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Minimally Invasive Plate Osteosynthesis (MIPO)

Original Editors - Angeliki Chorti

Top Contributors - Angeliki Chorti and Lucinda hampton  

Introduction

Minimally invasive plate osteosynthesis (MIPO) was developed over the past 20 years as an alternative to ORIF for the management of distal tibial fractures. MIPO techniques aims:

  • Minimize soft tissue dissection
  • Preserve the fracture's blood supply by utilizing smaller incisions
  • Percutaneous insertion of the fixation plate.

This method facilitates fracture healing via:

Background

Treatment of fractures is often challenging, and in some cases, there is no widely accepted optimal surgical management. Although choice of treatment may rely on factors such as fracture morphology, displacement and comminution,[3] several options have been developed for the surgical treatment of fractures. These may include:

  • Closed reduction and cast application,
  • Closed reduction and external fixation,
  • Intramedullary nailing (IMN),
  • Open reduction and internal fixation with plate,
  • Minimally Invasive Plate Osteosynthesis (MIPO).

Historical perspective

Early fracture surgery often involved anatomic reduction with fixation of all fracture fragments, but with a cost of extensive exposure and soft tissue compromise; thus, a more “biologically friendly” surgery that guaranteed preservation of osseous and soft tissue vascularity was warranted. [4] Since its conception in 1989, MIPO has received widespread acceptance and interest in this procedure has led to studies in over forty countries with most of the publications originating from Asia, Europe and North America. [5]

Related Evidence

The majority of studies suggest the greatest benefit of minimally invasive procedures for humeral shaft and calcaneus fractures.[5] Other anatomical regions also show promise; for example, the MIPO technique has been reported as a stable fixation with satisfactory clinical and radiological results for tibial fractures irrespective of the fracture type. [6] [7][8] Complex distal femoral fractures and periprosthetic distal femoral fractures can also be managed using the MIPO approach. [9] [10] For midshaft clavicle fractures, the MIPO technique has demonstrated satisfactory results when compared to open reduction (ORIF), and lower surgical times and neurological impairments. [11] Especially, combining MIPO with a mini-open approach and supraclavicular nerve preservation may result in less skin numbness [12] making this an appealing alternative choice for the fixation of clavicle fractures, when there is technically more experienced staff and well-equipped operating room facilities. [13] Nevertheless, more studies are needed to confirm its widespread clinical utility.

Conclusion

Minimally invasive plate osteosynthesis (MIPO) is a satisfactory and appealing alternative surgical option for a wide variety of fractures, with more studies needed to establish its widespread clinical utility.

Resources

MIPO (Multifragmentary)

Minimally Invasive Plate Osteosynthesis (OTA)

References

  1. ↑ EVALUATING THE EFFICACY OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS FOR DISTAL TIBIAL FRACTURE TREATMENT Manesh Chacko Philip1 , Girish Kumar K2 Available: https://www.academicmed.org/Uploads/Volume6Issue2/191.%20%5B3029.%20Arpita%5D%20935-939.pdf(accessed 8.3.2025)
  2. ↑ Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury. 2003 Nov;34 Suppl 2:B63-76.
  3. ↑ Gupta P, Tiwari A, Thora A, Gandhi JK, Jog VP. Minimally Invasive Plate Osteosynthesis (MIPO) for Proximal and Distal Fractures of The Tibia: A Biological Approach. Malays Orthop J. 2016 Mar;10(1):29-37.
  4. ↑ Moloney GB on behalf of the Orthopaedic Trauma Association (OTA). Minimally Invasive Plate Osteosynthesis. Available from: https://ota.org/sites/files/2021-06/General%20A6%20MIPO%20Technique.pdf[accessed 4/3/2025]
  5. ↑ 5.0 5.1 van de Wall BJM, Beeres FJP, Knobe M, Link BC, Babst R. Minimally invasive plate osteosynthesis: An update of practise. Injury. 2021 Jan;52(1):37-42.
  6. ↑ Beytemür O, Barış A, Albay C, Yüksel S, Çağlar S, Alagöz E. Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2). Acta Orthop Traumatol Turc. 2017 Jan;51(1):12-16.
  7. ↑ Kang H, Song J-K, Rho JY, Lee J, Choi J, Choi S. Minimally invasive plate osteosynthesis (MIPO) for mid-shaft fracture of the tibia (AO/OTA classification 42): A retrospective study. Ann Med Surg (Lond) 2020; 60: 408-12.
  8. ↑ Kang H, Rho JY, Song JK, Choi J, Kwon YS, Choi S. Comparison between intramedullary nailing and minimally invasive plate osteosynthesis for tibial shaft fractures. Injury. 2021 Apr;52(4):1011-1016.
  9. ↑ Abdelmonem AH, Saber AY, El Sagheir M, El-Malky A. Evaluation of the Results of Minimally Invasive Plate Osteosynthesis Using a Locking Plate in the Treatment of Distal Femur Fractures. Cureus. 2022 Mar 29;14(3):e23617.
  10. ↑ Park YG, Kang H, Song JK, Lee J, Rho JY, Choi S. Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty. J Orthop Surg Res. 2021 Jul 6;16(1):433.
  11. ↑ La Banca V, Lima GHV, Vigano AVP, Gonzalez FF, Schaffhausser HL, Almeida LHO, Nascimento LGP, Murachovsky J, Ikemoto RY. Complications and clinical outcomes with minimally invasive plate osteosynthesis (MIPO) technique for midshaft clavicle fractures: a systematic review and meta-analysis. JSES International. 8(2): 257-67.
  12. ↑ Liu LT, Chen JC, Yang TC, Tseng HJ, Yen SH, Lu CC, Chen CH, Chung WR, Wang YC. Minimally Invasive Plate Osteosynthesis with Mini-Open Technique and Supraclavicular Nerve Preservation Reduces Postoperative Numbness in Acute Displaced Midshaft Clavicle Fracture. Medicina (Kaunas). 2024 Oct 11;60(10):1669.
  13. ↑ Devkota P, Acharya BM, Pradhan NMS, Shrestha SK, Thakur AK, Gyawali B. Minimally-Invasive Plate Osteosynthesis for Clavicle Fractures. Rev Bras Ortop (Sao Paulo). 2021 Oct 1;57(2):295-300.
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