Minimally invasive osteosynthesis (MIO)―when to use it?

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Presentation transcript:

Minimally invasive osteosynthesis (MIO)―when to use it? Published: September 2013 Reto Babst, CH AOT Basic Principles Course

Learning outcomes Describe the concept and principles of the MIPO technique Specify the effect of implants on fracture stability Discuss the bridge plating concept, including the biological and biomechanical priniciples List the risks and benefits of MIPO

MIO principles Approach the bone far from the fracture zone Indirect reduction of the fracture Flexible fixation of the fracture Secondary bone healing

Concept of minimally invasive plate osteosynthesis (MIPO) Careful handling of soft tissue through small soft-tissue windows Approach the bone far from fracture zone Indirect reduction of the fracture (alignment, axis, and rotation) Percutaneous direct reduction if needed Maintaining reduction for C-arm control Flexible fixation of the fracture

MIPO shaft Soft-tissue window: Far from the fracture site Large enough to see, palpate, and fix the plate

MIPO fracture site Little additional trauma if direct reduction is needed Use instruments that leave small “footprints”

Bridge plating Long plate to distribute forces (six holes on each side if possible) Acts as an extramedullary splint Fixation with bicortical screws, minimum three in each fragment Provides relative stability

Bridge plating Comminuted fractures Screws placed close to the fracture Simple fractures Screws 1–2 holes away from the fracture

Reduction in MIPO Indirect reduction by Traction along the axis of the limb Force application remote from the fracture site Soft-tissue envelope helps reduction

Reduction in MIPO Direct reduction Direct force applied at the fracture site Percutaneously or mini opening

Maintaining reduction in MIPO Traction table External fixator Forceps Cerclage Screw Plate

Reduction control—needs a stable operative field Adjuncts Temporary fixation K-wire, Schanz screw, screw, drill bit, clamps, plate Cable Prevent malunion

Indication for MIPO Periarticular fractures Joint level: anatomical Shaft: aligned (length, axis, and rotation) No nail possible Narrow, deformed, or occupied canal (implant) Open physis Trauma load (ISS), pelvis Soft-tissue conditions

Benefits Bone healing less disturbed Infection rate decreased Less bone graft needed Operation time decreased Less pain Faster rehabilitation Cosmetic appearance

Risks Limited view Increased C-arm time Malunion Delayed/nonunion Demanding technique with important learning curve

Take-home messages Approach through soft-tissue windows Indirect reduction Percutaneous direct reduction (tools) Maintenance of reduction (x-ray control) Elastic fixation Selected indications