Search

Background: Operative treatment of the distal tibia fractures have higher rate of non-union and infection rates. Minimally Invasive Plate Osteosynthesis (MIPO) is one treatment option with added advantages of minimal soft tissue dissection. In this paper we explained the radiological and functional outcome of closed distal tibial fractures treated by MIPO. The objectives of this study were to determine the radiological and functional outcome of closed tibial fractures treated by Minimally Invasive Plate Osteosynthesis (MIPO). Material and Methods: This descriptive study was conducted in Orthopaedic Division Lady Reading Hospital Peshawar from 30th July 2021 to 30th June 2023. In this study all patients of distal tibia fracture fulfilling the inclusion criteria were treated with MIPO. Post-operative radiological outcomes was determined using Radiologic Union Scale in Tibia(RUST) and functional outcome using Knee Society Clinical Rating and Olerud-Molander Ankle Score(OMAS) respectively. The data was analyzed with SPSS version 29. Results: We treated 38 distal tibia fractures with MIPPO. Thirty-three patients were male and 5 females. The mean age was 31±3.2 years (ranged 20 to 60 years). At 9±5.3 months 35(92.1%) patients were radiologically healed with RUST score of 3. At one year 32 (91.42%) patients had excellent outcome and 3 (8.57%) had acceptable outcome using Knee Society Clinical Rating. The Olerude-Molander Ankle score was excellent in 30(85.71%) and good in 5(14.28%) patients. Conclusion: Minimally Invasive Plate Osteosynthesis (MIPO) produced excellent radiological and functional results in majority of our patients. We therefore recommend MIPO as treatment of first choice for closed distal tibial fractures. [ABSTRACT FROM AUTHOR]

no abstract

Introduction: Minimally invasive percutaneous osteosynthesis (MIPO) plating techniques have demonstrated good outcomes in the treatment of distal tibia fractures. Early arthritis and functional impairment may occur if length and rotation are not restored. This study aims to determine the incidence and severity of tibia malrotation following MIPO plating of isolated unilateral distal tibia fractures, defined as torsional difference of greater than 10° as compared to the contralateral limb and whether the degree of malrotation affects functional outcomes scores. Materials and methods: This was a level 2 prospective cohort study. All patients with fractures of the distal tibia who underwent surgical fixation with the exclusion of patients with polytrauma, neurovascular injuries or pre-existing disabilities were recruited. Patients underwent MIPO plating followed by a post-operative Computed Tomography (CT) scan of bilateral lower limbs. AOFAS ankle-hindfoot score was recorded at six months and one year follow-up. Results: A total of 24 patients (28 to 83 years old) were recruited. Nineteen patients obtained CT scans. Nine of the 19 patients (47.3%) had tibia malrotation. The mean tibia malrotation angle was 10.3° (0° - 45°). The average AOFAS scores was 82.4 and 84.3 at 6 months and 1 year follow-up. Degree of CT malrotation was not significantly associated with AOFAS scores at 6 month (spearman rho -0.386) and 1 year (spearman rho -0.343). Conclusions: Tibia malrotation following MIPO plating of distal tibia fractures is common, with an incidence of 47.3% and an average malrotation angle of 10.3°. The degree of malrotation does not appear to have significant mid-term functional impact on the patient.

Background: Clavicle fractures are among the most common upper limb fractures in adults, with the midshaft region being the most frequently affected site. Minimally invasive plate osteosynthesis (MIPO) has emerged as an alternative to the traditional open reduction and internal fixation (ORIF) technique, offering potential advantages. The purpose of this study was to conduct a systematic review to explore the results of this technique in the existing literature, with emphasis on the occurrence of surgical complications and functional outcomes and also to provide a comprehensive comparison of MIPO and ORIF in the management of midshaft clavicle fractures. Methods: We conducted a systematic review to evaluate the complication incidence and clinical outcomes of MIPO for midshaft clavicle fractures. We searched PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, the Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews databases without language or date restrictions. Studies focusing on midshaft clavicle fractures treated with MIPO were included, while other clavicle fractures and nonclinical studies were excluded. The risk of bias was assessed using the Methodological Index for Nonrandomized Studies criteria and the Risk of Bias Tool 2 Cochrane tool. Data synthesis included qualitative analysis, and if applicable, quantitative analysis and meta-analysis. Adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines ensured reporting quality. Results: A total of 107 studies were initially identified, after applying inclusion and exclusion criteria, 22 studies were included for data extraction. These studies involved the evaluation of 714 clavicles treated with the MIPO technique. Of the 714 MIPO cases, 11 cases of implant failure, 5 nonunions, 2 infections, and 28 cases with neurological impairment were observed. Quantitative analysis comparing MIPO with ORIF revealed that MIPO had significantly shorter surgery time (mean difference −12.95, 95% confidence interval [−25.27 to −0.63], P = .04) and lower occurrence of numbness (odds ratio 0.29, 95% CI [0.15-0.56], P = .0002) compared to ORIF. Time to bone union, functional outcomes, and other complications were similar between MIPO and ORIF at the final follow-up. An overall moderate risk of bias was found across the studies. Conclusion: The MIPO technique yields good and comparable results to ORIF for midshaft clavicle fractures. Additionally, the MIPO technique may offer advantages such as reduced surgical time and lower chances of neurological impairment.

Purpose: To compare union rate, union time, alignment, and complication rate in ipsilateral tibia plateau and shaft fractures treated via suprapatellar intramedullary nailing with screw fixation and minimally invasive locking plate fixation. Materials and methods: A retrospective study was conducted on 48 patients who underwent minimally invasive plate fixation (n = 35) or suprapatellar intramedullary nailing with screw fixation (n = 13), for the treatment of ipsilateral tibial plateau and shaft fractures with at least 1-year follow-up. Union rate, union time, radiologic alignment, and complication rate such as malalignment, nonunion, and fracture-related infection (FRI) were investigated. Results: Demographic data were not different between the two groups. Coronal plane alignment was 0.17 ± 4.23 in the plate group and −0.48 ± 4.17 in the intramedullary nail group (p = 0.637). Sagittal plane alignment was −0.13 ± 5.20 in the plate group and −1.50 ± 4.01 in the suprapatellar intramedullary nail group (p = 0.313). Coronal and sagittal malalignment recorded equal results: (p > 0.99), FRI (p = 0.602), nonunion and union times recorded (p = 0.656) and (p = 0.683, 0.829), respectively, and showed no significant difference between the two groups. Conclusion: Suprapatellar intramedullary nailing with screw fixation had similar surgical outcomes with minimally invasive locking plate fixation in ipsilateral tibial plateau and shaft fractures in terms of union rate, union time, alignment, and complication rate. Thus, frequent use of intramedullary nailing combined with screw fixation is anticipated in patients with ipsilateral tibial plateau and shaft fractures when the soft tissue condition is not desirable. Level of evidence: Level III [ABSTRACT FROM AUTHOR]

Introduction: This study introduced a novel approach for the treatment of midshaft clavicle fractures, utilizing patient-specific 3D-printed models for accurate preoperative contouring of dynamic compression plates (DCPs) and an alternative minimally invasive plate osteosynthesis (MIPO) technique with precontoured DCPs through small vertical separated incisions. Patient and methods: Mirror image 3D clavicular models were reproduced from 40 patients with acute displaced midshaft clavicle fractures who underwent MIPO using precontoured DCPs inserted through small, vertical separated incisions. Exclusion criteria included patients with open fractures, pathological fractures, ipsilateral limb injury, skeletal immature patients, and those who had previous clavicle fractures or surgery. Postoperative evaluation was conducted using clinical and radiographic review. The Constant–Murley and American Shoulder and Elbow Surgeons Shoulder Scores were used for clinical evaluations, and the Patient and Observer Scar Assessment Scale was used to assess surgical scars. Results: The average time to union of all fractures was 12.88 weeks (range, 8–15) without loss of reduction. The patient-specific precontoured DCPs fitted well in all cases, with fracture consolidation and minimal three cortical sides connecting the fracture fragment. No hardware prominence and skin complications occurred, and clinical evaluation showed no existing difference compared with the contralateral sides. The average Constant–Murley and American Shoulder and Elbow Surgeons Shoulder Scores were 96.33 ± 3.66 and 93.26 ± 5.15, respectively. Two patients requested their implant removal, and scar qualities were satisfactory. Conclusions: Our study demonstrated that the use of a patient-specific precontoured DCP, in combination with 3D printing technology, provides accurate preoperative planning, effective fracture reduction, and improved postoperative outcomes in displaced midshaft clavicle fractures. The MIPO with a patient-specific precontoured DCP through separated vertical incisions along the Langer's lines appears to be a promising option, regarding appearance, avoiding associated complications, and obviating the need for reoperation. These results suggest that this technique has merit and can be a viable option for the treatment of midshaft clavicle fractures. [ABSTRACT FROM AUTHOR]

