Short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis / 中华医学杂志(英文版)

BACKGROUND@#The effect of short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis (ADS) has not been clarified. This study aimed to compare the clinical and radiographic results of short-segment fusion vs. long-segment fusion and osteotomy for patients with Lenke-Silva type VI ADS.@*METHODS@#Data of 28 patients who underwent spinal surgery for ADS from January 2012 to January 2014 in the General Hospital of Northern Theater Command were reviewed. Of the 28 patients, 12 received long-segment fusion and osteotomy and 16 received short-segment fusion. Radiographic imaging parameters and clinical outcomes, including the sagittal vertical axis (SVA), lumbar lordosis (LL) angle, pelvic tilt (PT), sacral slope (SS), the visual analog scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and lumbar stiffness disability index (LSDI) scores, were recorded. The difference between groups was compared using the dependent t test or Chi-squared test.@*RESULTS@#The Cobb and LL angles and SVA improved in both groups; however, PT and SS angles did not improve following short fusion. There were significant differences in the post-operative SVA (26.8 ± 5.4 mm vs. 47.5 ± 7.6 mm, t = -8.066, P  0.05). The post-operative LSDI score was 3.5 ± 0.5 in the long fusion group, which was significantly higher than that of the short fusion group (1.4 ± 0.7; P < 0.001).@*CONCLUSIONS@#The clinical outcomes of patients with Lenke-Silva type VI ADS who underwent short-segment decompression/fusion were comparable to those of patients who underwent long-segment decompression/fusion and osteotomy despite poor correction of sagittal imbalance. Moreover, short-segment decompression/fusion showed a short operation time and reduced surgical trauma.

Short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis / 中华医学杂志(英文版)

Background@#The effect of short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis (ADS) has not been clarified. This study aimed to compare the clinical and radiographic results of short-segment fusion vs. long-segment fusion and osteotomy for patients with Lenke-Silva type VI ADS.@*Methods@#Data of 28 patients who underwent spinal surgery for ADS from January 2012 to January 2014 in the General Hospital of Northern Theater Command were reviewed. Of the 28 patients, 12 received long-segment fusion and osteotomy and 16 received short-segment fusion. Radiographic imaging parameters and clinical outcomes, including the sagittal vertical axis (SVA), lumbar lordosis (LL) angle, pelvic tilt (PT), sacral slope (SS), the visual analog scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and lumbar stiffness disability index (LSDI) scores, were recorded. The difference between groups was compared using the dependent t test or Chi-squared test.@*Results@#The Cobb and LL angles and SVA improved in both groups; however, PT and SS angles did not improve following short fusion. There were significant differences in the post-operative SVA (26.8 ± 5.4 mm vs. 47.5 ± 7.6 mm, t = -8.066, P < 0.001), PT (14.7 ± 1.8° vs. 29.1 ± 3.4°, t = -13.277, P < 0.001), and SS (39.8 ± 7.2° vs. 26.1 ± 3.3°, t = 6.175, P < 0.001) between the long and short fusion groups. All patients had improved ODI, JOA, and VAS scores post-operatively (all P < 0.001), with no significant difference between the groups (all P > 0.05). The post-operative LSDI score was 3.5 ± 0.5 in the long fusion group, which was significantly higher than that of the short fusion group (1.4 ± 0.7; P < 0.001).@*Conclusions@#The clinical outcomes of patients with Lenke-Silva type VI ADS who underwent short-segment decompression/fusion were comparable to those of patients who underwent long-segment decompression/fusion and osteotomy despite poor correction of sagittal imbalance. Moreover, short-segment decompression/fusion showed a short operation time and reduced surgical trauma.

