Introduction We describe percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO) for periprosthetic femoral shaft fractures.
Step 1: Preoperative Planning and Assessment of the Length, Alignment, and Rotation of the Extremity A well-developed preoperative plan and assessment of the length, alignment, and rotation of the extremity are critical.
Step 2: Prepare the Tunnel After making the appropriate incision, use the tunneling device anterior and posterior to the femur to create a soft-tissue tunnel.
Step 3: Insert and Connect the Cerclage Passer Insert the cerclage passer carefully by keeping it in close contact with the bone.
Step 4: Insert the Cerclage Wire and Remove the Wire Passer The cerclage wire may be incrementally inserted according to the direction on the passer to prevent kinking.
Step 5: Place and Fix the Submuscular Plate 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.
Step 6: Closure and Postoperative Rehabilitation Encourage an immediate range of motion to aid in postoperative recovery.
Results 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.
Pitfalls & Challenges
We describe percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO) for periprosthetic femoral shaft fractures.
The evolution of MIPO in recent years has led to the development of new reduction tools to facilitate fracture reduction. This approach is meant to minimize additional trauma to the fracture site, thus protecting vascularity and bone healing when applied in a minimally invasive fashion1. The deforming forces acting on periprosthetic femoral fractures, particularly femoral shaft fractures, make it challenging to obtain and maintain the reduction for plate …
Enter your JBJS login information below.