Bone alignment after minimally invasive plate osteosynthesis of the tibia in dogs / Avaliação do alinhamento ósseo após osteossíntese minimamente invasiva com placa de tíbia em cães

ABSTRACT: This study assessed radiographically changes in tibial alignment in the frontal and sagittal planes in dogs that underwent minimally invasive plate osteosynthesis (MIPO) without the aid of image intensifiers. Radiographs of dogs with complete non-articular tibial fractures submitted to MIPO were included and evaluated, without the aid of a transoperative image intensifier and / or an association of implants. The tibial mechanical angles (mMPTA, mMDTA, mCaPTA and mCrDTA) were measured by three evaluators. The data obtained were compared with results from previously published studies. Twenty-seven animals were included in the study. The mean and standard deviation of the angular changes were as follows: mMPTA, 2.54° ± 3.10 (-1.1º to 8.7º); mMDTA, 0.03º ± 0.16 (-3.44º to 0.79º); mCaPTA, 37º ± 4.29 (-6.23º to 14.87º); and mCrDTA, 8.25° ± 5.53 (-0.2º to 17.28º). There was a negative correlation between "mCaPTA" and "mCrDTA". MIPO of the tibia without using image intensifiers and implant association can potentially cause angular changes, which can lead to clinically relevant deformities after bone healing.

RESUMO: Este estudo teve como objetivo avaliar radiograficamente as alterações no alinhamento da tíbia nos planos frontal e sagital em cães submetidos à osteossíntese minimamente invasiva com placa (MIPO) sem o auxílio de intensificadores de imagem. Foram incluídas e avaliadas radiografias de cães com fraturas completas da tíbia não articulares submetidos a MIPO, sem o auxílio de intensificador de imagem transoperatório e/ou associação de implantes. Os ângulos mecânicos tibiais (mMPTA, mMDTA, mCaPTA e mCrDTA) foram mensurados por três avaliadores. Os dados obtidos pela média de todas as avaliações foram comparados com resultados de estudos previamente publicados. Vinte e sete animais foram incluídos no estudo. A média e desvio padrão das alterações angulares foram os seguintes: mMPTA= 2,54° ± 3,10 (-1,1º a 8,7º); mMDTA= 0,03º ± 0,16 (-3,44º a 0,79º); mCaPTA= 37º ± 4,29 (-6,23º a 14,87º); e mCrDTA= 8,25 ° ± 5,53 (-0,2º a 17,28º). Houve uma correlação negativa entre "mCaPTA" e "mCrDTA". A realização de MIPO em tíbia sem o uso de intensificadores de imagem e associação de implantes pode causar alterações angulares, o que pode levar a deformidades clinicamente relevantes após a cicatrização óssea.

Percutaneous application of allogeneic adipose-derived mesenchymal stem cell in dogs submitted to minimally invasive plate osteosynthesis of the tibia

ABSTRACT Purpose To evaluate clinical outcome following minimally invasive plate osteosynthesis (MIPO) associated with percutaneous transplantation of allogeneic adipose-derived mesenchymal stem cells (AD-MSC) at the tibial fracture site in dogs. Methods Thirty-six dogs presenting with nonarticular complete tibial fracture were included in this study. All fractures were treated by the same MIPO technique. The animals were divided in group 1 (n = 20) received a percutaneous application of 3 × 106 AD-MSC at the fracture site and group 2 (n = 16) did not receive any adjuvant treatment. Postoperative radiographic examinations were made at 15, 30, 60, 90 and 120 days. Results Fifty-eight percent of the patients were classified as skeletally immature. The median weight of the animals was 18.8 kg. The mean radiographic union time differed statistically between the AD-MSC group (28.5 days) and the control group (70.3 days). Sixty percent of dogs in group 1 and 56.25% of the group 2 were considered immature. Conclusions The use of allogeneic AD-MSC cell therapy and MIPO is a safe, viable and effective technique for promoting bone healing in nonarticular tibial fractures in dogs.

Comparative Study Regarding Functional and Radiological Outcomes of Different Modes of Fixation for Distal Femur Fracture.

