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

Using a Traction Table for Fracture Reduction during Minimally Invasive Plate Osteosynthesis (MIPO) of Distal Femoral Fractures Provides Anatomical Alignment

INTRODUCTION

Fracture reduction and fixation of distal femur fractures are technically demanding. Postoperative malalignment is still commonly reported after minimally invasive plate osteosynthesis (MIPO). We evaluated the postoperative alignment after MIPO using a traction table with a dedicated femoral support.

METHODS

The study included 32 patients aged 65 years or older with distal femur fractures of all AO/OTA types 32 (c) and 33 (except 33 B3 and C3) and peri-implant fractures with stable implants. Internal fixation was achieved with MIPO using a bridge-plating construct. Bilateral computed tomography (CT) scans of the entire femur were performed postoperatively, and measurements of the uninjured contralateral side defined anatomical alignment. Due to incomplete CT scans or excessively distorted femoral anatomy, seven patients were excluded from analyses.

RESULTS

Fracture reduction and fixation on the traction table provided excellent postoperative alignment. Only one of the 25 patients had a rotational malalignment of more than 15° (18°).

CONCLUSIONS

The surgical setup for MIPO of distal femur fractures on a traction table with a dedicated femoral support facilitated reduction and fixation, resulting in a low rate of postoperative malalignment, despite a high rate of peri-implant fractures, and could be recommended for surgical treatment of distal femur fractures.

Minimally invasive plate osteosynthesis without floating segment fixation for segmental fracture of femur

Segmental fractures of the femur are technically difficult to manage by intramedullary nailing, the gold standard treatment. We specifically describe minimally invasive plate osteosynthesis (MIPO) without floating segment fixation for this particular fracture pattern. Twenty patients with segmental fractures of the femur were operated on by the MIPO technique. Data were collected on operative time, postoperative complications, union times, and clinical outcomes. The mean operative time was 63.5 minutes (range 50-90). There were no peri-operative complications. All fractures were united with a mean union time of 16.1 weeks (range 12-20). Regarding postoperative malalignment, limb shortening was demonstrated in 4 patients, valgus angulation in 2 and varus angulation in 3. One patient had a bent plate with 7°varus angulation. According to the Thoresen score, 13 were determined to be excellent values, 6 to be good and 1 to be fair. MIPO without floating segment fixation is a safe and effective alternative for segmental fractures of the femur especially in circumstances that are unsuitable or unfeasible for intramedullary nailing.

The utility of reverse distal femur locking compression plate in minimally invasive osteosynthesis for type C subtrochanteric fractures of the femur: technical description and a clinical series of 50 cases

BACKGROUND

Establishing fracture consolidation and avoiding postoperative complications of comminuted subtrochanteric fractures of the femur are technically challenging. The authors delineated a technical description of minimally invasive plate osteosynthesis (MIPO) by using a reverse distal femur locking compression plate (LCP-DF) and retrospectively reviewed the outcomes of these particular fractures.

METHODS

Fifty patients with 51 type C subtrochanteric fractures of the femur were operated on by MIPO and reverse LCP-DF fixation. The collected data included postoperative complications, union times, and clinical outcomes.

RESULTS

All fractures were united with a mean union time of 19.4 weeks (range 16-22). Regarding postoperative complications, asymptomatic valgus angulation occurred in five patients and trochanteric pain in six. According to Harris hip score, nine patients were determined to be excellent, 36 to be good and five to be fair.

CONCLUSION

MIPO by reverse LCP-DF is reliable and effective for type C subtrochanteric fractures of the femur particularly in situations where intramedullary nailing is not feasible.

Minimally invasive plate osteosynthesis: An update of practise

Since its conception in 1989, minimally invasive plate osteosynthesis (MIPO) has gained widespread popularity. It has been studied in over forty countries with most of the publications originating from Asia, Europe and North America. This review aims to describe the scientific path of MIPO from the very beginning to where it stands in current day times; study the pattern and contributing factors influencing its global spread. Finally, the up to date evidence is discussed with regard to several anatomical regions in which MIPO is mostly used. In the meantime, MIPO treads steadily towards accomplishing the same or better outcomes for more and more indications with the goal to leave a smaller surgical footprint to allow for undisturbed bone healing.

