Minimally Invasive Plate Osteosynthesis (MIPO) of Periprosthetic Femoral Fractures with Percutaneous Cerclage Wiring for Fracture Reduction: Tips and Technique.

Abstract

We describe percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO) for periprosthetic femoral shaft fractures. A well-developed preoperative plan and assessment of the length, alignment, and rotation of the extremity are critical. After making the appropriate incision, use the tunneling device anterior and posterior to the femur to create a soft-tissue tunnel. Insert the cerclage passer carefully by keeping it in close contact with the bone. The cerclage wire may be incrementally inserted according to the direction on the passer to prevent kinking. Verify the alignment and length of the plate with intraoperative images and precontour the plate to fit the lateral aspect of the femur as necessary. Encourage an immediate range of motion to aid in postoperative recovery. In our original study, ten patients with a Vancouver type-B1 periprosthetic femoral shaft fracture (mean age, seventy-four years; range, forty-seven to eighty-four years) were treated with the described percutaneous cerclage wire and MIPO techniques.IndicationsContraindicationsPitfalls & Challenges.