scholarly journals Mid-term outcomes of minimally invasive plate osteosynthesis for fresh and old calcaneal fractures with locked plate

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0022
Author(s):  
Tatsuji Fujiwara
Keyword(s):  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Calcaneal Fractures ◽  
Locked Plate ◽  
Early Weight Bearing ◽  
The Mean

Category: Trauma Introduction/Purpose: Since the mid-1990s, open reduction and internal fixation via an extended L-shaped lateral approach has been considered the gold standard for surgical treatment of displaced intraarticular calcaneal fractures. However, postoperative wound healing complications, including wound infection, skin edge necrosis, wound breakdown, and hematoma, remain a major concern. To minimize the incidence of and offer rigid stabilization of the calcaneal fracture fragments, we have performed minimally invasive plate osteosynthesis (MIPO) with locked plate for fresh and old calcaneal fractures. This study aims to assess the clinical and radiological mid-term outcomes in surgical treatment of the fresh and old calcaneal fractures using a minimally invasive technique and a locking plate to permit early weight bearing. Methods: A total of 29 fractures in 24 patients were found that met our inclusion criteria. 23 foots were fresh calcaneal fractures with an average age of 53.9 years (range, 17-80 years). We defined calcaneal fractures more than 6 weeks old as old calcaneal fracture. 6 foots were old calcaneal fractures with an average age of 43 years (range,35-52 years). Patients with fresh calcaneal fracture had been followed up for an average of 25.8 months (range, from 18-65 months). Patients with old calcaneal fracture had been followed up for an average of 29.4 months (range, from 24-48 months). The mean interval between injury and operation was 8.9 days (3-19 days) in fresh calcaneal fractures and 97 days (43-154 days) in old calcaneal fractures. There were 19 foots Sanders type II fractures, 9 foots Sanders type III and one Sanders type IV. Results: For fresh calcaneal fractures, the mean change in Böhler’s angle and width of the calcaneus from immediately after surgery to final follow-up were 0.5° and 0.7 mm, respectively. For old calcaneal fractures, the mean change in Böhler’s angle and width of the calcaneus from immediately after surgery to final follow-up were 3.4° and 1.7 mm, respectively. The reduction was graded as nearly anatomical (less than 2 mm residual articular displacement) in all fractures. One of the 22 foots had a blister. There were no events of osteomyelitis or infection or nonunion. Eight foots had revision surgery for symptomatic hardware removal. At final follow up the average American Foot and Ankle Society Score (AOFAS) were 82.8 for fresh calcaneal fractures and 83.2 for old calcaneal fractures. Conclusion: This study is first report to show that MIPO with locked plate and early weight bearing can be effectively treated for displaced intra-articular calcaneal fractures. Surgical preparation, reduction maneuvers, and fixation techniques can take time to master; however, with experience, all types of calcaneus fractures can be treated with this technique.

scholarly journals A Novel Minimally Invasive Reduction Technique by Balloon and Distractor for Intra-Articular Calcaneal Fractures: A Report of 2 Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
M. Prod’homme ◽  
S. Pour Jafar ◽  
P. Zogakis ◽  
P. Stutz
Keyword(s):  
Soft Tissue ◽  
Minimally Invasive ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Invasive Technique ◽  
Calcaneal Fractures ◽  
Early Weight Bearing ◽  
Articular Fractures ◽  
Minimally Invasive Reduction

Treatment of displaced intra-articular fractures of the calcaneus remains a challenge for the orthopaedic surgeon. Conservative therapy is known to produce functional impairment. Surgical approach is plagued by soft-tissue complications and insufficient fracture reduction. We describe a minimally invasive technique that will hopefully improve these issues. We want to present our first experience through two cases. The first was a 46-year-old man who presented with a Sanders type IIBC calcaneal fracture, and the second was a 86-year-old woman with a type IIIBC calcaneal fracture. We introduced 2 Schanz screws in the talus and the calcaneus. After distraction, we introduced an inflatable balloon inside the calcaneus. By inflating the balloon, the articular surface was reduced by lifting it up. Then bone cement was injected in order to maintain the reduction. Additional screw fixation was used in the young patient. Postoperative imaging showed good congruence of the subtalar joint without leakage of cement, for the two cases. After 2 months, the patients had no pain and were without soft-tissue complications. We advocate this technique to perform a minimally invasive reduction and fixation of intra-articular calcaneal fractures because it preserves soft-tissues and provides good clinical results with early weight-bearing.

