Development and clinical application of a new reduction device for the treatment of tibial plateau fracture under arthroscopic monitoring / 中国骨伤

OBJECTIVE@#To develop a reduction device for the arthroscopy-assisted treatment of tibial plateau fracture and explore its clinical efficacy.@*METHODS@#From May 2018 to September 2019, 21 patients with tibial plateau fracture were treated, including 17 males and 4 females. Their ages ranged from 18 to 55 years old with an average of (38.6±8.7) years old. There were 5 cases of Schatzker typeⅡand 16 cases of Schatzker type Ⅲ. The self-designed reductor combined with arthroscope was used for auxiliary reduction and fixation(minimally invasive percutaneous plate osteosynthesis). The efficacy was analyzed by observing the operation time, blood loss, fracture healing time and knee function(HSS and IKDC scoring criteria).@*RESULTS@#All the 21 patients were followed up for 8 to 24 with an average of(14.0±3.1) months. The operative time ranged from 70 to 95 min with an average of(81.7±7.6)min, incision length ranged from 4 to 7 cm with an average of(5.3±0.9) cm, intraoperative blood loss ranged from 20 to 50 ml with an average of(35.3±5.2) ml, postoperative weight-bearing time ranged from 30 to 50 d with an average of(35.1±9.2) d, fracture healing time ranged from 65 to 90 d with an average of(75.0±4.4) d, and complications were 0 cases, respectively. The fracture was well healed and no screw plate fracture was observed. The knee function scores of HSS and IKDC 18 months after operation were significantly higher than those before operation(P<0.05).@*CONCLUSION@#The custom-made reduction tool for the arthroscopic management of tibial plateau fracture is reasonable in design and simple in operation. The specific reduction tool could effectively reduce the fracture, and shorten the fixation time with minimally invasive procedure.

A COMPARATIVE STUDY ON FUNCTIONAL OUTCOME OF SUPRACONDYLAR FEMUR FRACTURE MANAGED BY OPEN REDUCTION VS MIPPO.

Background: Distal femur fractures are complex injuries producing long term disability and present considerable challenges in management. These fractures poses challenges to the treating surgeon because of thin cortex of the femoral condyles, wide medullary canal, relative osteopenia, short condylar fragment and comminution involving articular surface. Distal femur fracture disrupts normal knee joint functioning, hence needed anatomical reduction and stable internal fixation to prevent crippling disabilities and hardware failure Objectives: This study aimed to Compare Functional outcome of supracondylar fracture femur managed by Open reduction VS MIPPO Material & Methods: In this study 30 patients with fracture of distal femur were studied. The method used for fracture fixation was both closed and open reduction with internal fixation with locking compression plate. Patients were selected based on inclusion and exclusion criteria and were followed up ranged from 3 months to 1 year. The results were analysed with NEER'S score. Results: In our study of 30 lower end of femur fractures, 5 was Muller's Type A1; 5 were of Muller's Type A2.; 4 were of Muller's Type A3;2 were B;3 was of Muller's Type C1 ; 9 were of Muller's Type C2; and remaining 2 were Muller's Type C3. Mean age of the patients was 48.4 years with age ranging from 18-70 years with more than two thirds of them being male. Right sided fractures were predominant. RTA being the cause of injury for most of them but there are also cases of fall in the older age group >50 years. MIPPO surgery was done in less time when compared to open reduction.2/3rd of cases done by MIPPO are done in less than 90 minutes when compared to open reduction where the average duration of times was between 90 to 120 minutes accounting 60% of patients. There is not even a single case done by MIPPO with duration of more than 120 minutes. Early radiological union less than 16-18 weeks was seen in most cases of MIPPO technique when compared to OPEN reduction. Open reduction accounted nearly 20% of cases with infections while MIPPO accounted only 6.67% infections mostly of superficial type. There is single implant failure seen in our study that too with MIPPO technique which underwent revision surgery. Better functional outcome was seen in MIPPO procedure accounted 73.33% when compared to open procedure of 66.67%.Poor functional outcome was seen in 13.3% of patients who underwent open reduction and 6.67% cases who underwent MIPPO procedure. Functional outcome was based on NEER's scoring system. Conclusion: Locking compression plate is an important armamentarium in treatment of fractures around knee especially when fracture is severely communited and in situations of osteoporosis. Overall MIPPO has better functional outcome than OPEN reduction especially in extraarticular fractures with comminution as there will be early radiological union,less soft tissue damage,least infection rate which ultimately helps in early physiotherapy and early weight bearing resulting in best functional outcome.

