPO via the posterior dual approach associated with preoperative position and protection of radial nerve by B-ultrasound does not increase radial nerve injury, however, it exhibits obvious advantages in the bone union, which is worthy of clinical application.