Minimally Invasive Plate Osteosynthesis Technique Research Articles

Evaluation of a 3D-Printed Reduction Guide for Minimally Invasive Plate Osteosynthesis of Short Oblique Radial Diaphyseal Fracture in Dogs: A Cadaveric Study.

This study aims to evaluate the clinical application of three-dimensional (3D)-printed custom reduction guides (3DRG) for minimally invasive plate osteosynthesis (MIPO) of short oblique radial diaphyseal fractures. Canine forelimb specimens (n = 24) were prepared and a diaphyseal short oblique fracture was simulated in the distal radius and ulna. Bone fragments were stabilized with the MIPO technique using a 3DRG (Group A), open reduction (Group B), or closed reduction with circular external skeletal fixation (ESF) (Group C). The diaphyseal short oblique fractures were created in each radius at one-third of the radial length from the distal radial articular surface. Surgical stabilization of the fractures was performed in each group. Pre and postoperative radiographic images were obtained to measure frontal angulation (FA), sagittal angulation (SA), frontal joint reference line angulation (fJRLA), sagittal joint reference line angulation (sJRLA), translational malalignment and fracture gap width. Surgical time was also measured. In the homogeneity test, differences in SA, sJRLA, craniocaudal translation and fracture gap before and after surgery had no significant difference among the three groups. On the other hand, differences in FA, fJRLA, mediolateral translation and surgical time before and after surgery had significant differences among the three groups. In the post hoc test, only surgical time showed a significant difference between the three groups, and group A showed the shortest surgical time. The use of 3DRG for MIPO of short oblique radial diaphyseal fractures in dogs is reliable for the alignment and apposition of fractures and reduces surgical time.

Fracture gap and working length are important actionable factors affecting bone union after minimally invasive plate osteosynthesis for the treatment of simple diaphyseal or distal metaphyseal tibia fractures

IntroductionIndirect reduction of minimally invasive plate osteosynthesis (MIPO) can often result in delayed union in tibia fractures. This study evaluated several factors in MIPO in relation to bone union. HypothesisWe hypothesized that the fracture gap, plate – tibia distance, or working length would have a substantial effect on the tibia union rate. Materials and methodsForty-one patients with simple diaphyseal or distal metaphyseal tibia fractures who underwent internal fixation surgery using the MIPO technique were divided into two groups: patients with delayed union and patients without delayed union. Non-actionable factors involving AO/OTA classification, fibula fracture and actionable factors including postoperative fracture gap, plate – tibia distance, working length in relation to parameters of bone union were compared between the two groups. Also cumulative rates of bone union and risk factors of delayed union according to variables of interest were investigated. ResultsAO/OTA classification, site of fibula fracture, postoperative fracture gap, working length, and bone union rate of the two groups significantly differed (p<0.05). The cumulative rate of bone union during 1-year follow-up according to 43A tibia fracture, distal fibula fracture, fracture gap, and working length significantly differed between the two groups (p<0.05). By univariate Cox proportional hazards model, 43A tibia fracture, distal fibula fracture, facture gap, and short working length were risk factors for delayed union (p<0.05). DiscussionNon-actionable factors involving AO/OTA classification, distal fibula fracture and actionable factors including postoperative fracture gap, working length were significant factors affecting bone union after MIPO. The present study indicated that small fracture gap and long working length during MIPO might facilitate bone healing in tibia fracture. Level of evidenceIV; single-center retrospective cohort study.

Biomechanical comparison of three different surgical methods in the surgical treatment of distal tibial metaphyseal fractures. An animal model study.