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.

Operative Management of Calcaneal Fractures using Mippo Technique

Introduction: Calcaneal fractures continues to be a topic ofcontroversy in terms of the optimal management modality.Current study aimed to access the sinus tarsi approach forthe fixation of calcaneal fractures in terms of radiological andfunctional results.Material and Methods: Study was conducted on 30 patientsof both genders aged between 20 and 60 years with both jointdepression and tongue type fractures, Sanders type 2 and type3 fractures.Results: In our study, as per AOFAS Scale at 3 months, 19(63.33%) calcaneum cases fell into the excellent group, 9 (30%)into good and 2(6.66%) into poor result group. The Mean ±SDAOFAS scale was 78.43±7.17 (range 55-85). At 6 months, theresult as per AOFAS scale showed further improvement with 28(93.33%) calcaneum cases falling into the excellent group and 2(6.66%) falling into the good result group. None of them fell inpoor group at 6 months follow up. The Mean ±SD AOFAS scalewas 90.03±5.24 (range 74-95).Conclusion: Fixation with plate using MIPPO techniquethrough sinus tarsi approach is an effective and safe methodwith good clinical and radiological results, for the treatmentof calcaneal fractures; to achieve anatomical restoration undervision, stable fixation and early mobilization with minimal softtissue complications.

Modified knee spreader combined with minimally invasive percutaneous plate internal fixation for complex tibial plateau fractures / 中国组织工程研究

BACKGROUND: Studies have shown that the adjuvant use of long bone distraction device for unstable tibial plateau fractures achieved satisfactory results, but the safety of its use of long bone distraction device is not high, and the device could easily lead to soft tissue damage. OBJECTIVE: To compare the clinical efficacy of modified knee joint spreader combined with minimally invasive percutaneous plate internal fixation and traditional incision reduction plate internal fixation for the treatment of complex tibial plateau fractures. METHODS: A total of 71 patients with complicated tibial plateau fractures admitted to Xiangdong Hospital Affiliated to Hunan Normal University from January 2016 to January 2018 were included, including 48 males and 23 females. The 34 patients in the experimental group received modified knee spreaders combined with minimally invasive percutaneous plate internal fixation treatment. The 37 patients in the control group received traditional open reduction and plate internal fixation. The incision length, operation time, intraoperative blood loss, hospital stay, the time of fracture healing and the incidence of postoperative complications were compared between the two groups. Knee HSS scores were assessed at 1 month and at the last follow-up. The trial was approved by the Ethics Committee of Xiangdong Hospital Affiliated to Hunan Normal University. RESULTS AND CONCLUSION: (1) The operation time, intraoperative blood loss, incision length, and hospital stay were shorter in the experimental group than in the control group (P 0.05). (2) One case of joint stiffness and one case of traumatic arthritis were found in the experimental group. One case of postoperative infection, five cases of joint stiffness, one case of traumatic arthritis and one case of loosening of the internal fixation were found in the control group. The incidence of complications in the experimental group was less than that in the control group (P 0.05). (4) The results showed that compared with the traditional open reduction and internal fixation, the modified knee spreader combined with minimally invasive percutaneous plate internal fixation for complex tibial plateau fractures can improve the operation efficiency, reduce surgical trauma, reduce the incidence of postoperative complications, and shorten hospital stay for patients.

Treatment of Fracture Distal Tibia by Distal Tibial Locking Plate Verses Interlocking Nail: A Prospective Comparative Study

