内固定技术精选.ppt

Definitions MIO Small incisions Big enough to deal with an articular fracture Small at the level of the fracture if necessary and minimal at the shaft MIPO VS. conventional plating Disadvantages of MIPO A cadaver injection study of minimally invasive VS. conventional plate osteosynthesis Farouk Osama, Krettek Christian, Miclau Theodore, Schandelmaier Peter, Guy Pierre, and Tscherne Herald Minimally Invasive vs.Conventional Plating (Farouk et al., JOT, 1999) Conclusion 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. But we forget  with the technique that has least disturbance of the soft tissue. What I have changed ? If you believe that close IM nailing is a great advanced in operative treatment of fracture Why not doing closed extramedullary plating ? Midshaft Femoral Fracture 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 fracture Misunderstanding Make the smallest incision possible Relative stability is not stable Too much radiation exposure Prolong operative time It have more malalignment How to locate the plate 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 hole Small incisions Indirect reduction Aligning length, axis, rotation Precontouring of plate Shifting of plate in preexisting cavities Fixation of plate on each side No exposure of fracture-site Minimally invasive plate No attempts to achieve anatomical reduction No interfragmentary compression Stab incision for screw-insertion Only few screws No screws at fracture site Plate as a bridging function only No bone-graft is necessary Minimally invasive plate Review of the AO’s Minimally Invasive Plate Osteosynthesis (MIPO) book