scholarly journals A minimally invasive cerclage of the tibia in a modified Goetze technique: operative technique and first clinical results

2021 ◽  
Author(s):  
Stefan Förch ◽  
Jan Reuter ◽  
Franziska von der Helm ◽  
Leonard Lisitano ◽  
Christopher Hartwig ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Soft Part ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Tibial Fractures ◽  
Full Weight Bearing ◽  
Invasive Technique ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Documentation System ◽  
The Stability

Abstract Introduction In spiral fractures of the tibia, the stability of an osteosynthesis may be significantly increased by additive cerclages and, according to biomechanical studies, be brought into a state that allows immediate full weight bearing. As early as 1933, Goetze described a minimally invasive technique for classic steel cerclages. This technique was modified, so that it can be used for modern cable cerclages in a soft part saving way. Method After closed reduction, an 8 Fr redon drain is first inserted in a minimally invasive manner, strictly along the bone and placed around the tibia via 1 cm incisions on the anterolateral and dorsomedial tibial edges using a curette and a tissue protection sleeve. Via this drain, a 1.7 mm cable cerclage can be inserted. The fracture is then anatomically reduced while simultaneously tightening the cerclage. Subsequently, a nail or a minimally invasive plate osteosynthesis is executed using the standard technique. Using the hospital documentation system, data of patients that were treated with additional cerclages for tibial fractures between 01/01/2014 and 06/30/2020 were subjected to a retrospective analysis for postoperative complications (wound-healing problems, infections and neurovascular injury). Inclusion criteria were: operatively treated tibial fractures, at least one minimally invasive additive cerclage, and age of 18 years or older. Exclusion criteria were: periprosthetic or pathological fractures and the primary need of reconstructive plastic surgery. SPSS was used for statistical analysis. Results 96 tibial shaft spiral fractures were treated with a total of 113 additive cerclages. The foregoing resulted in 10 (10.4%) postoperative wound infections, 7 of which did not involve the cerclage. One lesion of the profundal peroneal nerve was detected, which largely declined after cerclage removal. In 3 cases, local irritation from the cerclage occurred and required removal of material. Conclusion In the described technique, cerclages may be inserted additively at the tibia in a minimally invasive manner and with a few complications, thus significantly increasing the stability of an osteosynthesis. How this ultimately affects fracture healing is the subject of an ongoing study.

scholarly journals Minimally Invasive Percutaneous Plate Osteosynthesis Does Not Increase Complication Rates in Extra-Articular Distal Tibial Fractures

2015 ◽  
Vol 9 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Izzet Bingol ◽  
Nadir Yalcin ◽  
Vedat Bicici ◽  
Tolga Tulunay ◽  
Kaan Yuksel ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Soft Tissues ◽  
Callus Formation ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Cohort Analysis ◽  
Tibial Fractures ◽  
Full Weight Bearing ◽  
Complication Rates ◽  
Distal Tibial Fractures

Background : Selection of a treatment method in cases of unstable, nonarticular distal tibial fractures is still a matter of discussion. Intramedullary nailing, which is a “gold standard” for tibial shaft fractures, does not always work for this specific transition area between diaphysis and metaphysis. Instead, new minimally invasive techniques with special implants are popular. Aims : To determine the functional and radiological results of distal tibial fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Study Design : Retrospective cohort analysis. Methods : Thirty distal tibial fractures treated with MIPPO method, between January 2006 and December 2010, were evaluated retrospectively. All patients were classified according to AO/OTA classification. Period of hospital stay, time of fracture union, time to allow full weight bearing, early and late complications were inquired. Functional outcomes were assessed by AOFAS scores. Results : There were 13 male and 17 female patients with an average age of 44.26 (range, 22-77 years). One superficial infection and one malunion were observed. Two patients were revised for the loss of reduction and healed uneventfully. According to the AO/OTA classification, 23 patients were 43-A1 (76.6%), 3 were 43-A2 (10%) and 4 were 43-A3 (13.3%). Post-operative mean stay of patients at the hospital was 2.6 ± 1.42 days (range, 1-7 days). Mean full weight-bearing period of the patients was found out as 13.16 ± 2.6 weeks (range, 10-22 weeks). The mean period of union of fracture for patients was found out as 19.8 ± 2.99 weeks (range, 16-34 weeks). Conclusion : Treatment of distal tibial fractures with MIPPO method provides a successful treatment strategy as long as used as per the technique, and it respects and does not harm soft tissues which allows early callus formation and rapid healing that enable the patient to walk as early as possible after the operation. The overall clinical and functional outcome is still good despite minor complications.

