Microsoft Word - 16SirbuMinimallyInvasive


 
 
 

 Romanian Neurosurgery (2011) XVIII 1: 101 – 102          101 

 
 
 

Minimally invasive plate osteosynthesis using systems with 
angular stability in complex fractures of the distal femur. 
Fashion or real advantages? Regenerative medicine as an option 
for bone regeneration 

P.D. Sîrbu1, T. Petreuș1, R. Asaftei1, C.E. Cotrutz1, E. Carata2, P. Botez1, S. 
Stratulat1 

1“Gr.T. Popa” University of Medicine and Pharmacy, Iasi, Romania 
2“Gh. Asachi” Technical University, Iasi, Romania 

 

Keywords: LISS, LCP, combi-holes, 
polyaxial stability, internal fixators 

Introduction  
Complex distal femoral fractures 

represent a challenge for orthopaedic 
surgeons. The disadvantages of classic 
surgery led to the development of new 
surgical techniques (minimally invasive 
plate osteosynthesis - MIPO and 
transarticular approach and retrograde plate 
osteosynthesis - TARPO) and new 
implants with angular stability (internal 
fixators).  

Aims 
The purpose of this study is to present 

the preliminary results in treating the distal 
femoral fractures with plates with angular 
stability and to exhibit the advantages and 
differences between these efficient systems. 

Material and methods 
The study included 22 fractures (4 type 

A2, 7 type A3, 6 type C2, and 5 type C3 
AO). There were 2 periprosthetic knee 
fractures. The study included 4 open 
fractures: 2 - grade I, 1 grade II, and 1 grade 
IIIA (Gustilo). The authors used a Less 

Invasive Stabilization System (LISS) in 10 
cases, Locked Compression Plate (LCP) 
with combi-holes in 6 cases, and plates with 
polyaxial stability in 6 cases. For 
extraarticular fractures, the plates were 
inserted through a minimally antero-lateral 
incision beneath the vastus lateralis (by 
means of an aiming device), after indirect, 
closed fracture reduction of the metaphysis 
and shaft area (MIPO technique). For 
articular fractures we have first performed a 
lateral parapatellar arthrotomy and 
reconstruction of the articular block 
(TARPO technique). Newer polyaxial 
locked plates were used in difficult type C3 
distal femoral fractures due to some 
freedom in angulation of screws, prior to 
final screw plate sitting.  

Results and discussions 
All fractures less one (with bone loss 

which required bone grafting after three 
months) healed within a mean time of 13 
weeks (with no infections, implant breakage 
or secondary displacement), 

These plates with angular stability 
represent the ideal treatment in difficult 
fractures with short distal fragment, 
osteoporotic fractures, fractures above knee 



 
 
 
102          P.D. Sîrbu et al          Minimally invasive plate osteosynthesis 

 
 
 

arthroplasties and some open fractures. The 
key to success for internal fixators are: 
correct/incorrect indications, the usage of 
the appropriate plates, proper fracture 
reduction before plate insertion and screw 
drilling, avoidance of the eccentric plates 
placement, full-weight bearing allowed 
when callus is seen in serial postoperative 
radiographs. The authors prefer the LCP 
system and a newer polyaxial locked plate 
due to their advantages of screw pathway 
adjustment. 

Conclusions 
Close cooperation between orthopaedic 

surgeon, biomechanics specialist and the 
departments of cell biology and pathology, 
will contribute to the development of the 
ideal internal fixator and will sustain the 
future experimental investigations in order 
to elucidate the dynamic and coherent 

process of callus formation with these 
biological plates and techniques. 

References 
1.  Frigg R., Appenzeller A, Christensen R., Frenk A, 
Gilbert S., Schavan R. “The development of the distal 
femur. Less Invasive Stabilization System (LISS)”, 
Injury, Int. J. Care Injured, 2001, 32, pp. 24-31. 
2. Wagner M, Frigg R (eds) AO Manual of fracture 
management – Internal Fixators. Thieme Stuttgart 
(2006) 
3. Richter M, Droste P, Goesling T, Zech S, Krettek C. 
- Polyaxially-locked plate screws increase stability of 
fracture fixation in an experimental model of calcaneal 
fracture. J Bone Joint Surg Br. 2006 Sep;88(9):1257-63. 
4. Sirbu P.D., Schwarz N., Belangero V.D., Livani B., 
List M., Botez P., Mihaila R.I. Minimally invasive plate 
ostheosynthesis in long bone fractures, Casa de Editura 
Venus, Iasi, Romania 2008. 
5. Sirbu P.D., Friedl W., Botez P., Stratan L., Hopulele 
S., Asaftei R. Osteosinteza minim invaziva cu placi - 
Fixatoare interne, Casa de Editura Venus, Iasi, Romania 
2008 
6. Ip David, Orthopedic Traumatology – A Resident’s 
Guide; Springer Berlin-Heidelberg 2006