Minimally invasive plate osteosynthesis for distal femur fractures.

Suman K Shrestha, Pramod Devkota, Padam B Khadka, Hemant K Manandhar, Nabeesman S Pradhan, Balakrishnan M Acharya


Many methods have been applied to manage the distal femur fractures. Minimally invasive plate osteosynthesis (MIPO) is the latest technology using locking compression plate (LCP) is the new concept for the management of these fractures. Total of 29 cases of the distal femur fractures ( 21 AO type 33A  and eight AO type 33C) were treated with the MIPO technique. Clinical and radiological evaluation was done at 6, 10, 14, 20, 24 weeks and 9, 12, 18, 24 and 30 months respectively.The mean age of the patients was 44.96 years (range 20 -70); male patients were 18 and female were 11. The mean follow-up time was 36.62 months (range, 30 - 42 months). The patients were evaluated using Knee Society scores and the mean score was 90.24 (range, 75 – 100); the mean full weight bearing time was 15.41 weeks (range, 11 - 20 ) and union time was 22.55 weeks(range, 15 - 28).  Superficial infections and slight mal-alignment were seen on  five patients each. The MIPO with LCP technique can be used successfully to treat complex distal femur fractures with minimal complications. It can be an alternative method for the treatment of the distal femur fractures. 


Minimally Invasive Plate Osteosynthesis; Biological Osteosynthesis, locking compression plate, soft tissue

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Gerber C, Mast J, Ganz R. Biological Internal Fixation of Fractures. Arch Orthop Trauma Surg 1990; 109:295-303.

Palmer RH. Biological Osteosynthesis. Vet Clin North Am Small Anim Pract 1999;29:1171-85.

Li M, Zhang X, Liu X, Jing Y. The Recent Development of MIPO in Long Bone Fractures. Open J Orthop 2012;2:159-65.

Winquist RA, Hansen ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 1984;66:529–39.

Rozbruch SR, Muller U, Gautier E, Ganz R. The evolution of femoral shaft plating technique. Clin Orthop Relat Res 1998;345: 195–208.

Riemer BL, Foglesong ME, Miranda MA. Femoral plating. Orthop Clin North Am 1994;25:625–33.

Kinast C, Bolhofner BR, Mast JW, Ganz R. Subtrochanteric fractures of the femur. Results of treatment with the 95 degrees condylar blade-plate. Clin Orthop Relat Res 1989;238:122–30.

Sink EL, Hedequist D, Morgan SJ, Hresko T. Results and technique of unstable pediatric femoral fractures treated with submuscular bridge plating. J Pediatr Orthop 2006;26:177–81.

Kanlic EM, Anglen JO, Smith DG, Morgan SJ, Pesantez RF. Advantages of submuscular bridge plating for complex pediatric femur fractures. Clin Orthop Relat Res 2004;426:244–51.

Krettek C. Concepts of Minimally Invasive Plate Osteosynthesis. Injury 1997; 28: A1-A2.

Insall JN, Dorr LD, Scot RD, Scot WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; 248:13-14

Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Berlin: Springer-Verlag; 1990.

Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58:453-8.

Hasenboehler E, Rikli D, Babst R. Locking Compression Plate with Minimally Invasive Plate Osteosynthesis in diaphyseal and distal tibial fracture: A retrospective study of 32 patients. Injury 2007; 38:365-70.

Wong KM, Leung F, Chow SP. Treatment of distal femur fractures in the elderly using a less-invasive plating technique. Int Orthop 2005;29:117-20.

Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury 1997;28:A7-12.

Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? J Orthop Trauma 1999;13:401-6.

Krettek C, Müller M, Miclau T. Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur.

Injury 2001;32 :SC14-23.

Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop 2009; 33: 1119–26.

Endo H, Asaumi K, Mitani S, Noda T, Minagawa H, Tetsunaga T, Ozaki T. The minimally invasive plate osteosynthesis (MIPO) technique with a locking compression plate for femoral lengthening. Acta Med Okayama 2008;62:333-9.

Doshi HK, Wenxian P, Burgula MV, Murphy DP. Clinical outcomes of distal femoral fractures in the geriatric population using locking plates with a minimally invasive approach. Geriatr Orthop Surg Rehabil 2013;4:16-20.

Boldin C, Fankhauser F, Hofer HP, Szyszkowitz R. Three-year Results of Proximal Tibia Fractures Treated with the LISS. Clin Orthop Relat Res 2006;445:222-9.

Buckley R, Mohanty K, Malish D. Lower limb malrotation following MIPO technique of distal femoral and proximal tibial fractures. Injury 2011;42:194-9.

Kanabar P, Kumar V, Owen PJ, Rushton N. Less invasive stabilization system plating for distal femur fractures. J Orthop Surg 2007;15:299-302.

Schutz M, Muller M, Regazzoni P, Hontzsch D, Krettek C, Van der Werken C et al. Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33)fractures: a prospective multicenter study. Arch Orthop Trauma Surg 2005;125:102-8.

Hernanz González Y, Díaz Martín A, Jara Sánchez F, Resines Erasun C. Early results with the new internal fixator systems LCP and LISS: a prospective study. Acta Orthop Belg 2007;73:60-69.



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