Accuracy verification of anterior cruciate ligament anchor point locating under the guidance of 3D model and AR navigation / 局解手术学杂志

Objective To investigate the precision and clinical practicability of anchor point locating under the guidance of augmented reality (AR) navigation for anterior cruciate ligament (ACL) reconstruction.Methods A cube model was made by 3D print which contained some concentric circles of different diameters to be the target.Fifty orthopedists were chosen and numbered from 1 to 50 to locate with AR guidance.Finally,the results of precision and score of satisfaction were analyzed.Results The location precision guided by AR in different diameter concentric circle were 74％ (0.25 cm),78％ (0.5 cm),83％ (0.75 cm),86％ (1.0 cm),89％ (1.25 cm),96％ (1.5 cm) respectively.The average satisfaction score of the orthopedists' was (8.7 ± 1.3).Conclusion Anchor point locating under the guidance of AR navigation is a feasible and effect method for clinical ACL reconstruction,which can observe the relations of the anchor point and the adjacent structure in real time.

Clinical curative effect of percutaneous vertebroplasty combined with percutaneous pedicle screw fixation for thoracolumbar fracture / 局解手术学杂志

Objective To discuss the clinical curative effect of percutaneous vertebroplasty(PVP)combined with percutaneous pedicle screw fixation for thoracolumbar fracture.Methods Retrospectively analyzed the clinical data of 43 patients with thoracolumbar fracture who underwent PVP combined with percutaneous pedicle screw fixation in our hospital from November 2015 to June 2017.Those patients included 28 males and 15 females,and the age of patients ranged from 50 to 66 years old,with an average age of(58.26 ±3.67)years old.The func-tional outcome were evaluated by VAS scores and ODI scores before and after the operation.The sagittal Cobb angle was used to evaluate the reduction of fracture.Results All these patients all successfully completed the operation,and there was no complications after operation.The operation time ranged from 60 to 126 min,with an average time of(96.07 ±15.69)min;the blood loss ranged from 60 to 180 min,with an average time of(113.26 ±24.7)min.All the patients were followed up for 4 to 23 months,with an average time of(12.07 ±4.01)months. The VAS score,ODI score and sagittal Cobb angle were significantly decreased in the last follow -up period compared with those before surgery,and the difference was statistically significant(P<0.05).Conclusion PVP combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar fracture has smaller incision,less blood loss,shorter operation time and better improvement of local pain,func-tional movement and kyphosis.

Clinical application of glenohumeral ligament combined with articular capsule in the repair of anterior and infe-rior labrum complete defect / 局解手术学杂志

Objective To investigate the method and effect of arthroscopic repair of recurrent anterior shoulder dislocation caused by anterior and inferior labrum complete defect.Methods Retrospective analyzed the clinical data of 23 patients with anterior and inferior la-brum complete defect who were admitted into hospital from June 2014 to October 2016 and recieved arthroscopic repair opreation with gleno-humeral ligament combined with articular capsule.Intraoperative arthroscopy was used to suture the lower glenohumeral ligament and articular capsule at the missing part of the glenoid labrum.The Rowe score,ASES score and UCLA score were compared before and after operation. Results There was no postoperative complications such as dislocation or infection occurred.All the 23 cases were followed up for 12~42 months,with an average of(19.6 ±3.4)months.The average lost angle of shoulder external rotation was(17.3 ±3.9)°.And the postopera-tive Rowe score,ASES score and UCLA score were significantly better than those before operation.Conclusion Arthroscopic repair opreation with glenohumeral ligament combined with articular capsule can effectively restore the stability of front shoulder joint,and it can be a good method for the treatment of recurrent anterior shoulder dislocation caused by anterior and inferior labrum complete defect.

Comparison of prevertebral soft tissue swelling and dysphagia between Zero-p and traditional cage and titanium plate for anterior cervical discectomy with fusion / 局解手术学杂志

