Osteosynthesis Technique Research Articles

Trends of incidence and treatment strategies for operatively treated distal fibula fractures from 2005 to 2019: a nationwide register analysis

IntroductionValid epidemiological data about distal fibular fractures and their treatment strategies are missing. Innovative osteosynthesis techniques were introduced and improved during the past 15 years. The aim of this study was to investigate the epidemiologic development and the implementation of new treatment strategies in a nationwide register in Germany over a period of 15 years.Materials and methodsData of the German Federal Statistical Office from 2005 until 2019 were screened. Adults with a fracture of the distal fibula were included. Data were separated for gender, age and treatment strategy.ResultsDuring the past 15 years, there was a steady annual incidence of distal fibula fractures of 74 ± 32 per 100,000 people without any significant changes (p = 0.436). 60.1% ± 0.6% of all fractures occurred in females. The annual incidence for male was nearly constant over the different age groups, whereas for female, there was a clear increase in incidence above the age of 40. Whereas 66% of fractures in between 20 and 30 years of age occurred in male, approximately 70% of fractures above the age of 60 occurred in females. The relative quantity of locking plates increased from 2% in 2005 to 34% in 2019. In 2019, only 1.02% of the patients were operated with an intramedullary nail.ConclusionsOperatively treated distal fibular fractures revealed an age dependent increase in incidence in postmenopausal women compared to younger females. Regarding the treatment strategy, there was an increase in application of locking plates. The data implicate a typical fragility fracture related age and gender distribution for distal fibula fractures.

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

<p class="abstract"><strong>Background: </strong>Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.</p><p class="abstract"><strong>Methods:</strong> This was the prospective comparative study of 50 patients with distal third tibia fractures divided into two groups. First group of patients were treated with MIPPO technique while second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, non-union, superficial and deep infection between the two groups.</p><p class="abstract"><strong>Results: </strong>Average time taken by patients for full weight bearing in group A was 17.6 weeks as compared to 16.7 weeks in group B. All patients were able to bear weight prior to complete union of fracture. By the process of weight bearing, we believed that it would promote secondary bone healing. On taking X-rays during follow up of included patients starting of radiological union was observed carefully by looking for bridging callus, haziness of fracture line. Appearance of callus was taken average time of 12.5 weeks in group A and 12.1 weeks in group B.</p><p class="abstract"><strong>Conclusions: </strong>Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.</p>

Behandeling van instabiele enkelfragiliteitsfracturen: nieuwe inzichten

Treatment of unstable ankle fragility fractures: current concepts Displaced ankle fractures are frequently seen in the geriatric population. It is well known that diabetes, osteoporosis and peripheral vascular disease, which are common in the geriatric population, have a negative impact on the postoperative outcome of these fractures. Therefore, the management of these ankle fragility fractures poses specific challenges. The standard in the treatment of unstable ankle fractures, even in the elderly, is an open reduction and internal fixation (ORIF). Major complications (infections, malunion, implant failure), however, often occur. In recent years, new osteosynthesis techniques (intramedullary fibular nailing, fixation with an external fixator, hindfoot nailing) in combination with optimized perioperative care have reduced the risk of complications. In this study, the case report of an unusually severe complication after plate-and-screw fixation augmented with retrograde pinning in an 87-year-old male patient is presented, as well as a review of the literature concerning the optimal treatment of unstable ankle fractures in the elderly. This review can be used as a guideline for the general practitioner, geriatrician, emergency doctor and orthopaedic surgeon treating these difficult injuries.

Study of clinical and radiological outcome of extra-articular proximal tibia fracture treated with minimally invasive plate osteosynthesis (MIPO) technique

Background: The management of proximal extra-articular tibia fractures is challenging to a surgeon because of its complex fracture pattern and anatomical location. The aim of our study is to assess the functional, clinical and radiological outcome of MIPO in extra articular proximal tibia fractures. Materials and Methods: This is a prospective study of 43 closed extra articular proximal tibia fracture patients. The study was done in between July 2017 to September 2019 at a tertiary care centre in India. Results: The mean age was 32.5 years (range 31-65). The primary bony union was achieved by an average of 16.32 weeks (range 14 to 24 weeks). According to the Modified Rasmussen’s criteria, 23 patients (53.48%) had excellent outcome, 12 patients (27.90%) had good outcome and 8 patients (18.60%) had fair outcome. The mean range of motion of the knee is 124.23° (Range 10-150°). The complications include Infection (9.3%) and varus malunion (18.60%). Conclusion: Minimally invasive percutaneous plate osteosynthesis technique offers biological advantage with minimal complication and fulfils the demands of fast implantation, soft tissue protection and high biomechanical stability.