The aim of this study is to investigate mechanical properties of minimally invasive plate osteosynthesis (MIPO), supracutaneousplating (SP), and unilateral external fixators (UEF) which can be performed for open tibial fractures. An unstable diaphysial tibia fracture was created in 60 fresh sheep tibia specimens by performing an osteotomy at the middle of bones. Specimens were divided into 3 groups. Specimens underwent fracture fixation with a standard MIPO technique, im-planting the plate 15 mm from the bone for SP group. Unilateral uniplanar external fixators were achieved for UEF group. First, thirty specimens (10 specimen for each group) were loaded vertically along the tibial axis to 1800 N. Second, other 30 preperated bones were used for cyclical loading to avoid metal fatigue. For dynamic tests, a 350 N force was applied for 10,000 cycles. In compression testing (vertical loading up to 1800 N) of the three fixation instruments; construct stiffness was highest in MIPO group when compared with SP and UEF groups. While the stiffness of the MIPO group was similar to SP group, it was statistically higher than UEF group (P=0.08 and P=0.002, respectively). SP group was significantly stiffer than UEF group (P=0.0021). The mean peak load was highest in SP group and lowest in UEF group. The peak load in SP group was similar to the MIPO group, it was statistically higher than the UEF group (P=0.743 and P=0.002, respectively). Based on the biomechanical properties from this in vitro animal model study, SP technique was biomechanically stronger than UEF and has similar biomechanical properties with MIPO in terms of axial loading.

Minimally Invasive Plating Osteosynthesis Technique versus Anterolateral Approach for Fixation of Humeral Mid-Shaft Fractures (Systematic Review/Meta-Analysis)

Background In this study, we performed a meta-analysis to identify whether minimally invasive plate osteosynthesis (MIPO) was superior to conventional open reduction internal fixation for treating humeral shaft fracture. Methods A systematic literature search was conducted up to February 2020 in ScienceDirect, Springer, MEDLINE, and PubMed databases for relevant papers that compared the outcomes of MIPO with ORPF, such as open reduction with plate osteosynthesis (ORPO) and for treating humeral shaft fractures. Meta-analysis was performed with jamovi project (2019) (jamovi Version 1.0 Computer Software). Results According to the search strategy, six studies that covered 300 patients were enrolled, including three randomized controlled trials (RCTs), one prospective cohort trials, and two retrospective cohort trials. Our meta-analysis did not detect any significant difference between MIPO and ORPF in terms of operative time, fracture union rate, and fracture union time. However, MIPO has a less rate of complications and iatrogenic radial nerve palsy than that of ORPO. Conclusions From this study, we concluded that humeral shaft fractures could be effectively treated with the MIPO technique due to the advantages of shorter fracture union time and lower incidence of fracture nonunion and iatrogenic radial nerve palsies rather than the conventional open reduction and internal fixation technique.

Proximal humerus fractures: deltopectoral open reduction and internal fixation vs deltosplit minimally invasive plate osteosynthesis: which surgical approach provides superior results?

To compare the two main surgical approaches to address proximal humerus fractures (PHFs) stratified for Neer fracture types, to demonstrate which approach gives the best result for each fracture type. A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in PubMed, Web of Science, and Cochrane databases up to 4 January 2022. Inclusion criteria were studies comparing open reduction and internal fixation (ORIF) with deltopectoral (DP) approach and minimally invasive plate osteosynthesis (MIPO) with deltosplit (DS) approach of PHFs. Patient's demographic data, fracture type, Constant-Murley Score (CMS), operation time, blood loss, length of hospital stay, complications, fluoroscopy time, and radiological outcomes were extracted. Results were stratified for each type of Neer fracture. Eleven studies (798 patients) were included in the meta-analysis. No functional difference was found in the CMS between the two groups for each type of Neer (P = n.s.): for PHFs Neer II, the mean CMS was 72.5 (s.e. 5.9) points in the ORIF group and 79.6 (s.e. 2.5) points in the MIPO group; for Neer III, 77.8 (s.e. 2.0) in the ORIF and 76.4 (se 3.0) in the MIPO; and for Neer IV, 70.6 (s.e. 2.7) in the ORIF and 60.9 (s.e. 6.3) in the MIPO. The operation time in the MIPO group was significantly lower than in the ORIF group for both Neer II (P = 0.0461) and Neer III (P = 0.0037) fractures. The MIPO with DS approach demonstrated no significant differences in the results to the ORIF with DP approach for the different Neer fractures in terms of functional results, with a similar outcome, especially for the Neer II and III fracture types. The MIPO technique proved to be as safe and effective as the ORIF approach.