Objective To explore the relationship among the prevertebral soft tissue swelling and dysphagia rate after anterior cervical diskectomy and fusion(ACDF),and to investigate the prevertebral soft tissue swelling and dysphagia rate after Zero-p or traditionaI cage and titanium plate for one-level lesion of cervical myelopathy.Methods The clinical data of 54 patients with one-level lesion (C5/6) of cervical myelopathy who undelwent anterior cenrical discectomy and fusion by Zero-p (n =25) or traditional cage and titanium plate (n =29) were analyzed.The postoperative prevertebral soft tissue swelling was measured by lateral radiographs.Patients were divided into the swelling group (n =24) and the non-swelling group(n =30) based on the degree of prevertebral soft tissue swelling and the incidences of dysphagia were analyzed.Patients were divided into the Zero-p group (n =25)and the Cage group (n =29) based on surgical treatment,the postoperative prevertebral soft tissue swelling and dysphagia rate were compared.Results The rate of dysphagia in swelling group was 45.8％,which was higher than 13.3％ in non-swelling group,the difference was significant(P ＜0.05).The postoperative prevertebral soft tissue swelling was 6.22 mm averagely after Zreo-p,which was less than that after traditional cage and titanium plate for anterior cervical discectomy with fusion(9.25 mm),the difference was significant (P ＜ 0.05).The incidence of dysphagia in Zero-p group was 12％,which was lower than 41.4％ in Cage group,and the difference was statistically significant (P ＜ 0.05).Conclusion It is a clinical significance to evaluate the degree of prevertebral soft tissue swelling by cervical lateral X-ray after ACDF,when the degree of prevertebral soft tissue swelling is greater,the incidence of complications such as dysphagia is higher.In addition,The Zero-p for the treatment of single one-level lesion of cervical myelopathy(C5/6) has a lower degree of prevertebral soft tissue swelling and dysphagia rate than the traditional Cage and titanium plate fusion.

Treatment of chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effects of chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft.</p><p><b>METHODS</b>From September 2014 to November 2016, 28 patients with chronic anterolateral ankle instability underwent lateral ligament reconstruction with semitendinosus autograft. Among them, including 20 males and 8 females with an average age of 28.6 years(18 to 47 years old). Preoperative complications were recorded. AOFAS and VAS score were used to evaluate clinical outcomes.</p><p><b>RESULTS</b>Twenty-eight patients were followed up from 6 to 28 months with an average of 18.2. No iatrogenic fracture or infection occurred. There was no ankle instability or limited at the latest follow-up. AOFAS score was improved from 53.1±6.8 before operation to 90.4±5.9 at the latest follow-up , and had statistical difference(<0.05); while VAS score was increased from 6.3±1.7 before operation to 0.8±0.5 at the lastest follow-up(<0.05).</p><p><b>CONCLUSIONS</b>Chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft has advantages of simple operation, good recovery, less compilations and good clinical effects. It is one of stable methods for the treatment of chronic anterolateral ankle instability.</p>

Diagnosis of malignancy of adult mediastinal tumors by conventional and transesophageal echocardiography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transesophageal echocardiography (TEE) is a well-established method for detecting and diagnosing heart tumors. In contrast, its role in assessing the presence, growth and evidence of malignant tumors originating from mediastinal sites remains unclear. The aim of this study was to compare the diagnostic impact of TEE and transthoracic echocardiography (TTE) for determining the localization, growth and malignancy of adult mediastinal tumors (MTs).</p><p><b>METHODS</b>In a prospective and investigator-blinded study, we evaluated 144 consecutive patients with MT lesions to assess the diagnostic impact of TEE and TTE for detecting the presence of tumors spreading both inside and outside of the heart and for determining infiltration and invasion using pathological examination results as a reference.</p><p><b>RESULTS</b>All tumor lesions were diagnosed and carefully evaluated by biopsy. Biopsy revealed malignant tumors in 79 patients and benign tumors in 65 patients. When compared to histological findings, TEE predicted malignancy from the presence of tumors spreading both inside and outside of the heart and from infiltration and invasion in 49/79 patients (62.0%). TTE predicted malignancy in only 8/79 patients (10.1%, P < 0.005). TEE visualized tumor lesions in 130 patients (90.3%) while the TTE visualized tumor lesions in 110 patients (76.4%) and was less effective at detecting MT lesions (P < 0.001). TTE and TEE could detect anterior MTs and adequately verified MTs (P > 0.05); TEE detected medium MTs better than TTE (P < 0.001).</p><p><b>CONCLUSIONS</b>TEE is effective and superior to TTE for predicting the localization and growth of MTs as well as for accessing evidence of tumor malignancy. TTE and TEE were able to detect anterior MTs; TEE was able to detect medium MT better than TTE.</p>

