Comparison between intramedullary nailing and minimally invasive plate osteosynthesis for tibial shaft fractures

IntroductionIntramedullary nailing (IMN) is currently considered the gold standard in the surgical treatment of tibial shaft fractures in adult patients. In this case-control comparative study, we aimed to compare the efficacy of minimally invasive plate osteosynthesis (MIPO) and IMN in treating tibial shaft fractures.Materials and methodsThe clinical and radiological outcomes, such as a modified trauma scale, operation time, fracture healing, rate of re-operation, and complications such as malunion, nonunion, shortening, and infection were assessed between IMN and MIPO for the treatment of tibial shaft fractures.ResultsSeventy-three skeletally mature patients who underwent IMN (group I) or MIPO (group M) for a closed extra-articular tibial shaft fracture (AO/OTA type 42) from June 2010 to May 2016 were retrospectively reviewed. The mean age was 51.16 (18~79) years, and the mean follow-up period was 22 (12~50) months. Bony union was achieved in all cases but one for each group - group I (35 cases) and group M (36 cases) (p > 0.05). Mean callus formation was observed in 12 (8 – 16) weeks in both groups (p > 0.05). There was no significant difference in operative time, hospital stay, bone healing, and the rate of complications among the two groups (p > 0.05). There was also no postoperative difference in functional evaluation between the two methods (p > 0.05).ConclusionsNo discrepancy was found in radiological and clinical outcomes between IMN and MIPO for tibial shaft fractures. It can be concluded that both IMN and MIPO are equally effective treatment modalities for tibial shaft fractures.     

经皮微创接骨板技术治疗胫骨远端骨折的疗效分析

目的 探讨经皮微创接骨板(MIPO)技术治疗胫骨远端骨折的的手术方法及疗效.方法 2006年3月至2010年2月采用MIPO技术治疗22例胫骨远端骨折患者,男8例,女14例;年龄24～75岁,平均45.3岁.术后定期复查X线片,观察骨折愈合情况,应用Johne-Wruhs方法评估患肢功能和骨折愈合情况.结果 所有患者术后获6～33个月(平均14个月)随访.全部患者骨折均获愈合,愈合时间为15～24周,平均18.6周,1例出现软组织损伤.按照Johner-Wruhs评分评定疗效:优12例,良9例,可1例,优良率为95.5%.结论应用MIPO技术治疗胫骨远端骨折,可有效提高骨折愈合率,获得良好功能,并能减少并发症的发生.

Abstract：

Objective To report the efficacy of treatment of distal tibial fractures with minimally invasive plate osteosynthesis (MIPO). Methods From March 2006 to January 2010, 22 cases of distal tibial fractures were treated with close reduction and the MIPO technique. They were 8 men and 14 women,with an average age of 45. 3 years (range, 24 to 75 years). The fracture healing was observed through regular follow-up radiography. Functional recovery of affected lower extremity was evaluated according to Johner-Wruhs scoring system. Results All the patients were followed up for an average of 14 months (range,6 to 33 months). All the fractures were healed after an average time of 18. 6 weeks (range, 15 to 24 weeks). Soft tissue problem occurred in only one case. According to Johner-Wruhs scoring, 12 cases were excellent, 9 good and one fair. The total excellent to good rate was 95. 5%. Conclusion In treatment of distal tibial fractures, MIPO technique can improve fracture healing and functional recovery through decreasing postoperative complications.     

Clinical comparison between open plating and minimally invasive plate osteosynthesis for displaced proximal humeral fractures: A prospective randomized controlled trial

BackgroundRecently, minimally invasive plate osteosynthesis (MIPO) has been widely used for the treatment of proximal humeral fractures. However, there is concern about whether the MIPO in comminuted proximal humeral fractures is also comparable to open plating. The purpose of this study was to compare the clinical and radiographic outcomes of open plating and MIPO for acute displaced proximal humeral fractures.Materials and methodsIn this prospective, randomized controlled study, 107 patients who had an acute proximal humeral fracture were randomized to either the open plating or MIPO techniques. Forty-five patients treated with open plating and 45 with the MIPO technique who were followed up at least 1 year were evaluated. Shoulder functional assessment, operating time, several radiographic parameters, and complications were evaluated at final follow-up.ResultsThe mean follow-up period was 15.0 months in the open plating and 14.3 months in the MIPO technique. There were no statistically significant differences in functional assessment scores and radiographic parameters between the two groups. High complications rates were found in 4-part fracture in both surgical methods The average operation time in the MIPO group were significantly lower compared to the open plating group (p < 0.05).ConclusionThis study showed MIPO in proximal humerus fractures had similar clinical and radiographic outcomes compared to the open plating. However, the MIPO technique in proximal humerus fracture provided significantly shorter operation time than the open plating.     