[Clinical outcome of internal fixation of middle third clavicle fractures using locking compression plate: comparison between conventional open plating and minimally invasive plate osteosynthesis].

Objective: To compare the outcomes of conventional open plating and minimally invasive plate osteosynthesis (MIPO) for treatment of displaced middle third clavicle fractures. Methods: A retrospective cohort study. From January 2016 to December 2020, a total of 42 patients with middle third clavicle fractures treated with locking compression plates in the Department of Orthopedics, Nanping First Hospital Affiliated to Fujian Medical University were analyzed retrospectively, including 27 males and 15 females with a mean age of (36.5±8.7) years (19-61 years). According to the different treatment methods, the patients were divided into 2 groups: the traditional incision group (n=20) were treated with conventional open plating and the MIPO group (n=22) were treated with the MIPO technique. The supraclavicular nerve was preserved in those patients. The two groups were compared in terms of operation time, intraoperative blood loss, incision length, fracture healing time, and the ratio and length difference with the uninjured clavicle. The shoulder joint function was evaluated with Constant score and Disability of the Arm, Shoulder and Hand score (DASH) at the last follow-up. The incidence of numbness around the incision was evaluated at 6 weeks, 12 weeks and 1 year after operation, and the complications of the two groups were compared. Results: The patients were followed-up for an average of 16.5 months (ranged from 13 to 35 months). The operating time [(68.4±12.7) min vs (55.3±10.2) min], intraoperative blood loss[(72.5±16.9) ml vs (52.8±13.5) ml], as well as incision length [(8.7±2.3) cm vs (4.5±1.2) cm] were all significantly greater in traditional incision group than those in MIPO group (all P<0.05). There was no significant difference between the two groups in the time of fracture healing, the length of contrast with the contralateral clavicle, and the constant score and DASH score of shoulder joint function at the last follow-up (all P>0.05). The incidence of numbness around the incision after operation at 6 weeks [60.0%(12/20) vs 27.3%(6/22)] and 12 weeks [45.0%(9/20) vs 13.6%(3/22)] were obviously higher in traditional incision group than those in MIPO group (both P<0.05), but there was no significant difference between the two groups at 1 year after operation [15.0%(3/20) vs 4.5%(1/22), P=0.531]. There was no significant difference in postoperative complications incidence between the two groups (P>0.05). Conclusions: It is showed that both conventional open plating and MIPO are effective and safe treatment methods for displaced middle third clavicle fractures with locking compression plates. MIPO can reduce operating time, intraoperative blood loss and the incidence of early postoperative numbness around the incision.

Influence of surgical performance on clinical outcome after osteosynthesis of distal radius fracture

IntroductionClinical outcome after surgery depends on the surgeon's level of expertise or performance. The present study of minimally invasive plate osteosynthesis (MIPO) with anterior plate for distal radius fracture assessed whether clinical outcome correlated with surgeon performance. MethodsThe series included 30 distal radius fractures: 15 operated on by 4 level III surgeons (Group 1) and 15 by 4 level V surgeons (Group 2), utilizing the MIPO technique. The surgical performance of all 8 surgeons was assessed using the OSATS global rating scale. Clinical outcomes were assessed at 3 months’ follow-up using the modified Mayo score (MMS), in 4 grades: 0–64 (poor), 65–79 (moderate), 80–89 (good), and 90–100 (excellent). The QuickDASH score (QDASH) was also calculated, and complications were recorded. ResultsMedian MMS was better for level V (75 = fair result) than level III surgeons (62 = poor result). Median QDASH score likewise was better in group 2 (9.1) than group 1 (22.7). In group 1, there were 2 paresthesias in the median nerve territory, 1 type-1 complex regional pain syndrome, and 1 hypoesthesia in the scar area. Mean correlation between the 2 scores was –0.68. Group 1 patients were on average 7 years older. The number of patients, number of surgeons and distribution of OA A and C fractures were almost identical in the two groups. On MMS, the overall result of the two groups was moderate (70.5), which can be explained by short mean follow-up. DiscussionQuality of the clinical outcome on MMS and QDASH increased with surgical performance, with fewer complications. In the patients' interest, protocols for improving surgical performance should be implemented, for example, through deliberate practice.