Early effect of induced membrane technique for the reconstruction of chronic osteomyelitis defects in limbs of adult patients / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the early clinical efficacy of induced membrane technique for reconstruction of large bone defects after debridement in adults with chronic osteomyelitis of limbs.</p><p><b>METHODS</b>From March 2010 to March 2012,a total of 23 adult patients with chronic osteomyelitis of limbs were treated in our department. There were 15 males and 8 females, with a mean age 35.2 years old (ranged from 26 to 49 years old). Sixteen patients had open fracture history. According to the lesion site, there were 12 cases of tibia, 7 cases of femur, 3 cases of humerus, and 1 case of both radius and ulna. Among them, 19 patients had diseases in diaphysis and 4 patients in the metaphysis. The mean interval from infection to operation was 6.9 months (ranged from 4 to 13 months). All the patients were treated by using induced membrane technique. The follow-up evaluation included clinical complications, time of bone healing and limbs function. The Chinese version of SF-36 scores was used in the assessment of quality of life pre- and post-operation.</p><p><b>RESULTS</b>The average duration of follow-up was (27.6 ± 5.3) months (ranged from 18 to 43 months). Two patients had postoperative flap edge necrosis, 1 patient had superficial iliac incision infection, no obvious complications were recorded. Twenty patients obtained radiological union at a mean time of 4.6 months (ranged from 3 to 7 months). Among them, 16 patients treated with lower limbs surgery achieved full weight-bearing at about 5.2 months (ranged from 4 to 8 months) postoperatively. Four patients suffered from reinfection during follow-up, but 3 of them achieved complete bone healing after the second surgeries with induced membrane technique. At the final follow-up, there was a substantial improvement in each dimension scores and total scores of SF-36 as compared with those before surgery.</p><p><b>CONCLUSION</b>When treating with adult chronic osteomyelitis of limbs, the induced membrane technique can effectively reconstruct large bone defects after debridement, significantly shorten treatment cycle, provide satisfactory results with minimal complications, promote good recovery of limbs function and require relatively simple operation technique.</p>

Case-control study on the efficacy of preoperative recombinant human erythropoietin administration for reducing transfusion requirements in elderly patients undergoing elective surgery for femoral intertrochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate preoperative application of recombinant human erythropoietin (rHuEPO) in reducing transfusion requirements in elderly patients undergoing elective surgery for femoral intertrochanteric fractures.</p><p><b>METHODS</b>From January 2011 to December 2013,442 cases of elderly patients with femoral intertrochanteric fracture were retrospectively reviewed. According to inclusion and exclusion criteria, 119 cases were eventually included and divided into the treatment group and the control group. There were 12 males and 40 females, with a mean age (71.4 ± 12.8) years old, and the patients received preoperative administration of rHuEPO 10,000 U qod combined with iron dextran 200 mg (3 times each day). While 16 males and 51 females in control group, with a mean age (70.9 ± 16.2) years old, and the patients only received preoperative administration of iron dextran 200 mg (3 times each day). All the patients received closed reduction and PFNA-II or Internal fixation surgeries. The perioperative blood transfusion rate, average amount of blood transfusion, postoperative complications, the length of hospital stay and mortality within 30 days were compared between the two groups.</p><p><b>RESULTS</b>There were no statistical differences between two groups in the baseline indexes (P > 0.05). Overall,71 of 119 patients (59.7%) received at least one unit allogeneic blood transfusion (ABT). However,there were significant differences in perioperative ABT rates (48.1% vs 68.7%, χ2 = 4.77, P < 0.05) and the average amount of blood transfusion between treatment group and control group, which were (1.8 ± 0.4) U/pte vs (3.6 ± 1.1) U/pte (t = 2.244, P < 0.05). Postoperative hemoglobin (Hb) on postoperative days 7 and 30 was higher in treatment group than that in control group. In addition, in treatment group, Hb levels were higher on postoperative day 30 than those on admission, which were (128.2 ± 20.6) g/L vs (118.2 ± 18.9) g/L (t = 2.133, P < 0.05). There were no statistical differences in postoperative complications, the length of hospital stay and mortality within 30 days.</p><p><b>CONCLUSION</b>For elderly patients with femoral intertrochanteric fractures undergoing elective surgery, preoperative application of rHuEPO can significantly reduce perioperative transfusion requirements, and is likely to reduce ABT-related infection, but its long-term safety remains to be evaluated.</p>