MIPO For Complex Comminuted Bone Fractures in the Floating Knee IIC According Fraser: a Case Report

2021 ◽  
Author(s):  
Chuangang Peng ◽  
Guangkai Ren ◽  
Minghan Dou ◽  
Baoming Yuan ◽  
Dankai Wu
Keyword(s):  
Minimally Invasive ◽  
Lower Limb ◽  
Bone Structure ◽  
Bone Fractures ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Intraarticular Fracture ◽  
Limited Mobility

Abstract Objective:Floating knee type IIC according to Fraser’s classification is an uncommon severe injury that typically occurs in polytrauma. In this case, mainly due to both intraarticular fracture and the high degree of comminution and malformation on the femoral mid-distal segments, fixation was challenging. The purpose of this study was to prove that minimally invasive plate osteosynthesis (MIPO) technology can simplify complex problems and improve prognosis. Case Presentation:A 38-year-old man injured his left leg in a car accident, causing pain, swelling, deformity, and limited mobility on his left knee and thigh, and two small open wounds were noted mainly on the anterior aspect of the mid-distal thigh. Physical examination and lower limb computed tomography angiography (CTA) confirmed that the neurovascular status was normal. The clinical diagnosis were closed intraarticular fracture of the proximal tibia, open intraarticular fracture of the distal femur with extension to the diaphysis, and a patellar fracture on the ipsilateral knee.In this case, a locking plate system characterized by minimally invasive plate osteosynthesis (MIPO) technology was used as the treatment. Results and Conclusion:Postoperative evolution was satisfactory, with immediate functional exercise, full weight bearing after three months, and return to daily activity without pain. Final follow-up taken at 3 years showed good lower limb alignment and complete plasticity of the bone structure, by which time the patient showed good limb function. Minimally invasive techniques can provide a simple and effective treatment for some complex fractures.

scholarly journals Midshaft Clavicular Fractures - Osteosynthesis with Minimally Invasive Technique

2016 ◽  
Vol 4 (4) ◽  
pp. 647-649 ◽  
Author(s):  
Tabet A. Al-Sadek ◽  
Desislav Niklev ◽  
Ahmed Al-Sadek
Keyword(s):  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Deep Infection ◽  
Delayed Union ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Clavicle Fractures ◽  
The Mean ◽  
Mechanism Of Trauma

BACKGROUND: Fractures of the clavicle are one of the most common fractures in modern orthopaedics and traumatology practice. Knowing the mechanism of trauma, and it's pathophysiological elements, it's clear distinction and it's individual features are essential to the development of more new and effective methods for their treatment, and the minimising of postoperative complications.AIM: The aim of this paper was to present the results of our patients treated with minimally invasive plate osteosynthesis (MIPO).MATERIAL AND METHODS: Between January 2011 and March 2013, 12 patients were treated with MIPO technique. The mean age was 47.5 years (range, 16-79 years). Outcomes and complications of clinical treatment were reviewed.RESULTS: All fractures healed within a mean period of 4.9 months (range, 2-10 months). Regarding complications, there was no occurrence of implant failure or deep infection. There were no nonunions, but one 79-year-old man had a delayed union. Almost of all the cases didn’t need bending of the plate. Seven plates were removed by their hopes. And there weren’t any cases that required new incisions.CONCLUSIONS: A pre-contoured plate anatomically configured to fit the clavicle was easier to apply. MIPO technique for midshaft clavicle fractures may be a good option.

scholarly journals Outcome of minimally invasive plate osteosynthesis in distal tibial fractures

2017 ◽  
Vol 17 (2) ◽  
pp. 18-22
Author(s):  
Nabees Man Singh Pradhan ◽  
JA Khan ◽  
B Acharya ◽  
S Shrestha ◽  
R Tamrakar ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Internal Fixation ◽  
Plate Osteosynthesis ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Type I ◽  
Distal Tibial Fractures ◽  
Non Union ◽  
The Mean

