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Krettek Christian M.D.; Stephan, Christine M.D.; Miclau, Theodore M.D.; Tscherne, Harald M.D.
Techniques in Orthopaedics: September 1999
Minimally Invasive Orthopaedics: Articles: PDF Only


In a prospective study, supracondylar femoral fractures were stabilized with a dynamic condylar screw (DCS) inserted using a minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. The technique consisted of four major steps: (1) placement of the guide wire under fluoroscopic control and condylar screw insertion through a stab incision; (2) plate insertion beneath the vastus lateral muscle; (3) engagement of the condylar screw to the plate using a modified T-handle; and (4) plate fixation to the shaft using percutaneously inserted self-cutting screws. In a pilot study between October 1995 and December 1996, six supracondylar fractures in five patients met the inclusion criteria. Three fractures were closed and three were open. One 81-year-old patient was lost to follow up. There was no infection and all cases healed without a second procedure. At follow up (minimum 21 months), there was no varus deformity above 5& one shortening above 20 mm in a patient with a preexisting shortening after total hip, and one rotational deformity of 20&. According to the Neer score, there were four excellent and one unsatisfactory result and no failures. The results of this technique compare favorably with those of other series of osteosynthesis of subtrochanteric or supracondylar femoral fractures treated with internal fixation without the added morbidity associated with an extensive approach or autogenous bone grafting. However, the surgical technique is demanding, and care must be taken to restore the axial alignment.

© 1999 Lippincott Williams & Wilkins, Inc.