Thursday 06th Feb, 2020
Blue’s X-rays showed the non-displaced, greenstick, spiral fracture of his right femur, but what was the best option?
Given Blue’s significant lameness and his very boisterous personality, this was a situation where we felt that internal stabilisation was definitely required.
While ‘strict rest’ might work for some greenstick fractures, the fracture configuration (spiral) and the difficulty in ensuring a period of adequate rest meant this would have had risks of failing to enable the fracture to heal.
What internal stabilisation was chosen?
Minimally Invasive Plating Osteosynthesis (MIPO) has been developed as a way of stabilising fractures without ‘opening them up’ at all. The principle is that the fracture is not at all disturbed, and therefore should heal quicker.
Why choose MIPO?
Fractures such as Blue’s, where the bone it still aligned despite it being fractured, are ideally suited to the use of MIPO.
We made carefully placed incisions: one at the top of the femur, and the other distally, centred on pre-planned landmarks.
The 3.5 LCP plate, which had been pre-contoured based on pre-op X-rays and bone model, was then carefully ‘passed’ from distal to proximal, taking care to ensure the plate holes were positioned exactly where they should be relative to pre-op planning. This was all done through the two small incisions.
The locking screws were then placed, based again on pre-op plans, taking care to avoid growth plates.
What did Blue’s post-op X-rays look like?
We were pleased with the post-op X-rays which showed that we had placed the plate where we wanted to be, and had stabilised the fracture without compromising the growth plates.
The MIPO was entirely performed without fluoroscopy, and using the pre-op X-rays. This highlights the importance of good pre-op X-rays, and planning!
How did Blue recover?
Blue recovered really well, and demonstrated the immediate benefit of MIPO, with good weight bearing within 24hrs, and back to enthusiastic weight bearing quickly.
The video below was sent in 10 days post-surgery, and shows Blue’s confidence in his operated leg!