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Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated

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The aim of this study was to examine the results of minimally invasive plate osteosynthesis (MIPO) of the femoral shaft fracture in patients where intramedullary nailing is contraindicated and evaluate the proper number of the screws for stable fixation. This was a retrospective study of 36 closed femoral shaft fractures which underwent MIPO using a conventional 4.5 broad dynamic compression plate (DCP) with 14–18 holes fixed with three or four screws in the proximal and distal fragments. Thirty-three fractures had bony union in 21.0 weeks (range, 12–28 weeks), two had delayed union that required bone graft and union at 28 and 32 weeks. Malalignment occurred in five cases. Sixty-two fragments were fixed with three screws—40 in cluster and 22 in separated positions. Ten fragments were fixed with four screws—eight in cluster and two separated. Broken screws were found in three cases; all were in the group with three screws fixed in cluster group. MIPO of the femoral shaft fracture is an alternative treatment in the patient where intramedullary nailing is contraindicated. Malalignment is the common complication that must be carefully evaluated intraoperatively. We recommend using at least three separated screws in each fragment to reduce the risk of screw breakage.


L’objectif de cette étude est d’étudier les résultats de la technique MIPO pour les fractures de la diaphyse fémorale chez les patients pour lesquels l’enclouage centro-médullaire est impossible ou contre indiqué. Le but de l’étude est d’évaluer le nombre de vis permettant d’avoir une fixation stable. Matériel et méthode: une étude rétrospective a été réalisée sur 36 fractures diaphysaires fémorales fermées en utilisant une plaque DCP, avec vis de 4,5, une plaque de 14 à 18 trous fixée par 3 ou 4 vis dans le fragment proximal et 3 ou 4 vis dans le fragment distal. Résultats: 3 fractures ont consolidé en moyenne à 21 semaines (12 à 28 semaines). 2 ont présenté une retard de consolidation nécessitant une greffe avec une consolidation de 28 à 32 semaines. Un cal vicieux est survenu dans 5 cas. 62 fragments ont été fixés par 3 vis, 40 bien groupés et 22 dans une position différente plus étalés. 10 fragments ont été fixés par 4 vis, 8 en position groupée, 2 en position différente. Nous avons constaté une fracture de vis dans 3 cas, toutes les vis cassées se sont retrouvées dans le groupe des vis fixées de façon convergente bien groupée. En conclusion: la technique MIPO est une alternative au traitement des fractures diaphysaires fémorales chez les patients pour lesquels l’enclouage est contre-indiqué. Un cal vicieux est une complication relativement fréquente et doit être prévenue opératoirement. Nous recommandons d’avoir au moins 3 vis dans des directions différentes pour chaque fragment afin de réduire le risque de fracture de vis.

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  1. Apivatthakakul T, Arpornchayanon O, Bavornratanavech S (2005) Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report. Injury 36:530–538

    Article  PubMed  CAS  Google Scholar 

  2. Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H (1999) Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? J Orthop Trauma 13:401–406

    Article  PubMed  CAS  Google Scholar 

  3. Field JR, Tornkvist H, Hearn TC, Sumner-Smith G, Woodside TD (1999) The influence of screw omission on construction stiffness and bone surface strain in the application of bone plates to cadaveric bone. Injury 30:591–598

    Article  PubMed  CAS  Google Scholar 

  4. Geissler WB, Powell TE, Blickenstaff KR, Savoie FH (1995) Compression plating of acute femoral shaft fractures. Orthopedics 18:655–660

    PubMed  CAS  Google Scholar 

  5. Heitemeyer U, Kemper F, Hierholzer G, Haines J (1987) Severely comminuted femoral shaft fractures: treatment by bridging-plate osteosynthesis. Arch Orthop Trauma Surg 106:327–330

    Article  PubMed  CAS  Google Scholar 

  6. Jeon IH, Oh CW, Kim SJ, Park BC, Kyung HS, Ihn JC (2004) Minimally invasive percutaneous plating of distal femoral fractures using the dynamic condylar screw. J Trauma 57:1048–1052

    Article  PubMed  Google Scholar 

  7. Kanlic EM, Anglen JO, Smith DG, Morgan SJ, Pesantez RF (2004) Advantages of submuscular bridge plating for complex pediatric femur fractures. Clin Orthop Relat Res 244–251

  8. Karunakar MA, Frankenburg EP, Le TT, Hall J (2004) The thermal effects of intramedullary reaming. J Orthop Trauma 18:674–679

    Article  PubMed  Google Scholar 

  9. Kinast C, Bolhofner BR, Mast JW, Ganz R (1989) Subtrochanteric fractures of the femur. Results of treatment with the 95 degrees condylar blade-plate. Clin Orthop Relat Res 122–130

  10. Krettek C, Miclau T, Grun O, Schandelmaier P, Tscherne H (1998) Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury 29(suppl 3):C29–39

    Article  PubMed  Google Scholar 

  11. Krettek C, Schandelmaier P, Miclau T, Bertram R, Holmes W, Tscherne H (1997) Transarticular joint reconstruction and indirect plate osteosynthesis for complex distal supracondylar femoral fractures. Injury 28(suppl 1):A31–41

    Article  PubMed  Google Scholar 

  12. Krettek C, Schandelmaier P, Miclau T, Tscherne H (1997) Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury 28(suppl 1):A20–30

    Article  PubMed  Google Scholar 

  13. Krettek C, Schandelmaier P, Tscherne H (1996) Distal femoral fractures. Transarticular reconstruction, percutaneous plate osteosynthesis and retrograde nailing. Unfallchirurg 99:2–10

    PubMed  CAS  Google Scholar 

  14. Mast J Jr, Ganz R (1989) Planning and reduction technique in fracture surgery. Springer, Berlin Heidelberg New York

    Google Scholar 

  15. Muller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer, Berlin

    Google Scholar 

  16. Riemer BL, Foglesong ME, Miranda MA (1994) Femoral plating. Orthop Clin North Am 25:625–633

    PubMed  CAS  Google Scholar 

  17. Rozbruch SR, Muller U, Gautier E, Ganz R (1998) The evolution of femoral shaft plating technique. Clin Orthop Relat Res 195–208

  18. Sink EL, Hedequist D, Morgan SJ, Hresko T (2006) Results and technique of unstable pediatric femoral fractures treated with submuscular bridge plating. J Pediatr Orthop 26:177–181

    PubMed  Google Scholar 

  19. Thompson F, O’Beirne J, Gallagher J, Sheehan J, Quinlan W (1985) Fractures of the femoral shaft treated by plating. Injury 16:535–538

    Article  PubMed  CAS  Google Scholar 

  20. Tornkvist H, Hearn TC, Schatzker J (1996) The strength of plate fixation in relation to the number and spacing of bone screws. J Orthop Trauma 10:204–208

    Article  PubMed  CAS  Google Scholar 

  21. Wenda K, Runkel M, Degreif J, Rudig L (1997) Minimally invasive plate fixation in femoral shaft fractures. Injury 28(suppl 1):A13–19

    Article  PubMed  Google Scholar 

  22. Winquist RA, Hansen ST, Clawson DK (1984) Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 66:529–539

    PubMed  CAS  Google Scholar 

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Apivatthakakul, T., Chiewcharntanakit, S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated. International Orthopaedics (SICOT) 33, 1119–1126 (2009).

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