Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures / 中华创伤杂志(英文版)

PURPOSE@#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.@*METHODS@#This 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).@*RESULTS@#Average 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).@*CONCLUSION@#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.

Complex Proximal Humeral Fracture Fixation with PHILOS Plate using Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) Technique: A Series of 30 Patients

@#plate osteosynthesis depends on the quality of the bone,design of the fixation devices and intra-operative soft tissuedissection. This study evaluates the functional outcome ofminimally invasive percutaneous plate osteosynthesis usinglocking compression plate in proximal humerus fracturetreatment. MaterialsandMethods:The study was conducted on 30patients with complex proximal humerus fractures treated byminimally invasive percutaneous plate osteosynthesis usinglocking compression plate (PHILOS). There were 21 malesand 9 females. The average age of our study group was 58.8years. All the patients were evaluated at six weeks, threemonths, four months, six months and 12 months followingsurgery. Results:All patients had fracture union at an average of 13.2weeks. The mean DASH score at the follow-up was 8.69 (2.5to 17.16), the average range of flexion was 143.83 degrees(100 to 170 degrees) and abduction was 121.49 degrees (90to 160 degrees). We had superficial infection in three patientswhich resolved with a short course of antibiotics. There wasexcellent outcome in 26 patients, good and fair in twopatients each. Conclusion:Proximal humerus fractures treated withminimally invasive percutaneous plate osteosynthesis usinglocking compression plate with minimal soft tissuedissection, provides good functional outcome and earlyreturn of shoulder function.

Treatment of Distal Tibia Fracture using MIPPO Technique with Locking Compression Plate: Comparative Study of the Intraarticular Fracture and Extraarticular Fracture / 대한족부족관절학회지

PURPOSE: To evaluate the efficiency of the minimally invasive percutaneous plate osteosynthesis (MIPPO) with locking compression plate (LCP) for distal tibial metaphyseal intra-articular fracture compared with extra-articular fracture. MATERIALS AND METHODS: From February 2006 to June 2008, 21 patients with distal tibia metaphyseal intra-articular fracture and 20 patients with extra-articular fracture were treated operatively by MIPPO technique with LCP and followed for at least one year. In the group with intra-articular fracture, mean age was 48.85 years old and a mean follow-up was 15 months. In the other group with extra-articular fracture, mean age was 52.35 years old and a mean follow-up was 14.5 months. The type of fracture was evaluated using the AO/OTA classification and open-fractures were according to the Gustilo-And gron classification. Radiologic evaluation with fracture healing and tibial alignment, clinical evaluation with Olerud and Molander ankle score and restriction of motion were done for treatment. RESULTS: According to AO/OTA classification, There were 21 type A, 15 type B, 5 type C. Average union time of the intra-articular fracture (type B, C) was 18.7 weeks. Average union time of the extra-articular fracture (type A) was 17.1 weeks. All fractures were healed without malunion. There were no difference of mean restriction angle between intra-articular fracture (ankle dorsiflexion was 3.57 degree, plantar-flexion was 5.95 degree) and extra-articular fracture (ankle dorsiflexion was 3 degree, plantar-flexion was 3.75 degree). There were no difference of Olerud and Molander ankle score between them as a mean score of intra-articular and extra-articular was 89.25, 91.25 each other. As a complication, there were 3 case of skin necrosis, 8 case of discomfortable skin tenting by plate and 1 superficial infection, but could be healed by conservative care. CONCLUSION: MIPPO technique, combined articular reduction, with LCP of distal tibial metaphyseal fracture was a good method with high functional recovery.

Treatment of Distal Tibial Metaphyseal Fracture Using MIPPO Technique / 대한족부족관절학회지

PURPOSE: To evaluate the results of MIPPO (minimal invasive percutaneous plate osteosynthesis) technique for distal tibial metaphyseal fractures. MATERIALS AND METHODS: It is a retrospective study of 13 patients who were treated by MIPPO technique for distal tibial metaphyseal fractures from Jan. 2001 to Jan. 2003. The average age was 46.7 years and mean follow-up period was 13.3 months. According to AO classification, there were 8 cases of A1, 3 cases of A2, 1 case of B1 and 1 case of C2. One case of A1 was a Gustilo-Anderson type I open fracture and fibular fractures were combined in 12 cases. We applied anatomical reduction and internal fixation for the fibular fractures and internal fixation on the medial side of the tibia by MIPPO technique for distal tibial metaphyseal fractures. Clinical results were evaluated using radiographic results, Neer score, the starting time of postoperative exercise and clinical complications. RESULTS: According to the Neer score, all cases showed satisfactory results. Active ankle ROM was started at average 2.4 weeks (2~4 weeks) and full weight bearing ambulation at average 5.2 weeks (4~8 weeks) postoperatively. Union of fractures was obtained by average 14.4 weeks (8~18 weeks) postoperatively. Two cases showed 5 degrees limitation of motion without functional deficits and other cases showed satisfactory ROM results. One case had 6 degrees valgus deformity without functional deficits. There were not any other complications like soft tissue problems and delayed-or non-union. CONCLUSION: MIPPO technique for the treatment of distal tibial metaphyseal fractures is a feasible technique with a good clinical outcomes.

MIPPO Technique using DCS in Comminuted Fracture of the Distal Femur / 대한정형외과학회잡지

PURPOSE: To evaluate the advantages of transarticular reconstruction and fixation by MIPPO (Minimally Invasive Percutaneous Plate Osteosynthesis) using DCS in comminuted fractures of the distal femur. MATERIALS AND METHODS: From February, 1998 to August, 2000, we experienced 23 cases of comminuted fractures of the distal femur, which were treated by MIPPO and lateral parapatellar arthrotomy in most cases. The follow up period was minimally 12 months. Clinical results were evaluated using Neer scores, radiographic results and the presence of clinical complications. RESULTS: According to the Neer scores, 18 cases (78.3%) showed satisfactory results and 5 cases (21.7%) unsatisfactory results. The average period until radiographic union was 16 weeks (range 11-20 weeks). As for alignment measured using the tibiofemoral angle, 2 cases showed valgus deformity and no posterior angulation was present over 10dgrees. As for complications, 1 case showed a leg length discrepancy of 2 cm and 5 cases showed delayed union, which showed a gap radiographically between the bone fragment at the site of the fracture, and callus formation on ultrasound, but which did not need a bone graft. The radiographic union was achieved at the final follow-up. CONCLUSIONS: In the case of comminuted fractures of the distal femur, transarticular reconstruction and fixation by the MIPPO technique using DCS could reduce complications including non-union and infection.