1、MIODefinitions MIO(Minimal Invasive Osteosynthesis)fracture zone not openedclosed reduction, mainly by indirect maneuvresMIPOMinimal Invasive Plate OsteosynthesisMeta-daiphyseal fractures, stabilised with a plate (or int fix)function of the plate: mostly bridging, but also neturalisation or compress

2、ion is possibleMISOMinimal Invasive Screw OsteosynthesisEpiphyseal fractures,closed reduced and stabilised by percutaneous screw fixationMINOMinimal Invasive Nail OsteosynthesisAll closed nailing procedures (unreamed?)MIEFOMinimal Invasive External Fixator Osteosynthesis Small incisions Big enough t

3、o deal with an articular fractureSmall at the level of the fracture if necessary and minimal at the shaftMinimally invasiveCaring of soft tissue!MIPO VS. conventional plating Rapid bone healing ,bone graft Less infection Less post op pain Less bleeding no matching of blood Early recovery CosmesisDis

4、advantages of MIPO C-arm dependent Difficulty in reduction Malalignment Technical demanding Instruments,implantsWhat happen after introduce plate under the muscle ?How much damage to the blood supply to the bone ?A cadaver injection study of minimally invasive VS. conventional plate osteosynthesisFa

5、rouk Osama, Krettek Christian, Miclau Theodore, Schandelmaier Peter, Guy Pierre, and Tscherne HeraldMinimally Invasive vs.Conventional Plating (Farouk et al., JOT, 1999)Marked difference: 70%No difference: 30%p 0.002MIPOMedullary perfusionCLPMarked difference: 50%Moderate: 33% Mild: 17%p 0.001Perios

6、teal perfusionConclusion from study MIPO has better preservation of PAs, NA, Periosteal filling & Medullary perfusion. This study support the clinical results using MIPO technique in complex femoral fracture.Which technique for reduction ?Different bone formation between anatomical and indirect redu

7、ctionIndirect reduction and bone healing Indirect reduction and bone healingIndirect reduction is more favorable in multifragmentary fracture What are the problem in the past with conventional plating technique ? Plate fixation has a bad reputation from poor surgical technique and bad soft tissue ha

8、ndling But we forget with the technique that has least disturbance of the soft tissue.Goal of operative fracture treatment is stable fixation Select the technique that will preserve the blood supply to the bone because only living bone will healWhat I have changed ? If you believe that close IM nail

9、ing is a great advanced in operative treatment of fracture Why not doing closed extramedullary plating ?Do you need this exposure? Why do you have to expose fracture site if you do not need to do that ? Why do you have to make a long incision if you do not need to do that ?Midshaft Femoral Fracture

10、When LCP is used curved plate is recommended for long plate The chance of missing locking screw is less Support the thigh with towel to reduce the fracture90 years old chinese male fell from the last step of stair and sustained pain and deformity at left thigh. He has transferred to the hospital 3hr

11、s after accidentMisunderstanding Make the smallest incision possible Relative stability is not stable Too much radiation exposure Prolong operative time It have more malalignment It is not necessary to look at the fracture as well as the hole of the plate to insert the screwsHow to locate the plate

12、hole ? Never use C arm to find the plate hole Use another plate with the same length Make a stab incision and use hemostat to locate the holeSmall incisionsIndirect reductionAligning length, axis, rotationPrecontouring of plateShifting of plate in preexisting cavities Fixation of plate on each sideN

13、o exposure of fracture-site Minimally invasive plateNo attempts to achieve anatomical reductionNo interfragmentary compression Stab incision for screw-insertion Only few screws No screws at fracture site Plate as a bridging function onlyNo bone-graft is necessary Minimally invasive plateReview of th

14、e AOs Minimally Invasive Plate Osteosynthesis (MIPO) book.“This book is well produced, eminently readable and the illustrations are clear and appropriate to the text. It should be a standard reference text in theatres and hospital libraries.” N Geary, the Journal of Bone and Joint Surgery British Volume, Vol 89-B, Issue 10, 1412. Thank you for your attention Can we use MIPO in case we want to have absolute stability Yes we can 24 yrs old lady with 4 months pregnancy sustained closed femoral shaf