Background: High velocity vehicular accidents are responsible for distal femoral fractures commonly observed in young and middle aged. Low energy mechanisms such as trivial fall at home may be responsible for producing fractures of distal femur in the elderly population, especially women. This study intends to obtain the functional outcome of extra articular fractures of distal femur in skeletally mature patients treated with distal femur locking plate using MIPO (Minimally Invasive Plate Osteosynthesis). Materials and Methods: This prospective study was carried out at Orthopaedics department of Rangaraya Medical College, Kakinada from December 2020 to December 2022. A total of 20 patients with extraarticular fractures of the distal femur treated were with distal femoral locking compression plates was included. The patients were aged between 20 years and 70 years with the mean age of 45.1 years. The time of operation ranges from the 1st day of injury to the 8th day of injury with the mean time of operation being 4.6 days. The clinical results of our study were based on the Neer's criteria. Conclusion: In the treatment of distal femoral fractures, the LCP condylar plate is the preferred option, especially in Type A fractures where we have observed higher Neer scores. Additionally, LCP avoids periosteal vessels from being compressed. [ABSTRACT FROM AUTHOR]

The minimally invasive plate osteosynthesis (MIPO) for proximal metaphyseal-diaphyseal humeral fracture is an effective alternative treatment with satisfactory outcomes. In this study, we described the surgical techniques and clinical results using MIPO via a lateral approach and long PHILOS plate fixation in 23 patients. All fractures were successfully united within a mean union time of 13.5 weeks (range 9–18). There was no iatrogenic radial nerve palsy. The deltoid power was grade 5 in all patients, except for 2 patients who had associated brachial plexus injury and gunshot injury at the deltoid muscle. The mean Constant–Murley score was 85.6 (range 16–98) and DASH score was 12.1 (range 1.7–85). Based on these findings, the lateral MIPO with long PHILOS plate fixation could be an alternative for the proximal metaphyseal-diaphyseal fractures of the humeral shaft. [ABSTRACT FROM AUTHOR]

Proximal humeral fractures (PHFs) are one of the most common types of fractures, accounting for up to 5% of all fractures, and they are the third most common fracture in the elderly population, increased by more than three times between 1970 and 2002 (1, 2, 3, 4). By 2030, the incidence of PHFs is expected to further grow, due to the ageing population and a more active lifestyle among the elderly (4). The treatment strategy of PHFs depends on different aspects: patient characteristics (age and co-morbidity), injury patterns (fracture type and displacement), and different available options about the surgical technique (5, 6, 7). The majority of PHFs are undisplaced or minimally displaced, thus treated conservatively, while displaced or unstable fractures require surgical treatment to achieve an optimal functional outcome (8, 9). Various surgical techniques, like open reduction and internal fixation (ORIF) with proximal humeral plate, intramedullary nailing, and arthroplasty, have been described in the literature (10, 11). In recent years, the locking plate has become increasingly used for the fixation of PHFs, especially for elderly patients (12, 13, 14).

Purpose: To compare the radiological alignment, union time, union rate, and complication rate between suprapatellar intramedullary nails and minimally invasive locking plate fixation in the treatment of proximal tibial fractures. Materials and methods: We retrospectively analyzed 103 patients who underwent plate fixation (n = 50) or suprapatellar intramedullary nailing (n = 53) for proximal tibial fractures involving the meta-diaphyseal junction between November 2015 and October 2020 at our institution. The union rate, union time, radiologic alignments, and complications, such as malalignment, nonunion, and deep infection, were investigated. Results: The demographic data did not differ between the plate and suprapatellar intramedullary nail groups. The alignment of the coronal plane was 0.24 ± 3.19 in the plate group and − 0.49 ± 2.22 in the intramedullary nail group (p = 0.196). Sagittal plane alignment was − 0.29 ± 4.97 in the plate group and 0.24 ± 4.12 in the intramedullary nail group (p = 0.571), and coronal malalignment (p = 0.196), sagittal malalignment (p = 0.57), deep infection (p = 0.264), nonunion (p = 0.695), union time (p = 0.329), and final union rate (p = 0.699) were not significantly different between groups. Conclusion: Compared with the minimally invasive locking compression plate group, the suprapatellar intramedullary nail group yielded comparable results in terms of radiological alignment and complications. Considering that proximal tibial fractures are associated with high-energy trauma and severe soft tissue damage, we believe that a suprapatellar intramedullary nail may be a good alternative. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

This systematic review evaluates postoperative complications and functional outcomes of minimally invasive plate osteosynthesis (MIPO) for distal tibial pilon fractures. This paper aims to fill a key literature gap, as no previous reviews have specifically addressed MIPO for tibial pilon fractures or fractures other than those involving the humeral shaft. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was done using PubMed, Embase, Web of Science, and Scopus databases from 2000 to 2022. Inclusion criteria were MIPO treatment in skeletally mature patients, while exclusion criteria were non-English papers, conference abstracts, papers with multiple treatment modalities that didn't analyze MIPO outcomes separately, skeletally immature patients, case reports, and cohorts smaller than five patients. Unpublished papers were also searched using Clinical Trials. Data extraction included general study information, injury specification, outcome measures, and complications. Finally, a risk of bias assessment (RoB) was performed. A total of 1732 studies were identified, of which 23 were included in this review, with 673 patients and 678 fractures analyzed. The mean follow-up ranged from 6 to 62.53 months, with most studies representing intermediate to long-term follow-up. Primary outcome measures showed that 87.33% achieved 'excellent to good' results, 8.67% achieved 'fair' results, and 4% achieved 'poor' results. Stratified by fracture type, 76.47%, 80.05%, and 76.92% of AO/OTA type A, B, and C fractures, respectively, achieved 'excellent to good' results. 35.06% of cases reported complications (236 in total). These included one case of deep infection (0.148%), 28 superficial wound infections (4.16%), 4 nonunion cases (0.59%), and 22 malunion instances (3.27%). RoB assessment showed that 52.17% had a moderate overall risk of bias, 39.13% had a serious overall risk of bias, and 8.7% had a critical overall risk of bias. MIPO technique for pilon fractures showed good functional outcomes and reliability, with low complication rates and should be considered in cases where proper indirect reduction is possible. However, while the evidence is promising, further high-quality studies with larger sample sizes, longer-term follow-up, and comparison to other techniques are needed to evaluate the efficacy and safety of this technique. IV [ABSTRACT FROM AUTHOR]

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A minimally invasive plate osteosynthesis (MIPO) technique has become increasingly popular in long bone fracture fixation as it could eliminate postoperative complications. However, the most challenging aspect of employing the MIPO for midshaft clavicle fractures among general orthopedic surgeons is the technically demanding that indirect reduction is typically a closed maneuver. We present a consecutive series of patients with displaced midshaft clavicle fractures undergoing clavicular fixation using the MIPO technique between January 2017 and October 2019. The joystick technique was used to obtain anatomical reduction. Clinical outcomes were assessed using the Constant-Murley and the American shoulder and elbow surgeons shoulder scores. Thirty patients with a mean age of 42.44 years were included. The functional shoulder scores showed no disabilities compared with those of a healthy population. No major complications requiring re-operation were noted, and all fractures were completely healed with an average time of 12.53 weeks. This study demonstrated that facilitating the MIPO for midshaft clavicle fractures using simple operative devices and techniques was possible. The joystick technique with the use of an external fixator for temporary stabilization is a safe and effective method that can be added to achieve anatomical alignment with the fracture site unexposed. This technique could be performed either in a fresh fracture or a delayed case with failed conservative treatment. [ABSTRACT FROM AUTHOR]

