Minimally invasive plate osteosynthesis (MIPO) for mid-shaft fracture of the tibia (AO/OTA classification 42): A retrospective study

Kang, Hyunseong; Song, Jung-Kook; Rho, Joseph Y.; Lee, Jaehwang; Choi, Jae-Won; Choi, Sungwook

doi:10.1016/j.amsu.2020.11.033

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…Notably, in this comparison, MIPPO shows virtually no prevalence of anterior knee pain; one study reports a prevalence of anterior knee pain in 29 out of 37 patients with IMN, but 0 of 36 with MIPPO reported pain [37]. While there is existing literature demonstrating better outcomes with MIPPO in tibial shaft fractures [41,44], they are balanced by equal studies showing preference for IMN [30,35]. There are no studies comparing MIPPO with external fixation alone; however, combined internal and external fixation (CIEF; two closed titanium elastic nails combined with an external fixator) had equivalent time to union, time to return to work, and American Orthopedic Foot and Ankle Society score [45].…”

Section: Techniques and Outcomesmentioning

confidence: 81%

“…Kati et al also indicate MIPPO as an alternative for spiral oblique and spiral wedge tibial shaft fractures, theorizing that it provides better alignment and torsional stability [28]. Lastly, a posteromedial approach for diaphyseal tibial fractures using cadaveric specimens has shown that MIPPO can be used for patients with periprosthetic fractures, open physis, and inadequate access to intramedullary osteosynthesis [30,31]. The literature suggests that contraindications of MIPPO include severe open fractures with suboptimal soft tissue envelope of the medial ankle or distal ankle, severe comminution, and neurovascular compromise [27].…”

Section: Indicationsmentioning

confidence: 99%

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A Review of Tibial Shaft Fracture Fixation Methods

Tamburini,

Zeng,

Neumann

et al. 2023

Trauma Care

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Tibial shaft fractures are a commonly seen injury in orthopedic trauma patients. Fractures commonly occur following high energy mechanisms, such as motor vehicle collisions. There are multiple ways to stabilize tibial shaft fractures. Knowledge of the indications, contraindications, techniques, and complications associated with each technique allows the orthopedic surgeon to make the appropriate decision for each patient by providing both fracture and patient characteristics. This review discusses the indications, techniques, outcomes, and complications associated with intramedullary nailing, minimally invasive percutaneous plate osteosynthesis, and external fixation of tibial shaft fractures.

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Section: Techniques and Outcomesmentioning

confidence: 81%

Section: Indicationsmentioning

confidence: 99%

A Review of Tibial Shaft Fracture Fixation Methods

Tamburini,

Zeng,

Neumann

et al. 2023

Trauma Care

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“…A total of 58 patients were evaluated. In group M, mean patient age was 43 (19-63) years, seventeen of the 26 patients were male and mean follow-up was18.5 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) months. In group A, mean patient age was 44.3 (18-68) years, 21 of the 32 patients were males and mean follow-up was 17.3 (14-20) months.…”

Section: Resultsmentioning

confidence: 99%

AO distractor and manual traction reduction techniques repair in distal tibial fractures: a comparative study