Minimally invasive plate osteosynthesis of distal tibial fractures: a comparison of medial and lateral plating

PurposeThe hypothesis of this study was that lateral minimally invasive plate osteosynthesis (MIPO) would be comparable with medial MIPO with regard to clinical and radiographic results. The purpose of this study was to compare the results of medial and lateral MIPO for treatment of distal tibial fractures.Materials and methodsBetween June 2005 and February 2009, 24 patients with a distal tibia fracture were treated using MIPO. Patients were divided into two groups according to the MIPO methods used; 12 patients were fixated by medial MIPO (group M) and the other 12 patients by lateral MIPO (group L). These two groups were compared with regard to time to union. Clinical results were assessed by use of the IOWA ankle-rating system and the range of ankle motion at last follow-up. Mean operation time and postoperative complications were evaluated by chart review. Radiographic results were assessed on the basis of tibial angulation and shortening at last follow-up.ResultsRadiological evidence of bony union was observed for all study subjects. Mean union time was not significantly different between the two groups. Mean IOWA score, range of ankle motion, and operation time were no different between the two groups. No significant difference in angulation and shortening was observed between the groups, and no patient had an angular deformity >5° or tibial shortening >10 mm at the last follow-up. Skin irritation was encountered in one case in group M and limited motion because of entrapment of the tibialis anterior muscle was observed in one patient in group L.ConclusionBoth medial and lateral MIPO produced good clinical and radiological results for distal tibial fractures. Lateral MIPO may be an effective option when soft tissue condition on the medial side of the distal tibia is poor or when the fracture line is close to the ankle joint.     

Minimally invasive plate osteosynthesis has equal safety to reamed intramedullary nails in treating Gustilo-Anderson type I,II and III-A open tibial shaft fractures

ObjectivesThe best fixation method for open tibial fractures has long been a matter of debate, many studies have recommended the use of intramedullary nails over external fixation for treating such fractures, recent studies also showed favorable results for the use of plates in managing open tibial fractures. However, there are very few (if any) reports in the literature comparing the use of minimally invasive plate osteosynthesis to reamed intramedullary nails in the fixation of open tibial fractures.The aim of this study was to compare the safety & efficiency of minimally invasive plate osteosynthesis to reamed intramedullary nails in treating open tibial shaft fractures.DesignA single-center, parallel group, prospective, randomized study.SettingAcademic Level 1 Trauma Center, during the period from October 2014 to December 2016.PatientsA total of 60 patients with open tibial fractures were randomized to reamed intra-medullary nails (R-IMN) (group A) or minimally invasive plate osteosynthesis (MIPO) (group B).Outcome measurementPatients were assessed for union (clinical & radiographic) & complications (e.g.; non–union, infection).ResultsNo statistically significant differences were found between the 2 methods in term of the incidence of infection or non-union. Time to full union was shorter for the R-IMN group when compared to that of the MIPO group & that was found to be statistically significant.ConclusionMIPO technique has equal safety to R-IMN technique in treating Gustilo-Anderson type I, II and III-A open tibial shaft fractures, as both techniques have similar rate of infection & non-union. These findings suggest that the MIPO technique can be considered a valid treatment alternative for such fractures.Level of evidenceLevel II, Therapeutic study.     

Minimally invasive plate osteosynthesis using posterolateral approach for distal tibial and tibial shaft fractures

ObjectiveThe objective of the study was to evaluate the effectiveness of the posterolateral minimally invasive plate osteosynthesis (MIPO) method for managing distal tibial or tibial shaft fractures with severe anterior and medial soft tissue injuries.Materials and methodsFive consecutive patients with three distal tibial and two tibial shaft fractures (three open fractures) at a level-1 trauma and tertiary referral center were retrospectively reviewed. All patients were definitively treated and followed to bone union. Main outcome was measured by American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, complications, and bone union on radiographs.ResultsThe average follow-up period was 15.8 months (range, 12–24 months). The average AOFAS score was 88.2 (range, 81–90). There were no complications, such as incision breakdown, deep infection, or impingement of the flexor hallucis longus tendon. Bone union was achieved in all cases.ConclusionsPosterolateral MIPO is a feasible option when treating these fractures, especially in cases with severe anterior and medial soft tissue injuries.     