Background and Objectives: The surgical treatment of proximal humeral shaft fractures usually considers application of either long straight plates or intramedullary nails. By being able to spare the rotator cuff and avoid the radial nerve distally, the implementation of helical plates might overcome the downsides of common fixation methods. The aims of the current study were (1) to explore the biomechanical competence of different plate designs and (2) to compare their performance versus the alternative treatment option of using intramedullary nails. Materials and Methods: Twenty-four artificial humeri were assigned to the following four groups for simulation of an unstable proximal humeral shaft fracture and instrumentation: Group 1 (Straight-PHILOS), Group 2 (MULTILOC-Nail), Group 3 (45°-Helical-PHILOS), and Group 4 (90°-Helical-PHILOS). All specimens underwent non-destructive, quasi-static biomechanical testing under loading in axial compression, torsion in internal/external rotation, and pure bending in four directions, accompanied by motion tracking. Results: Axial stiffness/displacement in Group 2 was significantly higher/smaller than in all other groups (p ≤ 0.010). Torsional displacement in Group 2 was significantly bigger than in all other groups (p ≤ 0.017). Significantly smaller coronal plane displacement was identified in Group 2 versus all other groups (p < 0.001) and in Group 4 versus Group 1 (p = 0.022). Significantly bigger sagittal plane displacement was detected in Group 4 versus all other groups (p ≤ 0.024) and in Group 1 versus Group 2 (p < 0.001). Conclusions: Intramedullary nails demonstrated higher axial stiffness and smaller axial interfragmentary movements compared with all investigated plate designs. However, they were associated with bigger torsional movements at the fracture site. Although 90°-helical plates revealed bigger interfragmentary movements in the sagittal plane, they demonstrated improved resistance against displacements in the coronal plane when compared with straight lateral plates. In addition, 45°-helical plates manifested similar biomechanical competence to straight plates and may be considered a valid alternative to the latter from a biomechanical standpoint. [ABSTRACT FROM AUTHOR]

Introduction: Distal tibial fractures make up approximately 3% to 10% of all tibial fractures or about 1% of lower extremity fractures. MIPO is an appropriate procedure and method to achieve stable metal plate fixation and osseointegration by minimizing soft tissue damage and vascular integrity at the fracture site. MIPO to the medial tibia during distal tibial fractures induces skin irritation due to the thickness of the metal plate, which causes discomfort and pain on the medial side of the distal leg, and if severe, complications such as infection and skin defect may occur. The reverse sural flap is a well-researched approach for covering defects in the lower third of the leg, ankle, and foot. Materials and Methods: Among 151 patients with distal tibia fractures who underwent minimally invasive metal plate fixation, soft tissue was injured due to postoperative complications. We treated 13 cases with necrosis and exposed metal plates by retrograde nasogastric artery flap surgery. For these patients, we collected obligatory patient records, radiological data, and wound photographs of the treatment results and complications of reconstructive surgery. Results: In all the cases, flap survival was confirmed at the final outpatient follow-up. The exposed area of the metal plate was well coated, and there was no plate failure due to complete necrosis. Three out of four women complained of aesthetic dissatisfaction because the volume of the tunnel through which the skin mirror passed and the skin plate itself were thick. In two cases, defatting was performed to reduce the thickness of the plate while removing the metal plate. Conclusions: Metal plate exposure after distal tibial fractures have been treated with minimally invasive metal plate fusion and can be successfully treated with retrograde nasogastric artery flaps, and several surgical techniques are used during flap surgery. [ABSTRACT FROM AUTHOR]

Amaç: Amacımız, distal tibia eklem hattına uzanan tibia diyafiz kırıklarında intramedüller çivilemenin sonuçlarının araştırılması ve minimal invaziv plak osteosentez yöntemi ile karşılaştırılmasıdır. Gereç ve Yöntem: Kliniğimizde tibia distal eklem hattına uzanan ancak eklemde impaksiyon izlenmeyen tibia diyafiz kırığı nedeni ile 2019 – 2021 yılları arasında tedavi ve takibi yapılan tüm hastalar retrospektif olarak araştırıldı. Tüm hastaların yaş, cinsiyet ve taraf gibi demografik verileri, yaralanma mekanizmaları, tibia diyafiz ve pilon kırık tipleri, klinik ağrı skorları, radyolojik kaynamaları ve komplikasyonları değerlendirildi. Bulgular: Çalışmaya dahil edilen 27 hastadan 15 hasta (%55,56) intramedüller çivileme ile tedavi edilirken, 12 hastada (%44,44) minimal invaziv plak osteosentez kullanılmıştır. İMÇ uygulanan grubun ortanca yaşı 62 (Aralık: 34-67 yaş) iken, MİPO uygulanan grupta ortanca yaşı 51 (Aralık: 33-52) olduğu ve aralarında anlamlı fark olduğu görüldü (p=0,038). Yaralanma mekanizmaları açısından gruplar arasında anlamlı fark tespit edildi (p=0,023). Taraf, cinsiyet, kırık tipi ve ağrı skorları açısından iki grup arasında fark görülmedi (p>0,050). Hastaların tamamında radyolojik tam iyileşme elde edildi. Dört hastada (%14,81) yara yerinde yumuşak doku ilişkili komplikasyonlar tespit edildi. Komplikasyon gelişen hastaların tamamının MİPO grubunda olduğu görüldü ve gruplar arasında komplikasyon gelişimi açısından anlamlı fark tespit edildi (p=0,028). Sonuç: Distal tibia eklem hattına uzanan tibia diyafiz kırıklarında, eklemde impaksiyon eşlik etmiyor ise, perkütan kanüllü vidalar ile eklemde mutlak stabilitenin elde edilmesini takiben uygulanan intramedüller çivileme ile tatminkar klinik ve radyolojik sonuçlar ve düşük komplikasyon oranları elde edilebilir.

Background: Minimally invasive plate osteosynthesis (MIPO) is an emerging fracture management modality in small animal orthopedics. Although cranial plate application has been consistently advocated when performing radial MIPO, medial plating affords several purported advantages including improved screw purchase through the wider medial-to-lateral dimension of the radius, the potential to use smaller plates allowing more screws per unit length, and avoidance of extensor tendons which can complicate cranial plate placement in distal diaphyseal or metaphyseal fractures. Aim: To compare cranial verses medial MIPO applications for the stabilization of diaphyseal radius and ulna fractures in dog cadavers. Methods: Simulated bilateral antebrachial fractures were stabilized with cranial MIPO on one forelimb and medial MIPO on the contralateral limb, facilitated by a 2-ring circular fixator construct. Procedure times and ease, number of fluoroscopic images obtained, and post-procedural frontal and sagittal alignment and radial length, were compared between plating groups. The ease of construct placement, fracture reduction, radial approach, and plate application, were subjectively scored 1-5 for each procedure. Paired t tests were performed to identify significant differences (P [Open Vet J 2023; 13(5.000): 501-509]

