The safety and feasibility of minimally invasive plate osteosynthesis (MIPO) on the medial side of the femur: A cadaveric injection study

Jiamton, Chittawee; Apivatthakakul, Theerachai

doi:10.1016/j.injury.2015.08.032

Cited by 46 publications

(26 citation statements)

References 17 publications

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“…In a previous study that used double plating in different directions (orthogonal, i.e., lateral and anterior) [22], various types of periprosthetic fractures (around total hip replacement arthroplasty, TKA, and interprosthetic fractures) were assessed, while including only one case of periprosthetic distal femoral fracture following TKA. PHILOS plates has many advantages in medial xation, including a similar shape to the contour of the medial condyle and a size that does not interfere with the femoral component of TKA.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Plate Osteosynthesis with Dual Plating for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty

Park

Kang

Song

et al. 2020

Preprint

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Introduction: Adequate treatment for periprosthetic distal femur fractures is challenging because of various reasons, including severe osteoporosis and distal fragments that are too small or too distal. We have introduced a new surgical technique for dual plating of periprosthetic distal femur fractures following total knee arthroplasty (TKA) and determined the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with a dual locking compression plate (LCP). Materials and methods: Between January 2010 and July 2019, 18 patients [mean age, 74.8 (68–89) years; average follow-up period, 14.8 (12–43) months)] underwent MIPO with distal femoral LCP laterally and proximal humeral internal locking system (PHILOS) medially for periprosthetic distal femoral fractures following TKA. The minimum follow-up was one year. The clinical and radiological outcomes were assessed using the modified WOMAC scores, knee range of motion, time to callus formation, time to union, and complications of malunion, nonunion, and shortening.Results: The average time to union was 18.4 weeks (range, 10–51 weeks) and to callus formation was 7.8 weeks (range, 2–14 weeks). At the one-year follow-up, the average JLETS was 37.6 (range, 24–53), average knee ROM was 110.3° (range, 80°–135°), and average varus-valgus angles of the distal femur were 3.2° (range, -2.9°–10.5°). No nonunion, broken plates, or implant failure occurred. Malunion occurred in three patients.Conclusion: MIPO with dual LCP is a reliable method for stabilizing periprosthetic distal femoral fractures following TKA, with satisfactory bone union rates and low complication rates.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Plate Osteosynthesis with Dual Plating for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty

Park

Kang

Song

et al. 2020

Preprint

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“…In a previous study comparing locked versus non‐locked double plate constructs in comminuted fractures with poor bone stock, Jazrawi et al reported that the former provide significantly higher fixation stability than the construct with medially and laterally placed conventional plates interconnected with traversing screws and tapped nuts to create an angle‐stable unit. Although the medial approach is generally considered as rather demanding, a cadaveric study by Jiamton et al proved that the distal 60% of the femur are safe for MIPO. In another angiographic study, Kim et al concluded that anteromedial MIPO is safe up to 8 cm below the lesser trochanter.…”

Section: Discussionmentioning

confidence: 99%

Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?

Todorov

Zderic

Richards

et al. 2018

Journal Orthopaedic Research

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Treatment of complex osteoporotic distal femur fractures with the Less Invasive Stabilization System (LISS) has been associated with high complication rates. The aim of this study was to investigate the biomechanical competence of two different techniques of augmented versus conventional LISS plating. Unstable distal femoral fracture AO/OTA 33-A3 was created via osteotomies in artificial femora simulating osteoporotic bone. Three study groups, consisting of 10 specimens each, were created for fixation with either LISS plate, LISS plate with additional polylactide intramedullary graft, or LISS plate plus medial locking plate (double plating). All specimens were non-destructively tested under axial (20-150 N) and torsional (0-4 Nm) quasi-static loading. Each bone-implant construct was tested with two different working length (WL) configurations (long and short) of the LISS plate. Relative movements between the most medial superior and inferior osteotomy aspects were investigated via three-dimensional motion tracking analysis. Double plating revealed significantly smaller longitudinal and shear displacement than the other two techniques (p ≤ 0.001). In addition, LISS plus graft fixation was with significantly less longitudinal displacement in comparison to conventional LISS plating (p < 0.001). Long WL resulted in significantly higher longitudinal and shear displacement compared to short WL for LISS and LISS plus graft (p ≤ 0.032), but not for double plating (p > 0.999). In conclusion, intramedullary grafting resulted in significantly increased fracture stability under axial loading in comparison to conventional LISS plating. Although it was not efficient enough to provide comparable stability to double plating, intramedullary grafting may be considered as a useful biological alternative to the latter in a surgeon's armamentarium. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2604-2611, 2018.

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“…Следует отметить, что в современной науч-ной литературе имеются лишь единичные пу-бликации, посвященные разработке методик остеосинтеза, способных обеспечить медиаль-ную стабильность при переломах дистального отдела бедренной кости [16][17][18]. Недостаток сведений о сравнительной эффективности фик-сации многооскольчатых переломов только латеральной или двумя пластинами послужил основанием для проведения собственного экс-периментального исследования.…”

Section: Discussionunclassified

“…Доступ осу-ществляли поверхностно между портняжной и прямой мышцами бедра, после чего продольно рассекали волокна медиальной и промежуточ-ной широкой мышц до бедренной кости. при этом авторы отметили риск повреждения при выполнении проксимального доступа нисходя-щей ветви латеральной огибающей бедренную кость артерии и необходимость лигирования ветвей этой артерии в ряде случаев [17]. В целом же в настоящее время можно кон-статировать отсутствие детально разработан-ной методики малоинвазивного остеосинтеза пластиной, установленной по медиальной сто-роне бедренной кости для восстановления ста-бильности ее медиальной колонны.…”

Section: материал и методыunclassified

Experimental and Theoretical Validation of Double Column Internal Fixation Theory for Distal Femoral Fractures

Беленький¹,

Sergeev²,

Майоров³

et al. 2017

Traumatology and Orthopedics of Russia

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Purpose of the study – to experimentally compare efficiency of lateral and bilateral (lateral and medial) plate fixation of distal femoral fractures and to validate the appropriateness of double column theory of distal femur anatomy for internal fixation for these fractures.Material and methods. The authors performed a biomechanical study in two series on polyurethane models of right femur corresponding in dimensions to natural femur. After simulating a 33 C2 fracture type it was fixed by one lateral plate or two (lateral and medial) plates. After fixation the models were tested in six load ranges with maximal load from 20 to 120 kgf in cyclic mode.Results. The authors obtained a significant difference in absolute values of fragments displacement amplitude depending on fixation method. In the first series of the experiment – one plate fixed on the lateral surface of the femur – under minimal load the displacement value was reported as0.3 mm and under maximal load —1.9 mm; in the second series of experiment – two plates fixed on the lateral and medial surfaces of the femur – displacement values were reported as0.35 mm and0.95 mm respectively. Conclusion. The presence or absence of medial support after internal fixation has a profound impact on ensuring stability in cases of comminuted fractures of distal femoral fractures. In this context the use of double column theory of distal femur anatomy for internal fixation can significantly improve the treatment outcomes for such patients. After trials of minimally invasive fixation method on anatomical specimen the described theory can be implemented into the clinical practice.

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The safety and feasibility of minimally invasive plate osteosynthesis (MIPO) on the medial side of the femur: A cadaveric injection study

Cited by 46 publications

References 17 publications

Minimally Invasive Plate Osteosynthesis with Dual Plating for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty

Minimally Invasive Plate Osteosynthesis with Dual Plating for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty

Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?

Experimental and Theoretical Validation of Double Column Internal Fixation Theory for Distal Femoral Fractures

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