MINIMALLY INVASIVE PLATE FIXATION IN FEMORAL-SHAFT FRACTURES

Bridge-plating with its advantages in terms of vascularity and bone he aling is a well established procedure today in the treatment of commin uted femoral fractures. Bridge-plating means that the fracture site is not interfered with during the operative procedure. This paper introd uces a surgical technique in which the plate is inserted through isola ted proximal and distal incisions only, behind the vastus lateralis. A lignment is secured by the plates, the fracture site remains untouched , fixation and screw insertion is restricted to the proximal and dista l main fragments. Longitudinal femoral fractures extending right into the trochanteric and or condylar areas are the main indication for min imally invasive plate fixations with angled blade plates or condylar s crews since fractures which are restricted to the diaphyseal area are mostly treated by nailing today. The surgical trauma resulting from pl ating by proximal and distal incisions only is less than that associat ed with conventional techniques. Indirect reduction of femoral fragmen ts is much easier since the integrity of the surrounding muscles and s oft tissue is preserved, the fragments often being reduced simply by t raction. Adjustment of rotation is an essential aspect requiring caref ul attention. For special indications, namely comminuted fractures aff ecting a large part of the femur and extending into the trochanteric o r condylar areas, insertion of the plate via proximal and distal incis ions only is a further development in bridge-plating which minimizes s urgical trauma and operation time.