Background: Minimally invasive plate osteosynthesis (MIPO) is an emerging fracture management modality in small animal orthopedics. Although cranial plate application has been consistently advocated when performing radial MIPO, medial plating affords several purported advantages including improved screw purchase through the wider medial-tolateral dimension of the radius, the potential to use smaller plates allowing more screws per unit length, and avoidance of extensor tendons which can complicate cranial plate placement in distal diaphyseal or metaphyseal fractures. Aim: To compare cranial versus medial MIPO applications for the stabilization of diaphyseal radius and ulna fractures in dog cadavers. Methods: Simulated bilateral antebrachial fractures were stabilized with cranial MIPO on one forelimb and medial MIPO on the contralateral limb, facilitated by a two-ring circular fixator construct. Procedure times and ease, number of fluoroscopic images obtained, and post-procedural frontal and sagittal alignment and radial length were compared between plating groups. The ease of construct placement, fracture reduction, radial approach, and plate application, were subjectively scored 1-5 for each procedure. Paired t-tests were performed to identify significant differences (p < 0.05) between the two plating groups. Results: There was no difference in total or incremental procedural times, subjective ease scores, or the number of fluoroscopic images obtained between plating groups. Both plating groups had comparable post-procedural frontal and sagittal plane alignment. There was a significant difference between plating groups for final radial length (p = 0.004) and change in radial length compared to the intact radii, (p = 0.002). Medial-plated radii measured longer than cranialplated radii. Conclusion: The only outcome measure significantly different between plating groups was the post-procedural radial length. The change in length compared to intact radii was <1%, regardless of the plating group, and unlikely to be clinically relevant. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the technical specifications and long-term results of “early minimally invasive surgery” that we have been implementing on AO 43-C3 pilon fractures. Methods: Twelve patients with AO 43-C3 closed fracture were operated within the first 36 h of trauma with the goal of providing definitive treatment. After consideration of the associated fibular fracture, tibial articular surface was fixed with anatomical reduction and rigidly percutaneously. Subcutaneous anatomical medial plating was applied to provide relative stability between articular block and the comminuted metaphyso-diaphyseal part. Results: The average age was 50 (range: 36-62) years. The average time between trauma and surgery was 18 (range: 6-36) hours. The average follow-up period was 60 (range: 24-78) months. There were no wound problems or infections. The reduction quality was excellent in 7 patients and good in 5 patients. Clinical results were excellent for 4 and good for 8 patients. Stage 1 arthrosis was observed in 4, stage 2 in 6, and stage 3 arthrosis in 2 patients. Conclusion: Single-stage minimally invasive plating of AO 43-C3 pilon fractures may result in a satisfactory functional score in the long term because of the quality of joint reduction and the effect of the energy load of the trauma, which is important for the development of arthrosis. [ABSTRACT FROM AUTHOR]

Background: Proximal humeral shaft fractures are surgically challenging and plate osteosynthesis with a long straight plate is one operative treatment option in these patients although endangering the radial nerve distally. Helical plates potentially avoid the radial nerve by twisting around the humeral shaft. Aim of the study was to investigate in a human cadaveric model the biomechanical competence of helical plates versus straight lateral plates used for fixation of proximal third comminuted humeral shaft fractures. Methods: Eight pairs of humeral cadaveric humeri were instrumented using either a long 90°-helical plate (Group1) or a straight long PHILOS plate (Group2). An unstable proximal humeral shaft fracture was simulated by means of a 5 cm osteotomy gap. All specimens were tested under quasi-static loading in axial compression, internal and external rotation, and bending in four directions. Subsequently, progressively increasing cyclic loading in internal rotation until failure was applied and interfragmentary movements were monitored by motion tracking. Results: During static testing flexion/extension deformation in Group1 was significantly higher, however, varus/valgus deformation as well as shear and torsional displacement under torsional load remained statistically indifferent between both groups. During cyclic testing shear and torsional displacements were both significantly higher in Group1 compared to Group 2. However, cycles to catastrophic failure remained statistically indifferent between the groups. Conclusions: From a biomechanical perspective, although 90°-helical plating is associated with higher initial stability against varus/valgus collapse and comparable endurance under dynamic loading, it demonstrates lower resistance to flexion/extension and internal rotation with bigger shear interfragmentary displacements versus straight lateral plating and, therefore, cannot be considered as its real alternative. Alternative helical plate designs should be investigated in the future. [ABSTRACT FROM AUTHOR]

Three-dimensional printing opens up many opportunities for use in traumatology and orthopedics, because it takes into account personal characteristics of the patients. Modern methods of high-resolution medical imaging can process data to create threedimensional images for printing physical objects. Today, three-dimensional printers are able to create a model of any complexity of shape and geometry. The article provides a review of the literature about three-dimensional digital modeling in shaping implants for osteosynthesis. Data search was carried out on the Scopus, Web of Scince, Pubmed, RSCI databases for the period 2012–2022. The effectiveness of three-dimensional printing for preoperative modeling of bone plates has been confirmed: implants perfectly corresponds with the unique anatomy of the patient, since the template for it is based on the materials of computed tomography. Individual templates can be useful when the geometry of patients' bones goes beyond the standard, and when improved results of surgery are expected due to better matching of implants to the anatomical needs of patients.

Copyright of Sakarya Tıp Dergisi is the property of Sakarya Tip Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Helical plates are preferably used for proximal humeral shaft fracture fixation and potentially avoid radial nerve irritation. Aims: Safety of applying four different long plate designs (straight, 45°-, 90°-helical and ALPS) with MIPO technique as well as assessment and comparison of their distances to adjacent anatomical structures. Methods: MIPO was performed in 16 human cadaveric humeri using either a straight (group 1), a 45°-helical (group 2), a 90°-helical (group 3) plate, or an ALPS (group 4). Applying CT angiography, distances between brachial arteries and plates were evaluated. All specimens were dissected and distances to the axillary, radial and musculocutaneous nerve were evaluated. Results: No specimens demonstrated injuries of the anatomical structures at risk after MIPO with all investigated plate designs. Closest overall distance (mean (range); mm) between each plate and the radial nerve was 1 (1–3) in group 1, 7 (2–11) in group 2, 14 (7–25) in group 3 and 6 (3–8) in group 4. It was significantly bigger in group 3 and significantly smaller in group 1 compared to all other groups, p < 0.001. Closest overall distance between each plate and the musculocutaneous nerve was 16 (8–28) in group 1, 11 (7–18) in group 2, 3 (2–4) in group 3 and 6 (3–8) in group 4. It was significantly bigger in group 1 and significantly smaller in group 3 compared to all other groups, p < 0.001. Conclusions: MIPO with 45°- and 90°-helical plates as well as with ALPS is safely feasible and demonstrates significantly bigger distances to the radial nerve compared to straight plates. However, the distances remain small and attention must be paid to the musculocutaneous nerve and the brachial artery when MIPO is applied using ALPS, 45°- and 90°-helical implants. [ABSTRACT FROM AUTHOR]

Introduction: The results of surgical techniques vary depending on the level of the surgeon's experience. The level of expertise can be evaluated quantitatively or qualitatively. In this study, we evaluated the duration of the procedure and the size of the incision of minimally invasive fixation of distal radius fractures as a means of grading expertise and surgical performance. The null hypothesis of our study was that the level of expertise did not match the level of performance. Material and methods: The study included 52 surgeons split in five levels of expertise who had performed 467 minimally invasive fixations of distal radius fractures. The performance of the surgeons in terms of duration of the procedure and size of the incision were scored according to the five levels of surgical experience using four different methodologies: clinical (setting limits compared to data found in literature), statistical (setting statistical limits of comparison in percentiles (20th, 40th, 60th, 80th) for each of the two parameters measured), arithmetical (setting limits compared to equal intervals for each of the 2 variables), and success rate (setting a threshold for each of the 2 variables). Results: Our results showed a great disparity between levels of experience depending on the method used. The scores for levels 1 and 2 were 72% for expertise, 13% for performance according to the clinical method, 75% for the statistical method, 0% for the arithmetical method, and 57% according the success rate. The rate of level 3 was 23% for expertise, 41% for performance by the clinical method, 17% by the statistical method, 17% by the arithmetical method, and 15% by the success rate. The rates of levels 4 and 5 were 5% for expertise, 46% for performance clinical method, 8% by the statistical method, 83% by the arithmetical method, and 28% by the success rate. Discussion: The null hypothesis of our study was confirmed by the results which show that there was no correlation between levels of expertise and performance. The clinical method of assessment appears to reflect best the true level of performance of the surgeon. Conclusion: Publications reporting the results of a surgical technique for a given pathology should always mention the level of performance as measured on a clinical scale. [ABSTRACT FROM AUTHOR]

