Minimally invasive plate osteosynthesis (MIPO) is a surgical technique for fracture stabilization consisting of bone plate and screw application through small surgical approaches connected by an epiperiosteal tunnel. The technique stresses preservation of vascular supply in the periosteum and soft tissue envelope as well as minimal disruption of the fracture site in an effort to preserve the fracture hematoma and maximize biological healing potential. MIPO is typically utilized in concert with closed, indirect reduction, rather than open, direct reduction as has traditionally been performed prior to bone plate application. Indirect reduction techniques are used to achieve alignment of the joint above and below the fracture and to re-establish bone length, not to anatomically reconstruct a fracture site. Indirect reduction techniques and MIPO are best suited for application to comminuted fractures rather than to simple fractures. Simple fractures or fractures with large butterfly segments are typically still most amenable to open, anatomical reconstruction followed by internal fixation. Bone plates utilized for MIPO are typically applied in bridging fashion. Locking bone plates are particularly well suited for use in MIPO applications as precise plate contouring is not required. Potential benefits of MIPO technique include: superior preservation of soft tissue envelope and fracture hematoma, less disruption of periosteal blood supply, decreased postoperative discomfort, decreased infection risk, and faster healing.
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