COMPARISION OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF DISTAL THIRD TIBIA FRACTURE MANAGED WITH IMILN vs. VA-LCP – A RETROSPECTIVE STUDY.

Background: Distal tibia fractures are challenging injuries because of their inherent instability, scarcity of soft tissues, subcutaneous nature and poor vascularity of bone. Although, distal tibial fractures accounts for approximately 7% of all tibial fractures, the best treatment still remains controversial. The purpose of our study is to assess the radiological outcomes of distal third tibia fracture treated with surgical techniques i.e., intramedullary nailing using closed reduction internal xation technique vs. locking compression plating using minimal invasive plate osteosynthesis technique. This Retrospective, observational, hospital-based study wa Method And Materials: s conducted at tertiary health care center KOLAR, involving patients with extra articular closed tibia fractures of distal 1/3 up to 43-A3 of AO classication, from DEC 2016 - DEC2019. Demographic data and clinic-radiological data were collected and evaluated during pre- and post-procedure. Mean union time Result: in intramedullary nailing using closed reduction internal xation technique group was 17.25 ± 1.065weeks and locking compression plating using minimal invasive plate osteosynthesis technique group was 20.19 ± 1.759 weeks, which was statistically signicant with p value less than 0.05. Conclusion: The group receiving the intervention of Locking Compression plating took more time to unite distal third tibia fractures compared to the group receiving the tip locking nailing.

FACTORS AFFECTING FUNCTIONAL OUTCOME OF DISTAL TIBIA FRACTURES TREATED BY PLATING USING MINIMAL INVASIVE PERCUTANEOUS PLATE OSTEOSYNTHESIS TECHNIQUE

Introduction: Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Minimally invasive plating offers the advantage of fracture fixation without disturbing the soft tissue cover, less chances of infection, early mobilization of patient. Using a locking compression plate reduces the tendency for varus collapse and at the same time affords better stability Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them. Clinical and radiological outcomes were studied, and clinical indications &amp; efficacy of the procedure reviewed. Materials and Methods: An ambispective analysis of 30 patients of closed distal tibial fractures were operated by MIPO technique. Bone and soft tissue healing and complications encountered were analyzed. Result: It has been a well-known fact that distal tibia fractures have recently been treated by minimally invasive techniques. Literature above says that there is risk of disrupting blood supply with open reduction internal fixation leading to soft tissue healing problems. However, we did not face any of these complications in our patients, infection or wound breakdown with implant exposure. Conclusion: Distal tibial fractures can successfully be treated by single stage MIPPO plating. Considering a proper surgical timing, respect for soft tissue handling, a good fixation can be achieved. Minimally Invasive Osteosynthesis of distal tibial fracture produced reliable results with acceptable range of movement and resuming early return to activities of daily living.