Treatment of distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Advent of MIPO technique has reduced the amount of soft tissue injury, delayed healing, tissue necrosis and infections. The objective was to compare the functional and radiological outcome of fracture distal femur treated by open reduction with LCP by minimally invasive plate osteosynthesis (MIPO). We wanted to compare the clinical and radiological differences between open and MIPO techniques for distal femoral fracture fixation.METHODSThis was a prospective interventional study. 41 subjects with closed supracondylar femur fracture treated surgically from March 2013 to December 2017, were evaluated prospectively for functional and radiological outcome results after fixation with distal femoral locking compression plate in open or minimally invasive way, with minimum follow up of 1 year. IBM SPSS Ver. 25 software was used to perform statistical analysis.RESULTSThe mean age of 41 treated patients was 53.8 ± 13.7 years and ranged from 23 to 84 years. 19 patients were females and 22 were males. Mean time to surgery was 5.7 ± 2.9 days with minimum 2 and maximum of 18 days from injury. Initially 20 patients underwent open surgery and 21 patients were operated by minimally invasive plating technique. In all cases, a 316L stainless steel alloy distal femoral locking plate was used.CONCLUSIONSKnee ROM could be started at a mean of 1.4 weeks earlier in the MIPO group and this was statistically significant. The two groups did not differ significantly in start of full weight bearing. Knee flexion at 6 weeks was also comparable in the two groups. However, knee flexion was average 21.9° higher in MIPO group at 1 year which was significantly different than ORIF group. The proportion of patients with >90° and >110° knee flexion also varied significantly between the groups. VAS score in MIPO group was significantly less at 6 weeks but difference was non-significant at 1 year. There were 2 cases with non-union and implant failure in the ORIF group, but the proportion was not significant. There was 10° FFD in 1 patient of ORIF group, while varus deformity occurred in 3 patients of MIPO group. The proportion of deformity was not significantly different between the two groups.

Minimally Invasive Plate Osteosynthesis (MIPO) for Proximal and Distal Fractures of the Tibia

Introduction: The treatment of fractures of proximal and distaltibia is challenging, because of the possibility of soft tissuecomplications. The treatment of choice remains controversialand it depends on the fracture morphology, displacement andpresence of comminution. Options for the management ofthese fractures vary from closed reduction and cast applicationto open reduction and fixation with plate. Open reduction andplate osteosynthesis is associated with extensive dissectionand soft tissue complications in post-operative period. Weconducted a case series on management of these fractures byusing Minimally Invasive Plate Osteosynthesis (MIPO)technique, which has the advantage of preservation of osseousand soft tissue vascularity.Methods: We conducted a prospective study on closedreduction and percutaneous plating by MIPO technique in 30cases (mean age 42.5 years; 23 males and 7 females) ofclosed fractures of tibia. 22 cases had proximal tibial fracturesand eight had distal tibial fractures. The mean time from injuryto surgery was 7.6 days.Results: Mean time for radiological union was 18 weeks(range: 14-24 weeks). Two patients had superficial operativesite infections, which were managed with oral antibiotics andregular dressings. One patient with proximal tibia fracturedeveloped a non-union, which was treated with bone grafting.Conclusions: In closed peri-articular fractures of the tibia,favourable results can be achieved by MIPO technique.Principles of MIPO technique like minimal soft tissuedissection, closed and indirect reduction, biological fixation andearly mobilization have to be followed for a favourablefunctional outcome.

Tratamiento quirúrgico de las fracturas mediodiafisarias desplazadas de clavícula mediante placas precontorneadas con técnica mininvasiva / Surgical treatment of clavicle displaced midshaft fractures with pre-contoured plates using mini invasive technique (MIPO)

Introducción: Las fracturas mediodiafisarias de clavícula representan hasta el 10% de las fracturas del esqueleto. El tratamiento conservador brinda buenos resultados con baja incidencia de complicaciones. Sin embargo, en trazos desplazados, multifragmentarios o con deformidad significativa, se debe considerar la cirugía. El propósito de esta serie retrospectiva es exponer nuestra experiencia en el tratamiento de fracturas cerradas, desplazadas y mediodiafisarias de clavícula con placas precontorneadas mediante la técnica MIPO, describir la técnica y los resultados funcionales preliminares. Materiales y Métodos: Serie retrospectiva de 13 pacientes (11 varones [84,6%] y 2 mujeres [15,4%]), media de la edad: 31 años, con fracturas diafisarias cerradas desplazadas de clavícula de tipo 2B de Robinson (Edimburgo), tratadas mediante reducción y osteosíntesis con placas precontorneadas con MIPO, entre abril de 2010 y noviembre de 2013. Seguimiento promedio: 13 meses (rango 11-25). Se realizaron controles radiográficos y tomografías computarizadas, valorando la funcionalidad mediante las escalas de Constant-Murley modificada, QuickDASH y el dolor con la escala analógica visual. Resultados: El tiempo promedio hasta la cirugía fue de 8 días; la cirugía duró 35 minutos y el tiempo de internación posoperatoria fue de 1.28 días. La consolidación clínico-radiológica se registró en una media de 15.2 semanas. El puntaje promedio de Constant-Murley modificado fue 88; el de QuickDASH, 26,9 y la escala analógica visual arrojó un valor de 0,3. No hubo complicaciones sistémicas ni cosméticas. Conclusión: La osteosíntesis mínimamente invasiva en fracturas cerradas mediodiafisarias desplazadas de clavícula representó una técnica reproducible con un tiempo quirúrgico reducido y puntajes funcionales aceptables, sin complicaciones de relevancia. Nivel de Evidencia: IV