Introduction: Fractures of distal third of tibia pose greaterchallenge to the treating surgeon, in view of its relative lack ofvascularity, as it is devoid of muscular envelope and is coveredonly by skin and tendons. Its proximity to the ankle joint makesit further complex than any diaphyseal fracture. A variety oftreatment modalities are available including non operative,external fixation, IM nailing and plating. Whereas, closedreduction and casting is known for redisplacement withresultant malunion and joint stiffness because of prolongedimmobilisation, external fixators are of utility only for compoundfractures of mid third and are known for pin track infections.Material and Methods: A Comparative prospective study oftwo procedures, for displaced fractures of distal third tibia inadults was conducted in Govt. Medical College (GMC),Jammu. 30 patients (Group A) were treated by ClosedReduction and fixation with IMIL Nailing and another 30 (GroupB) were treated by closed reduction and fixation using DistalTibial Locking Plate with MIPPO Technique. The patients werefollowed for a minimum of one year wherein the clinicalparameters, radiological progress and final functional resultswere evaluated as per American Orthopaedic Foot and AnkleSociety Score (AOFAS).Results: There was no significant difference in fracture healingtime or ambulation time. Good to Excellent results of 60% werefound in Group A and 73.3% in Group B. There were 13.3% ofpoor results in Group A as compared to 6.7% of Group B.Overall complication rate was higher in Group A. IMIL Nailinghad to be abandoned in 2 cases (6.7%) and switched on toDTLCP, due to per operative finding of medullary canal beingnarrower than 8 mm in one and curved in another. IMIL GroupA, also had 2 cases (6.7%) bent nail, 2 cases (6.7%) brokennail and another 3 cases (10%) of bent/broken locking bolts.No such implant related complications were observed inGroup B.Conclusion: IMIL Nailing is a technically demandingprocedure, requiring a thorough pre- operative work up and askilled experienced surgeon with all sizes of nails, reamers andalternative options available before contemplating it. However,DTLCP by MIPPO technique is easier to learn, is equallybiological, based on sound AO principles of indirect reductionand stabilization by extra periosteal fixed angle construct. Theprocedure has fewer per operative and postoperativecomplications and gives comparable or better results than IMILNailing. The choice of the procedure should be guided by thesite and geometry of fracture and individual experience of thetreating surgeon.

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.

Needle 'double reverse' traction reset and fixation with MiPPO for tibial plateau fractures / 局解手术学杂志

Objective To analyze the indications and evaluate the efficacy of the needle to 'double reverse' traction reset,inside and outside double column locking plate internal fixation with MiPPO for tibial plateau fractures.Methods From August 2015 to March 2017,a total of 31 patients with tibial plateau fractures in our hospital were divided into treatment group and control group.The treatment group with 12 cases were treated with the needle to be 'double reverse' traction reset,inside and outside double column locking plate MiPPO fixation.The control group with 19 cases received open reduction and internal fixation with locking plate.Results In treatment group,the operation time was (51.3±6.5)minutes,the intraoperative bleeding was (60±8.7)mL.In the control group,the operation time was (68.5±6.6)minutes,the intraoperative bleeding was (230±7.8)mL.The operation time and blood loss of treatment group were less than those of control group,the differences were statistically significant(P<0.05).The postoperative X ray film of fracture showed that the bone plate and screw position were ideal compared with those before operation,no complication occurred.Conclusion The needle 'double inverse' traction and locking plate MiPPO fixation treatment have good clinical effect for patients of Schatzker Ⅴ,Ⅵ tibia platform fracture,with less complication.

Closed reduction and percutaneous locking compression titanium plate internal fixation in treatment of distal tibial fractures / 中国基层医药

Objective To evaluate operative methods and the clinical effect of closed reduction and percuta-neous locking compression titanium plate internal fixation in treatment of distal tibial fractures.Methods The clinical data of 21 patients with fracture who received closed reduction technology through the subcutaneous tunnel of fracture end,minimally invasive percutaneous treatment of tibial locking titanium plate fixation were retrospectively analyzed. Results All 21 patients were followed up from 6 to 18 months(11 months in average).All patients recovered with good healing of fracture.According to criteria of Johner -Wruhs score,the results were excellent in 12 cases,good in 6 cases,fair in 3 cases,and poor in 0 case.The excellent and good rate was 85.71%.Conclusion The method of closed reduction and percutaneous locking compression titanium plate internal fixation in treatment of distal tibial frac-tures can protect skin soft tissue,reduce the damage to the blood -supply of the fracture,promote the healing of the fracture and reduce complications.

EFFECT OF ARTHROSCOPY IN CONJUNCTION WITH MINIMALLY INVASIVE PERCUTA-NEOUS PLATE OSTEOSYNTHESIS IN THE TREATMENT OF TIBIAL PLATEAU FRACTURE / 现代医院

Objective To study the effect of arthroscopy in conjunction with minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of tibial plateau fracture.Methods 78 cases of tibial plateau fracture patients admitted during March 2011 and June 2014 were retrospectively analyzed, with 38 cases given the conven-tional open reduction treatment (group A) and 40 given arthroscopy in conjunction with MIPPO (group B).The clini-cal efficacy, Rasmussen excellent rate and good rate, and postoperative complications in both groups were then com-pared.Results The operative time showed no significant difference in both groups (p >0.05); the time of hospital-ization, the length of surgical incision and healing time of group B were significantly better than group A (p <0.05);after follow -up observation, Rasmussen excellent rate and good rate of group B were significantly higher than group A (p <0.05).Conclusion Arthroscopic in conjunction with MIPPO has the advantages of smaller surgical wound, faster recovery and fewer complications, and have good efficacy and better clinical value for the treatment of tibial plateau fractures.