Treatment of distal radius fracture by MIPO technique at Thu Duc City Hospital

Objective: To assess the possibility of anatomical correction when treating fractures of the distal radius fracture with a locking plate through a minimally invasive incision and evaluate the possibility of early recovery of wrist function after treatment of the distal radius fracture with minimally invasive incision preserving the pronator quadratus (PQ) muscle. Subject and method: Acute distal radius fracture patients aged 18 to 65 years old, who came for examination and treatment at the Orthopedic and Trauma Department of Thu Duc City Hospital from October 2020 to May 2021. Classification of the distal radius fracture according to AO: A2, A3, B3, C1 and C2. Result: The result of anatomical reduction included VT 6.22o, RI 22.0o, and UV 0.81 mm. X-ray grading gave 75.0% excellent and 25.0% good results, with 100% bone healing after 12 weeks. At 12 weeks, the mean GRIP Strength score was 71.3%, the VAS score was 1.7 points, the Q-DASH score was 18.1 good function points, and the MAYO score was 74. The average time to return to normal activities was 7 weeks. Conclusion: minimally invasive plate osteosynthesis (MIPO) is a method that gives good results for some fracture types in treating distal radius fractures, by indirect reduction with small incisions to help preserve the PQ muscle and early return the wrist function.

Minimally invasive plate osteosynthesis (MIPO) for distal humeral fractures: a cadaveric study and first clinical application

BackgroundThe indication for minimally invasive plate osteosynthesis (MIPO) may include articular fractures depending on the fracture pattern. The goal of this study was to evaluate the feasibility of the MIPO technique for extra- and intra-articular distal humeral fractures.MethodsThe feasibility of the MIPO technique was assessed on 8 cadaveric elbows and 2 clinical cases. The four surgical approaches tested included a 20-mm ulnar incision, a 20-mm dorsoradial incision, and two incisions for olecranon osteotomy (A and B). Surgical incision A was 40 mm on the osteotomy level of the olecranon, and surgical incision B was an extension of the radial incision toward the osteotomy of the olecranon (80 mm).The four approaches were tested on 4 extra-articular (AO 13 A3) fractures and 4 intra-articular (AO 13 C3) fractures.ResultsReduction and plate fixation of all distal humeral fractures (8 cadaveric) with and without osteotomy was feasible. However, when using approach B, the soft tissue tension is reduced due to the wider incision. Nevertheless, both approaches A and B showed the same adequate intra-articular fracture control and reduction.ConclusionThe MIPO technique for reduction and plate fixation in distal humeral fractures is feasible.Level of evidenceAs a feasibility study, this study cannot be clearly classified into a level of evidence. It corresponds most closely to level IV.

Minimally Invasive Plating of Distal Radius Fracture: A Series of 42 Cases and Review of Current Literature.

Surgical techniques developed for distal radius fracture fixation have become increasingly advanced, including minimally invasive plate osteosynthesis (MIPO). This study aimed to introduce and evaluate the functional outcome of a novel MIPO technique that differs from previous reports. This study included 42 patients with distal radius fractures who underwent minimally invasive surgical plating of the distal radius. All patients were treated with closed reduction, fixation using K-wire, and subsequent insertion of a volar anatomical stable angle short plate on the distal radius. An arthroscopy-assisted evaluation and repair procedure were performed to correct intra-articular involvement, triangular fibrocartilage complex tears, and scapholunate injuries. Functional outcomes were assessed using a visual analog scale score; quick disabilities of the arm, shoulder, and hand score; and postoperative range of motion of flexion, extension, supination, and pronation at the 3-month follow-up, showing significant improvement in all parameters (all p ≤ 0.05). This study provides a simpler yet reliable method with reproducible and consistent results to treat distal radius fractures using minimally invasive plating with closed reduction and plate insertion, resulting in satisfactory clinical outcomes in all patients.

Minimally invasive plate osteosynthesis for displaced midshaft clavicle fractures: An indirect reduction using joystick technique