Introduction: Midshaft clavicular fractures represent up to 10% of skeleton fractures. Conservative treatment usually provides good results with low incidence of complications. However, surgical treatment should be considered in displaced, multifragmentary fractures or cases with significant deformity. The purpose of this retrospective case series is to report our experience in the treatment of closed and displaced midshaft clavicular fractures with pre-contoured plates using MIPO technique, to describe the technique and report preliminary functional results. Methods: Retrospective series of 13 patients (11 males [84.6%] and 2 females [15.4%], mean age: 31 years), with closed and displaced midshaft clavicle fractures classified as type 2B according to Robinson (Edinburgh) treated by reduction and internal fixation with pre-contoured plates osteosynthesis using minimally invasive technique (MIPO) between April 2010 and November 2013. Mean follow-up: 13 months (range 11-25). Radiographic and tomographic controls were carried out to assess function using modified Constant-Murley scale, QuickDASH Questionnaire and the visual analogue scale to evaluate pain. Results: Average time to surgery was 8 days, surgical time: 35 minutes, days in hospital after surgery: 1.28. Clinical and radiological consolidation was recorded at 15.2 weeks on average. The average modified Constant-Murley score was 88, QuickDASH 26.9 and visual analogue scale 0.3. No systemic or cosmetic complications were recorded. Conclusion: Minimally invasive plate osteosynthesis (MIPO) in displaced and closed midshaft clavicle fractures represented a reproducible technique with reduced surgical time and acceptable functional scores. Level of Evidence: IV

Comparative Analysis of Results of Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) and Intramedullary Nail (IMN) In Humerus Shaft Fracture – A Prospective Study.

Background: Treatment of humeral shaft fractures continues to evolve as advances are made in both non-operative and operative management. The encouraging results that have been reported with recent advances in internal fixation techniques and instrumentation. The controversy still exist between plating and intramedullary nailing. MIPO (Minimal invasive plate osteosynthesis) has emerged as a new alternative mode or treatment. In this study, we compare the result of MIPO and intramedullary nailing. Methods: This was an institution based, prospective longitudinal and comparative study. Patients of age of 20 to 60 years (skeletally mature) which required operative intervention in this study. Pathological fractures, segmental fractures, neurovascular injury were excluded. Patients were followed for at least one year. Results: 130 patients were included in this study. Intramedullary nailing was done in 60 patients and MIPO plating done in 70 pts. Demographically, there was no difference between the groups. No statistical difference was found regarding union and complication. There was significant statistical difference of UCLA shoulder score between the groups. But no difference in Mayo elbow performance score. Discussion: This study shows that the MIPPO technique is safe, convenient and effective, since there was a minimal soft tissue injury and no major complications. It does not disturb the fracture hematoma like open plating and thus help in fracture union. There is no injury to the rotator cuff or supraspinatus tendon like intramedullary nailing in MIPO plating. Conclusion: MIPO is a modality which results in a relatively stable fracture construct while preserving a biologic environment that facilitates rapid bone healing without disturbing rotator cuff.

Fracturas de tobillo. comparación entre la cirugía abierta y el método mínimamente invasivo / Ankle fractures. comparison between open surgery and a minimally invasive method

Introducción: Las fracturas de tobillo son lesiones traumáticas frecuentes. El tratamiento, en general, es quirúrgico. La cirugía puede ser abierta o percutánea. El objetivo de este estudio es comparar el método mínimamente invasivo y el de la cirugía convencional abierta en el tratamiento de las fracturas detobillo AO B. Materiales y Métodos: Estudio prospectivo comparativo de 75 casosde fracturas AO B operados con MIPO y 58 casos operados por vía convencional. Se agruparon según la clasificación AO. Se evaluaron las características durante el período intraoperatorio y la hospitalización, los resultados funcionales, según los puntajes de la AOFAS y de Weber, y los resultados radiológicos El seguimiento promedio de ambos grupos fue de 20.4 meses. Resultados: Se mencionan los resultados comparativos del tiempo quirúrgico, la estadía hospitalaria, el tiempo de fluoroscopia, la carga del peso. El puntaje de la AOFAS a los 3 meses: grupo A: 96,5 y grupo B: 99. Reducción radiológica: 97,4% con MIPO y 98,3% de los casos convencionales. Retorno a la actividad laboral: grupo A, 3.6 meses promedio, grupo B: 2.5 meses promedio. Retorno a la actividad deportiva: grupo A: media 4.8 meses; grupo B: media 3.7 meses. Conclusiones: De este estudio, se desprende que la MIPO para tratar las fracturas transindesmales es una buena opción, la evolución y la recuperación son más rápidas que con la técnica abierta, y el índice de complicaciones es bajo.

