Minimally invasive plate osteosynthesis: Does percutaneous plating disruptfemoral blood supply less than the traditional technique?

Objectives/Hypothesis: Proximal and distal femur fractures have traditional ly been treated with open reduction and internal fixation through a standar d lateral approach. New, "minimally invasive" internal fixation techniques, however, have been developed in an effort to devascularize the bone less t han the traditional method. The purpose of this study was to determine whet her a minimally invasive percutaneous plating technique better preserves bo ne vascularity relative to the traditional method by comparing the effect o f the two approaches on the blood supply of the distal femur using silicone arterial dye injection in a cadaveric model. Study Design/Methods: Ten fresh human cadavers underwent lateral convention al plate osteosynthesis (CPO) through a standard lateral approach on one si de and minimally invasive plate osteosynthesis (MIPO) through two three-cen timeter incisions on the contralateral side. After injection of silicone dy e, a dissection was performed bilaterally to identify the femoral perforati ng and nutrient arteries. Results: All MIPO specimens showed intact perforating and nutrient arteries , whereas the CPO specimens had a variable incidence of vessel disruption. The MIPO group demonstrated better periosteal perfusion in each of the cada vers and improved medullary perfusion in 70 percent of the MIPO specimens c ompared with the CPO specimens. Conclusion: A percutaneous minimally invasive plating technique disrupts th e femoral blood supply less than the traditional open method. Such minimall y invasive methods may be more advantageous biologically than the tradition al method.