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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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Abstract

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.

Résumé

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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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). https://doi.org/10.1007/s00264-008-0603-2

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