Introduction: Ankle fractures are common traumatic injuries. Treatment is usually surgical. Surgery may be open or percutaneous. The aim of this study is to compare the minimally invasive method and the conventional open reduction internal fixation surgery in the treatment of AO type B ankle fractures. Methods: This prospective study included 75 patients with AO type B ankle fracture operated on with MIPO technique and 58 patients operated on by RAFI technique. They were grouped according to the AO classification. Intraoperative characteristics and hospitalization, functional outcomes according to AOFAS and Weber scores, and radiological results were evaluated. The follow-up was 20.4 months for both groups. Results: Comparative results of surgical time, hospital stay, fluoroscopy time, weight load. AOFAS at 3months: Group A, 96.5 points, and group B, 99 points. Anatomical reduction: 97.4% with MIPO technique and 98.3% using RAFI technique. Return to work activity: Group A, average 3.6 months; Group B: average 2.5 months. Return to sport: in Group A: mean 4.8 months; Group B: mean 3.7 months. Conclusions: It is clear from this study that the MIPO technique for the treatment of syndesmotic fractures isa good choice; the evolution and recovery are faster than with the open surgery, with a low complication rate.

Osteosíntesis mininvasiva con placas bloqueadas en fracturas metafisarias distales de tibia. Comparación de resultados entre fracturas AO 43A y AO 43C / Minimally invasive plate osteosynthesis in distal metaphyseal fractures of tibia. Comparison of results between AO 43A and 43C fractures

Introducción: Las fracturas distales de tibia son un desafío terapéutico debido a la escasa cobertura y la particular vascularización. Los objetivos de este estudio son analizar los resultados clínicos y funcionales de los pacientes con fractura de tibia distal, tratados con técnica MIPO con placas bloqueadas; comparar los resultados del grupo de fracturas AO 43A con el de fracturas AO 43C1-C2; y comparar los resultados de la técnica MIPO con el tratamiento abierto convencional. Materiales y Métodos: Entre 2004 y 2012, se evaluaron 32 fracturas de tibia distal tratadas con la técnica MIPO. El 59,4% tenía fracturas AO 43A y el 40,6%, AO 43C. Seguimiento promedio: 39.6 meses, mediante la escala de la AOFAS y radiología. Se consignaron las complicaciones. Se compararon los resultados de los grupos AO A y AO C. Resultados: El grupo AO A: media de 95,89 puntos en la escala AOFAS, en el posoperatorio. El grupo AO C1-2: media de 92,15 puntos en el posoperatorio. Carga del peso corporal: a las 8.7 semanas promedio. Comparación entre AO 43A y AO 43C: p = 0,46 (no significativa). Retorno a la actividad previa a la lesión: 9.3 meses promedio. Comparación entre tipo A y tipo C: p = 0,16 (no significativa). Se detectaron complicaciones en el 18,75% y se retiró la osteosíntesis en 14 casos. Conclusiones: La osteosíntesis mínimamente invasiva con placa y tornillos es una buena opción para las fracturas de tibia distal; con buena evolución clínico-funcional y escasas complicaciones cuando se la compara con la cirugía abierta. Las fracturas 43A presentan menos complicaciones mayores que las 43C, tratadas con la técnica MIPO. Nivel de evidencia: IV.

Introduction: Distal tibial fractures are a therapeutic challenge due to the limited coverage and specific vascularization. The aims of this study are to analyze the clinical outcome and functional results in patients with tibial fracture treated with MIPO technique with locked plates, and to compare AO 43A and AO 43C1-C2 fracture results, and conventional open treatment with MIPO technique. Methods: Between 2004 and 2012, 32 distal tibial fractures treated with MIPO technique were evaluated. The 59.4% were AO 43A fractures and 40.6% were AO 43C. Mean follow-up: 39.6 months using AOFAS Score and X-rays. Complications were recorded. Results in AO A and AO C groups were compared. Results: Mean postoperative AOFAS score was 95.89 and 92.15 in AO A fracture and AO C1-2 fractures respectively. The mean time of weight bearing was 8.7 weeks. The mean time to return to activities was 9.3 months. Complications were detected in the 18.75% and removal of the hardware was necessary in 14 cases. Conclusions: Minimally invasive plate osteosynthesis is a good choice for tibial distal fractures, clinical and functional outcomes are good, and there are fewer complications in comparison to open surgery. AO 43A fractures have less complications than AO 43C with this technique. Level of evidence: IV.