Background and Objectives: The surgical treatment of proximal humeral shaft fractures usually considers application of either long straight plates or intramedullary nails. By being able to spare the rotator cuff and avoid the radial nerve distally, the implementation of helical plates might overcome the downsides of common fixation methods. The aims of the current study were (1) to explore the biomechanical competence of different plate designs and (2) to compare their performance versus the alternative treatment option of using intramedullary nails. Materials and Methods: Twenty-four artificial humeri were assigned to the following four groups for simulation of an unstable proximal humeral shaft fracture and instrumentation: Group 1 (Straight-PHILOS), Group 2 (MULTILOC-Nail), Group 3 (45°-Helical-PHILOS), and Group 4 (90°-Helical-PHILOS). All specimens underwent non-destructive, quasi-static biomechanical testing under loading in axial compression, torsion in internal/external rotation, and pure bending in four directions, accompanied by motion tracking. Results: Axial stiffness/displacement in Group 2 was significantly higher/smaller than in all other groups (p ≤ 0.010). Torsional displacement in Group 2 was significantly bigger than in all other groups (p ≤ 0.017). Significantly smaller coronal plane displacement was identified in Group 2 versus all other groups (p < 0.001) and in Group 4 versus Group 1 (p = 0.022). Significantly bigger sagittal plane displacement was detected in Group 4 versus all other groups (p ≤ 0.024) and in Group 1 versus Group 2 (p < 0.001). Conclusions: Intramedullary nails demonstrated higher axial stiffness and smaller axial interfragmentary movements compared with all investigated plate designs. However, they were associated with bigger torsional movements at the fracture site. Although 90°-helical plates revealed bigger interfragmentary movements in the sagittal plane, they demonstrated improved resistance against displacements in the coronal plane when compared with straight lateral plates. In addition, 45°-helical plates manifested similar biomechanical competence to straight plates and may be considered a valid alternative to the latter from a biomechanical standpoint.

Purpose: Osteosynthetic treatment strategies of PHFs include MIPO or ORIF techniques. The aim of this study was to compare the 1 year outcome following either technique in type B PHFs. Methods: This study was designed as a retrospective cohort study of patients treated at one academic Level 1 trauma center. Patients from 2009 to 2019 who required surgical treatment of a type B PHF were eligible to be included in this study. Patients with A- or C-type fractures or patients requiring arthroplasty were excluded. All patients were treated with Proximal Humerus Interlocking System (PHILOS) and stratified according the approach into Group MIPO or Group ORIF. Outcome measures include local complications that occurred during hospitalization, nonunion after 12 months, and range of motion after 1 year follow-up. Results: This study included 149 (75.3%) patients in Group ORIF, and 49 (24.7%) in Group MIPO. The fracture morphology and concomitant injuries were comparable amongst these groups. When compared with Group MIPO, Group ORIF had a 2.6 (95% CI 0.6–11.7) higher risk of suffering from local complications. The rate of postoperative nerve lesions was comparable (OR 0.9, 95% CI 0.1–9.7) as was the rate of soft tissue complications (OR 2.0, 95% CI 0.2–17.2). The risk for nonunion was 4.5 times higher (95% 1.1–19.5) in Group ORIF when compared with Group MIPO. Group MIPO had a higher chance of flexion above 90° (OR 8.2, 95% CI 2.5–27.7). Conclusion: This study provides indications that patients following surgical treatment of PHFs in MIPO technique might have favourable outcome. Large-scale and high-quality studies are warranted to confirm these results. [ABSTRACT FROM AUTHOR]

Trajectory outlier detection is one of the fundamental data mining techniques used to analyze the trajectory data of the Global Positioning System. A comprehensive literature review of trajectory outlier detectors published between 2000 and 2022 led to a conclusion that conventional trajectory outlier detectors suffered from drawbacks, either due to the detectors themselves or the pre-processing methods for the variable-length trajectory inputs utilized by detectors. To address these issues, we proposed a feature extraction method called middle polar coordinates (MiPo). MiPo extracted tabular features from trajectory data prior to the application of conventional outlier detectors to detect trajectory outliers. By representing variable-length trajectory data as fixed-length tabular data, MiPo granted tabular outlier detectors the ability to detect trajectory outliers, which was previously impossible. Experiments with real-world datasets showed that MiPo outperformed all baseline methods with 0.99 AUC on average; however, it only required approximately 10% of the computing time of the existing industrial best. MiPo exhibited linear time and space complexity. The features extracted by MiPo may aid other trajectory data mining tasks. We believe that MiPo has the potential to revolutionize the field of trajectory outlier detection. [ABSTRACT FROM AUTHOR]

Calcaneal fractures are 60% of all tarsal injuries and 2% of all fractures in adults. Although open reduction and internal fixation (ORIF) is the gold standard, it has been found to have soft-tissue problems that are proportionally related to the degree of surgical invasiveness. Because soft tissues are protected, minimally invasive plate osteosynthesis (MIPO) procedures promise a lower risk of wound complications, a quicker recovery period, and faster healing. [ABSTRACT FROM AUTHOR]

Background: Establishing fracture consolidation and avoiding postoperative complications of comminuted subtrochanteric fractures of the femur are technically challenging. The authors delineated a technical description of minimally invasive plate osteosynthesis (MIPO) by using a reverse distal femur locking compression plate (LCP-DF) and retrospectively reviewed the outcomes of these particular fractures. Methods: Fifty patients with 51 type C subtrochanteric fractures of the femur were operated on by MIPO and reverse LCP-DF fixation. The collected data included postoperative complications, union times, and clinical outcomes. Results: All fractures were united with a mean union time of 19.4 weeks (range 16–22). Regarding postoperative complications, asymptomatic valgus angulation occurred in five patients and trochanteric pain in six. According to Harris hip score, nine patients were determined to be excellent, 36 to be good and five to be fair. Conclusion: MIPO by reverse LCP-DF is reliable and effective for type C subtrochanteric fractures of the femur particularly in situations where intramedullary nailing is not feasible. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Proximal humerus fractures with metaphysodiaphyseal extension represent a challenge for the orthopedic surgeon due to their reduced incidence and the difficulty in the treatment decision. These can be treated with an intramedullary nail or using the MIPO technique, associating different advantages and complications depending on the procedure. The objective of this study was to compare metaphyseal-diaphyseal fractures of the humerus treated with antegrade intramedullary nailing and those operated using the MIPO technique to see if there were significant differences in terms of functional, clinical, and radiological results.Material and Methods: retrospective, analytical and unicentric review of 29 patients with proximal fracture with metaphyseal-diaphyseal extension treated by MIPO technique and 33 patients surgically treated by antegrade intramedullary nailing (IMN) in our hospital from 2014 to 2020. Demographic, functional, radiographic and clinical data were obtained..Results: No significant differences were observed between both groups in terms of fracture mechanism (p=0.34), fracture type (p=0.13) or Maresca classification (p=0.32). Surgical time was significantly shorter in the IMN group compared to the MIPO technique (p=0.014). No significant difference was observed regarding the need for blood transfusion (p=0.32). The mean consolidation in the MIPO group was 21 weeks compared to 21 weeks in the IMN, with no significant differences between both groups (p= 0.88). No significant differences were observed between CONSTANT test at one year in the MIPO group versus the IMN group (p=0.79), nor in radial nerve palsies (p=0.28).Conclusions: Proximal fractures with metaphyseal-diaphyseal extension are a challenge for the orthopedic surgeon due to the infrequency, the complexity of these fractures and the fact that there is no established consensus on the ideal treatment for this type of injury. Both the MIPO technique with the Philos plate and the intramedullary nail are valid options for the treatment of these fractures, with no differences observed in terms of fracture consolidation time or in terms of functional results. [ABSTRACT FROM AUTHOR]

