Mipo

স্বাগতম,[object Object]

MIPO (Minimal Invasive Plate Osteosynthesis)A Good Option for Treatment of Comminuted Diaphyseal and Metaphyseal Fracture of a Weight bearing Long bone.,[object Object]

Presented by,[object Object],Dr. Mohammad KhurshedAlam,[object Object],Assistant Professor,[object Object],Department of Orthopaedics and Traumatology,[object Object],Dhaka Medical College,[object Object]

Our study,[object Object],Place of Study: ,[object Object],Dhaka Medical College Hospital and private clinics in Dhaka.,[object Object],Period of study: July 2009---December 2010,[object Object],Study Population:,[object Object], comminuted diaphyseal and metaphyseal fracture of Femur and tibia.,[object Object],Number of Patients: 23,[object Object],Follow-up Period: 6 months to 18 months,[object Object],Fixation Techniques: MIPO,[object Object],Implant used: LCP/ Metaphyseal Locking Plate ,[object Object], (Distal Femoral / Proximal Tibial ),[object Object]

Mipo,[object Object],MIPO: minimally invasive plate osteosynthesis,[object Object],Tunneling a plate across a fracture via small skin incisions at each end of the bone. ,[object Object],avoids the long surgery time and big wounds associated with traditional plate fixation,[object Object]

Mipo-Benefits,[object Object],MIPO,[object Object]

Indication,[object Object],MIPO is most suitable for,[object Object],Multi-fragmentary fractures,[object Object],Fractures extending to the articular surfaces,[object Object],Segmental Fractures,[object Object],Narrow medullary canals (<9mm),[object Object],Deformed shaft ( malunion),[object Object],Open fractures, after wound coverage & ,[object Object], infection control.,[object Object]

Contraindications,[object Object],Severe soft tissue loss with no coverage of exposed bone,[object Object],Associated vascular injuries,[object Object],Compartment Syndrome,[object Object],Pathological fractures,[object Object],Osteomyelitis,[object Object],Delayed surgery with shortening of the limb,[object Object],Delayed reconstruction ( required bone graft),[object Object]

Fractures we faced.,[object Object],3,[object Object],4,[object Object]

Fractures we faced.,[object Object]

Options we have,[object Object]

Choice of implants.,[object Object],Locking plates and screws,[object Object]

Surgical Procedure,[object Object],Positioning of the patient,[object Object],Manual Reduction,[object Object]

Surgical Procedure…,[object Object],Primary fixation on the condyles,[object Object],Incision and insertion of the plate.,[object Object]

Surgical Procedure…,[object Object],K-wire fixation with the shaft,[object Object],Second incision and palpation of the plate,[object Object]

Surgical Procedure…,[object Object],Distal screw insertion,[object Object],First proximal screw insertion,[object Object]

Surgical Procedure…,[object Object],Fixation of plate with the shaft,[object Object],Completed osteosynthesis,[object Object]

After care,[object Object],Isometric quardiceps exercise from 1st POD.,[object Object],Non-weight bearing crutch walking when pain subsides,[object Object],knee bending exercise after 4 weeks. ,[object Object],Toe touch weight bearing after 6 weeks. ,[object Object],partial weight bearing from 12 weeks ,[object Object],full weight bearing from 20 -22 weeks after seeing the progress in X –ray . ,[object Object], Radiographic evaluation was performed every six weeks until complete healing occurs.,[object Object]

Our experiences,[object Object],Case one details:,[object Object],Mrs. Patient, 45 years old house –wife.,[object Object],H/O Fall on the ground.,[object Object],Fixation done after 7 days of trauma,[object Object]

Our experiences…,[object Object],After Reduction,[object Object],Position of the plate,[object Object]

Our experiences…,[object Object],Fixation checked under C-Arm,[object Object],Skin incision closure,[object Object]

Follow-up after 6 wks,[object Object],Follow-up after 12 wks,[object Object],Our experiences…,[object Object]

Our experiences…,[object Object],Case two details:,[object Object],Mr. Patient, 42 years old Banker. ,[object Object],H/O Motor bike accident.,[object Object],Fixation done after 10 days of trauma.,[object Object]

Follow up after 2 wks,[object Object],After 4 wks.,[object Object],Our experiences…,[object Object]

Our experiences…,[object Object],Follow-up after 6 wks of fixation.,[object Object],Follow-up after 6 wks of fixation,[object Object]

Our experiences…,[object Object],After 12 wks ,[object Object]

Another case:,[object Object],Our experiences…,[object Object],Mr. Patient2, 25 years, male,[object Object],H/O Road traffic accident,[object Object],A case of Polytrauma,[object Object],Head injury with ,[object Object],[object Object]

Communited # Distal radius with articular extension

Posterior dislocation of hip.,[object Object]

Outcome,[object Object],23 patients were studied, 3 lost in follow-up,[object Object],Average age 31.5 years (20-50 years). ,[object Object]

Outcome,[object Object],[object Object]

15 from RTA and 5 from fall from height.,[object Object]

Outcome,[object Object],Fracture union time:,[object Object],[object Object]

2 had delayed union :>32 weeks . Alignment after union:,[object Object],There were no varus or valgus mal-alignment more than 10⁰,[object Object],[object Object]

10 degrees ⁰ varus angulation: One patient,[object Object]

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