scholarly journals An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures

2021 ◽  
Vol 9 ◽  
pp. 205031212110409
Author(s):  
Ali Varol ◽  
Yunus Oc ◽  
Bekir Eray Kilinc
Keyword(s):  
Bone Grafting ◽  
Plate Osteosynthesis ◽  
Locking Plates ◽  
Foot And Ankle ◽  
Calcaneal Fractures ◽  
Type Iii ◽  
Heel Height ◽  
The Mean ◽  
American Orthopaedic

Objective: To demonstrate the efficacy of locking plate osteosynthesis performed by an L-shaped lateral approach in patients with Sanders type III and IV intra-articular calcaneal fractures with posterior facet displacement. Methods: Fifty-three patients with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and additional bone grafting were included in the study. Böhler and Gissane angles, and heel height values were measured on the radiological examinations. Clinical results of the patients were evaluated using the American Orthopaedic Foot and Ankle Society and Maryland evaluation criteria. The presence of arthrosis was investigated with Broden’s view. Preoperative and postoperative values were evaluated. Results: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the mean heel height was 40.82 mm on radiographs at initial presentation of the patients. The mean Gissane angle was 114.63°, the mean Böhler angle was 23.33° and the mean heel height was 47.84 mm on the early postoperative radiographs of the patients. In patients, a mean 4.69° recovery was achieved in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and Ankle Society score and Maryland score were 86.91 and 86.53, respectively, on the last follow-up. Conclusion: Internal fixation and grephonage using low-profile locking plates provides good functional results to patients since it facilitates anatomic restoration of the subtalar joint and correction of calcaneal height, width and varus/valgus heel.

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

Management of feline tibial diaphyseal fractures using orthogonal plates performed via minimally invasive plate osteosynthesis

2017 ◽  
Vol 20 (1) ◽  
pp. 6-14 ◽  
Author(s):  
Andrew Craig ◽  
Philip G Witte ◽  
Tristram Moody ◽  
Karen Harris ◽  
Harry W Scott
Keyword(s):  
Minimally Invasive ◽  
Bone Healing ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Major Complication ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Diaphyseal Fractures

Objectives The objective was to assess the medium- and long-term outcomes (radiographic and owner questionnaire) of feline tibial diaphyseal fractures with orthogonal plate fixation via a minimally invasive plate osteosynthesis (MIPO) approach. Methods Medical records and radiographs of cats that had tibial diaphyseal fractures stabilised with orthogonal plates were obtained (2012–2016). Immediate postoperative radiographs were reviewed to assess the construct configuration and follow-up radiographs (where available) were used to assess bone healing and implant-related complications. An owner-completed questionnaire (feline musculoskeletal pain index [FMPI]) was used at a minimum of 6 months following surgery to assess the cats’ ability to perform normal activities. Results Eight feline tibial diaphyseal fractures met the inclusion criteria. One major complication was observed, most likely due to an operative technical error. There were no further complications following revision surgery. Six of the eight cases that had radiographic follow-up either had clinical bone union or showed evidence of bone healing. All cases were classified as successful according to FMPI. Conclusions and relevance Orthogonal plating of feline tibial diaphyseal fractures via an MIPO approach resulted in successful outcomes and a lower complication rate compared with previously reported techniques.

scholarly journals Bone alignment after minimally invasive plate osteosynthesis of the tibia in dogs

2021 ◽  
Vol 51 (9) ◽  
Author(s):  
Jose Sergio Costa Junior ◽  
Rafael Manzini Dreibi ◽  
Guilherme Galhardo Franco ◽  
Luis Gustavo Gosuen Gonçalves Dias ◽  
Rogerio Giuffrida ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Minimally Invasive ◽  
Negative Correlation ◽  
Bone Healing ◽  
Plate Osteosynthesis ◽  
Image Intensifier ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
The Mean ◽  
Image Intensifiers

