A 45-year-old man accidentally discharged a gun while putting it in his pocket when he got into a car. He sustained an open fracture of the shaft of his right femur. The patient was conscious and in a stable condition to transfer to the hospital. There was no neurovascular injury of the right lower limb.
Indication for MIPO
This patient had an open fracture with soft-tissue damage as a result of a gun shot wound. Debridement of the wound should be performed as soon as possible. As the patient was operated on a normal operating table for debridement, bridge plating using a MIPO technique was planned to continue the operation on the same table without transferring the patient to a fracture table for femoral nailing.
Preoperative planning determines plate length to serve as the bridging plate as well as the type, the number, and sequential placement of screws for fixation. On each fragment proximal and distal to the fracture 3–4 screws are fixed into the plate holes while leaving some holes without screws. The length of the plate that spans the fracture zone also has no screws (Fig 17.2-2).