title: Does MIPO of fractures of the distal femur result in more rotational malalignment than ORIF? A retrospective study.
abstract: OBJECTIVE
  Intraoperative control of rotational malalignment poses a big challenge for surgeons when using modern MIPO (minimally invasive plate osteosynthesis) techniques. We hypothesized that distal femoral fractures treated with MIPO technique are more often fixed in malrotation than those treated with open reduction internal fixation (ORIF).
  
  
  METHODS
  In this retrospective study, we identified 20 patients who met the inclusion criteria and agreed to take part in the study. In ten patients MIPO was applied, in the other ten ORIF was used. Mean age was 44.8 (19-71 years). Functional status was assessed using clinical scores (Harris Hip Score, WOMAC Hip, KS Score, WOMAC Knee, Kujala Score). Rotational alignment was assessed with magnetic resonance imaging and compared to the opposite leg.
  
  
  RESULTS
  We discovered a significant difference in the mean rotational difference between the MIPO group (14.3°) and the ORIF group (5.2°). Functionally, patients in the ORIF group outperformed patients in the MIPO group in all clinical scoring systems although no one proved to be statistically significant. MIPO technique was associated with significantly more rotational malalignment compared to ORIF in distal femur fracture fixation. However, implant failure and nonunion was more common in the ORIF group, with a revision rate of 3 versus 1 in the ORIF group. Clinical scoring did not significantly different between both groups.
  
  
  CONCLUSIONS
  Taking into account the undisputable advantages of minimally invasive surgery, improved teaching of methods to avoid malrotation as well as regular postoperative investigations to detect any malrotation should be advocated.
authors.affiliation: Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria. Markus.Lill@auva.at.|Trauma Hospital Salzburg, Dr. Franz-Rehrl-Platz 5, 5020, Salzburg, Austria. Markus.Lill@auva.at.
authors.forename: M
authors.initials: M
authors.lastname: Lill
authors.affiliation: Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Attal
authors.affiliation: Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Rudisch
authors.affiliation: Department of Radiology, Karolinska University Hospital, 17176, Stockholm, Sweden.
authors.forename: M C
authors.initials: MC
authors.lastname: Wick
authors.affiliation: Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Blauth
authors.affiliation: Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Lutz
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D059408:Pain Management; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Distal femur; Fracture; MIPO; ORIF; Rotational malalignment