Minimally Invasive Plate Osteosynthesis for Fractures of Distal Tibia / 고신대학교의과대학학술지

OBJECTIVES: This study analyzed clinical and radiologic results, and complications of minimally invasive plate osteosynthesis(MIPO) for distal tibia fracture. METHODS: 16 patients (17 cases) who were performed MIPO for distal tibia fractures between January 2007 and June 2011, post-operative followed up at least for one year, were selected for this study. The average age was 55.0(26-76) years old and the average period of follow-up was 15.1(6-27) months. Most of the patients were encouraged to perform ankle dorsiflexion and straight leg raising exercise on splints, from the next day of the operation. As radiologic evaluation, we checked period until bone union, degree of angulation. And post-operative complications were also checked. For functional evaluation of the ankles, American Orthopaedic Foot and Ankle Society(AOFAS) score was used. RESULTS: 16 of the 17 cases were achieved primary bone union, and average period of bone union in all the cases was 17.4 (12-42) weeks. Mean varus/valgus angulation after the bone union was 0.8 degrees and mean anteroposterior(AP) angulation was 1.8 degrees. Mean AOFAS score was 85.2(71-95) points; 5 cases of excellent, 10 cases of good, 1 case of fair, showing that 93.8% of the patients represented at least good AOFAS scores. As complications, there were 2 cases of superficial infection, and each 1 case of nonunion and skin irritation. There were no cases of deep infection, metal breakage, nor limb length discrepancy. CONCLUSIONS: MIPO for distal tibia fracture is considered to be an effective operative method, because of its high bone union rate and low complications by minimal disruption of soft tissue and improved bone fixation strength. Also, for earlier return to daily life, ankle joint exercise should be started as soon as possible after the operation.

Técnica mínimamente invasiva por vía posterior para el tratamiento de fracturas diafisarias de húmero / Minimally invasive plate osteosynthesis through a posterior approach for humeral shaft fractures

Objetivo: Comunicar la técnica mínimamente invasiva por vía posterior para la osteosíntesis de las fracturas diafisarias de húmero y evaluar los resultados clínicos y radiológicos de una serie de pacientes. Materiales y métodos: Se evaluaron 11 pacientes (9 hombres y 2 mujeres; edad promedio, 33 años). Diez fracturas eran cerradas y una era expuesta. Se describe prolijamente la técnica quirúrgica. El seguimiento promedio fue de 22 meses. Resultados: La flexo-extensión del codo fue de 140º-0°. La movilidad del hombro fue de 170° de elevación, 70° de rotación externa y rotación interna de D9. El dolor según la escala analógica visual: 0 puntos, DASH: 6; puntaje de la Clínica Mayo: 96, test de la UCLA: 33 puntos. Todas las fracturas consolidaron. Se observó una alineación normal de la diáfisis humeral en 3 de los pacientes, 7 tenían alguna deformidad en varo y uno en valgo. Un paciente desarrolló una parálisis radial posoperatoria y otro necesitó la extracción del implante por una infección. Conclusiones: La técnica mínimamente invasiva posterior es una buena opción para el tratamiento de fracturas diafisarias de húmero. Es particularmente útil cuando la línea de fractura está cerca de la fosa olecraneana, debido a que, en estos casos, la técnica mínimamente invasiva por vía anterior es difícil de realizar. Los buenos resultados son similares a los reportados con las vías anterior y lateral

AbstractBackground: To report the MIPO technique through a posterior approach for the treatment of humeral shaft fractures, and to evaluate the clinical and radiographic outcomes of a series of patients treated with this procedure.Methods: Eleven patients were evaluated (9 men and 2 women; mean age, 33 years old). Ten fractures were closed and one open. The surgical technique is described in detail. The follow-up was 22 months.Results: Elbow flexo-extension was 140°-0°. Shoulder motion was: 170° of elevation, 70° of external rotation and internal rotation of D9. Pain (VAS): 0, MEPS: 96 points, UCLA test: 33 points. All fractures healed. Normal alignment of the shaft fracture was evidenced in 3 patients, a varus angulation was observed in 7 and a valgus angula-tion in one patient. Radial postoperative palsy was noted in one patient and another required implant removal due to an hematogenous infection.Conclusions: This technique represents a reliable therapeutic option for any middle and distal shaft fractures. It is particularly useful in fractures of the distal diaphysis when the line of fracture is near the olecranon fossa since, in these cases, the MIPO through an anterior approach is not feasible. Good results are similar to those reported in the MIPO technique through the anterior or lateral approach.