Introduction: Definitive treatment of distal extra-articular fractures of the tibia is challenging and both minimal invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are considered to be feasible surgical modalities with their own implant-specific merits and demerits. This retrospective study was designed to compare MIPO versus IMN in terms of fracture healing, complications, functional and radiological outcomes and to assess the efficacy of intra-operative alignment control to reduce the rate of malalignment after definitive fixation of distal extra-articular fractures of the tibia. Materials and methods: All consecutive adult patients with extra-articular distal meta- or diaphyseal tibia fractures that were treated between January 2012 and September 2019 either with MIPO or IMN were included. Outcome measures included fracture healing, complications (infection, malalignment, subsequent surgeries), functional and radiological outcomes. Intra-operative alignment control encompassed bilateral draping of the lower extremities. Results: A total of 135 patients were included out of which 72 patients (53%) were treated with MIPO and 63 patients (47%) underwent IMN. There was a significantly higher incidence of non-union for fractures treated with IMN (13 (22%) vs. 4 (6%), p = 0.04). There was no significant difference between both groups in terms of rotational malalignment (3% vs. 10%) and angular malalignment (4% vs. 5%). A significantly higher rate of infection was found after MIPO after correction of significant differences in baseline characteristics. No differences were found in subsequent surgeries or functional outcomes. Conclusion: Both MIPO and IMN are reliable surgical techniques. IMN is associated with higher rates of non-union, whereas MIPO results in a higher risk for infection. The incidence of malalignment was surprisingly low endorsing the utility of the intra-operative alignment control. [ABSTRACT FROM AUTHOR]

Helical plates used for proximal humeral shaft fracture fixation avoid the radial nerve distally as compared to straight plates. To investigate in a human cadaveric model the biomechanical competence of straight lateral plates versus 45° helical plates used for fixation of proximal comminuted humeral shaft fractures, eight pairs of human cadaveric humeri were instrumented using either a long straight PHILOS plate (Group 1) or a 45° helical plate (Group 2) for treatment of an unstable proximal humeral shaft fracture. All specimens were tested under non-destructive quasi-static loading in axial compression, internal and external rotation, and bending in four directions. Subsequently, progressively increasing cyclic loading in internal rotation was applied until failure and interfragmentary movements were monitored by motion tracking. Axial displacement (mm) was 3.13 ± 0.31 in Group 1 and 2.60 ± 0.42 in Group 2, p = 0.015. Flexion/extension deformation (°) in Group 1 and Group 2 was 0.56 ± 0.42 and 0.43 ± 0.23, p = 0.551. Varus/valgus deformation (°) was 6.39 ± 0.44 in Group 1 and 5.13 ± 0.87 in Group 2, p = 0.012. Shear (mm) and torsional (°) displacement were 5.36 ± 0.76 and 17.75 ± 1.06 in Group 1, and 5.03 ± 0.46 and 16.79 ± 1.36 in Group 2, p ≥ 0.090. Cycles to catastrophic failure were 10000 ± 1401 in Group 1 and 9082 ± 1933 in Group 2, p = 0.708. From a biomechanical perspective, 45° helical plating is associated with lower axial and varus/valgus displacement under axial loading and demonstrates comparable resistance to failure versus straight plating. Therefore, 45° helical plates can be considered as a valid alternative to straight plates for treatment of proximal humeral shaft fractures., (© 2024 The Author(s). Journal of Orthopaedic Research® published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.)

Introduction: Distal tibial fractures make up approximately 3% to 10% of all tibial fractures or about 1% of lower extremity fractures. MIPO is an appropriate procedure and method to achieve stable metal plate fixation and osseointegration by minimizing soft tissue damage and vascular integrity at the fracture site. MIPO to the medial tibia during distal tibial fractures induces skin irritation due to the thickness of the metal plate, which causes discomfort and pain on the medial side of the distal leg, and if severe, complications such as infection and skin defect may occur. The reverse sural flap is a well-researched approach for covering defects in the lower third of the leg, ankle, and foot. Materials and Methods: Among 151 patients with distal tibia fractures who underwent minimally invasive metal plate fixation, soft tissue was injured due to postoperative complications. We treated 13 cases with necrosis and exposed metal plates by retrograde nasogastric artery flap surgery. For these patients, we collected obligatory patient records, radiological data, and wound photographs of the treatment results and complications of reconstructive surgery. Results: In all the cases, flap survival was confirmed at the final outpatient follow-up. The exposed area of the metal plate was well coated, and there was no plate failure due to complete necrosis. Three out of four women complained of aesthetic dissatisfaction because the volume of the tunnel through which the skin mirror passed and the skin plate itself were thick. In two cases, defatting was performed to reduce the thickness of the plate while removing the metal plate. Conclusions: Metal plate exposure after distal tibial fractures have been treated with minimally invasive metal plate fusion and can be successfully treated with retrograde nasogastric artery flaps, and several surgical techniques are used during flap surgery.

Objectives: To evaluate the efficacy of minimally invasive plate osteosynthesis (MIPO) performed via a lateral approach as a means of stabilising diaphyseal humeral fractures in dogs and cats. Materials and Methods: Clinical data including surgical technique and implants utilised were recorded. Post-operative humeral length and alignment were compared to the intact contralateral humerus. Post-operative complications, time to union and functional outcomes were recorded. Results: Fractures sustained by seven dogs and four cats were included. A plate-rod construct was used in all fractures. The mean ± SD absolute discrepancies in frontal and sagittal plane alignment were 1.9° ± 1.3° and 4.3° ± 1.5°, respectively. The mean ± SD relative discrepancy in humeral length was 2.7% ± 3.9%. Post-operative complications occurred in four animals, with three of these animals requiring revision procedures. Time to union, as assessed via serial radiographs, was available in six animals; three of these animals had uncomplicated fracture healing, with a mean ± SD time to union of 82 ± 49 days. The remaining three animals, which all underwent revision procedures, had a mean ± SD time to union of 185 ± 93 days. Clinical significance: This case series documents that MIPO performed via a lateral approach consistently yielded acceptable post-operative reduction and alignment of diaphyseal humeral fractures, ascribed in part to the physiologic positioning of the fractured limb during surgery. Complications occurred most frequently in open fractures, suggesting that MIPO may not mitigate risks inherent to such cases. [ABSTRACT FROM AUTHOR]

Purpose: Helical plates potentially avoid the medial neurovascular structures of the thigh. Two implant designs for additional medial 90° helical plate in double plate constructs for geriatric patients and 180° helical plate for single plating in young patients are potential alternatives to widely used standard straight plates.Aims: (1) assess the distances to adjacent anatomical structures being at risk when applying medial 90° and 180° helical plates with MIPO technique to the femur, (2) compare these distances with medial straight plates, and (3) correlate measurements performed during surgical dissection with CT angiography.Methods: MIPO was performed in ten human cadaveric femoral pairs using either a 90° helical 14-hole LCP (Group 1) or a 180° helical 15-hole LCP-DF (Group 2). Using CT angiography, distances between femoral arteries and plates as well as distances between plates and perforating vessels were evaluated. Following, specimens were dissected and distances determined again. All plates were removed and measurements were repeated with straight medial plates (Group 3).Results: Overall closest distances between plates and femoral arteries were 14.5 mm (11-19 mm) in Group 1, 21.6 mm (15-24 mm) in Group 2 and 6.5 mm (5-8 mm) in Group 3, with significant differences between Group 3 and both other groups (p < 0.001). Distances to the nearest perforating vessels were 22.4 mm (15-30 mm) in Group 1 and 1.2 mm (1-2 mm) in Group 2. Measurement techniques (visual after surgical disection and CT angiography) demonstrated a strong correlation (p < 0.010).Conclusions: Inserting 90° and 180° helical plates with MIPO technique is safe, however, attention must be paid to the medial neurovascular structures with 90° helical plates and to the proximal perforating vessels with 180° helical plates. Helical plates can avoid irritation of medial neurovascular structures - compared with straight plates - although care must be taken during their distal insertion. Measurements during surgical dissection correlate with CT angiography. [ABSTRACT FROM AUTHOR]

