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Minimally invasive plate osteosynthesis is a new technics in Bangladesh. This presentation is for Annual BOSCON Conference, 2011

Minimally invasive plate osteosynthesis is a new technics in Bangladesh. This presentation is for Annual BOSCON Conference, 2011

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    Mipo Mipo Presentation Transcript

    • স্বাগতম
    • MIPO (Minimal Invasive Plate Osteosynthesis)A Good Option for Treatment of Comminuted Diaphyseal and Metaphyseal Fracture of a Weight bearing Long bone.
    • Presented by
      Dr. Mohammad KhurshedAlam
      Assistant Professor
      Department of Orthopaedics and Traumatology
      Dhaka Medical College
    • Our study
      Place of Study:
      Dhaka Medical College Hospital and private clinics in Dhaka.
      Period of study: July 2009---December 2010
      Study Population:
      comminuted diaphyseal and metaphyseal fracture of Femur and tibia.
      Number of Patients: 23
      Follow-up Period: 6 months to 18 months
      Fixation Techniques: MIPO
      Implant used: LCP/ Metaphyseal Locking Plate
      (Distal Femoral / Proximal Tibial )
    • Mipo
      MIPO: minimally invasive plate osteosynthesis
      Tunneling a plate across a fracture via small skin incisions at each end of the bone.
      avoids the long surgery time and big wounds associated with traditional plate fixation
    • Mipo-Benefits
      MIPO
    • Indication
      MIPO is most suitable for
      Multi-fragmentary fractures
      Fractures extending to the articular surfaces
      Segmental Fractures
      Narrow medullary canals (<9mm)
      Deformed shaft ( malunion)
      Open fractures, after wound coverage &
      infection control.
    • Contraindications
      Severe soft tissue loss with no coverage of exposed bone
      Associated vascular injuries
      Compartment Syndrome
      Pathological fractures
      Osteomyelitis
      Delayed surgery with shortening of the limb
      Delayed reconstruction ( required bone graft)
    • Fractures we faced.
      3
      4
    • Fractures we faced.
    • Fractures we faced.
    • Options we have
    • Choice of implants.
      Locking plates and screws
    • Surgical Procedure
      Positioning of the patient
      Manual Reduction
    • Surgical Procedure…
      Primary fixation on the condyles
      Incision and insertion of the plate.
    • Surgical Procedure…
      K-wire fixation with the shaft
      Second incision and palpation of the plate
    • Surgical Procedure…
      Distal screw insertion
      First proximal screw insertion
    • Surgical Procedure…
      Fixation of plate with the shaft
      Completed osteosynthesis
    • After care
      Isometric quardiceps exercise from 1st POD.
      Non-weight bearing crutch walking when pain subsides
      knee bending exercise after 4 weeks.
      Toe touch weight bearing after 6 weeks.
      partial weight bearing from 12 weeks
      full weight bearing from 20 -22 weeks after seeing the progress in X –ray .
      Radiographic evaluation was performed every six weeks until complete healing occurs.
    • Our experiences
      Case one details:
      Mrs. Patient, 45 years old house –wife.
      H/O Fall on the ground.
      Fixation done after 7 days of trauma
    • Our experiences…
      After Reduction
      Position of the plate
    • Our experiences…
      Fixation checked under C-Arm
      Skin incision closure
    • Follow-up after 6 wks
      Follow-up after 12 wks
      Our experiences…
    • Our experiences…
      Case two details:
      Mr. Patient, 42 years old Banker.
      H/O Motor bike accident.
      Fixation done after 10 days of trauma.
    • Follow up after 2 wks
      After 4 wks.
      Our experiences…
    • Our experiences…
      Follow-up after 6 wks of fixation.
      Follow-up after 6 wks of fixation
    • Our experiences…
      After 12 wks
    • Another case:
      Our experiences…
      Mr. Patient2, 25 years, male
      H/O Road traffic accident
      A case of Polytrauma
      Head injury with
      • Communited # shaft tibia
      • Communited # Distal radius with articular extension
      • Posterior dislocation of hip.
    • Per-operative X-ray
      Follow-up after 6 wks
      Our experiences…
    • Outcome
      23 patients were studied, 3 lost in follow-up
      Average age 31.5 years (20-50 years).
    • Outcome
      • Out of 20 fractures , 15 diaphyseal and 5 Metaphyseal.
      • 15 from RTA and 5 from fall from height.
    • Outcome
      Time of surgery:
      7- 15 days (Average 9 days).
      operating time:
      Average 105 minutes (90minutes-135 minutes).
      Average C-arm /X-ray exposure :
      7 minutes (5 – 12 minutes).
      Follow up period:
      6 months to 18 months (average 12 months).
    • Outcome
      Fracture union time:
      • 18 fractures were united within 16-28 weeks (average- 18 weeks) ,
      • 2 had delayed union :>32 weeks .
      Alignment after union:
      There were no varus or valgus mal-alignment more than 10⁰
      • 10 ⁰(A/P) mal-alignment: One patient
      • 10 degrees ⁰ varus angulation: One patient
    • Outcome
      Criteria:
      Fracture union
      Knee ROM
      Ability to return to previous activities
      One patient required one dose of bone marrow injection for fracture union .
      one has to change his profession.
    • Conclusion
      “MIPO technique is the good option for comminuted, diaphyseal and metaphyseal fracture
      of a weight bearing long bone”
    • ধন্যবাদসবাইকে