INTRODUCTION
Minimally invasive plate osteosynthesis (MIPO) has the advantages of reducing surgical trauma to the soft tissue envelope with less disturbance of the fracture site haematoma and a reduced wound length.1–4 Potential disadvantages include entrapment of neurovascular structures beneath the plate, mal-reduction and inaccurate plate position. We present a technique which significantly reduces X-ray exposure when performing MIPO. The example used is that of the distal tibia locking compression plate (LCP; Synthes, Stratec Medical, Oberdorf, Switzerland); however, the principle can be applied to any minimally invasive plating system for which there are no specific jigs.
Figure 1.
Screw holes of the superficial plate are marked, mirroring the screw holes inserted plate
TECHNIQUE
The fracture is reduced, the plate is introduced through a small incision and its position confirmed using fluoroscopy. Temporary k-wires are inserted through the designated holes in each end of the plate. Usually, fluoroscopy is required to locate each screw hole in the plate prior to making incisions for screw insertion. Instead of this, a duplicate, ‘mirror’, plate is applied over the previously inserted k-wires and pressed down onto skin. Using a sterile marker pen, the holes of the overlying plate are drawn onto the underlying skin. The superficial plate essentially mirrors the inserted plate and acts as a template for screw positions. Incisions are centred on these skin marks and the screws are inserted in the usual manner into either the locking or compression holes.
DISCUSSION
We have found this to be a highly useful technique which not only aids in screw hole location but also significantly reduces the operation time and the use of intra-operative fluoroscopy.
References
- 1.Redfern DJ, Syed SU, Davies SJM. Fractures of the distal tibia: minimally invasive plate osteosynthesis. Injury. 2004;35:615–20. doi: 10.1016/j.injury.2003.09.005. [DOI] [PubMed] [Google Scholar]
- 2.Cole PA, Zlowodzki M, Kregor PJ. Less invasive stabilization system (LISS) for fractures of the proximal tibia: indications, surgical technique and preliminary results of the UMC clinical trial. Injury. 2003;34(Suppl. 1):A16–29. doi: 10.1016/s0020-1383(03)00254-7. [DOI] [PubMed] [Google Scholar]
- 3.Schütze M, Kääb MJ, Haas N. Stabilization of proximal tibial fractures with the LISS-system: early clinical experience in Berlin. Injury. 2003;34(Suppl. 1):A30–5. doi: 10.1016/s0020-1383(03)00255-9. [DOI] [PubMed] [Google Scholar]
- 4.Stannard JP, Wilson TC, Volgas DA, Alonso JE. Fracture stabilization of proximal tibial fractures with the proximal tibial LISS: early experience in Birmingham, Alabama (USA) Injury. 2003;34(Suppl. 1):A36–42. doi: 10.1016/s0020-1383(03)00256-0. [DOI] [PubMed] [Google Scholar]