Minimally Invasive Plate Osteosynthesis for Femoral Mid-Diaphyseal Fractures

Hyoung-Keun Oh; Suk-Kyoo Choo; Jong-In Kim; Sung-Jong Woo

doi:10.12671/jkfs.2013.26.2.140

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Oh, Choo, Kim, and Woo: Minimally Invasive Plate Osteosynthesis for Femoral Mid-Diaphyseal Fractures

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2013; 26(2): 140-146.

Published online: 22 April 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.2.140

Minimally Invasive Plate Osteosynthesis for Femoral Mid-Diaphyseal Fractures

Hyoung-Keun Oh, M.D., Suk-Kyoo Choo, M.D., Jong-In Kim, M.D., Sung-Jong Woo, M.D.

Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.

Address reprint requests to: Hyoung-Keun Oh, M.D. Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Korea. Tel: 82-31-910-7968, Fax: 82-31-910-7967, osd11@paik.ac.kr

Received 23 October 2012 Revised 14 January 2013 Accepted 12 February 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the surgical outcomes of patients with femoral mid-diaphyseal fractures treated with minimally invasive plate osteosynthesis (MIPO), which were difficult to intramedullary nailing.

Materials and Methods

We evaluated 11 patients with femoral mid-diaphyseal fractures who were treated with MIPO. There were 7 males and 4 females and the mean age was 47 years (20-85 years). According to AO/OTA classification, there were 1 type of A1, 5 types of A3, 1 of B2 and 4 of B3. The reason of plate fixation instead of intramedullary nailing is as follows: femoral vessel and severe soft tissue injuries-2 cases, polytrauma patients with chest injury-6 cases, and narrow medullary canal diameter-3 cases. Six out of 11 cases were treated with initial external fixation as a damage control orthopedics.

Results

The mean union time of 6 cases was 3.7 months (3-5 months). There were 5 cases (45%) of nonunion, which should be treated with autogenous bone graft. All cases of nonunion resulted from severe soft tissue damage and polytrauma, which needed initial external fixation. There was no case of malalignment and implant-related complication.

Conclusion

In cases of difficult intramedullary nailing for the femoral mid-diaphyseal fractures, MIPO could be an alternative surgical option, but concurrent soft tissue injuries and multiple trauma may increase the risk of nonunion in spite of biological fixation.

Keywords: Femur, Femoral shaft fracture, Minimally invasive plate osteosynthesis

Figures and Tables

Fig. 1

(A) A case of 20 years old male. Plain radiographs shows B3 femoral mid-diaphyseal fracture. Intamedullary nailing was contraindicated because of narrow medullay canal.

(B) (a) Postoperative radiograph shows good reduction and alignment of fracture after minimally invasive plate osteosynthesis. (b) Three months follow-up radiograph shows bridging callus. (c) Twelve months follow-up radiographs show solid bony union.

Fig. 2

(A) A case of 32 years old male. Plain radiographs and angiography show B3 femoral mid-diaphyseal fracture with total occlusion of the femoral artery (arrow).

(B) (a) There was severe soft tissue injury on the lateral thigh. (b) Bypass femoral artery reconstruction (arrow) was carried out through the medial open wound. (c) Femoral fracture was stabilized by temporary external fixation.

(C) (a) External fixator was converted to interal fixator using minimally invasive plate osteosynthesis technique after 18 days of the initial injury. (b) Previous external fixator and prevented locking compression plate could be used as a reduction tool. (c) Postoperative radiographs show good alignment of the fracture.

(D) (a) Plain radiographs show nonunion of femoral mid-diaphyseal fracture after 8 months of plate fixation. (b) After autogenous bone graft and supplementary plate fixation, solid bony union could be obtained.

Table 1

Demographic Data and Surgical Outcomes

E/F: External fixation, F: Female, M: Male, LCP: Locking compression plate, LCP-DF: Locking compression plate in distal femur.

^*AO/OTA classification, ^†Gustillo-Anderson classification.

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