Biologic fixation of lower extremity long bone fractures with minimally invasive percutaneous plate osteosynthesis

Twent-three patients (24 lower extremity fractures) who were admitted to Department of Orthopaedics and Traumatology, Faculty of Medicine, Abant Izzet Baysal University between January 2007 and June 2009 with lower extremity long bone fractures were included to the study. The patients were treated by biological fixation using the Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) method. Sixteen of our cases were male and seven were female, with an average age of 43.6 years.Out of total 24 applications, 17 were applied to the tibia and seven were applied to the femur. Four of the tibia fractures were proximally, 10 were diaphysially, and three were distally placed; as for the femur fractures, four were diaphysially, and three were distally placed. Five patients had open fractures.Biological fixation was applied in all cases using equally sized plates under fluoroscopy control following indirect reduction by manual traction. Average surgery time was 76.6 minutes, with the average scopy time being 183.7 seconds. During the surgery, no patients needed primary grafting. Partial weight-bearing periods were; 6th week in five patients, 9th week in one patient, and 12th week in one patient for femur fractures. Mobilization by partial weight was allowed at the end of 6th week in all patients with tibia fractures. Full weight-bearing period was 6th week in one patient, 9th week in three patients, 12th week in two patients, and 6th month in one patient for femur fractures. Full weight was given at the 6th week in eight patients, 9th week in six patients, and 12th week in two patients for tibia fractures. An evaluation of radiological union periods revealed an union in an average of 5,2 months in patients with femur fractures, and at the end of an average of 3,1 month in patients with tibia fractures. No patients showed complications like superficial and/or deep skin infections and skin necrosis during the early postoperative period. None of our patients showed non-union, refractures, and osteomyelitis. Average follow-up period was 17.8 months (12-24 months). Final follow-ups showed 15° valgus deformity in a patient with tibia fracture and 10° valgus deformity in a patient with femur fracture. Patients with femur fractures were evaluated functionally using the Johner and Wrush criteria, and patients with tibia fractures were evaluated on the basis of modified Ketenjian?s criteria. Femur applications showed fair results in two patients, good results in three patients, and excellent results in two patients. Whereas tibia applications showed fair results in one patient, good results in three patients, and excellent results in 12 patients.Biological fixation using the MIPPO technique is an alternative treatment method with successful results in diaphyseal fractures as well as in metaphyseal and intra-articular fractures. This technique reduces the dependence on scopy thanks to screw fixation applied by equally sized plating method.