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Does MIPO of fractures of the distal femur result in more rotational malalignment than ORIF? A retrospective study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Intraoperative control of rotational malalignment poses a big challenge for surgeons when using modern MIPO (minimally invasive plate osteosynthesis) techniques. We hypothesized that distal femoral fractures treated with MIPO technique are more often fixed in malrotation than those treated with open reduction internal fixation (ORIF).

Methods

In this retrospective study, we identified 20 patients who met the inclusion criteria and agreed to take part in the study. In ten patients MIPO was applied, in the other ten ORIF was used. Mean age was 44.8 (19–71 years). Functional status was assessed using clinical scores (Harris Hip Score, WOMAC Hip, KS Score, WOMAC Knee, Kujala Score). Rotational alignment was assessed with magnetic resonance imaging and compared to the opposite leg.

Results

We discovered a significant difference in the mean rotational difference between the MIPO group (14.3°) and the ORIF group (5.2°). Functionally, patients in the ORIF group outperformed patients in the MIPO group in all clinical scoring systems although no one proved to be statistically significant. MIPO technique was associated with significantly more rotational malalignment compared to ORIF in distal femur fracture fixation. However, implant failure and nonunion was more common in the ORIF group, with a revision rate of 3 versus 1 in the ORIF group. Clinical scoring did not significantly different between both groups.

Conclusion

Taking into account the undisputable advantages of minimally invasive surgery, improved teaching of methods to avoid malrotation as well as regular postoperative investigations to detect any malrotation should be advocated.

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Authors and Affiliations

  1. Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    M. Lill, R. Attal, M. Blauth & M. Lutz

  2. Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    A. Rudisch

  3. Department of Radiology, Karolinska University Hospital, 17176, Stockholm, Sweden

    M. C. Wick

  4. Trauma Hospital Salzburg, Dr. Franz-Rehrl-Platz 5, 5020, Salzburg, Austria

    M. Lill

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  1. M. Lill
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  2. R. Attal
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Correspondence to M. Lill.

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An institutional ethical committee approved the study and all patients gave written informed consent.

Conflict of interest

Markus Lill, Rene Attal, Ansgar Rudisch, Marius Wick, Michael Blauth and Martin Lutz declare that they have no conflict of interest.

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Lill, M., Attal, R., Rudisch, A. et al. Does MIPO of fractures of the distal femur result in more rotational malalignment than ORIF? A retrospective study. Eur J Trauma Emerg Surg 42, 733–740 (2016). https://doi.org/10.1007/s00068-015-0595-8

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  • DOI: https://doi.org/10.1007/s00068-015-0595-8

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