Online ISSN: 2515-8260

Keywords : MIPPO

Surveillance of biological plating in comminuted fractures of long bones: Our experience at a tertiary care hospital

Rabindra Kumar Nayak, Sambit Kumar Panda, Sidhartha Samal, S Jaganath Subudhi, Abanikanta Mishra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1608-1619

Osteosynthesis with open reduction technique in comminuted fracture has several disadvantages like increase rate of non-union, non-healing of soft tissue, infection and failure of implant. These problems can be managed by percutaneous minimally invasive plating technique which preserve the vascularity and soft tissue anatomy of fracture fragments.
A total of 40 patients were involved in this study. Distal tibia with or without fibula fracture (12), Diaphyseal tibia (10), Proximal tibia (8), Supra condylar Femur (6) and Subtrochanteric Femur (4) were operated by using the principles of indirect reduction and biological fixation with plates under C-arm guidance. Weight bearing was allowed according to the clinical and radiological union at follow up.
Most patients regained excellent range of motion of adjoining joints. Mean time of radiological union was 20.12 weeks. Two patients had soft tissue infections which healed with wound care and dressing. One patient had non-union which was managed by bone grafting. In this study excellent result was seen in eighteen cases, good in five and fair in other patients.
This study indicates that minimally invasive percutaneous plating is an effective method for treatment of comminuted diaphyseal fracture of long bones. These complex fractures goes onto complete recovery and normal limb function at an early stage with fewer complication

Approach to Multiple Injuries of Foot and Ankle (Single stage procedure for lisfranc injury, pan metatarsal fractures with distal tibia fracture and medial malleolus fracture): A rare case report

Dr.K.Vijaya shankar, Dr.A.Senthilnathan, Dr.R.Prabhakar, Dr.M.Chakravarthi .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 96-101


Outlines the necessity of early diagnosing and management of lisfranc injury and metatarsal fracture to avoid chronic instability.
Advantages of plate fixation for (proximal) fifth metatarsal fracture in addition to k-wire.
To assessing the functional outcome and duration of union using MIPPO technique in the management of distal third tibia fracture.

Materials and Methods:
Case Report: We report a case of 32 year old man presenting with multiple injuries to foot and ankle diagnosed as comminuted distal third tibia fracture (with medial malleolus fracture) with panmetatarsal fracture with lifranc dislocation of right lower limb. A single stage procedure done for fixation of all these injuries.
Result; The patient follow up for one year, mean duration union of all fractures noted radiologically by 11±2 weeks. Patient allowed to weight bear after 3 months, Functional range of motion improved from the end of 3 months to 8 months. Prospective functional evaluation of this patient assessed by American orthopaedic foot and ankle society score (AOFAS) 96/100 at the end of 6 months and Pain relief is evaluated periodically by visual analogue scale.
Conclusion: Best results are obtained by immediate anatomical reduction and fixation of lisfranc injuries. In addition to k-wire, plate fixation for fifth metatarsal provides alignment with high union rate, especially when the fracture is comminuted. MIPPO technique is reliable fixation in fracture of distal tibia preserving most osseous (periosteal) blood supply and haematoma  in fracture site and in turn provides  more biological repair.