Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures

Abstract

In a prospective study, 14 cases of supracondylar or subtrochanteric fractures or osteotomies were stabilized with a dynamic condylar screw (DCS) inserted using a minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. The technique consisted of 4 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. Between October 1994 and December 1995, 14 cases in 12 patients met the inclusion criteria. There were 11 acute fractures (6 subtrochanteric, 5 supracondylar) and 3 corrective osteotomies. Nine fractures were closed, and 2 were open. One 97-year-old patient died 6 weeks after trauma. There were no infections and 12 of 13 cases healed without a second procedure. There was 1 implant failure (plate screw breakage), which required repeat fracture fixation. At follow-up, there were 2 varus deformities above 5 degrees, 2 shortenings over 20 mm, and 1 rotational deformity of 20 degrees. According to the Neer score, there were 6 excellent, 1 satisfactory, 3 unsatisfactory results and no failures. The results of this technique compare favourably 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.