BackgroundA minimally invasive plate osteosynthesis (MIPO) technique has become increasingly popular in long bone fracture fixation as it could eliminate postoperative complications. However, the most challenging aspect of employing the MIPO for midshaft clavicle fractures among general orthopedic surgeons is the technically demanding that indirect reduction is typically a closed maneuver. MethodsWe present a consecutive series of patients with displaced midshaft clavicle fractures undergoing clavicular fixation using the MIPO technique between January 2017 and October 2019. The joystick technique was used to obtain anatomical reduction. Clinical outcomes were assessed using the Constant-Murley and the American shoulder and elbow surgeons shoulder scores. ResultsThirty patients with a mean age of 42.44 years were included. The functional shoulder scores showed no disabilities compared with those of a healthy population. No major complications requiring re-operation were noted, and all fractures were completely healed with an average time of 12.53 weeks. ConclusionThis study demonstrated that facilitating the MIPO for midshaft clavicle fractures using simple operative devices and techniques was possible. The joystick technique with the use of an external fixator for temporary stabilization is a safe and effective method that can be added to achieve anatomical alignment with the fracture site unexposed. This technique could be performed either in a fresh fracture or a delayed case with failed conservative treatment.

Minimally invasive plate osteosynthesis for clavicle shaft fractures

Abstract Objective Whereas open reduction and internal fixation remains the surgical standard for displaced clavicle shaft fractures, the minimally invasive plate osteosynthesis (MIPO) technique has been introduced for multifragmentary, non-antomically reducible fractures, and unstable fractures with significant soft tissue injuries. Its advantages lie in the preservation of the vascular supply of the fracture zone and the preservation of the supraclavicular nerve. The aim of this study was to prove feasibility and share our experiences with this technique. Methods In this single center retrospective case series, we analyzed all patients that underwent MIPO for displaced clavicular shaft fractures from 2001–2021. Patient history, fracture morphology and perioperative data were documented. Outcomes were assessed based on clinical and radiographic follow-up reports. Results In total, 1128 clavicle osteosyntheses were performed, of which 908 (80.5%) were treated with a plate and 220 (19.5%) with titanium elastic nail (TEN). Of the 908 plate osteosyntheses, 43 (4.7%) were performed with the MIPO approach. Mean age was 44 ± 15 years, 83.3% were males and 79.1% were sports injuries. The fractures were categorized as AO/OTA type C injuries (n=26) in most patients, followed by A (n=9) and B (n=8). Two open (Gustilo I) and 41 closed fractures were noted (Tscherne 0=26; I=13, II=2). In seven patients (16.7%), the clavicle fractures were part of a severe polytrauma. Concomitant serial rib fractures and scapular fractures were found in 19 (45.2%) and 10 patients (23.8%), respectively. Length of surgery was 63 ± 28 min, and hospitalization was 4 ± 3 days (excl. polytraumas). 27 of the 43 fractures (62.8%) were clinically and radiographically followed up in our outpatient clinic, of which 26 (96.3%) healed with noticeable callus formation. In one case, a pseudoarthrosis was found two years after fracture treatment. Otherwise, all patients followed a remarkable postoperative course, were pain-free and able to return to work, most within five weeks. Conclusion In this retrospective analysis, 96.3% of the clavicle shaft fractures treated with MIPO healed in a timely manner. The MIPO technique is feasible and plausibly advantageous for distinct fracture and injury patterns (i.e. multifragmentary fractures or unstable fractures with soft tissue injuries). Future comparative studies are warranted to clarify our observations.

A new surgical strategy for the treatment of tibial pilon fractures with MIPO facilitated by double reverse traction repositor

The present study aims to introduce a technique combining double reverse traction repositor (DRTR) with minimally invasive plate osteosynthesis (MIPO) in the surgical treatment of pilon fractures and to observe the efficiency of this approach during a short-term follow-up period. From January to December 2018, patients with pilon fractures who were treated by MIPO with DRTR were reviewed. The demographic and fracture characteristics, surgical data, and prognostic data of 24 patients were extracted. In all 24 patients, closed reduction was achieved with the MIPO technique, and excellent functional and radiological outcomes were observed. The average duration of surgery and intraoperative blood loss were 95.0 ± 14.2 min and 152.1 ± 52.1 ml, respectively. A mean of 16.0 ± 1.9 intraoperative fluoroscopies were conducted. At the 12-month follow-up evaluation, the average AOFAS score was 85.2 ± 5.1. Anatomic or good reduction was observed in 23 (95.8%) patients. The mean ranges of motion of dorsiflexion and plantarflexion were 11.0 ± 2.7 and 32.7 ± 11.1, respectively. Two patients with deep venous thrombosis and one patient with wound non-purulent exudate were noted. Additionally, the wounds healed after routine dressing change. No other complications, including skin necrosis or delayed, non-union or malunion, were observed. The new strategy combining DRTR with MIPO in the treatment of pilon fractures allowed excellent radiological and clinical outcomes and a low postoperative complication rate to be achieved in a short-term follow-up period. Further large sample and comparative studies should be conducted to validate our results.