Identification of peroneal nerve’ s safety zone and its clinical value in treatment of MIPPO for proximal tibia fracture / 局解手术学杂志

Objective To define the peroneal nerve’ s safety zone and study its clinical value in treatment of MIPPO for proximal tibia fracture. Methods The peroneal nerve’ s safety zone was defined according to dead body anatomy. Patients with proximal tibia fracture were divided into traditional therapy group ( control group) and peroneal nerve’ s safety zone therapy ( observation group) . The curative effects and complications were compared. Results The peroneal nerve’s safety zone of R1 was (45. 30 ± 1. 55) mm,R2 was (45. 61 ± 1. 40) mm,R3 was(45. 42 ± 1. 62) mm,angle A was(33 ± 2. 1)°,angle B was(97 ± 2. 3)°. The operating time,bleeding volume,hospitalization time and fracture time in observation group were significantly lower than those in the control group,but there was no siginificant difference in post-ther-apy infection,delayed healing and other complications. Conclusion The curative effects according to peroneal nerve’ s safety zone are better than traditional MIPPO in proximal tibia fracture.

Minimally invasive percutaneous plate osteosynthesis treatment of distal tibial fractures / 中国医师进修杂志

Objective To explore the clinical application and efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) treatment of distal tibial fractures.Method From March 2007 to February 2013,MIPPO technology locking compression plate for the treatment of 49 cases of distal tibial fractures,including 12 cases of open fractures,37 cases of closed fractures involving the articular surface 7 cases,38 cases of fracture reduction and limited open reduction of 11 cases.Results Forty-nine patients were followed up for 6-24 months,an average of 12 months,1 case of a finite complex open reduction and nonunion,and re-open reset grafting healing,2 cases of distal tibial fractures delayed healing.The mean healing time was 4.9 months,press the Johner-Wruhs score,excellent in 42 cases,good in 5 cases,and middle in 2 cases.Excellent rate of 95.9％ (47/49).Conclusion MIPPO technology locking compression plate fixation of distal tibial fracture trauma,can reduce the interference of the blood supply of the fracture,fracture healing rate and reduce the rate of infection,is the ideal treatment of distal tibial fractures.

Minimally Invasive Percutaneous Plate Osteosynthesis Using a Lateral Plate in Distal Tibial Fracture

PURPOSE: To evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) using a lateral plate (Zimmer, Periarticular Lateral Distal Tibial Plates, USA) in distal tibial fracture within 3 cm to plafond, associated with medial soft tissue damage. MATERIALS AND METHODS: From January 2005 to December 2007, 15 patients with distal tibial fracture treated by MIPPO technique using a lateral plate were analyzed. The duration of follow-up was more than 1 year. We evaluated union time by simple X-ray, clinical results by IOWA ankle rating system, and complication. RESULTS: The bone union was achieved in all cases at average 16.7 weeks. Evaluation of the ankle function test showed an average of 90.3 points, resulting in satisfactory. At the last follow-up, there was no non-union, angular deformity more than 5 degrees or infection. CONCLUSION: We concluded that MIPPO technique using a lateral plate is a efficient method for high functional recovery with good bone healing and low complication in distal tibial fracture within 3 cm to plafond, associated with medial soft tissue damage.

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.

Two-staged Delayed Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Open Fractures

PURPOSE: To evaluate the outcomes of distal tibial open fractures treated by two-staged delayed minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. MATERIALS AND METHODS: 25 cases of distal tibial open fractures were treated with temporary ring fixation and two-staged delayed MIPPO. A mean age was 46 years old, follow-up was 23 months. The type of fracture was evaluated using the AO/OTA classification. The type of open fracture was evaluated using the Gustilo-Anderson classification that revealed 6 cases of type I, 9 cases of type II, 8 cases of type IIIA and 2 cases of type IIIB. We analyzed the radiologic results and postoperative complications. The clinical and functional result were evaluated by using Teeny and Wiss scores. RESULTS: The average time of bone union was 18 weeks in 24 cases. There were three delayed union that achieved union twenty weeks after second operation, and 1 case underwent bone graft with additional plate fixation. 6 cases of skin necrosis were treated with skin graft, 2 cases were treated with flap. The clinical and functional assessment showed that 6 cases were excellent, 16 cases were good, 2 cases were fair, and 1 case were poor results. CONCLUSION: Two-staged MIPPO technique for distal tibia open fractures seems to be a good procedure to obtain bone union.