Gold standard surgical treatment remains controversial for pilon fractures. This retrospective study aimed to analyze the mid-term results of tibial pilon fractures that were treated with the Ilizarov external fixator and Minimally Invasive Plate Osteosynthesis (MIPO). The study population consists of 50 patients with a minimum of one-year follow-up. Patients were divided into two groups bases on the treatment method (Group 1, Ilizarov, n=25; Group 2, MIPO, n=25). The American Orthopaedic Foot and Ankle Society (AOFAS) score, the Foot and Ankle Disability Index (FADI), and Visual Analogue Scale (VAS) score were used in the evaluation of functional outcomes. Ankle and subtalar joint range of motion (ROM) were evaluated at the last evaluation. The association between reduction quality and the development of ankle OA was analyzed as well. There was no significant difference between the two groups regarding AOFAS, FADI, VAS scores, and ankle ROM at the last follow-up (P>0.05). Also, union time and complication rates were similar between the two groups (P>0.05 ). Both MIPO and the Ilizarov techniques are effective and safe methods with low complication rates in the treatment of pilon fractures. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate the feasibility and safety of a new minimally-invasive surgical approach–anteromedial minimally-invasive plate osteosynthesis (MIPO)–in the treatment of middle and distal humeral shaft fractures. Methods Fourteen patients with humeral shaft fracture treated with anteromedial MIPO from November 2016 to March 2020 (MIPO Group) were selected as the study subjects. Open reduction and internal fixation (ORIF) were used to treat 14 patients with humeral shaft fractures as the control group (ORIF group). The two groups were fixed with a locking compression plate (LCP) or LCP + multi-directional locking screw system (MDLS). The incision length, intraoperative blood loss, intraoperative fluoroscopy time, operation time, length of hospital stay, fracture healing time, QuickDASH score and Constant score were observed and compared between the two groups. Results Fourteen patients were enrolled in each group. The incision length (7.79 ± 2.39 cm), intraoperative blood loss (96.07 ± 14.96 mL), operative time (110.57 ± 21.90 min), hospital stay (6.29 ± 1.49 days) and fracture healing time (14.94 ± 0.99 weeks) in the MIPO group were all lower than those in the ORIF group, and the difference was statistically significant for each parameter (P

Background: The purpose of this study was to identify nerves at risk when using a minimally invasive plate osteosynthesis precontoured long proximal humerus locking plate and to evaluate the risk of injury to deltoid insertion and brachialis muscle. Methods: Ten cadaveric upper limb specimens were used. A transdeltoid anterolateral approach was performed proximally and a second anterior approach was performed distally. A 14-hole “low” long precountored ALPS locking plate (Biomet Trauma; Zimmer Biomet, Warsaw, IN, USA) was used. Subsequently, anatomic dissection to measure the anatomic relationship of the plate with the deltoid insertion, with the brachialis muscle, and with the axillary, radial, and musculocutaneous nerves was performed. Results: The mean humeral length was 302 mm (standard deviation 52.3, 99% confidence interval: 259.3-344.6). In 6 specimens, the axillary nerve was located at the level of the third row of holes of the plate; in 3 specimens, at the level of the fourth row; and in one specimen, at the level of the second row. The distance between the plate and the musculocutaneous nerve was on average 10.2 mm (standard deviation 4, 99% confidence interval: 6.9-13.5) and between the plate and the radial nerve was on average 7.9 mm (standard deviation 4.7, 99% confidence interval: 4-11.8). The plate pierced the anterior distal fibers of the deltoid in all specimens. In 8 specimens, no brachialis muscle fibers were located under the plate. Conclusions: The use of the long precontoured 14-hole ALPS locking plate with the minimally invasive plate osteosynthesis technique, previously identifying the axillary and musculocutaneous nerves, is feasible; however, the distances between the plate and the nerves remain low, so caution should be maintained. Despite the curved design of the plate, the deltoid insertion is partially compromised in all cases.

Minimally invasive surgery is gaining tremendous popularity in reconstructive foot and ankle surgery, as well as with trauma. Minimally invasive approaches have demonstrated equivalent to outcomes to traditional open incisional approaches with the added benefit of less risk for wound healing complications and surgical site infections. Advances in orthopedic hardware and surgical techniques are allowing minimal incision surgery for trauma to become more widespread. While there is a steeper learning curve to become proficient, minimally invasive surgery is likely to become the standard for most foot and ankle trauma cases., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Abstract Background Minimally invasive plate osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) in the treatment of different long bone fractures. Nevertheless, in distal fibula fractures, the evidence of MIPO remains scarce. The aim of this retrospective study was to compare the clinical and radiological outcomes of the minimally invasive techniques applied to the distal fibula with open reduction and internal fixation within a 12 months follow-up. Methods A consecutive series of patients who underwent surgery using either ORIF or MIPO for the treatment of distal fibula fractures between 2010 and 2014 were retrospectively analyzed. All distal fibular fractures requiring an operative treatment (Danis-Weber type B ≙ AO type 44 B1, 2, 3 and Danis-Weber type C ≙ AO type 44 C1, 2) were included (ORIF n = 35, MIPO n = 35). Patients were assessed for postoperative pain using a visual analog scale (VAS) for pain (ranging from 0 to 10) and classified into 4 groups: “no pain” for VAS = 0, “low” for VAS = 1–3, “moderate” for VAS = 3–5, and “severe” for VAS = 5–10. In addition, complications of postoperative fracture-related infection, wound healing disorders, vascular and nerve injury and development of nonunion were evaluated and analyzed. Radiologic outcome measures assessing the talocrural angle, lateral and medial clear space, tibiofibular overlap, and talar tilt angle were evaluated postoperatively. Results The overall complication rate showed to be lower in the MIPO group compared to the ORIF group (14% vs. 37%, p = 0.029). Even though not statistically significant, specific surgery-related complications such as skin necrosis (3% vs. 9%, p = 0.275), nonunion (0% vs. 6%, p = 0.139), infections and wound healing disorders (9% vs. 20%, p = 0.141), as well as postoperative pain (17% vs. 26%, p = 0.5) were found more frequently in the ORIF group. The tibiofibular overlap demonstrated to be significantly lower in the ORIF group (3.3 mm vs. 2.7 mm, p = 0.033). The talocrural angle, talar tilt angle, and lateral and medial clear space showed to be equivalent in both groups. Conclusion In this retrospective single-center consecutive series, MIPO was superior to ORIF in the surgical treatment of distal fibula fractures with respect to the overall complication rate. Trial registration EKNZ Project-ID: 2019-02310 , registered on the 20th of December 2019 with swissethics

Background The purpose of this study was to investigate the clinical differences between open reduction and plate fixation via a deltopectoral approach with allogenous fibular bone graft and a minimally invasive plate osteosynthesis (MIPO), in Neer's classification two-, three- part proximal humeral fractures. Methods In this retrospective study, 77 patients with two-, three-part proximal humeral fractures were treated at two different institutions. Clinical and radiological evaluations were performed in 39 patients, who underwent MIPO at one institution (group A), and 38 patients, who underwent a deltopectoral approach with allo-fibular bone graft (group B) at another institution. The results between the groups were compared. Results The MIPO technique was significantly less time consuming and caused less bleeding than the deltopectoral approach with allo-fibular bone graft (P

Abstract Backgrounds Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues. Methods Seventeen patients with Pilon fractures were enrolled in this retrospective study from December 2009 to October 2014. The injuries were graded according to AO Classification and the Gustilo-Anderson system. Patients were treated with minimally invasive plate osteosynthesis (MIPO) combined with curved incision on the anterior area of ankle. The ankle function and radiological outcome were assessed by the modified Mazur ankle score and Burwell-Charnley criteria, respectively. Visual analogue score (VAS) score was used to assess the degree of patient’s ankle pain, and related complications were also recorded. Results The mean time for fracture healing was 3.6 months (range: 3–6 months). According to Mazur’s criteria, surgical treatment achieved good or excellent outcome in 15 (88.2%) cases, and the average VAS score was 1.19 ± 0.52. On the basis of Burwell-Charnley score, 12 (70.5%) patients achieved anatomic recovery, 4 (23.5%) obtained good reduction, and only 1 (5.9%) patient was diagnosed with valgus deformity. Additionally, 1 (5.9%) patient developed a superficial infection around incision, and 2 (11.8%) experienced superficial peroneal nerve damage. In addition, 2 (11.8%) patients showed radiographic evidence of existing ankle osteoarthritis at the final follow-up. Conclusions This retrospective study is the first to assess the application of a curved incision on the anterior area of ankle with MIPO for the treatment of Pilon fractures, which achieves high functional recovery with a low complication rate. However, large randomized controlled trials comparing different approaches and fixation methods are still needed to conclusively identify the optimal treatment protocol.

