Introduction
Minimally invasive plate osteosynthesis (MIPO) and distraction histogenesis are biologically oriented methods of fracture reconstruction and limb reconstruction. Both seek to preserve living tissues: MIPO protects the fracture haematoma and periosteal blood supply, whereas distraction histogenesis uses controlled mechanical tension to generate new bone and soft tissue. Their successful application requires understanding of fracture biology, functional anatomy, biomechanics, imaging and meticulous postoperative monitoring.
Minimally Invasive Plate Osteosynthesis
Definition and fundamental principles
MIPO is a technique of fracture fixation in which the fracture is reduced indirectly, a plate is inserted through a limited incision or submuscular tunnel, and fixation is performed without extensive exposure of the fracture site. The essential objective is to preserve the fracture haematoma, periosteal circulation, muscle attachments and surrounding soft tissues while restoring alignment, length and rotation.
MIPO is not simply a smaller incision. It is a treatment philosophy based on:
- Respect for the vascularity of the bone and soft-tissue envelope.
- Indirect reduction rather than routine exposure and anatomical interfragmentary manipulation.
- Use of the plate as a bridging splint in multifragmentary fractures.
- Relative stability, allowing controlled interfragmentary movement and secondary callus formation.
- Accurate restoration of length, alignment and rotation, especially in the metaphysis and diaphysis.