Minimally-Invasive Plate Osteosynthesis for Clavicle Fractures.

Objective To analyze the radiological, clinical, and functional outcomes of clavicle fractures treated with the minimally-invasive plate osteosynthesis (MIPO) technique. Methods From June 2018 to July 2019, 17 cases of clavicular fractures were managed using the MIPO technique under C-arm fluoroscopy. The functional outcomes were assessed using the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical results of union, the complications, the operative time, the hospital stay, as well as infection, were analyzed. Results The mean follow-up time was of 10.41 ± 1.75 months (range: 8 to 14 months). There were 11 male and 6 female patients, with a mean age of 39.05 ± 10.76 years (range: 22 to 57 years). All fractures united on the mean time of 15.35 ± 3.08 weeks (range: 12 to 20 weeks). The mean operative time was of 98.11 ± 13.83 minutes (range: 70 to 130 minutes), and the mean length of the hospital stay was of 4.7 ± 1.12 days (range: 3 to 7 days). The mean Constant-Murley score was of 74.82 ± 6.36 in 4 th postoperstive month, and of 92.35 ± 5.48 in the 8 th postoperative month, which was statistically significant. The mean DASH score was of 9.94 ± 1.55 in the 4 th postoperative month, and of 5.29 ± 1.85 in the 8 th postoperative month, which was also statistically significant. One patient had superficial skin infection at the site of the incision. Conclusions The MIPO technique is an alternative method for the fixation of clavicle fractures, but it is technically more demanding, and requires well-equipped operating room facilities.

Современные методики лечения пациентов с закрытым переломом надколенника

Abstract. Introduction Treatment of patients with acute fractures of the patella is the task of the trauma and orthopedic service and should provide restoration of the integrity of the bone tissue and the extensor apparatus of the knee joint for its early mobilization. There is an opinion that conservative treatment cannot meet requirements of patients’ quality of life, and therefore, most traumatologists are inclined to surgically treat patellar fractures. Purpose Based on the available literature data, to determine the most rational way to treat patients with patellar fractures Materials and methods Available studies published in the last 10 years were analyzed. The databases NCBI Pubmed, Healio Orthopedics, Medline were searched. Results Such osteosynthesis methods as patella suture, osteosynthesis with plates, special internal devices, external fixation devices, Kirschner wires and wire cerclage, various screws were covered. The question of clinical application of patellectomy was touched upon; the contribution of the Department of Traumatology, Orthopedics and Urgent Surgery of the Krasnov Samara State Medical University to the development of operative techniques of osteosynthesis of the patella, the basic concepts of scientific research, and also the most optimal ways of treating patients with patellar fractures were described. Conclusion The conservative method of treating patients with patellar fractures is most relevant if there are contraindications to surgery. It inevitably leads to persistent arthrogenic contracture. The best functional results of treatment have been achieved with surgical treatment due to the possibility of early mobilization of the knee joint. According to the data of available studies, plates and screws as well as osteosynthesis with Kirschner wires and wiring cerclage show maximum stability. There is evidence of a direct correlation between the risk of developing infectious complications and pain in the postoperative period and the number of elements of subcutaneous metal implants. Thus, the most optimal way to treat closed fractures of the patella is osteosynthesis with the use of wires and wire cerclage according to the tension band principle.

Experience of Using Transpedicular Osteosynthesis in Traumatic Spondylolisthesis of the Axis.

