Pin hole surgery or Minimal Invasive surgery is a technique where we use small incision or close technique fro fracture fixation. Its advantages are that the MIPO technique does not interfere with the fracture site and thus provides improved biological healing,Complex periarticular fractures of the long bones are difficult to treat. Classic intramedullary osteosynthesis do not provide a stable fixation, while open reduction and rigid fixation by classic plates is requiring large incisions with important deperiostation.
Potential complications as infections, consolidation delays and construct damage due to nonunions undergo frequently. At that time, standard operative procedures considered that in epiphyseal-metaphyseal fractures, each fragment either from the articular or metaphyseal area should be subject for anatomical reduction and stabilization. There were obtained superior biomechanical results (absolute stability) but poor long-term biological effects. The main disadvantages of the anatomic reduction and rigid fixation by plates led to the development of the "biological plate osteosynthesis" concept. MIPO techniques avoid direct exposure of the fracture site and transform the implants in an internal extramedullary splint. Furthermore, MIPO was successfully extended to complex tibial fractures, being actually indicated in all long bones complex fractures that are not suitable for intramedullary osteosynthesis.
Three types of anesthesia may be used for knee arthroscopy surgery:
1. The treatment purpose in minimally invasive plate osteosynthesis consists in anatomic reconstruction of the articular area, axis, rotation and length reestablishment for the metaphyseal-diaphyseal area, long plates osteosynthesis with screws fixed only distally and proximally from the fracture, bridging the comminution and with early functional rehabilitation.
2. Various studies results demonstrate that MIPO and TARPO have undeniable advantages over classic techniques: fast healing, reduced complication rate, reduced primary or secondary grafting requirements, and shortening of the operative time. Moreover, TARPO procedure provides a good exposure of the knee joint.
3. Good results obtained by minimally invasive plate osteosynthesis are due to a fast healing by vascularization protection and also to an increased resilience to mechanical stress.
4. Fixation with long plates only distally and proximally from the fracture site maintains a certain instability degree that is useful for an accurate and fast healing (relative instability).
5. Minimally invasive plate osteosynthesis is a demanding technique, requiring a cautious intraoperative clinical and fluoroscopic control in order to reestablish limb axis, rotation and length.