ABSTRACT: This study assessed radiographically changes in tibial alignment in the frontal and sagittal planes in dogs that underwent minimally invasive plate osteosynthesis (MIPO) without the aid of image intensifiers. Radiographs of dogs with complete non-articular tibial fractures submitted to MIPO were included and evaluated, without the aid of a transoperative image intensifier and / or an association of implants. The tibial mechanical angles (mMPTA, mMDTA, mCaPTA and mCrDTA) were measured by three evaluators. The data obtained were compared with results from previously published studies. Twenty-seven animals were included in the study. The mean and standard deviation of the angular changes were as follows: mMPTA, 2.54° ± 3.10 (-1.1º to 8.7º); mMDTA, 0.03º ± 0.16 (-3.44º to 0.79º); mCaPTA, 37º ± 4.29 (-6.23º to 14.87º); and mCrDTA, 8.25° ± 5.53 (-0.2º to 17.28º). There was a negative correlation between “mCaPTA” and “mCrDTA”. MIPO of the tibia without using image intensifiers and implant association can potentially cause angular changes, which can lead to clinically relevant deformities after bone healing.

scholarly journals Prospective study of clinical, radiological and functional outcome of anterior bridge plating for shaft of humerus fracture

2020 ◽  
Vol 6 (6) ◽  
pp. 1245
Author(s):  
Abhishek Kumar ◽  
Rahul Bade
Keyword(s):  
Los Angeles ◽  
Minimally Invasive ◽  
Internal Fixation ◽  
Functional Outcome ◽  
Road Traffic ◽  
Plate Osteosynthesis ◽  
Treatment Protocol ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Bridge Plating

<p class="abstract"><strong>Background:</strong> Shaft of humerus (SOH) fracture has been conventionally treated with either open reduction internal fixation with plate osteosynthesis or immobilization as conservative treatment. Intramedullary interlocking nailing (IMIL) and anterior bridge plating (ABP) are both newer modalities of internal fixation for SOH fracture. Rotator cuff irritation is a known complication of IMIL nailing of the humerus. Here, we present clinical, radiological, and functional outcome of SOH fracture fixation by ABP using a minimally invasive method.</p><p class="abstract"><strong>Methods:</strong> Thirty patients with SOH fracture were treated surgically via an anterior minimally invasive plate osteosynthesis (MIPO) approach with ABP. There were 21 male and 9 female patients, and the average age was 38.6±10.45 years. The mechanism of injury was road traffic accidents (60%) and ground level fall (40%). Functional assessments were obtained with University of California at Los Angeles (UCLA) score and mayo elbow performance index (MEPI) during the follow-up period.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of 6 months follow-up, 29 (96.7%) patients had excellent to good UCLA and MEPI scores. Varus/valgus angulation was reported in 4 (13.3%) patients. Two patients (6.7%) had radial nerve neuropraxia and delayed union, while 1 (3.3%) patient had screw back-out or loosening. The mean duration of radiation exposure was 178±41.2 seconds. ABP for SOH fractures is a safe and effective treatment modality.</p><p class="abstract"><strong>Conclusions:</strong> This treatment protocol produces high rates of union, excellent functional recovery, and minimal biological disruption.</p>

scholarly journals Minimally invasive plate osteosynthesis of the humeral shaft with regard to adjacent anatomical characteristics

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Gloria Maria Hohenberger ◽  
Georg Lipnik ◽  
Angelika Maria Schwarz ◽  
Peter Grechenig ◽  
Magdalena Holter ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Distal Part ◽  
External Rotation ◽  
Plate Osteosynthesis ◽  
Upper Extremities ◽  
Neurovascular Bundle ◽  
Humeral Shaft ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Philos Plate ◽  
The Mean

AbstractThe study goal was to evaluate the distances from the radial (RN), the musculocutaneous (MN) and axillary nerves (AN) and the medial neurovascular bundle of the upper arm to a minimally invasive applied plate and to define its relation to the RN during different degrees of malrotation during MIPO. The sample involved ten upper extremities. Application of a PHILOS plate was performed through a Delta-split. Intervals between the AN, MN, RN and the medial vascular bundle were defined at various positions. The humeral shaft was artificially fractured at a height of about the mean of the plate. The distal fragment was brought into 15° and 30° internal (IR) as well as external rotation (ER) and here, the plate’s relation to the RN was evaluated. The medial neurovascular bundle intersected the plate at its distal part in two specimens. Regarding the distances from the RN to the plate during different rotation positions the distances became significantly longer during ER, respectively shorter during IR. The medial neurovascular bundle and the RN were identified as the main structures at risk. Care must be taken during distal screw placement and malrotation exceeding 15° must be avoided during MIPO.

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.

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