The aim of the study was to assess the efficacy and safety of direct posterior transpedicular osteosynthesis in traumatic spondylolisthesis of C2 vertebra.Materials and MethodsThe present study is an observational retrospective analysis of the results of surgical treatment of 19 patients operated on in 2014–2020 using the posterior transpedicular osteosynthesis technique with Herbert’s compression screws for a Hangman’s fracture type II according to Levine–Edwards classification. After the operation, the follow-up period lasted for 22 [10; 36] months.ResultsThe study group of patients (n=19) made 2.48% of all patients operated on for traumatic injury of the cervical spine (n=766) in the period from 2014 to 2020. In all cases, the surgical treatment was successful; there were no intraoperative complications in the form of damage to the vascular and nerve structures. The average duration of surgery was 70.8±24.5 min, and intraoperative blood loss was 92.9±41.8 ml. The length of hospitalization stay was 7 [5; 17] days. On the postoperative CT scans, no significant screw malposition (>2 mm) was found.ConclusionTranspedicular osteosynthesis with compression screws in C2 traumatic spondylolisthesis is a safe and sparing operation with a short duration and insignificant blood loss. Thorough preoperative planning and knowledge of the anatomic landmarks make it possible to perform this operation effectively under the C-arm X-ray system control without any navigation system.

Masquelet technique in post-traumatic infected femoral and tibial segmental bone defects. Union and reoperation rates with high proportions (up to 64%) of allograft in the second stage

Introduction The aim of this study was to describe union, reoperation and failure rates after using the induced membrane (IM) technique with ≥50% allograft over autograft to treat infected femoral and tibial segmental bone defects (SBD).Materials and methods We retrospectively analyzed patients with femoral and tibial SBD treated in our center between 2012 and 2019 using ≥50% allograft over autograft during the second stage of the Masquelet technique. We analyzed the affected bone, defect size, osteosynthesis technique used, time elapsed between the first and second stage of the technique, graft proportions, union time, reoperations, and non-union rates.Results We included 21 patients (61.90% men) with a median age of 41 (range 18-68) years. The tibia was affected in 61.90% (n:13) and the femur in 38.09% (n:8) of the cases. SBD length was 4.5 (range 3.5-14) cm. The median interval between both stages of the technique was 10 (range 6-28) weeks. The proportion of allograft used was 50 % in 10 patients, 51 to 55% in 5 patients, 56 to 59% in 4 patients, and 60 to 64% in 2. The union rate was 95.23% over a median time of 7 (range 6-12) months. There were 3 (14.28%) reoperations: 2 for relapse of infection and 1 for mechanical instability. There was one failure (4.76%). One patient presented non-union and nail break. The median follow-up after the second stage of the technique was 26 (range 13-54) months.Conclusion The use of the induced membrane technique and a high proportion of allograft (up to 64%) achieved similar union and failure rates than those reported for similar series that relied on lower allograft proportions.

Does Malrotation After Minimally Invasive Plate Osteosynthesis Treatment of Distal Tibia Metaphyseal Fractures Effect the Functional Results of the Ankle and Knee Joints?

To investigate whether rotational malalignment of tibia, after fracture management with minimally invasive plate osteosynthesis technique (MIPO), leads to impaired results in knee and ankle joint functional scores. Prospectively collected data were retrospectively analyzed for this study. Level III academic trauma center. Sixty-five consecutive patients who applied between October 2010 and January 2014 with a unilateral distal tibia fracture and had full bone union at their last visit were analyzed. Patients were excluded if they had a pathologic fracture, Gustilo-Anderson type II or III open fracture, additional ligamentous trauma, were pregnant, or had any deformity. A total of 27 patients were accepted into the study. All patients were treated with a MIPO technique after a mean of 2.8 days. The fibular fracture, when present, was fixed first. The main outcome of this study was the relation between tibial malrotation after a MIPO procedure, and Lower Extremity Functional Scale, American Orthopedic Foot and Ankle Society, KOOS scores, and range of motions of adjacent joints. Fourteen patients (51.8%) had a rotation higher than 10 degrees. The mean malrotation angle was 14.6 degrees. Concomitant fibular fractures were present in 13 patients, which did not seem to have a significant influence on malrotation. There was no significant difference between groups regarding functional scores and range of motions of the knee and ankle joints. Despite high rates of malrotation after tibial metaphyseal-diaphyseal fractures treated with MIPO technique, this finding does not seem to have a significantly negative effect on knee and ankle joint functions. Meticulous intraoperative evaluation, through a range of different techniques, should be performed to avoid malrotation. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Outcome of percutaneous locked plating of extra-articular distal tibial metaphyseal fractures