Chen

et al. 2022

Preprint

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Background: Minimally invasive plate osteosynthesis (MIPO) via percutaneous plate placement on the distal medial tibia can be performed with minimizes soft tissue injury and produces good clinical results. However, the difficulty with MIPO lies in how to achieve satisfactory fracture reduction and maintain that reduction via indirect reduction techniques to facilitate internal fixation.The purpose of this study was to compare the effects of AO distractor and manual traction reduction techniques combined with MIPO in the treatment of distal tibia fractures. Methods: Between January 2013 and December 2019, 58 patients with a distal tibia fracture were treated using MIPO. Patients were divided into two groups according to the indirect reduction method that was used: 26 patients were reduced with manual traction(group M), and 32 were reduced with an AO distractor (group A).Time until union and clinical outcomes including AOFAS ankle-rating score and ankle range of ankle motion at final follow-up were compared. Mean operative time, incision length, blood loss and postoperative complications were recorded via chart review. Radiographic results at final follow-up were assessed for tibial angulation and shortening by a blinded reader.Results: Mean operative time, incision length, and blood loss in group A were significantly lower than in group M(p=0.019, 0.018 and0.016, respectively).Radiographic evidence of bony union was seen in all cases, and mean time until union was equivalent between the two groups (p=0.384).Skin irritation was noted in one case(3.1%) in group A and three cases(11.5%)in group M, but the symptoms were not severe and the plate was removed after bony union. There was no statistically significant difference in postoperative complications between the two groups(p=0.461). Mean AOFAS score and range of ankle motion were equivalent between the two groups, as were varus deformity, valgus deformity, anterior angulation and posterior angulation. No patients had gross angular deformity. Mean tibial shortening was not significantly different between the two groups, and no patients had tibial shortening >10 mm.Conclusion: Both an AO distractor and manual traction reduction techniques prior to MIPO in the treatment of distal tibial fractures permit a high fracture healing rate and satisfying functional outcomes with few wound healing complications. An AO distractor is an excellent indirect reduction method that may improve operative efficiency and reduce the risk of soft tissue injury.

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“…The fracture is primarily reduced by ligamentotaxis, and plating is performed percutaneously using a minimally invasive technique. The use of indirect reduction techniques has led to improved fracture-healing and reduced the need for bone-grafting compared with older direct reduction techniques [ 20 ].Consequently, MIPO has recently been recognized as an ideal choice for the treatment of distal tibial fractures [ 6 – 9 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

AO distractor and manual traction reduction techniques repair in distal tibial fractures: a comparative study

Chen

et al. 2022

BMC Musculoskelet Disord

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Background Minimally invasive plate osteosynthesis (MIPO) via percutaneous plate placement on the distal medial tibia can be performed with minimizes soft tissue injury and produces good clinical results. However, the difficulty with MIPO lies in how to achieve satisfactory fracture reduction and maintain that reduction via indirect reduction techniques to facilitate internal fixation. The purpose of this study was to compare the effects of AO distractor and manual traction reduction techniques combined with MIPO in the treatment of distal tibia fractures. Methods Between January 2013 and December 2019, 58 patients with a distal tibia fracture were treated using MIPO. Patients were divided into two groups according to the indirect reduction method that was used: 26 patients were reduced with manual traction(group M), and 32 were reduced with an AO distractor (group A).Time until union and clinical outcomes including AOFAS ankle-rating score and ankle range of ankle motion at final follow-up were compared. Mean operative time, incision length, blood loss and postoperative complications were recorded via chart review. Radiographic results at final follow-up were assessed for tibial angulation and shortening by a blinded reader. Results Mean operative time, incision length, and blood loss in group A were significantly lower than in group M(p = 0.019, 0.018 and 0.016, respectively).Radiographic evidence of bony union was seen in all cases, and mean time until union was equivalent between the two groups (p = 0.384).Skin irritation was noted in one case(3.1%) in group A and three cases(11.5%)in group M, but the symptoms were not severe and the plate was removed after bony union. There was no statistically significant difference in postoperative complications between the two groups(p = 0.461). Mean AOFAS score and range of ankle motion were equivalent between the two groups, as were varus deformity, valgus deformity, anterior angulation and posterior angulation. No patients had gross angular deformity. Mean tibial shortening was not significantly different between the two groups, and no patients had tibial shortening > 10 mm. Conclusion Both an AO distractor and manual traction reduction techniques prior to MIPO in the treatment of distal tibial fractures permit a high fracture healing rate and satisfying functional outcomes with few wound healing complications. An AO distractor is an excellent indirect reduction method that may improve operative efficiency and reduce the risk of soft tissue injury.

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Minimally invasive plate osteosynthesis (MIPO) for mid-shaft fracture of the tibia (AO/OTA classification 42): A retrospective study

Cited by 6 publications

References 23 publications

A Review of Tibial Shaft Fracture Fixation Methods

A Review of Tibial Shaft Fracture Fixation Methods

AO distractor and manual traction reduction techniques repair in distal tibial fractures: a comparative study

AO distractor and manual traction reduction techniques repair in distal tibial fractures: a comparative study

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