锁定钢板小切口治疗胫骨干部及穹窿部骨折

目的探讨锁定钢板小切口治疗胫骨干部及穹窿部骨折的疗效。方法对31例胫骨干部及穹窿部骨折患者采用锁钉钢板小切口治疗。结果手术时间60～120（90±30）min。术后X线片显示骨折均达到解剖复位或接近解剖复位。31例均获得随访,时间5～24个月。根据Olerud-Molander评分系统评定：95～100（97.25±2.75）分,优24例,良5例,中1例,差1例,优良率达到93.55%。结论锁定钢板经皮小切口治疗胫骨骨折,固定方法简单,钢板把持力可靠,可早期恢复关节活动,临床效果好。     

Staged minimally invasive plate osteosynthesis of proximal tibial fractures with acute compartment syndrome

PurposeHigh-energy proximal tibial fractures often accompany compartment syndrome and are usually treated by fasciotomy with external fixation followed by secondary plating. However, the initial soft tissue injury may affect bony union, the fasciotomy incision or external fixator pin sites may lead to postoperative wound infections, and the staged procedure itself may adversely affect lower limb function. We assess the results of staged minimally invasive plate osteosynthesis (MIPO) for proximal tibial fractures with acute compartment syndrome.MethodsTwenty-eight patients with proximal tibial fractures accompanied by acute compartment syndrome who underwent staged MIPO and had a minimum of 12 months follow-up were enrolled. According to the AO/OTA classification, 6 were 41-A, 15 were 41-C, 2 were 42-A and 5 were 42-C fractures; this included 6 cases of open fractures. Immediate fasciotomy was performed once compartment syndrome was diagnosed and stabilization of the fracture followed using external fixation. After the soft tissue condition normalized, internal conversion with MIPO was done on an average of 37 days (range, 9–158) after index trauma. At the time of internal conversion, the external fixator pin site grades were 0 in 3 cases, 1 in 12 cases, 2 in 10 cases and 3 in 3 cases, as described by Dahl. Radiographic assessment of bony union and alignment and a functional assessment using the Knee Society Score and American Orthopedic Foot and Ankle Society (AOFAS) score were carried out.ResultsTwenty-six cases achieved primary bony union at an average of 18.5 weeks. Two cases of nonunion healed after autogenous bone grafting. The mean Knee Society Score and the AOFAS score were 95 and 95.3 respectively, at last follow-up. Complications included 1 case of osteomyelitis in a patient with a grade IIIC open fracture and 1 case of malunion caused by delayed MIPO due to poor wound conditions. Duration of external fixation and the external fixator pin site grade were not related to the occurrence of infection.ConclusionsStaged MIPO for proximal tibial fractures with acute compartment syndrome may achieve satisfactory bony union and functional results, while decreasing deep infections and soft tissue complications.     

Malalignment after minimally invasive plate osteosynthesis in distal femoral fractures

IntroductionAlthough minimally invasive plate osteosynthesis (MIPO) is a preferred operative treatment for fractures of the distal femur, malalignment is a significant concern because of indirect reduction of the fracture. The purpose of this study, therefore, was to evaluate radiologic alignment after MIPO for distal femoral fractures.Patients and methodsOf the 138 patients with fracture of the distal femur who underwent MIPO, we enrolled 51 patients in whom bilateral rotational alignment could be assessed by postoperative computed tomography (CT). The patients included 32 men and 19 women, with a mean age of 54.3 years. Thirteen patients had femoral shaft fractures (according to the AO/OTA classification: 32-A, n = 2; 32-B, n = 6; 32-C, n = 5), whereas 38 patients had distal femoral fractures (33-A, n = 7; 33-C, n = 31). Coronal and sagittal alignments were assessed using simple radiography, whereas rotational alignment was assessed using CT. According to the difference between the affected and unaffected sides, we divided the patients into satisfactory and unsatisfactory groups (reference point of 8°, using Handolin’s classification). Thereafter, we determined which factors can lead to malalignment, including fracture location (distal femoral shaft fracture or metaphyseal fracture), fracture pattern (simple fracture, n = 15; complex fractures, n = 36 patients), coronal and sagittal alignments, and combined ipsilateral long bone fractures.ResultsCoronal and sagittal alignment were satisfactory in 96.2% (average, 2.8°) and 98% (average, 2.2°), respectively, whereas the rotational alignment was satisfactory in 56.9% of patients. Leg length discrepancy was satisfactory in 92.3% of the patients (average, 10.9 mm). Concerning rotational malalignment, an unsatisfactory result was obtained in 48.6% of subjects with complex fractures and 26.7% of subjects with simple fractures (p = 0.114). No significant correlation was noted between the angular deformity in the coronal and sagittal planes and the degree of rotational alignment (p = 0.607 and 0.774, respectively).ConclusionsRegardless of the fracture pattern, rotational malalignment may occur at an extremely high rate after MIPO for fractures of the distal femur.     

