Minimally Invasive Plate Osteosynthesis Fracture Reduction Techniques in Small Animals

A 3‐dimensional‐printed patient‐specific guide system for minimally invasive plate osteosynthesis of a comminuted mid‐diaphyseal humeral fracture in a cat

“…An acceptable degree of malalignment in cats has not been quantified; however, the varus malunion of approximately 3° observed in this case did not cause clinically detectable lameness, conformational change, or joint pain. Humeral alignment is difficult to visualize during MIPO, justifying intraoperative imaging, ideally fluoroscopy, in veterinary patients . However, exposure of theatre staff to ionizing radiation is of concern in both human and veterinary orthopedics .…”

“…These potential benefits must be balanced against the greater technical difficulty associated with MIPO, most notably optimizing spatial orientation of the major proximal and distal fracture fragments without visualization or direct manipulation. Reduction aids include the use of an intramedullary pin, application of a precontoured plate, distraction tables, temporary external skeletal fixators, and fracture distractors . These aids are combined with intraoperative assessment of fracture alignment on the basis of the surgeon's clinical judgment or radiography (usually fluoroscopy).…”

“…Visual assessment of alignment, relative orientations of planes of joint movement above and below the fracture, and palpation of bone landmarks have been successfully employed for MIPO of tibial fractures . However, such features are less helpful in the upper limb, justifying the use of fluoroscopy . Even with fluoroscopic assistance, malreduction (especially rotation) remains a potential complication of MIPO in human humeral fractures .…”

Comparison of Outcomes from Minimally Invasive Plate Osteosynthesis (MIPO) Versus Open Reduction and Internal Fixation (ORIF) in Radial Fracture Gap Models

“…Also, the treatment of long bone diaphyseal fractures now focuses on preserving the vascular supply to fracture sites as an alternative to anatomic reconstruction and rigid stabilization (Guiot and Déjardin, 2011;Pozzi et al, 2013). Iatrogenic damage to soft tissues and the periosteum, along with fracture hematoma, can prolong fracture healing and predispose the area to infection, potentially resulting in delayed union or non-union (Marsell and Einhorn, 2011;Hudson et al, 2012;Peirone et al, 2012). In response to complications associated with ORIF techniques, a paradigm shift has occurred, and clinicians now focus on reducing iatrogenic trauma and encouraging early callus formation with rapid secondary bone healing.…”

“…MIPO does not usually require anatomical reduction of the fracture. Instead, it applies a bone plate as a bridge fashion without surgically approaching the fracture site (Peirone et al, 2012). Recently, the use of MIPO has been reported for the treatment of radius and tibia fractures in small dogs and cats to reduce iatrogenic vascular destruction (Hudson et al, 2012;Pozzi et al, 2013;Craig et al, 2018).…”