DISTAL TIBIA SPIRAL AND COMMINUTED FRACTURES: CAN ABSOLUTE ANATOMICAL REDUCTION BE COMPROMISED?

Purpose: Minimally invasive plate osteosynthesis (MIPO) is used for the treatment of distal tibial fractures, especially in cases of intra-articular fractures. There are many advantages of MIPO, including preservation of blood supply to the fracture site and enhanced bone healing, however, it is not without complication. The study aimed to elaborate the benefits of MIPO technique in managing distal tibia fractures and to describe the necessities for good union and functional outcome. Methods: A total of 38 patients with distal tibia comminuted and spiral fractures, having closed distal tibia AO/OTA 43-A, B or C fractures with or without fibular fractures, were included. All the cases were assessed for union time, complications and functional outcomes. Binomial regression using [Formula: see text] v3.6.0 was used to assess the success of MIPO based on four-cortex alignment. [Formula: see text] value [Formula: see text] was considered statistically significant. Results: The mean operative time was 70[Formula: see text]min. All 38 tibial fractures united and the mean union time was found to be 18 weeks. Five cases were noted to have complications (four superficial infections and one implant failure). Out of 38 patients, 28 (majority) showed excellent functional outcomes as assessed by the American Orthopaedic Foot and Ankle Society score, i.e. a score of [Formula: see text]90. Conclusion: MIPO is a good method for the management of tibial fractures with extra-articular and intra-articular involvement, with good union even when absolute four cortical contact is not achieved.

Clinical and radiographic evaluation of minimally invasive plate osteosynthesis (MIPO) in dogs with tibial fractures

The aim of this study was a clinical and radiographic evaluation of the minimally invasive plate osteosynthesis (MIPO) method for treatment in dogs with tibial fractures. Ten dogs of different breeds, ages, and sex with tibial fractures were used as the subjects. A medial approach to the tibia was used in all the cases. The tibial tuberosity was palpated proximally and a short incision was made along the midline. After reduction of the fracture, proximal and distal insertion incisions were made to approach the tibia. The mean times for the MIPO operations were 21 minutes. The patients were able to stand and walk postoperatively on the first day and recovery was rapid for all of the dogs. The fracture healing was completed on day 45 based on the radiographic evaluations of these cases. Dogs with tibia fractures treated by MIPO healed rapidly without any complications (90%). Correct fracture selection is important for the use of MIPO to be successful. Further studies with a larger group of dogs should be considered to compare the efficacy of MIPO and other fixation techniques and for the long-term evaluation of the repaired tibial fractures.

Functional Outcome of an Anatomically Contoured Locking Plate in Intra-Articular Pilon Fracture with MIPO Technique