Introduction: Distal tibial fractures present as a major challenge for the orthopedic trauma surgeons. Most non-operative treatments result in non-union or malunion and needs prolonged immobilization of the knee and ankle joints, with resulting stiffness. Open reduction and internal fixation as well as external fixation has high rate of infection and non-union. Minimally Invasive Plate Osteosynthesis has been shown to have a better outcome and has been the procedure of choice in most distal tibial fractures since the introduction of the locking compression plate. The objective of the study is to review the outcome of Minimally Invasive Percutaneous Osteosynthesis (MIPO) in unstable distal tibial fractures.Methods: Charts of patients who underwent MIPO from the year 2008 to 2013 for unstable distal tibial fractures over five years at Patan Hospital and Om Hospital were reviewed. All displaced closed fractures and Gustillo Anderson Type I and II fractures were included in the study. Plates consisted of the anatomically contoured 4.5 mm LCP and 3.5 mm LCP-Pilon form plate. A simple uniplanar external fixator was used to retain the reduction till the plate was inserted and secured with locking screws. The outcome of MIPO in distal tibial fractures were followed up and evaluated.  Clinical and radiological assessments were performed at 6 weeks, and at 3, 6, 9, 12 and 24 months.Results: Of the 75 patients (45 male, 30 female) age ranging from 19 to 70 years (mean 47 years), 5 patients were lost to follow-up. 28 patients at 3 months, 32 at 6 months, and 8 at 9 months met the criteria for a healed fracture. Two patients required autologous bone grafting at 9 months for non-union ultimately resulting in the fracture union at 16 months. There was one malunion attributable to the loss of reduction during plate fixation. There were no deep infections, no soft tissue complications and no failures of fixation. The cause of fracture were RTA (n=35), fall from height (n=9), twisting of ankle as a result of fall from standing height (n=22), and others (n=11). The mean time for surgery from the time of injury was 5 (range, 2 to 14) days; the mean hospital stay was 10 (range, 7 to 21) days.Conclusion: MIPO is an effective treatment for closed, unstable fractures of the distal tibia, avoiding the complications associated with more traditional methods of internal fixation and/or external fixation.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 7-11

scholarly journals Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

2014 ◽  
Vol 20 (1) ◽  
pp. 44-49
Author(s):  
Șerban Al. ◽  
Obadă B. ◽  
Turcu R. ◽  
Anderlik St. ◽  
Botnaru V.
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Ankle Joint ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Surgical Trauma ◽  
Distal Tibial Fractures

ABSTRACT Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours) open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68). The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks). All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks) showing radiological union. There were no cases of failures of fixation, or rotational misalignment. No significant complication was observed in our patients. MIPO is an effective method of treatment for distal tibial fractures, reduce surgical trauma and maintain a more biologically favorable environment for fracture healing, reducing risks of infection and nonunion.

scholarly journals Minimally Invasive Plate Osteosynthesis for Tibial Fractures

2007 ◽  
Vol 56 (2) ◽  
pp. 197-201 ◽  
Author(s):  
Takuya Ikuta ◽  
Futoshi Kuga ◽  
Mintaku Yo ◽  
Yasunori Tome
Keyword(s):  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis

Retrospective comparison between minimally invasive plate osteosynthesis and open plating for tibial fractures in dogs

2012 ◽  
Vol 25 (05) ◽  
pp. 410-417 ◽  
Author(s):  
A. Boero Baroncelli ◽  
B. Peirone ◽  
M. D. Winter ◽  
D. J. Reese ◽  
A. Pozzi
Keyword(s):  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Major Complication ◽  
Complete Healing ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Fracture Length ◽  
Plate Length ◽  
Working Length ◽  
Significant Difference

SummaryObjectives: To compare fracture healing in diaphyseal tibial fractures stabilized using either minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF).Methods: Dogs in each group were matched for type of fracture, age and body weight. Stage of healing was measured blindly every four weeks postoperatively until complete healing. Outcome variables including fracture length, plate length, plate bridging ratio, plate working length, healing grading, and fracture reduction were compared between groups using the Mann-Whitney test. Significant difference was set at p <0.05.Results: Based on the definition of clinical union, at 30 days five out of eight dogs managed with MIPO had healed, while two of the eight of dogs managed with ORIF had healed. We did not find any significant differences in the other outcome measures. No complications were reported in the MIPO group whereas one major complication was reported in the ORIF group.Clinical significance: All dogs treated by MIPO healed rapidly without any complications, nevertheless the difference in radiographic healing between the two groups was not significant.

scholarly journals Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures

2014 ◽  
Vol 22 (3) ◽  
pp. 299-303 ◽  
Author(s):  
Pramod Devkota ◽  
Javed A Khan ◽  
Suman K Shrestha ◽  
Balakrishnan M Acharya ◽  
Nabeesman S Pradhan ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Distal Tibial Fractures
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