Minimally Invasive Percutaneous Plate Osteosynthesis Using Periarticular Plate for Distal Tibial Fractures

PURPOSE: To evaluate the clinical results of minimally invasive percutaneous plate osteosynthesis using a periarticular plate (Zimmer, Warsaw, IN, USA) for distal tibia fractures. MATERIALS AND METHODS: 27 patients with distal tibia fractures were treated operatively by minimally invasive percutaneous plate osteosynthesis. The patients were followed for at least 1 year. The duration for bone union, complications after the surgery, the amount of skin irritation at the site of plate insertion was evaluated using the VAS score and the Olerud and Molander ankle score. The average age of the patients was 56 years old (range, 30~81 years) with an average follow up period of 21 months (range, 12~30 months). RESULTS: The average time from trauma to surgery was 6 days (range, 2~19 days). 10 cases showed an associated distal fibular fracture. The average time for bone fusion was 14 weeks (range, 8~40 weeks) with 1 case of angular deformity with more than 5 degrees. The amount of skin irritation due to the periarticular plate resulted in a VAS score of 2.2 points. Evaluation of the ankle function test showed an average of 90.2 points, resulting in satisfactory. CONCLUSION: The periarticular plate used in minimally invasive percutaneous plate osteosynthesis for distal tibia fractures was concluded to give a firm fixation of the fracture site as bony fusion could be acquired without any callus formation, and few skin irritation due to plate has seem to be an advantage.

Minimally Invasive Percutaneous Plate Osteosynthesis Using Periarticular Plate for Distal Tibial Fractures

PURPOSE: To evaluate the clinical results of minimally invasive percutaneous plate osteosynthesis using a periarticular plate (Zimmer, Warsaw, IN, USA) for distal tibia fractures. MATERIALS AND METHODS: 27 patients with distal tibia fractures were treated operatively by minimally invasive percutaneous plate osteosynthesis. The patients were followed for at least 1 year. The duration for bone union, complications after the surgery, the amount of skin irritation at the site of plate insertion was evaluated using the VAS score and the Olerud and Molander ankle score. The average age of the patients was 56 years old (range, 30~81 years) with an average follow up period of 21 months (range, 12~30 months). RESULTS: The average time from trauma to surgery was 6 days (range, 2~19 days). 10 cases showed an associated distal fibular fracture. The average time for bone fusion was 14 weeks (range, 8~40 weeks) with 1 case of angular deformity with more than 5 degrees. The amount of skin irritation due to the periarticular plate resulted in a VAS score of 2.2 points. Evaluation of the ankle function test showed an average of 90.2 points, resulting in satisfactory. CONCLUSION: The periarticular plate used in minimally invasive percutaneous plate osteosynthesis for distal tibia fractures was concluded to give a firm fixation of the fracture site as bony fusion could be acquired without any callus formation, and few skin irritation due to plate has seem to be an advantage.

The Comparison of MIPPO vs Open Plate Fixation in the Treatment of the Distal Tibia Fracture

PURPOSE: To evaluate the efficacy of the surgical treatment through the comparison of MIPPO vs open plate fixation in the treatment of the distal tibia fracture retrospectively. MATERIALS AND METHODS: 30 patients with distal tibia fracture from Jun. 2001 to Jun. 2004 were divided into two groups depending on the surgical method. Minimum follow up was 12 months. Group A consisted of 15 patients treated with MIPPO, Group B was 15 patients treated with open plate fixation. The clinical outcomes were evaluated retrospectively from operation time, rehabilitation, ROM, interval change of postoperative CRP to assess postoperative inflammatory reaction, postoperative complications and clinical result with the use of McLennan and Ungersma criteria. RESULTS: There were no significant differences in clinical result by McLennan and Ungersma criteria in both groups. The postoperative 3 days and 7 days CRP were 4.0mg% (0.9~7.2)/0.5 mg% (0.1~1.5) in group A and 7.97mg% (2.8~14.6)/1.0mg% (0.3~1.6) in group B, shows more minimal tissue injury and early recovery in group A. Operation time in group A was shorter than group B. Normal recovery of ROM was quicker in Group A. In complications, group A showed one superficial infection and one angular deformity and group B showed one superficial infection, one infected nonunion and two ankle stiffness. CONCLUSION: There were no significant differences in clinical result and bony union. MIPPO technique is superior to group B in view of the minimal tissue injury, complications, operation time and postoperative rehabilitation.

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.

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.