Trauma & Acute Care Open Access

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MIPO in the Management of Type IIIA Compound Femoral Shaft Fractures Caused by High Velocity Missiles

Ali Bakir Al-Hilli and Hassanein Hadi Alwan

Background: Compound femoral shaft fractures that caused by high-velocity missiles HVMs (bullets and shells) are very extensive injuries, and still remain one of the greatest challenges to orthopedic trauma surgeons, closed intramedullary locked nail is considered the gold standard treatment modality, but it is not always available or applicable, and conventional plating method of these fractures had Increasing rates of infection, delayed union, nonunion and implant failure.

Aim of the study: To evaluate MIPO (The Minimally Invasive Plate Osteosynthesis technique) technique as an alternative procedure to closed intramedullary locked nail in treatment of type IIIA femoral shaft fractures due to HVMs.

Patients and methods: This prospective study, from October 2014 to March 2016, included 16 male patient, aged between 22-47 y, 4 patients were civilians and 12 were militaries, with 16 compound femoral shaft fracture of type IIIA (Gustilo-Anderson Classification) that caused by HVMs, 13 fracture were caused by bullets and 3 by shells. All fractures had been treated by early wound debridement and external fixation and one-stage conversion to internal fixation by MIPO technique using long DCP within 2 weeks, when there are no signs of active infection.

Results: For all fractures, 4 of 16 fracture (25%) had bony union in 18 week, 10 of 16 fracture (62.5%) had bony union in 24 week, and only 2 of 16 fracture (12.5%) did not have complete bony union at 24 week (delayed union), which had complete healing of the fractures in the next 6 weeks (in 30 week) without secondary surgical intervention. For all fractures, there were no wound healing complications, infections, nonunion or implant failure.

Conclusion: MIPO treating HVMs femoral shaft fractures can be used as an alternative procedure to closed intramedullary locked nail.