3D printed navigation template-guided minimally invasive percutaneous plate osteosynthesis for distal femoral fracture: A retrospective cohort study

OBJECTIVE

To evaluate functional and radiological outcomes in distal femoral fracture patients (distal femoral shaft fractures or metaphyseal fractures) receiving indirect reduction and internal fixation with the minimally invasive percutaneous plate osteosynthesis (MIPPO) assisted by 3D printing navigation templates.

METHODS

This retrospective study included all adult (≥18 years) patients who underwent MIPPO for distal femoral fracture (AO32/33) at PLA 960 Hospital, Jinan, China between January 1, 2013 and December 31, 2016. 3D printed navigation templates were used to assist surgery. Functional assessment was performed using the Knee Society Score (KSS) and the Functional Knee Society Score (FKSS). Postoperative deformity was assessed with 3D-CT reconstruction using contralateral (non-fracture) side as the reference.

RESULTS

A total of 54 patients underwent MIPPO for distal femoral fracture during the review period (34 and 20 for conventional and template-guided MIPPO, respectively). At 10-14 months, the KSS score was 160.6 ± 18.1 and 167.5 ± 17.2 in the conventional and template-guided MIPPO groups, respectively (p = 0.18). The FKSS was 77.6 ± 9.4 in the conventional MIPPO group vs. 81.0 ± 8.5 in the template-guided MIPPO group (p = 0.15). Femoral length difference was smaller in template-guided MIPPO group (3.31 ± 1.53 vs. 9.50 ± 4.49 mm in the control; p < 0.01). Template-guided MIPPO group also had smaller anatomic lateral distal femoral angle (aLDFA) difference (1.57° ± 0.72° vs. 3.89° ± 1.72° in the control; p < 0.01), anatomic posterior distal femoral angle (aPDFA) difference (1.95° ± 0.78° vs. 5.04° ± 1.78°; p < 0.01), and anteversion angle difference (2.52° ± 1.00° vs. 8.23° ± 4.07°; p < 0.01). The rate of length discrepancy (>20 mm), coronal angulation deformity (aLDFA difference >5°), sagittal angulation deformity (aPDFA difference >10°), and rotational malalignment (anteversion angle >10°) was 5.9%, 20.5%, 2.9%, and 32.4% in the control group. No patients in the template-guided MIPPO group had deformity of any type.

CONCLUSIONS

MIPPO assisted by 3D printing navigation templates could practically improve surgical accuracy and eliminate postoperative rotational deformity in patients with distal femoral fractures.

Radiographic and Clinical Outcomes of Periprosthetic Distal Femur Fractures Treated With Open Reduction Internal Fixation

OBJECTIVES

To report outcomes and complications of periprosthetic distal femur fractures (PPDFF) treated with open reduction internal fixation (ORIF) using a plate construct, with or without endosteal augmentation.

DESIGN

Retrospective Case Series.

SETTING

One Level I trauma center and one tertiary care hospital.

PATIENTS/PARTICIPANTS

Forty patients with PPDFFs, treated by 3 surgeons, were identified using an institutional trauma registry. Thirty-two patients with 12 months of clinical and radiographic follow-up were included, and 8 patients were lost to follow-up before 12 months.

INTERVENTION

All patients underwent ORIF of the PPDFF with lateral locked plating, and 11 received additional endosteal augmentation using allograft fibula.

RESULTS

Thirty-two patients were available for the final follow-up. Ninety-four percent of patients achieved union at an average of 6.5 months postoperatively. Twenty-one percent of patients underwent subsequent surgery, with more than half of those being for removal of implants. Anatomic limb alignment was achieved in all cases (no malunions). Almost half of the patients required assistive devices for ambulation in the long term.

CONCLUSIONS

ORIF of PPDFF with direct visualization using periarticular locking plates ± endosteal strut allograft resulted in a 94% union rate and no deep infections. There was no difference in outcomes between groups treated with or without additional endosteal fibular allograft. However, these are catastrophic injuries in frail patients, and 20% of patients either died or were lost to follow-up, and almost half required an assistive device for ambulation after surgery despite restoration of limb alignment.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.