Introduction: Management of fractures involving the distal tibial metaphysis is one of the most challenging and controversial issue due to poor soft tissue envelop. Multiple different fixation modalities are available with different outcome. Percutaneous plating of the distal tibia fracture is gaining more popularity due to minimal interruption of the fracture biology and favorable functional and radiological outcomes. Purpose: To evaluate the functional and radiological outcome of management of distal tibia extra articular metaphyseal fractures using locked plates with Minimally Invasive Plate Osteosynthesis (MIPO) technique. Methods: Twenty four patients with extra- articular distal tibia metaphyseal fractures were operated with locked compression plates using MIPO technique. They were followed up at regular intervals. Functional and radiological results were evaluated at the end of follow up. Results: All fractures united at average time of 12.21 weeks (range; 8-20 weeks). Postoperatively, two patients developed deep infection and two patients developed malunion. Mean AOFAS score was excellent 90.6 points (range: 52-100) at last follow up. Conclusion: MIPO technique using distal tibia locked plating is an effective procedure for fixation of distal tibia extra-articular metaphyseal fractures. It provides near anatomical fracture reduction with sufficient stability and preservation of the blood supply to the fracture fragments. It provides excellent functional results with acceptable rate of complications.

A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for step-cut olecranon osteotomy

Olecranon osteotomies are frequently used to expose distal humeral intraarticular fractures. The step-cut olecranon osteotomy (SCOOT) is an augmented version of the oblique olecranon osteotomy, which has recently been evaluated biomechanically with tension band wiring (TBW) fixation. However, complications with TBW are common. In this study, we, therefore, compared the mean load to failure of TBW with compression screws for SCOOT fixation. We hypothesized a higher load to failure for the compression screw group. We performed a SCOOT on 36 Sawbones. Eighteen were fixed with TBW, and another 18 with two compression screws. The humeroulnar joint was simulated using an established test setup, which allows the application of triceps traction force through a tendon model to the ulna, while the humeroulnar joint is in a fixed position. Eight models of each fixation group were tested at 20°, and eight at 70° of flexion by isometrical loading until failure, which was defined as either a complete fracture or gap formation of more than 2 mm at the osteotomy site. At 20° of flexion, mean load to failure was similar between the TBW group (1360 ± 238 N) and the compression screw group (1401 ± 261 N) (P= .88). Also, at 70° of flexion, the mean load to failure wassimilar between the TBW group (1398 ± 215 N) and the compression screw group (1614 ± 427 N) (P= .28). SCOOTs fixed with TBW and compression screws showed similar loads to failure. A SCOOT fixed with compression screws might be a valuable alternative for surgeons when treating intraarticular distal humeral fractures. However, future invivo studies are necessary to confirm our results in a clinical setting.

C1-C2 Wiring With Timed Self-Obsolescence for Complex C2 Body Fracture.

Fractures of C2 are typically managed nonoperatively with good rates of healing. Management decisions are complicated, however, when there are additional fractures in the axis possibly leading to increased instability. Additionally, the techniques used for treating these unstable axis fractures can have either significant complications or permanent loss of range of motion. Here, we present a novel technique for the reduction and stabilization of complex C2 body fracture. A 34-yr-old woman with a complex C2 body fracture, which included a right pars and left lateral mass fracture, presented after a water slide accident. It was felt that this fracture was both unstable and would not heal in an anatomically acceptable way so an open surgical reduction was needed. After consideration of more traditional fusion and osteosynthesis techniques, we chose to perform a C1-C2 internal stabilization with C1 sublaminar and C2 spinous process wiring. The patient was then instructed to wear a Miami J collar for 3 mo. The outcome was favorable with good approximation and healing with preserved range of motion.

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

PurposeTreatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods. MethodsThis was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0). ResultsAverage malunion (degrees) in the MIPPO group was 5 (3–7) ± 1.41 vs. 10.22 (8–14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001). ConclusionBoth procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

Biomechanical Evaluation of Tarsometatarsal Fusion Comparing Crossing Lag Screws and Lag Screw With Locking Plate.