Outcome of accessory navicular fusion for the treatment of the painful accessory navicular bone of type II in adults / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of accessory navicular fusion for treatment of the painful accessory navicular bone of type II in adults.</p><p><b>METHODS</b>From June 2006 to June 2012, a total of 38 feet (in 35 adult patients) with painful accessory navicular with type I underwent an fusion operation of the primary and accessory navicular bones,including 26 males and 9 females with a mean age of (32.4±7.3) years old ranging from 18 to 44 years old. The course of disease ranged from 3 to 10 months. The perioperative complications and radiological outcomes were observed and recorded. The foot function before and after operation were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score, and the easement of the pain was evaluated by visual analog score (VAS).</p><p><b>RESULTS</b>Two patients had transient superficial inflammation of the incision, no obvious perioperative complications occurred. All patients were follow-up for (53.5±14.7) months (12 to 84 months). Bone union was confirmed on plain radiography in 32 cases (35 feet). The mean time from the operation to union was (13.7±2.3) weeks (9 to 18 weeks). Postoperative pain VAS score was improved obviosly than preoperative (V=12.14,P< 0.01). The talar-to-first metatarsal angle [(9.4±3.5)° vs (8.3±2.7)°, t=0.736, P>0.05)], calcaneal tilt angle [(17.7±2.2)° vs (18.9±3.4)°, t=0.794, P>0.05],talonavicular uncoverage angle [(14.3±3.4)° vs(12.5?4.6)°,t=0.947, P>0.05) ],and height of the first tarsometatarsal joint [(14.8±3.1) mm vs (15.9±2.8) mm,t=0.814,P>0.05)] before and after operations had no statistic difference. The AOFAS midfoot score was improced from preoperative 45.6±5.3 to postoperative 82.5±7.4 (t=3.214,P< 0.01).</p><p><b>CONCLUSION</b>For the painful accessory navicular bone of type II in adults, if the patient has a large navicular bone and not complicated with rigid flatfoot, once the conservative treatment fails, fusion of the primary and accessory naviculars may be a successful intervention. Overall, the procedure provides reliable pain relief, definite foot function improvement, and good patient satisfaction.</p>

Acutrak headless compression screw fixation for the treatment of scaphoid non-union / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the early clinical and radiographic outcome of scaphoid non-unions treated with Acutrak headless compression screw.</p><p><b>METHODS</b>From January 2008 to July 2011,21 patients with scaphoid non-union were treated in our department. There were 18 males and 3 females with a mean age of (23.6 +/- 4.6) years; 12 cases were on right hand and 9 were on left. According to Herbert-Fisher classification, there were 10 cases with type D1, 7 cases with type D2, 3 cases with type D3, and 1 case with type D4. The mean time from injury to operation was (12.4 +/- 2.7) months. All patients were treated with Acutrak headless compression screw fixation (6 cases received 2 screws fixation, 15 cases received 1 screw fixation, and Matti-Russe bone grafting was applied in 7 cases). The carpal height, the scaphoid index and changes of the scapholunate angle were assessed before and after the operation. Range of motion and grip strength were recorded and the wrist function was assessed according to the Patient-Rated Wrist Evaluation (PRWE).</p><p><b>RESULTS</b>Average duration of follow-up was (21.3 +/- 3.6) months. All the patients attained radiological union in a mean time of (13.3 +/- 2.4) weeks following the operation. No obvious complications were recorded. The surgical treatment allowed the preoperative mean scaphoid index of 0.61 +/- 0.13 and the preoperative mean scapholunate angle of (59.4 +/- 6.8) degree to be improved to 0.69 +/- 0.10 and (44.3 +/- 8.2)degree postoperatively, respectively. There was a substantial improvement in grip strength and pain amelioration after surgery. The preoperative mean PRWE score of 45.2 +/- 4.7 was improved to 76.1 +/- 5.2 postoperatively. All patients returned back to the original work,the average time from surgery to work was (6.0 +/- 1.1) months.</p><p><b>CONCLUSION</b>For scaphoid non-unions, Acutrak headless compression screw fixation can provide anatomical reduction, provide satisfactory results with a high union rate, well return of function and minimal complications in the early stage.</p>