Osteosíntesis mínimamente invasiva con placa en fracturas diafisarias de húmero / Minimally invasive plate osteosynthesis (mipo) for humeral diaphyseal fractures

Objetivo: Mostrar y analizar los resultados del tratamiento de un grupo de fracturas diafisarias de húmero con técnica MIPO. Se hizo particular énfasis en el análisis del dolor durante el posoperatorio inmediato, la demora en la reincorporación a las actividades cotidianas básicas, los tiempos hasta alcanzar la consolidación radiológica y las complicaciones. Materiales y métodos: Se evaluaron, en forma retrospectiva, 15 fracturas diafisarias de húmero. La edad promedio era de 57 años (18-84). El seguimiento promedio fue de 26 meses (12-96). Ocho casos fueron tratados con técnica MIPO por vía anterior utilizando implantes rectos, y siete, con técnica MIPO e implantes helicoidales. Resultados: Todos los casos alcanzaron la consolidación. El tiempo promedio hasta la consolidación radiológica fue de 12 semanas (6-32). Salvo un caso con retraso de la consolidación, el tiempo promedio fue de 10 semanas (6-16). El puntaje promedio del dolor según la escala analógica visual durante las primeras 48 horas del posoperatorio fue 2,4 (1-4). El tiempo promedio hasta retomar las actividades cotidianas básicas fue de 9 días (4-17). Las complicaciones fueron retraso de la consolidación (1 caso), infección superficial (1 caso) y tenosinovitis de la porción larga del bíceps (1 caso). Conclusiones: La técnica MIPO mostró ser un método con alta tasa de consolidación en un tiempo igual o inferior al de otros métodos de osteosíntesis. Los pacientes sufrieron dolor leve durante el posoperatorio inmediato y la reincorporación a las actividades cotidianas básicas fue rápida. Las complicaciones fueron tratadas con éxito

To show and analyze the treatment of a group of humeral diaphyseal fractures with the minimally invasive plate osteosynthesis (MIPO) technique. Special emphasis was placed in analyzing immediate postoperative pain; delay to return to basic daily activities; time to radiological healing; and complications.Methods: Fifteen humeral diaphyseal fractures were assessed retrospectively. The average age was 57 years (18-84). The average follow-up was 26 months (12-96). Eight cases were treated with anterior MIPO technique using straight implants. Seven cases were treated with MIPO technique using helical implants.Results: Healing was reached in all cases. The average time to radiological healing was 12 weeks (6-32). Excluding one case with delayed union, the average time was 10 weeks (6-16). The average pain score according to the visual analogue scale for the first 48 hours after surgery was 2.4 (1-4). The average time needed to return to basic daily activities was 9 days (4-17). Complications included delayed union (1 case), superficial infection (1 case) and tenosynovitis of the long head of the biceps (1 case).Conclusions: The MIPO technique proved to be a method with a high healing rate requiring the same time or less compared to other osteosynthesis methods. It caused mild immediate postoperative pain and return to basic daily activities was quick. Complications were managed successfully.

Analysis of the Result Treated with Locking Compression Plate-Distal Tibia and Zimmer Periarticular Locking Plate in Distal Tibia Fracture

PURPOSE: To evaluate the clinical and radiological results of minimally invasive plate, osteosynthesis, using either a locking compression plate-distal tibia (LCP-DT) or Zimmer periarticular locking plate (ZPLP) for distal tibia fractures. MATERIALS AND METHODS: Fifty one patients (51 cases), who underwent minimally invasive osteosynthesis using locking compression plate for distal tibia fractures between October 2008 and August 2011, were followed for more than six months. Eighteen patients were treated with LCP-DT and 33 patients with ZPLP. Time to bony union and anatomic alignment were evaluated radiologically. Clinically, American Orthopedic Foot & Ankle Society ankle-hindfoot scales (AOFAS score) and range of ankle motion were assessed and compared between two groups. RESULTS: All patients achieved bony union at an average of 18 weeks on LCP-DT group and 16weeks on ZPLP group. The average American Orthopedic Foot & Ankle Society ankle-hindfoot scales was 83.3 points on the LCP-DT group, 84.6 points on the ZPLP group, and range of ankle motion averaged at 45 degrees, 48 degrees, respectively. CONCLUSION: Both types of locking compression plates were effective when performing minimally invasive osteosynthesis for distal tibia fractures.

Minimal Invasive Plate Osteosynthesis (MIPO) Technique Using Anterolateral Approach for Treating Closed Proximal Humerus Fracture

Proximal humerus fracture is the second most common fracture of the upper extremity and presents several unique problems such as anatomical complexity, high risk of avascular necrosis, minimal bone stock for purchase, significant morbidity, and lack of a universally accepted treatment. Recent treatments for proximal humerus fractures include use of minimally invasive plate osteosynthysis (MIPO). The aim of this cross-sectional study was to evaluate the outcomes of our less invasive technique using a modified anterolateral approach for treatment of proximal humerus fractures. Ten such operative procedures were performed in patients of varying age and with varied mechanism of injury from 2002-2011. All cases were conducted in an acute setting. There were no cases of infection and the functional outcome scores were good. This approach represents an alternative treatment for closed proximal humerus fracture but more extensive studies are needed.