Background and Purpose: Residual axial and rotational deformities in tibial shaft fracture, after minimally invasive osteosynthesis (MIO) treatment, are widely described in literature. Nevertheless, there is still a lack of evidence about the malunion treatment strategies and results. The aim of our study is to present an innovative technique for tibial shaft malunion: a derotational proximal tibial osteotomy without removing the original plate (Plate-Retaining-Osteotomy: PR-Osteotomy)., Materials and Methods: We present the results of two consecutive patients' treatment, affected by tibial shaft fracture malunion, as sequelae of MIO treatment. The two patients, male 60 years old and female 39 years old, underwent previous surgical treatment with an average of 9 months span time before surgical revision. The affected limb showed significant external torsional defect associated with gait impairment, pain and limping. The amount of rotational deformity and the bone healing condition is assessed through a methodical preoperative planning, including weight bearing lower limbs Xray and bilateral computed tomography (CT) scan of the lower limbs. The surgical technique involves a monoplanar tibial osteotomy, in a perpendicular fashion to the tibial axis, at a level that would allow at least 3 proximal screw-holes to become available for subsequent fixation. Proximal to the osteotomy line the screws are removed, while the distal ones, if stable after testing, are left in place. The amount of torsional correction, planned on CT, is reproduced intraoperatively with the assistance of graduated templates. A fibular osteotomy may be performed if required. After temporary stabilization, the correct functional reduction is checked with the aid of fluoroscopy and empirical rod measurement, using the contralateral limb alignment as a reference. Once the desired correction is achieved, absolute stability is applied to the osteotomy site. Postoperative rehabilitation protocol involves partial weight bearing for 6-8 weeks with progression to full weight bearing by 10-12 weeks., Results: Both patients showed complete osteotomy healing at the 13th and 16th week respectively, with no complications and full recovery of normal gait and daily life activities., Conclusions: To our knowledge, this is the first description of such surgical technique. Less invasiveness, fast recovery time and cost reductions are the foremost proposed benefits. Further larger case series with longer follow up are needed to assess the advantages of the proposed treatment strategy., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aims: This study aimed to evaluate the clinical and radiologic outcomes of well-fixed periprosthetic tibial fractures after TKA.Patients and Methods: The medical records of patients who presented with Felix type 2A periprosthetic tibial fractures after TKA between March 2015 and February 2020 were retrospectively obtained from 5 institutions. Data on injury mechanism, fracture pattern including open fractures and Felix classification, and surgical method were recorded. Functional outcomes including range of motion (ROM) and Knee Society Score (KSS) at postoperative 1 year were reviewed. The need for reoperation was also reviewed. Radiologic findings included union time and mechanical proximal tibial angle (MPTA) at the last radiologic follow-up.Results: Eighteen patients (13 women, 5 men; average age, 73.9 years) were included. The average follow-up duration was 20.8 months. The fractures resulted from high-energy (11 cases) and low-energy (7 cases) injuries. Two cases involved open fractures. Anatomical locking plates were used in all cases: single plate (4 cases) and dual plates (14 cases). The average number of proximal screws was 7.1 (range, 4-9). All patients achieved bone union at an average of 18.6 weeks without secondary intervention. No infection occurred; however, 1 patient with skin necrosis required local flap. Implant removal was performed in 5 cases: 1 case, skin defect and 4 cases, discomfort due to plate prominence. The average ROM and KSS were 120.3° and 85.9, respectively. The mean MPTA was 87.8°; the MPTA was higher in the single-plate group (94.0° vs. 88.1°, p=0.013). Three cases involved values beyond the normal MPTA range (85-90°): 104° and 96° with a single plate and 92° with dual plates. The malalignment rate was higher in the single-plate group (p=0.043).Conclusion: Felix type 2A periprosthetic tibial fractures treated with minimally invasive osteosynthesis showed excellent clinical outcomes, and tibial alignment was well maintained in the dual-plate group. [ABSTRACT FROM AUTHOR]

Background: Ankle fractures are the most common traumatic bone injuries of the lower limb. Over 50% of ankle fractures occur at the syndesmosis level (type AO B). The goal of treatment is to achieve an anatomical reduction and appropriate stabilization. The present study aimed to evaluate the clinical-functional and radiological results, and complications of minimally invasive reduction and fixation technique for ankle fractures type AO B. The surgical technique also is detailed.Material and Methods: A prospective analysis of 451 patients undergoing surgery for type AO B displaced ankle fracture was performed. All patients were treated with minimally invasive surgery. The following times were recorded: time between trauma and osteosynthesis, hospitalization length, surgical time, and exposure time to fluoroscopy. Age and gender, mechanism of injury, and characteristics of fractures were recorded. For functional outcome, AOFAS score, VAS, and Weber score were used. Radiographic analysis was performed. The average follow-up was 112 months.Results: Mean age was 48.2 years old. Average length of stay in hospital was 5.72 h. Mean duration of the surgery was 32.8 min. Average fluoroscopic exposure time during surgery was 9.25 s. Mean bone union time was 38.2 days. Weber's score was on average 1.5/24 points and the long-term follow-up AOFAS score was on average 97.5/100. Postoperative complications incidence was 2.7%.Conclusions: Distal fibula fixation with the MIPO technique presented good functional outcomes and could be helpful in the avoidance of the complications associated with conventional open reduction and internal fixation. However, it needs more exposition to intraoperative fluoroscopy.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Introduction: This study evaluated the optimal anatomical locking plate position using three-dimensional printed models of the clavicle. Materials and methods: Three-dimensional models of the fractured clavicle were reproduced from seventeen patients who underwent minimally invasive plate osteosynthesis (MIPO) procedures. The fracture location—the percentage of the distal fragment length compared to the entire clavicle—ranged from 30–44%. We evaluated four commercially available plate systems for position and fitting with the bone. After reducing the fracture on each three-dimensional model, we determined the optimal plate and its position. Results: The anatomical plate fitted well when positioned in the middle of the clavicle for a fracture location ranging from 40 to 60%. When the fracture location was 30–40%, the anatomical plate fit well onto the bone model only in 36% of clavicles; otherwise, the reversed position of the anatomical plate or the lateral plate fit well. The anatomical plate was found to be unsuitable when the fracture location was less than 30%; in this case, the lateral plate was the best fit. Conclusion: Fitting the anatomical plate in MIPO for clavicle fractures depends on the fracture location. This can help surgeons determine the optimal plate for clavicle MIPO. [ABSTRACT FROM AUTHOR]

Trajectory outlier detection is one of the fundamental data mining techniques used to analyze the trajectory data of the Global Positioning System. A comprehensive literature review of trajectory outlier detectors published between 2000 and 2022 led to a conclusion that conventional trajectory outlier detectors suffered from drawbacks, either due to the detectors themselves or the pre-processing methods for the variable-length trajectory inputs utilized by detectors. To address these issues, we proposed a feature extraction method called middle polar coordinates (MiPo). MiPo extracted tabular features from trajectory data prior to the application of conventional outlier detectors to detect trajectory outliers. By representing variable-length trajectory data as fixed-length tabular data, MiPo granted tabular outlier detectors the ability to detect trajectory outliers, which was previously impossible. Experiments with real-world datasets showed that MiPo outperformed all baseline methods with 0.99 AUC on average; however, it only required approximately 10% of the computing time of the existing industrial best. MiPo exhibited linear time and space complexity. The features extracted by MiPo may aid other trajectory data mining tasks. We believe that MiPo has the potential to revolutionize the field of trajectory outlier detection.