ARTICOLE ORIGINALE - ORIGINAL PAPERS
MIPO TECHNIQUE WITH EXCLUSIVE PROXIMAL AND DISTAL INCISIONS FOR
THE COMPLEX SUPRACONDYLAR FRACTURES
P. Sîrbu, D. Pencu, G. Ghionoiu, O. Cristea,
R. Bruja, R. Asaftei, N. Georgescu
Emergency Clinic Hospital, Clinic of Orthopaedy and Traumatology,
University of Medicine and Pharmacy „Gr.T. Popa” Iasi
Jurnalul de chirurgie 2005; 1 (1):57-76
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Abstract
In order to limit the amount of both medial and lateral dissection,
the MIPO technique was developed for extraarticular fractures of the
femur, whereas the transarticular approach was designed for comminuted
intraarticular fractures of the distal femur. Watching the Wenda and
Krettek works, I have introduced these techniques in the Orthopedic
Department in Iasi, Emergency Hospital, for the first time in Romania.
Aims: The purpose of this prospective
study is to evaluate the results of the treatment by MIPO with exclusive
proximal and distal incisions for the complex supracondylar fractures.
Material and methods: The investigated
group of patients included 15 persons with 15 fractures, between January
2001 and October 2003. There were 7 A2/AO fractures and 8 A3/AO fractures.
According to Gustilo classification, the investigated group comprised
3 open fractures (I grade I, and 2 grade II), one of them being produced
by gunshot with low velocity bullet.
Surgical techniques:
The technique consisted in preoperative step, surgical technique itself
and postoperative treatment. The surgical technique consisted in:
- antero-lateral limited approach of the distal femur
- the selection of the appropriate plate by fluoroscopy
- the plate insertion beneath the vastus lateralis
- an additional minimal proximal incision which allows plate positioning
- distal fixation of the plate
- after the limb axis, length and rotation are confirmed by reliable
clinical and radiological techniques, the plate was fixed to the shaft
with 3, 4 or 5 screws placed divergently
Results: All fractures healed within
a mean time of 12 weeks (range 7-26 weeks) with no need for bone grafting.
Two late implant failures (plate screw breakage) did not required
repeat fixation. At follow-up, there were 3 varus/valgus deformities
of about 4-5 degrees and the mean leg length discrepancies was of
1 cm (range 0-2.2 cm). According to the Neer score there were 9 excellent,
5 satisfactory and 1 unsatisfactory result.
Conclusions: The key to MIPO is the
use of 2-part and 2-plane alignment achieved by a DCS inserted in
a submuscular fashion. The MIPO technique with proximal and distal
incisions minimizes surgical trauma and has the advantages of a faster
rate of union, with no need for bone grafting. Care should be taken
to ensure adequate axial and rotational alignment.
KEYWORDS: MINIMALLY INVASIVE PLATE
OSTEOSYNTHESIS, MIPO, FRACTURES OF THE DISTAL FEMUR
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