Background:Tarsometatarsal (TMT) arthrodesis is a common operative procedure for end-stage arthritis of the TMT joints. To date, there is no consensus on the best fixation technique for TMT arthrodesis and which joints should be included.Methods:Thirty fresh-frozen feet were divided into one group (15 feet) in which TMT joints I-III were fused with a lag screw and locking plate and a second group (15 feet) in which TMT joints I-III were fused with 2 crossing lag screws. The arthrodesis was performed stepwise with evaluation of mobility between the metatarsal and cuneiform bones after every application or removal of a lag screw or locking plate.Results:Isolated lag-screw arthrodesis of the TMT I-III joints led to significantly increased stability in every joint (P < .05). Additional application of a locking plate caused further stability in every TMT joint (P < .05). An additional crossed lag screw did not significantly increase rigidity of the TMT II and III joints (P > .05). An IM screw did not influence the stability of the fused TMT joints. For TMT III arthrodesis, lag-screw and locking plate constructs were superior to crossed lag-screw fixation (P < .05). TMT I fusion does not support stability after TMT II and III arthrodesis.Conclusion:Each fixation technique provided sufficient stabilization of the TMT joints. Use of a lag screw plus locking plate might be superior to crossed screw fixation. An additional TMT I and/or III arthrodesis did not increase stability of an isolated TMT II arthrodesis.Clinical Relevance:We report the first biomechanical evaluation of TMT I-III arthrodesis. Our results may help surgeons to choose among osteosynthesis techniques and which joints to include in performing arthrodesis of TMT I-III joints.

Evaluation of the Structural Behaviour of a Unilateral External Fixator for Osteosynthesis

Background: External fixation is an osteosynthesis technique particularly useful in trauma surgery and Damage Control Orthopedics (DCO). However, complications, such as pin loosening and pin tract infections, are fairly common. For reducing thermal damage and infection rates, monocortical pins have been proposed as an alternative to the most used bicortical pins. However, there is a lack of studies regarding their mechanical properties. Objective: The aim of the study is to assess the static and dynamic stability of a unilateral external fixator experimentally when applied through monocortical pins for the reduction of femur and tibia fractures. Methods: A modular unilateral external fixator was used and a total number of 6 pins were used per test. The static tests were performed in displacement control by applying a vertical displacement to the upper fixture at 1 mm/min until a tension load of 380 N was reached. The dynamic tests were performed by applying a sinusoidal displacement. During each test, forces and crosshead displacements were acquired. Two different stiffness indexes were assessed. Results: By comparing the two anatomic regions, it was found that the fixator behaves stiffer when mounted on the femur, regardless of the pins used, while stiffnesses comparable to the femur ones are reached by the tibia when 4 mm diameter pins are used. Static analysis revealed excellent fixator stability when implanted with 4 mm diameter monocortical pins on both anatomic regions. On the contrary, two tibia and one femur samples showed failures at the bone-pin interface when 3 mm diameter pins were used. Conclusion: Dynamic analysis showed no substantial difference between the tested configurations and confirmed the fixator's ability to sustain cyclic loading without further damage to the sample.

Evaluation of functional outcome of distal tibial fractures managed with locking compression plate using minimally invasive plate osteosynthesis (MIPPO) technique

Background: Treatment of distal tibial fracture is challenging, because of precarious blood supply leading to poor healing. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But this modalities doesnot give better functional outcome and had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To evaluate clinical, functional and radiological outcomes after minimally invasive plate osteosynthesis using distal tibial locking compression plates. Materials and Methods: In this study, 30 patients with distal third tibial extra articular Metaphyseo diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at Tripura Medical College, between August 2020 to July 2021. Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 6.27 days post- trauma, with an average operative time of 66.25 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 17.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 86.66% cases. Conclusion: It is concluded that locking plate fixation by minimally invasive percutaneous plate osteosynthesis technique (MIPPO), is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.

A prospective study of distal tibial fracture fixation with anatomical osteosyntheses using minimally invasive percutaneous plate osteosynthesis technique

Introduction: Our objective was to evaluate clinical results and functional outcomes of extraarticular distal tibia fracture treated using anatomical osteosyntheses by minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Materials and Methods: 30 patients of closed distal tibial extraarticular fractures operated by MIPPO technique from November 2018 to October 2019 with age from 20 to 60 years with or without fibula fracture upto 5 cm proximal to distal tibiofibular syndesmotic joint were included in the study. Clinical and radiological assessment for fracture union were performed at 3 weeks,12 weeks and 24 weeks interval and results were analysed by using AOFAS Ankle-Hind foot scale. Results: Thirty patients were followed for 6 months with mean fracture healing time was 16 weeks (12-60 weeks). 14 patients had excellent results with AOFAS score with two patients (6.7%) had delayed union and one patient (3.3%) developed superficial infection but fractures united completely. Conclusion: Minimally invasive percutaneous plate osteosynthesis technique is an effective method of treatment for distal tibial fractures, it provides good, stable fixation with minimal complications.

