MIPO

MIPO stands for Minimally Invasive Plate Osteosynthesis, a technique in orthopedic trauma surgery for fracture fixation. It uses submuscular plate placement with small incisions distant from the fracture, allowing indirect reduction and stabilization with screws, often a locking plate. By preserving the soft tissue envelope and the periosteal blood supply around the fracture, MIPO aims to enhance biological healing and reduce complications such as infection and nonunion. Reduction is achieved primarily by traction and careful alignment rather than by exposing the fracture site.

The procedure involves inserting the plate along the bone beneath the muscle sleeve and securing it with percutaneously placed screws through stab incisions. The approach minimizes dissection and soft tissue stripping, with fixation often relying on a bridging construct that supports the fracture while the biology heals. Indirect reduction and fluoroscopic guidance are commonly used to obtain alignment.

Indications typically include diaphyseal fractures of long bones such as the tibia, femur, and humerus, as well as select distal or proximal fractures and certain comminuted injuries. It is also used for open fractures after initial soft tissue management and for select polytrauma patients where preserving soft tissue and rapid stabilization are advantageous.

Advantages of MIPO include preservation of blood supply and soft tissues, lower risk of infection, reduced soft tissue damage, and potential for earlier mobilization. Limitations include a learning curve, dependence on imaging guidance, and risk of malalignment if indirect reduction is not meticulously performed. Complications can include malalignment, nonunion, infection, nerve or vessel injury, and hardware irritation, though outcomes are favorable in experienced hands for many long-bone diaphyseal fractures.