A 41-year-old man involved in a motorcycle accident sustained multifragmentary fractures of the left humeral shaft with proximal extension.
Indication for MIPO
The disadvantages of conventional plate fixation for multi-fragmentary humeral shaft fractures include extensive soft-tissue dissection and the frequent need for bone grafting. MIPO avoids these. Proximal extension of the fractures makes it difficult for intramedullary nailing.
a–b AP (a) and lateral (b) x-rays.
Preoperative planning
a–ea The proximal fragment, middle comminuted fragment, and distal fragment.b The precontoured plate is slid into the prepared tunnel and the plate is aligned in the correct position.c Proximal fixation with the first cortex screw to press the plate to the bone. The plate is fixed to the proximal fragment with two LHSs.d Gravity reduction by traction at the elbow until correct length and rotation is achieved.e Temporary fixation with K-wire and alignment is checked with image intensification, then fixation is completed in the distal fragment with LHSs.
Operating room setup
Anesthesia
General anesthesia is mandatory.
Patient and image intensifier positioning
The patient is placed in beach-chair position (Fig 13.3-3).
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Humerus, proximal
Humerus, shaft—introduction
Femur, proximal: extraarticular fracture, trochanteric area pertrochanteric simple—31-A1
Femur, distal: extraarticular simple fracture—33-A1.2
Extraarticular, bifocal closed fracture—42-A1, and articular trimalleolar ankle fracture—44-C2.3 (closed transverse fracture of the medial malleolus, lateral malleolus, and posterior malleolus)
Tibia and fibula, distal—introduction