Prospective study of surgical management of proximal tibia fracture with locking compression plate using minimally invasive percutaneous plate osteosynthesis technique

Introduction: The majority of tibial plateau fractures are secondary to high velocity road traffic accidents. Hence the management of high-energy proximal tibial fractures will need very good care of the soft-tissue envelope as the surface of the proximal tibia is covered only with skin and subcutaneous tissues The main goal of surgical treatment of proximal tibial fractures in this study is to restore and preserve normal knee function by using Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) technique. Method: 32 cases of proximal tibial fractures from Chigateri General Hospital and Bapuji Hospital attached to J.J.M Medical College, Davangere during the study period were included in study and cases were followed up for a minimum period of 12 months. At 4, 6, 9, 12, 16 weeks and then two monthly follow up till 12 months. Inability to take part in post operative rehabilitation & those with Open fractures were excluded from the study. Result: Based on Modified Rasmussen criteria for clinical assessment in our study we achieved 71.88% excellent results, 15.62% good results (with overall of 87.% excellent to good results) and 12.5% fair results.

A review of minimally invasive fracture stabilization in dogs and cats.

ObjectiveTo summarize and discuss peer‐reviewed studies on minimally invasive osteosynthesis (MIO) of long bone, physeal, and articular fractures in dogs and cats.Study DesignInvited review.MethodsA critique of literature was performed to assess MIO feasibility, outcomes, and complications through PubMed, Scopus, and CAB abstracts research databases (2000–2020).ResultsMore than 40 MIO articles have been published in the last 15 years, but most studies had small numbers, lacked control groups, and used limited outcome measures. Studies generally showed that MIO was feasible in dogs and cats with low complication rates. The current evidence does not demonstrate superior bone healing or functional outcomes with MIO when compared to standard methods. Although treatment principles, case selection, and techniques varied depending on the anatomical location, there were no salient differences in complication rates among long bones, physeal, and articular fractures treated by MIO.ConclusionThe current available evidence and the personal experience of the authors support MIO as a promising fracture management modality. MIO can yield excellent outcomes when applied in carefully selected cases, performed by surgeons experienced in the technique. We cannot, however, conclude that MIO is superior to open fracture stabilization based on the available evidence in veterinary literature. Randomized controlled studies are warranted to prospectively compare MIO with other osteosynthesis techniques and thereby validate its role in fracture management for dogs and cats.

Minimal invasive percutaneous plate osteosynthesis (MIPPO) in treatment of distal tibial fractures: A prospective study of 50 cases

Background: The limited soft tissue, subcutaneous location of large portion of tibia and precarious blood supply renders the treatment of distal tibial fracture very challenging. The main treatment of this type of fracture is reinstatement of the normal alignment and articular congruity. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed Reduction and MIPO with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia, maintains fracture haematoma and provides biomechanically stable construct, early mobilization, less complications and relatively higher rates of union. The aim of this study was to evaluate the functional and clinical outcomes of distal tibia fracture of patients, treated by internal fixation by minimally invasive plating osteosynthesis (MIPPO) technique with locking compression plate (LCP). Methods: 50 patients with distal tibia fracture with or without intra articular extension were treated in our department at Guru Gobind singh Medical College and Hospital, Faridkot by MIPPO with LCP and were prospectively followed for average duration of 6 months. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) score. Results: There were 50 patients in the study including 36 males and 14 female of mean age 38.4 years. The mean follow up period of our patients was 6 months. All fractures united at an average of 19.13 weeks (range- 16-24 to weeks) except two cases of non-union. There were 12 superficial wound infections which were treated with oral antibiotics and progressed to union and there were no failures of implants. . According to AOFAS score at 6 months, 6 cases had score of 31 to 70 and 44 cases had score of 71 to 100. Conclusions: Minimally invasive plating osteosynthesis (MIPPO) is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incision is technically demanding as it is effective, minimally invasive, optimises the operation time, promotes early healing and reduces the incidence of infections.