Osteosíntesis mínimamente invasiva con placa anatómica bloqueada en fracturas desplazadas del tercio medio de clavícula / Minimally invasive osteosynthesis with blocked anatomical plate in displaced fractures of the middle third of the clavicle

Resumen: El tratamiento quirúrgico de las fracturas desplazadas del tercio medio de clavícula ha ganado popularidad durante la última década, ya que permite acortar el período de recuperación, acelerando la reincorporación laboral y deportiva, al mismo tiempo que disminuye significativamente el riesgo de no unión. Sin embargo, las molestias relacionadas con el abordaje cutáneo como dolor e irritación a nivel de la cicatriz, las alteraciones sensitivas persistentes (hipoestesia, hiperestesia o disestesias) y la inconformidad cosmética continúan siendo motivo de preocupación por parte de los pacientes, alterando su percepción subjetiva del resultado quirúrgico obtenido. En tiempos recientes la técnica mínimamente invasiva se ha descrito para el manejo de este tipo de fracturas, demostrando reducir las posibles complicaciones de la técnica tradicional abierta mientras que mantiene sus principales beneficios, optimizando además la capacidad biológica reparativa de la clavícula, ya que respeta la vascularización del foco de fractura. El objetivo de este artículo es describir paso a paso la técnica quirúrgica mínimamente invasiva para el manejo de fracturas desplazadas del tercio medio de clavícula, reportando además los resultados clínicos obtenidos en una serie de casos intervenidos con esta técnica.

Abstract: Surgical management of displaced midshaft clavicular fractures has gained popularity in the last decade due to reductions in functional recovery times and lower rates of nonunion. However, several complications related to the open approach have been described and remain concerning for patients. These potential sequelae include scar pain, local irritation, peri-incisional numbness, and cosmetic deformity, all of which may contribute to unsatisfactory subjective outcomes. Recently, minimally invasive plate osteosynthesis (MIPO) technique has been described for the treatment of these fractures. This approach presents the opportunity to reduce shortcomings of the traditional open approach while maintaining its benefits, respecting the biological healing environment and preserving blood supply to the fracture site. The purpose of this study is to provide a step-by-step description of the MIPO surgical technique for management of displaced midshaft clavicular fractures and report the clinical outcomes of a case series using this technique.

Osteosíntesis percutánea con placas volares bloqueadas en fracturas metafisarias distales de radio. Descripción de la técnica y resultados preliminares / Percutaneous volar locked plate fixation in metaphyseal fractures of distal radius. Technical description and preliminary results

Objetivo: Evaluar los resultados objetivos y subjetivos obtenidos luego de una osteosíntesis con placas en T bloqueadas volares, colocadas mediante una técnica mínimamente invasiva, en fracturas de radio distal con extensión metafisaria. Materiales y Métodos: Evaluación retrospectiva de seis pacientes adultos que presentaron fracturas inestables de radio distal, extrarticulares o articulares parciales, con extensión metafisaria, tratadas quirúrgicamente con placas en T largas de compresión bloqueadas volares, mediante una técnica mínimamente invasiva, entre 2007 y 2012. Edad promedio: 40.17 años. Fracturas de tipo 23A3 (n=6) de la Clasificación AO/OTA. Se realizó la reducción indirecta, bajo radioscopia y, a través de dos pequeñas incisiones, se deslizó, en forma percutánea, una placa bloqueada volar en T. Se analizaron los parámetros radiográficos, el rango de movimiento y la fuerza. Los resultados subjetivos fueron evaluados usando la escala DASH y la escala analógica visual. Resultados: Tiempo de consolidación promedio: 2.4 meses. Los resultados radiográficos no mostraron diferencias significativas entre el primero y el último control al año de seguimiento. Flexión y extensión promedio: 70° y 60°, pronación y supinación: 79° y 80°, respectivamente. Fuerza de prensión promedio: 78,4%. Puntaje DASH 19,82; escala analógica visual 1,5 puntos. Conclusiones: Las técnicas mínimamente invasivas reducen el daño quirúrgico y las complicaciones. Son una opción en pacientes con daño grave de partes blandas, conminución metafisaria y trauma de alta energía. La colocación de placas volares bloqueadas percutáneas es un procedimiento técnicamente demandante, permite obtener fijaciones estables y restaurar la anatomía radial en fracturas de radio distal con extensión metafisaria.

