A 35-year-old man was hit by a truck and sustained a closed fracture of the left femoral shaft with an ipsilateral closed tibial fracture. His right lower leg was amputated as he sustained an open fracture from a severe crush injury. He suffered no neurological damage and was in a stable condition to allow transfer to the author‘s hospital.
Indication for MIPO
As this case was the result of a high-energy injury, there was considerable soft-tissue damage in the left leg so that even though it was a closed injury, external fixation of the tibial fracture was the treatment of choice. The external fixation of the left tibia should be performed first, and as the patient was placed on a normal operating table it is more practical to proceed for stabilization of the femoral fracture using a plate by MIPO technique. As the right leg had been amputated, indirect reduction was a good alternative because obtaining correct length was not so important. There was also no need for early weight bearing; it would take at least 2 months before a prosthesis could be fitted.
Operating room setup
In case of multiple fractures of the lower extremity general anesthesia is preferable as it is painful for the patient to be positioned for regional anesthesia.