Comparative Analysis of Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Intramedullary Nailing in Distal Tibial Metaphyseal Fractures

PURPOSE: To compare results between minimally invasive plate osteosynthesis using a periarticular plate and intramedullary nailing in distal tibial metaphyseal fractures in two treatment groups. MATERIALS AND METHODS: Sixty-one cases of distal tibial metaphyseal fractures from December 2008 to December 2009 were evaluated. The minimal follow-up period was 12 months. Thirty patients treated by minimally invasive plate osteosynthesis using a periarticular plate were Group A; 31 patients treated by intramedullary nailing were Group B. We compared and analyzed the results of each group by radiological and clinical assessments. RESULTS: The mean bony union time was 16.4 weeks in Group A and 17.2 weeks in Group B. The mean operation time was 45 minutes in Group A and 48 minutes in Group B. The mean radiation exposure times were 4.2 minutes and 4.8 minutes, respectively. VAS scores were 0.7 points and 0.5 points in each respective group. In Group A, the VAS score was 1.7 points when we applied pressure on the skin around the plate. The mean Olerud and Molander Ankle Score was 87.4 points and 86.3 points, respectively. A superficial wound infection occurred in 1 case in each group, and angular deformities more than 5 degrees occurred in 2 Group B cases. CONCLUSION: No significant differences in results were observed between the two groups. However, a higher incidence of angular deformity was seen in the intramedullary nailing group. Therefore, we must be careful during surgery.

Treatment of Tibial Plateau Fractures Using a Locking Plate and Minimally Invasive Percutaneous Osteosynthesis Technique

PURPOSE: To acknowledge the importance of precise reduction of articular surface of tibial plateau fractures and to make a guideline of treatment by evaluating outcomes and effectiveness of using locking plate and minimally invasive percutaneous osteosynthesis technique. MATERIALS AND METHODS: Twenty-nine patients who underwent surgery for tibial plateau fracture from November 2005 to March 2010 were enrolled with 12 months follow-up in a retrograde manner. The Shatzker classification was used to classify fractures, and we used lateral submeniscal approach to make a precise reduction of articular surface. Radiologic evaluation was determined by presence of bone union, malalignment, and reduction loss or joint depression of articular surface. Post-operative infection, time of active movement of the knee joint, time of partial weight loading, and range of motion (ROM) of knee joint were evaluated. Lysholm Knee Score was used for functional evaluation. RESULTS: Bone union took place in all but one case that developed osteomyelitis. Angulation deformity of more than 10degrees and reduction loss or joint depression of more than 5 mm were not observed. There was one case of osteomyelitis and one case of superficial surgical site infection. There were satisfactory clinical results, with an average time of active knee joint movement and weight loading of 6 weeks. The average ROM of knee joint was 125degrees in the last follow up. As for functional evaluation using Lysholm Knee Score, cases showed an average Lysholm Knee Score of 94 which was a satisfactory result. CONCLUSION: In cases of tibial plateau fractures, if a surgeon accurately reduces the articular surface of joint and use minimally invasive locking plate it will help in bone union biologically, reducing the incidence of soft tissue injuries, and biomechanically maintaining the articular surface of the joint, proving itself to be a useful method of treatment.

Biomechanical study on the novel minimally invasive anterior anatomic locking plate for mid-distal humeral shaft fractures / 医用生物力学

Objective To test the mechanical properties of a self-developed novel anterior mid-distal humerus anatomic locking plate (hereinafter referred to as the new plate) and to improve its design to provide theoretical support for its clinical application. Methods Twenty intact humerus from embalmed human cadavers were obtained and used for the biomechanical test on mid-distal humeral shaft fracture models by using the new plate (group A) and 4.5 mm LC DCP（limited contact dynamic compression plate）(group B), respectively. Both groups were compared under axial compression, medial-lateral bending, medial-lateral three-point bending and external rotation torque. Results The stiffness, strength and stress shielding of the new plate for mid-distal humeral shaft fractures under four different loads were superior to those of 4.5 mm LC-DCP, and the differences were statistically significant(P<0.05). Conclusions The new plate can satisfy the requirements of physical training at early stage for fixed mid-distal humeral shaft fractures, which gives great clinical values.