Effects of anterior fusion and posterior internal fixation on stability of upper cervical vertebra in type II Hangman fracture / 医用生物力学

Objective To evaluate biomechanical properties of internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate in reconstructing stability of the upper cervical vertebra, and compare them with conventionally used anterior internal fixation after C2-3 intervertebral fusion and posterior internal fixation by C2 transpedicle screws. MethodsSix fresh human upper cervical vertebra specimens (including C2-4) were divided into five groups: the intact specimen group(control group), the incision of the C2-3 group (Hangman group), the posterior internal fixation by C2 transpedicle screw group (posterior fixation group), the anterior internal fixation after C2-3 intervertebral fusion with Zephir plate group (anterior fixation group), and the internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate group (C2-4 incision +internal fixation group). Range of motion (ROM) of the C2-3 and C3-4 segments was tested respectively under 0.5, 1.5 and 2.5 N•m moment by measurement system for three-dimensional spinal movement, and the statistical analysis was also conducted. Results(1) C2-3 segment: ROM of anterior fixation group and C2-4 incision +internal fixation group was significantly smaller than that of Hangman group and posterior fixation group in all six directions under various loading conditions (P<0.05); there was no significant difference between anterior fixation group and C2-4 incision +internal fixation group. ROM of posterior fixation group was larger than that of intact group in all six directions under various loading conditions (P<0.05); There was no significant difference in flexion and extension direction under all loading conditions between posterior fixation group and Hangman group, but significant difference was found in left/right and right/left axial rotation and under 2.5 N•m moment between posterior fixation group and Hangman group (P<0.05). (2) C3-4 segment: there was no significant difference in ROM in six directions under various loading conditions among all groups except for C2-4 incision +internal fixation group. ROM of C2-4 incision +internal fixation group was significantly smaller than that of other groups in all six direction (P<0.05). Although ROM of anterior fixation group was slightly larger than that of Hangman group and posterior fixation group, the difference was not statistically significant. Conclusions From the view of biomechanics, internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate is a better surgical option for stabilizing the fracture than that of posterior internal fixation by C2 transpedicle screws to treat type II Hangman fracture with C2-3 intervertebral disc injury.

Minimally invasive transarticular plate osteosynthesis for type C fractures of distal femur / 中华创伤骨科杂志

Objective To report the clinical results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of type C fractures of distal femur.Methods A retrospective study was conducted to an- alyze 14 consecutive cases of distal femoral fractures who had been treated with MIPPO in our department from April 2002 to February 2005.According to AO/ASIF classification,there were three cases of type C1,six cases of type C2,and five cases of type C3.At first,the fractures of articular surface were directly reduced and fixed with spongy screws.Next,the condylar fractures were indirectly reduced and fixed with buttress or LISS (less invasive stabi- lization system) plates through transarticular approach.Results Follow-ups,ranging from 10 to 32 months for 12 cases,revealed that they all reached union.The time for their bony union was 10 weeks to 12 months (mean,4.6 months).Their functional recovery was evaluated according to criteria by Kolmert and Wulff.Four cases were rated as excellent,five as good,two as fair and one as poor.The total satisfactory rate was 75%.Conclusion MIPPO is a safe and effective procedure for the type C fractures of the distal femur with the benefits of limited invasion to soft tissues and a high rate of bone union.