MINIMALLY INVASIVE SURGERY IN TRAUMATOLOGY A MODERN PARADIGM SHIFT

摘要

Orthopaedic surgeons have long attempted to obtain the maximal stability of their osteosynthesis repair while preserving the soft tissue environment of the fracture site. As an example, this philosophy has been the basis of the use of compression plating techniques after anatomical reduction and has proven clinically successful for decades. Of late, however, this approach has been critically evaluated. Starting in the mid 80's, a better understanding of the crucial importance of gentle manipulation of soft tissues progressively led surgeons to increasingly rely on indirect reduction techniques during fracture treatment. The acceptance of these new techniques resulted in a paradigm shift, which became the foundation of a new concept known as "biological osteosynthesis". Adoption of biological osteosynthesis principles has been associated with several alterations of traditional plating techniques, which include the use of longer plates, a decrease in the number of plate screws and, more importantly,of interfragmentary reduction screws or cerclage wires. Other significant modifications include gentle manipulation of bone fragments using small fragment reduction forceps, no attempt at anatomical reduction and, last but not least, increasingly limiteduse of autogenous cancellous bone grafts. This evolution favors the preservation of a biological environment indispensable to bone healing and is further illustrated by the use of bridging plates, which bypass the fracture site altogether. The advantages of biological osteosynthesis, have been experimentally demonstrated and validated in the dog and include faster bone healing and a decreased number of complications and failures when compared to traditional techniques.