Aim: To evaluate the outcome of osteosynthesis by using anatomically contoured locking plates in the management of intraarticular fractures of tibial plafond with minimally invasive plate osteosynthesis (MIPO) technique Methods: All the 50 patients presenting with intra-articular fractures (Pilon fracture type B and C) in the Accident and Emergency (A&amp;E) department were included in this study. The patients involved in high-energy trauma were treated according to advanced trauma life support guidelines for any associated life- or limb-threatening injuries. The clinical, functional, and radiographic plain anteroposterior and lateral radiographs) evaluations were conducted at 6 months according to Modified Klemm and Borner scoring system and outcome variables i.e. excellent to good was labeled. Results: There were 76% males and 24% females. Most of the patients 23(46%) were in &gt;45 years, age group. Among 50 patients, 28(56%) had type-B fractures, while 22(44%) had type-C fractures. 36(72%) had BMI &lt;30, while 14(28%) had BMI ≥30. 3(6%) had wound infections. Among 50 patients, 41(82%) had an excellent-good outcome. A good outcome was seen in male patients (78%), as compared to female patients. A good outcome was observed in 39% of patients with age greater than 45 years followed by 32% in 18-30 years. An almost equal percentage of good (56-44%) and poor (55.6-44.4%) outcomes were reported in both types of fractures. 70.7% of patients with BMI &lt;30 reported a good outcome. A good outcome was observed in 41 patients who do not have wound infection. However, 6 patients reported a poor outcome who didn’t have wound infection. Conclusion: Plate osteosynthesis using anatomically shaped locking plates via minimally invasive method is an efficient way of stabilization for distal tibia fracture when considering union rates and final functional outcome. Keywords: Intra-Articular Fracture, Pilon Fracture, Plate Osteosynthesis.

Minimally invasive plate osteosynthesis without floating segment fixation for segmental fracture of femur.

Segmental fractures of the femur are technically difficult to manage by intramedullary nailing, the gold standard treatment. We specifically describe minimally invasive plate osteosynthesis (MIPO) without floating segment fixation for this particular fracture pattern. Twenty patients with segmental fractures of the femur were operated on by the MIPO technique. Data were collected on operative time, postoperative complications, union times, and clinical outcomes. The mean operative time was 63.5 minutes (range 50-90). There were no peri-operative complications. All fractures were united with a mean union time of 16.1 weeks (range 12-20). Regarding postoperative malalignment, limb shortening was demonstrated in 4 patients, valgus angulation in 2 and varus angulation in 3. One patient had a bent plate with 7°varus angulation. According to the Thoresen score, 13 were determined to be excellent values, 6 to be good and 1 to be fair. MIPO without floating segment fixation is a safe and effective alternative for segmental fractures of the femur especially in circumstances that are unsuitable or unfeasible for intramedullary nailing.

Outcome of minimally invasive plate osteosynthesis (MIPO) for distal tibial fractures

Background: Distal tibial fractures, also known as Pilon fractures constitute about 5 to 10 percent of the tibial fractures. These fractures are difficult to manage. MIPO (Minimal invasive plating osteosynthesis) technique is indicated for fractures with minimal articular comminution and the fractures where soft tissue envelops is minimally damaged. It works on Biological Fixation Principle, in which blood supply to the fracture fragments is maximally preserved. Aim: The purpose of this retrospective study is to evaluate the outcome of MIPO for distal tibial fracture.Design: This is a single center retrospective study conducted between 2016 and 2019 in a Tertiary Care Hospital (Medical College Hospital). Method: 19 patients of distal tibial fracture operated with MIPO technique using pre-contoured metaphyseal LCP (locking compression plate) were analyzed retrospectively. Fractures were classified as per AO system and patients were followed and scored according to TEENY and WISS clinical scoring criteria.Result: Among 19 patients operated, there were 14 males and 5 females with a mean age of 41.32years (ranging from26-66yrs). 16 patients sustained extra-articular fractures (type A), 02 partial-articular fractures (type-B) and 01 total-articular fracture (type C). High energy trauma (road traffic accident) predominated causing 13 fractures. Average trauma surgery interval was 10 days (02-16 days). Patients were followed, minimum for 01 year (range 1 -4 years). Surgical wound breakdown with implant exposure was seen in 01 case. Based on Teeny and Wises clinical rating system, all except one patient had an ‘Excellent’/good outcome.Conclusion: MIPO is an effective and safe technique for the management of distal tibial fractures without intra-articular comminution and minimum soft tissue damage. It preserves bone biology by maintaining balance between revascularization and mechanical perfection. Further studies with longer follow-up and large sample size are warranted.