Minimally invasive plate osteosynthesis with locking plate for metastatic humeral fractures

BackgroundLimited reports have examined the outcomes and complications of minimally invasive plate osteosynthesis (MIPO) with a locking plate (LP) in metastatic humeral fractures. Therefore, this study aimed to evaluate the effectiveness of MIPO in the treatment of metastatic humeral fractures.MethodsPatients who underwent MIPO for metastatic humeral fractures were included in this study. Data on patient demographics, new Katagiri score, operative time, amount of blood loss, bone union rate, range of motion (ROM) of the shoulder and elbow, and perioperative complications were obtained.ResultsTwelve patients (seven men and five women) with 14 fractures were included in this study. The median operative time was 92.6 ± 28.9 min (range, 57–175 min) and the median amount of intraoperative blood loss was 106.1 ± 109.5 g (range, 10–330 g). No patient required surgery-related transfusion. The median duration of acquisition of active elbow ROM of>100° and active shoulder flexion of >90° were 8.9 ± 6.6 days (range, 1–30 days) and 17.5 ± 13.0 days (range, 6–47 days), respectively. The mean follow-up period was 10.0 ± 9.0 months (range, 1–33 months). There were no complications, and no patient required any further surgery for the affected humerus until death.ConclusionMIPO using an LP provided acceptable functional outcomes in advanced-stage cancer patients with metastatic humeral fractures during their limited lifetime.     

锁定钢板系统在四肢骨折中的应用

目的 总结微创锁定钢板治疗四肢骨折的疗效.方法 2005年5月至2006年10月,分别采用微创内固定系统(less invasive stabilization system,LISS)与锁定加压钢板(locking compression plate,LCP)对64例70处四肢骨折进行治疗,男45例,女19例;年龄17-69岁,平均36.8岁;股骨远端骨折16例19处,胫骨近端骨折28例31处,胫骨远端骨折8例8处,肱骨近端骨折12例12处.50处股骨远端与胫骨近端骨折采用LISS固定,20处胫骨远端与肱骨近端骨折采用LCP同定.在影像增强器监视下先行闭合复位,复位满意后采用经皮微创接骨术于肌肉下骨膜外置入LISS或LCP,再次确认位置满意后通过导向器经皮拧入锁定螺钉.结果 随访时间4～22个月,平均8.8个月.全部伤口均一期愈合,无一例发生感染、骨折再移位、成角畸形或内固定失败等并发症.骨折临床愈合时间8～16周,平均12.3周.膝关节功能HSS评分70～95分,平均87.5分,ROM 90°～130°,平均122°;踝关节AOFAS评分82～95分,平均91.4分;肩关节功能Neer评分82～94分,平均90.6分.患肢功能均恢复良好.结论 微创技术结合锁定钢板治疗四肢骨折具有软组织创伤小、对骨骼血供影响小、骨折愈合快、手术感染率低、功能恢复好等优点.锁定钢板无须紧贴骨面即可获得可靠的固定,不易发生骨折冉移位或内固定松动.     

Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified.     

Minimally invasive plate osteosynthesis of subtrochanteric femur fractures with a locking plate: a prospective series of 20 fractures

Background  

Intramedullary nailing is a mainstay in the treatment of subtrochanteric femoral fractures. But nailing is often unsuitable for difficult fracture patterns with comminution or when the medullary canal is narrow. The purpose of this study was to clarify the efficacy of minimally invasive plate osteosynthesis (MIPO) with locking compression plate in the treatment of subtrochanteric fractures.     

Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation

Purpose  To present a case series of patients with isolated posterior coronal fractures of lateral tibial plateau treated by direct exposure and buttress plate fixation through posterolateral approach. Methods  Between May 2007 and April of 2008, eight middle aged patients were identified that had isolated posterior coronal fractures of the lateral tibial plateau. All eight patients underwent direct fracture exposure, reduction under visualization, and buttress plate fixation through posterolateral approach. Results  There were 1 case of split, two cases of pure depression and five cases of split-depression fractures. Four were associated fibular head split fractures without common peroneal nerve injuries. Five patients were injured from a simple fall on riding electrical bicycle while the knee was relaxed in 90° position The articular displacement (8 cases) measured in CT scan was 10.5 mm in average (range 8–15 mm). The cortical split length (from the articular rim to the distal tip, 6 cases) was 2.8 cm in average (range 2.4–3.5 cm). The articular reduction was perfect in seven (absolutely no step-off) and imperfect in 1(<2 mm step-off) as measured by X-ray. With a mean follow-up of 10 months (6 cases > 12 months), the average range of motion arc was 119°, four patients have flexion lag 10°–20°. The average SMFA dysfunction score was 15.8, and average HSS score was 98. All eight patients stated they were highly satisfied. Conclusions  Direct posterolateral approach by dividing lateral border of soleus muscle, provides excellent fracture reduction under visualization and internal buttress plate fixation for posterior coronal fracture of the lateral tibial plateau. Good functional results and recovery can be expected.     

Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures

Nowadays, the use of minimally invasive plate osteosynthesis (MIPO) in the management of fracture of the distal tibia is common. The various advantages of the MIPO technique, namely, preserving blood supply and better bone healing, have been described extensively in the literature. However, this technique is not without complication. Among all the complications, infection is one of the commonest. In the last 3 years, we have performed 48 cases of MIPO in treating distal tibia fractures. Our study was to evaluate the clinical outcome of these cases, with special attention to the infection rate and our experience in managing these infection cases. Our results showed that the average time until the patient started to bear full weight was 9.4 weeks. The average time for bony union was 18.7 weeks. There were 7 cases of late infection among these 48 cases. The rate was 15%. The presence of late infection had no obvious effect on the time to bony union. Twenty-five patients (52%) had the implants removed and the most common reason was skin impingement by the implant. The clinical presentation and management of these late infections are discussed. In conclusion, MIPO fixation of distal tibia fractures using a metaphyseal locking plate is safe and efficient. However, complications such as late wound infection and impingement are relatively common. The overall clinical outcome is still good despite the presence of these complications.     

Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis – A prospective series of 50 patients

Background

Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed. Though many studies on the subject have been done previously, these have been retrospective reviews or small series.

Methods

From May 2010 to May 2013, 50 patients of closed distal tibial fractures were operated by MIPO technique with a distal tibial anatomical locking plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 3 years.

Results

The mean fracture healing time was 21.4 weeks (range 16–32 weeks) and average AOFAS score 95.06 was out of a total possible 100 points. At last follow up, superficial infection occurred in 5 patients (10%); deep infection, implant failure and malunion in 1-patient each (2%).

Conclusion

MIPO technique provides good, though slightly delayed bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension.     

Treatment of middle third humeral shaft fractures: minimal invasive plate osteosynthesis versus expandable nailing

The purpose of this study is to compare the results of middle third humeral shaft fractures treated with minimally invasive plate osteosynthesis (MIPO) with those treated with an expandable nail technique. Thirty-four patients with middle third humeral shaft fractures were retrospectively analyzed and divided into two groups: group A included 15 patients treated by MIPO and group B included 19 patients treated with an expandable intramedullary nail. The operation time, postoperative complications, time to fracture union, the UCLA End-Result score of the shoulder, and Mayo elbow performance index (MEPI) were recorded and compared. The mean operation time in group A was 108.3 ± 28.7 min and 85.0 ± 35.7 min in group B, a difference of 23.3 (27.4%) minutes (P < 0.05). There were no cases of iatrogenic radial nerve palsy or superficial infection in either group. All fractures united. The mean time to fracture union in group A was 16.1 ± 6.0 (8–32)weeks, versus 15.0 ± 2.5 (10–21) weeks in group B (P > 0.05). One case of delayed union was identified in group A. The mean UCLA End-Result score in group A was 34.2 ± 1.1 points (31–35 points)and 31.8 ± 2.6 points (26–35) in group B (t = 3.318 P = 0.002, P < 0.05). All the patients had excellent elbow functions. In surgical treatment of middle third humeral shaft fractures, MIPO appeared to offer advantages in terms of better shoulder and no iatrogenic radial nerve injuries, although technically more difficult and time consuming.     