Objective: To evaluate objective and subjective outcomes after closed reduction and minimally invasive volar locked T-plate osteosynthesis for distal radius fractures with metaphyseal involvement. Methods: We retrospectively evaluated six patients treated with minimally invasive volar locked T-plate osteosynthesis for unstable extra-articular or partial articular distal radius fractures with metaphyseal involvement, between 2007 and 2012. Average age: 40.17 years. According to the AO/OTA classification, all patients had 23A3 type fractures. Indirect reduction was performed. Two volar small incisions were made; a volar locked compression T-plate was introduced in the sub-muscular plane, under radioscopic guidance. Analysis included radiological parameters, range of motion and strength. Subjective results were assessed using DASH score and the Visual Analogue Scale. Results: All fractures healed within 2.4 months. Radiographic outcomes showed no differences between the first postoperative control and the last one at one-year follow-up. Average flexion and extension 70° and 60°, pronation and supination: 79° and 80°. Grip strength: 78.4%. DASH score 19.82 and visual analogue scale: 1.5 points. Conclusions: Minimally invasive technique decreases surgical injury and complications. It is an option in patients with metaphyseal comminution, severe soft tissue injuries and high energy trauma. Percutaneous volar locked compression plate allows to obtain a stable fixation and to restore distal radius anatomy in radius fractures with metaphyseal involvement.

Minimally Invasive Percutaneous Plating of Pediatric Femoral Fractures / 대한정형외과학회잡지

PURPOSE: To determine the efficacy of percutaneous plating for pediatric femoral fractures. MATERIALS AND METHODS: Fourteen children (mean age, 9.1 years-old) with a femoral fracture were treated with minimally invasive percutaneous plating. After a temporary reduction by manual traction or flexible nailing, a plate was inserted into the submuscular plane through proximal or distal incisions of 2-3 cm. Screws were then fixed with the control of the fracture alignment under fluoroscopic guidance. All procedures were carried out without opening the fracture site. The locations of the fracture are as follows: 10 in the middle, 2 in the subtrochanteric, 1 in the proximal, and 1 in the distal area. Seven had a comminution in the fracture, and nine had associated injuries or fractures. According to Flynns criteria, the patients were evaluated after a minimum of 1 year (mean, 2.1 years). RESULTS: All the fractures united without the need for a bone graft. The mean radiographic healing time was 11.1 weeks (range, 1014 weeks). No residual radiographic frontal or sagittal plane angulation >10 or a leg length discrepancy >5 mm was observed in any patient. No patient showed any limitation in the joint, limping, or implant related problems. All the patients showed excellent final results. CONCLUSION: Minimally invasive percutaneous plating is a safe and acceptable surgical option for the treatment of pediatric femoral fractures.

Minimally Invasive Percutaneous Plate Stabilization of Proximal Tibial Fractures

PURPOSE: Despite of various treatment methods, proximal tibial fractures are common injuries that may be associated with poor outcomes and high rates of complications. To improve this, percutaneous plating technique was performed in the proximal tibial fractures. MATERIALS AND METHODS: Twenty-four proximal tibial fractures (AO 41A; 5, AO 41C; 12, AO 42; 7) were treated by percutaneous plating with either or both sides without bone graft. One was open fracture. RESULTS: All fractures were healed. The average time for fracture healing was 16.5 weeks (range, 8~24 weeks). Complications included a 1cm shortened case and two mal-alignments; a 6 degree valgus case and 5 degree varus case. There was one case of superficial infection, which healed after plate removal. But, there was no deep infection. Results were evaluated by modified Rasmussen score system, all patients had excellent or good result. CONCLUSION: Minimally invasive percutaneous plating technique can provide favorable results in the treatment of proximal tibial fractures.

Minimally invasive plate fixation in metaphyseal comminuted fractures of long tubular bones in lower extremities / 中华创伤骨科杂志

Objective To assess the clinical value of the mi nimally invasive plate fixation technique in treatment of metaphyseal comminute d fractures of long tubular bones.Methods Sixty-eight patients with metaphyseal comminuted fractures o f femur or tibia were treated with min imally invasive percutaneous plati ng and early recovery movement from April 1999to October 2001.Results All the patients were followed up for a mean time of 10months.The postopera tive radiograph showed that reducti on and internal fixation were satisfactory in sixty-five patients.Lateral angular deformity of 8?occurred in one c ase,and 2cm shortage of the lower lim b in two cases.Sixty-eight patients obt ained bone union and satisfactory clinical function.There were no deep i nfec-tion,nonunion or other complicatio ns.Conclusion For metaphyseal comminuted fractur es of long bones of lower extremities,minimally invasive percutaneous plate fixation is o f significant value due to the advant ages of less iatrogenic trauma,rigid fixation and early movement.[