স্বা�গতম

MIPO (Minimal Invasive Plate Osteosynthesis)

A Good Option for Treatment of Comminuted Diaphyseal and

Metaphyseal Fracture of a Weight bearing Long bone.

Presented by

Dr. Mohammad Khurshed Alam

Assistant ProfessorDepartment of Orthopaedics and Traumatology

Dhaka Medical College

Our study

• Place of Study: Dhaka Medical College Hospital and private clinics in Dhaka.

• Period of study: July 2009---December 2010• Study Population:

comminuted diaphyseal and metaphyseal fracture of Femur and tibia.

• Number of Patients: 23• Follow-up Period: 6 months to 18 months• Fixation Techniques: MIPO• Implant used: LCP/ Metaphyseal Locking Plate

(Distal Femoral / Proximal Tibial )

• MIPO: minimally invasive plate osteosynthesis

• Tunneling a plate across a fracture via small skin incisions at each end of the bone.

• avoids the long surgery time and big wounds associated with traditional plate fixation

Mipo

Mipo-Benefits

Blood supply maximally preserved.

Fracture hematoma minimally disturbed.

Biological plating technique

MIPO

Indication

MIPO is most suitable for• Multi-fragmentary fractures• Fractures extending to the articular surfaces• Segmental Fractures• Narrow medullary canals (<9mm)• Deformed shaft ( malunion)• Open fractures, after wound coverage &

infection control.

Contraindications

• Severe soft tissue loss with no coverage of exposed bone• Associated vascular injuries• Compartment Syndrome• Pathological fractures• Osteomyelitis• Delayed surgery with shortening of the limb• Delayed reconstruction ( required bone graft)

Fractures we faced.

3

4

Fractures we faced.

Fractures we faced.

Options we have

•Thermal necrosis during reaming.•More Blood loss•Cortical thinning.

Interlocking Intramedulla

ry nail

•Wide exposure•Fixed angled plate•More soft tissue handling.

Angled blade plate

•Knee stiffness•Mal-union.•Shortening.

Conservative

Choice of implants.

Locking plates and screws

Positioning of the patient Manual Reduction

Surgical Procedure

Incision and insertion of the plate. Primary fixation on the condyles

Surgical Procedure…

Second incision and palpation of the plate K-wire fixation with the shaft

Surgical Procedure…

Distal screw insertion First proximal screw insertion

Surgical Procedure…

Fixation of plate with the shaft Completed osteosynthesis

Surgical Procedure…

After care

• Isometric quardiceps exercise from 1st POD.• Non-weight bearing crutch walking when pain subsides• knee bending exercise after 4 weeks. • Toe touch weight bearing after 6 weeks. • partial weight bearing from 12 weeks • full weight bearing from 20 -22 weeks after seeing the

progress in X –ray .

Radiographic evaluation was performed every six weeks until complete healing occurs.

Case one details:• Mrs. Patient, 45 years old

house –wife.• H/O Fall on the ground.• Fixation done after 7 days of

trauma

Our experiences

After Reduction Position of the plate

Our experiences…

Fixation checked under C-Arm Skin incision closure

Our experiences…

Follow-up after 6 wks Follow-up after 12 wks

Our experiences…

Case two details:• Mr. Patient, 42 years old

Banker. • H/O Motor bike accident.• Fixation done after 10 days

of trauma.

Our experiences…

Follow up after 2 wks After 4 wks.

Our experiences…

Follow-up after 6 wks of fixation

Our experiences…

Follow-up after 6 wks of fixation.

After 12 wks

Our experiences…

Another case:

Our experiences…

• Mr. Patient2, 25 years, male• H/O Road traffic accident• A case of Polytrauma• Head injury with

• Communited # shaft tibia• Communited # Distal radius

with articular extension• Posterior dislocation of hip.

Per-operative X-ray Follow-up after 6 wks

Our experiences…

Outcome

23 patients were studied, 3 lost in follow-up Average age 31.5 years (20-50 years).

Outcome

12 3 3 2

• Out of 20 fractures , 15 diaphyseal and 5 Metaphyseal.• 15 from RTA and 5 from fall from height.

Outcome

• Time of surgery: 7- 15 days (Average 9 days).

• operating time: Average 105 minutes (90minutes-135 minutes).

• Average C-arm /X-ray exposure : 7 minutes (5 – 12 minutes).

• Follow up period: 6 months to 18 months (average 12 months).

Outcome

• Fracture union time: 18 fractures were united within 16-28 weeks (average- 18

weeks) , 2 had delayed union :>32 weeks .

• Alignment after union:• There were no varus or valgus mal-alignment more than 10⁰

10 ⁰(A/P) mal-alignment: One patient 10 degrees ⁰ varus angulation: One patient

Criteria:• Fracture union • Knee ROM • Ability to return to previous activities

One patient required one dose of bone marrow injection for fracture union .

one has to change his profession.

Outcome

Conclusion

“MIPO technique is the good option for comminuted, diaphyseal and metaphyseal fracture

of a weight bearing long bone”

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