MINIMALLY INVASIVE PERCUTANEOUS PLATE OSTEOSYNTHESIS (MIPPO) USING THE DCS IN PROXIMAL AND DISTAL FEMORAL FRACTURES

In a prospective study, 14 cases of supracondylar or subtrochanteric f ractures or osteotomies were stabilized with a dynamic condylar screw (DCS) inserted using a minimally invasive percutaneous plate osteosynt hesis (MIPPO) technique, The technique con:ted of 4 major steps: Ij pl acement Of the guide wire under fluoroscopic control and condylar scre w insertion through a stab incision; 2) plate insertion beneath the va stus lateral muscle; 3) engagement of the condylar screw to the plate using a modified T-handle and, 4) plate fixation to the shaft using pe rcutaneously inserted self-cutting screws, Between October 1994 and De cember 1995, 14 cases in 12 patients met the inclusion criteria. There were 11 acute fractures (6 subtrochanteric, 5 supracondylar) and 3 co rrective osteotomies. Nine fractures were closed, and 2 were open. One 97-year-old patient died 6 weeks after trauma. There were no infectio ns and 12 of 13 cases healed without a second procedure. There was I i mplant failure (plate screw breakage), which required repeat fracture fixation. At follow-up, there were 2 varus deformities above 5 degrees , 2 shortenings over 20 mm, and I rotational deformity of 20 degrees. According to the Neer score, there were 6 excellent, 1 satisfactory, 3 unsatisfactory results and no failures. The results of this technique compare favourably with those of other series of osteosynthesis of su btrochanteric or supracondylar femoral fractures treated with internal fixation without the added morbidity associated with an extensive app roach or autogenous bone grafting. However, the surgical technique is demanding, and care must be taken to restore the axial alignment.