Minimally Invasive Plate Osteosynthesis for Proximal Tibial Shaft Fracture

PURPOSE: To report the results of patients treated by minimally invasive plate osteosynthesis (MIPO) for proximal tibial shaft fractures. MATERIALS AND METHODS: From September 2003 to June 2008, thirty-two patients with proximal tibial shaft fractures weretreated by MIPO. There were 22 men and 10 women and mean age was 43.8 years (range; 21~72 years). Follow-up was available for all patients and the mean follow-up period was 19.5 months (range; 12~40 months). Duration of union, range of knee motion and postoperative complications were evaluated. RESULTS: Twenty-nine patients (90.6%) healed after the MIPO technique. The mean duration of radiographic union was 18.3 weeks (range; 10~28 weeks). The mean range of knee motion was 134 degrees at the last follow-up. There were 1 non-union, 2 delayed unions, 1 superficial infection, 1 deep infection, 2 malunions with more than 5 degrees of malalignment and 14 cases of skin irritation by plate. CONCLUSION: MIPO is an effective treatment for closed, proximal tibialshaft fractures. More aggressive treatment such as dual plating should be considered in fractures with severe comminution or bone loss.

Axial Malalignment after Minimally Invasive Plate Osteosynthesis in Distal Femur Fractures with Metaphyseal Comminution / 대한정형외과학회잡지

PURPOSE: We wanted to report on the functional results and the presence of axial malalignment after performing minimally invasive plate osteosynthesis in distal femur fractures with metaphyseal comminution. MATERIALS AND METHODS: Between March 2007 and June 2009, fifteen patients with distal femur fractures and metaphyseal comminution were treated with minimally invasive plate osteosynthesis, and they were followed for a mean of 17.0 months (range: 12-40 months). The fractures according to the AO/OTA classification were two cases of 33A and thirteen cases of 33C, and seven cases were open fracture. We analyzed the axial malalignment and functional results according to bone union and Sanders' score. RESULTS: All the fractures were united without a bone graft after a mean of 20.4 weeks (range: 16-26 weeks) after the definitive plate fixation. One case had superficial infection and a stiff knee. The average ROM of the knee was 123.6degrees. The average Sanders' score was 33.0, and the results were five cases of excellent results, eight cases of good results and two cases of fair results. There was axial malalignment such as varus malunion in 3 cases and valgus malunion in 2 cases and the average shortening of the limb length was 7.9 mm (range: 0.3-21.9 mm). CONCLUSION: Minimally invasive plate osteosynthesis in a distal femur fracture with metaphyseal comminution provides satisfactory outcomes. However, this should be approached with caution because of the possibility of axial malalignment.

Minimally Invasive Anterior Plating of Humeral Shaft Fractures

PURPOSE: We evaluated the efficacy and results of minimally invasive anterior plating for humeral shaft fracture. MATERIALS AND METHODS: Twenty-two cases of humeral shaft fracture were reviewed, including 8 cases of type A, 8 of type B and 6 of type C (AO/OTA classification). There were three open fractures. The fracture was fixed with MIPO (minimally invasive plate osteosynthesis) technique under C-arm guide. A locking compression plate was located in anterior aspect of the humerus with at least three screws fixed in each fragment. Radiologic and functional results were evaluated. RESULTS: In 20 of 22 cases, bony union was achieved with the mean period of 17.5 weeks, including 2 cases of delayed union. There were 2 cases of nonunion, which needed the further operative procedure. Except one case of distal 1/3 fracture, all cases showed satisfactory elbow and shoulder function with the mean Mayo elbow score of 17.4 and mean UCLA shoulder score of 97.3. In complication, there was one case of radial nerve palsy due to improper traction, but it was completely improved after 3 months. Otherwise, there was no complication including infection. CONCLUSION: Anterior MIPO for humeral shaft fracture may be another option of operative methods with high union and low complication rate.

Anatomically Percutaneous Wiring Reduction in Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures

PURPOSE: To report the method of anatomical reduction and its maintenance by percutaneous wiring reduction in minimally invasive plate osteosynthesis for distal tibial fractures. MATERIALS AND METHODS: 17 cases that were diagnosed oblique, spiral or transverse fracture of distal tibia from August 2007 to February 2010 and were able to anatomically reduce by the method of percutanous wiring reduction in minimally invasive plate osteosynthesis were included in this study. Mean age was 50, and mean follow up period was 18 months. We investigated the period until bone union was achieved, degree of angulation angle, and complications. For postoperative evaluation, Olerud and Molander ankle score and VAS pain score in daily living were checked. RESULTS: The mean varus/valgus angulation after bone union on AP radiograph was 0.9 degrees and the mean anterior/posterior angulation on lateral radiograph was 2.0 degrees The mean Olerud and Molander ankle score was 89.4, and mean pain score due to walk adjacent to metal plate was 0 points. CONCLUSION: By the method of percutaneous wiring reduction in distal tibial fracture, anatomical reduction is easily acquired, and only by wire itself, reduction could be maintained, so that without additional manual reduction, plate could be easily fixed.