Metaphyseal locking plate as an external fixator for open tibial fracture: Clinical outcomes and biomechanical assessment

ObjectiveThis study aimed to evaluate the outcome of using a metaphyseal locking plate as a definitive external fixator for treating open tibial fractures based on biomechanical experiments and analysis of clinical results.MethodsA metaphyseal locking plate was used as an external fixator in 54 open tibial fractures in 52 patients. The mean follow-up was 38 months (range, 20–52 months). Moreover, static axial compression and torsional tests were performed to evaluate the strength of the fixation techniques.ResultsThe average fracture healing time was 34.5 weeks (range, 12–78 weeks). At 4 weeks postoperatively and at the final follow-up, the average Hospital for Special Surgery knee score was 85 (range, 81–100) and 94 (range, 88–100), respectively, and the American Orthopaedic Foot and Ankle Society score was 88 (range, 80–100) and 96 (range, 90–100), respectively. Based on the static test result, the axial stiffness was significantly different among groups (p = 0.002), whereas the torsional stiffness showed no significant difference (p = 0.068).ConclusionsClinical outcomes show that the use of locking plate as a definitive external fixator is an alternative choice for tibial fractures after obtaining appropriate fracture reduction. However, external locked plating constructs were not as strong as standard locked plating constructs. Therefore, the use of external locked plating constructs as a definitive treatment warrants further biomechanical study for construct strength improvement.     

Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures

Objective: To investigate the efficacy of the locking internal fixator (LIF), which includes the locking compression plate (LCP) and the less invasive stable system (LISS), in the proximal and distal tibial fractures. Methods: We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the operation with LIF by the minimally invasive plate osteosynthesis (MIPO) technique. The data consisted of 43 proximal tibial fractures (type AO41C3) and 55 distal tibial fractures (type AO43C3). Results: No complications were observed in all patients after operation. The mean healing time was 8.4 months (range 5-14 months). Only two cases of delayed union occurred at postoperative 10 months. No infections were reported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at postoperative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion: Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing.     

The use of interfragmentary positional screw in minimally invasive plate osteosynthesis for simple distal femur fractures in elderly patients: A retrospective,single-centre pilot study

IntroductionMinimally invasive plate osteosynthesis (MIPO) using locking plates has been used in distal femur fractures, but various problems, such as nonunion, malalignment, and implant failure, have been reported. Simple fractures sometimes have poorer outcomes than complex fractures. We studied elderly patients with simple fracture patterns who underwent open reduction followed by placement of a single positional screw to hold the reduced interfragmentary gap, and compared these cases with patients who underwent surgery using conventional MIPO techniques.Patients and methodsA retrospective analysis was conducted on 80 cases of patients with distal femur fractures and simple fracture patterns (33-A1, A2, and C1). The mean age was 74 (60–90) years, and the mean follow-up period was 14 (12–25) months. Group A included 40 patients who underwent conventional MIPO technique while Group B included 40 patients who had surgery using positional screws. Interfragmentary gaps in Group B were reduced using percutaneous reduction clamps, and cortical screws were inserted to sustain the reduction. Then, locking plates were inserted using conventional MIPO techniques.ResultsBony union was achieved in all 80 cases, mean initial callus formation was observed in 11 weeks (8–13 weeks), and radiological union was observed in 27 weeks (15–54 weeks). Time to initial callus formation was not different, but radiologic union was achieved in 30 weeks (18–54 weeks) for Group A and 25 weeks (15–41 weeks) for Group B (p = 0.006). No differences were seen in clinical function at 1 year (p = 0.580). Five cases of malalignment occurred in Group A (p = 0.021). The rate of union during the 1-year period was significantly higher in group B than in group A (p = 0.002).ConclusionsIn a distal femur fracture with a simple fracture pattern, using positional screws to sustain the reduced interfragmentary gap may achieve a more rapid union by reducing fracture gap. Though functional differences were not seen in follow-ups, patients can be expected to return to their normal lives earlier as union is achieved in a shorter time. Performing MIPO using positional screws to sustain the reduced interfragmentary gap after fracture reduction will be helpful in the treatment of simple femoral fracture.