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Updated: Aug 19, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
[Actual relevance of minimal invasive surgery in fracture treatment]
1Departement Chirurgie, Kantonsspital, Spitäler Chur AG, Chur. christoph.sommer@scag.gr.ch
Abstract:
Minimal invasive osteosynthesis (MIO) should belong nowadays in the armentarium of each trauma surgeon. The tendency to minimize the invasivity of every operation is a logical development considering the goal of each surgeon to reduce the iatrogenic damage caused by the operation. The term 'MIO" stands for this criteria: Fracture zone not opened, reduction by indirect manoeuvres or percutaneously by joy-sticks, small approaches for the application of the implants, intraoperative assessment of the reduction by imaging (fluoroscopy, arthroscopy, endoscopy, etc.). Long time before the definition of "minimal invasive surgery" some technologies in trauma surgery as external fixator or intramedullary nailing already fulfilled these criteria. In the nineties of the 20th century first cases of percutaneously inserted plate osteosynthesis have been reported. This technique got a widespread acceptance under the term of MIPO (minimal invasive plate osteosynthesis) during the last five years, especially pushed with the new angular stable screw-plate systems (LISS, LCP). The main problem of the MIPO-technique is and remains the reduction (no direct manipulation possible) and their intraoperative assessment (no direct visualisation). The balance between the degree of invasivity and the achieved quality of reduction and stability is often difficult to define and must be related to several factors (localisation and type of fracture, local soft tissue conditions, quality of the bone, age and wishes of the patient, available implants, experience of the surgeon, etc.). New technologies as improved imaging, intraoperative navigation and percutaneous reduction tools will help to further reduce the invasivity of fracture surgery in the future.
Insights
Minimal invasive osteosynthesis (MIO) reduces surgical damage by using small incisions and indirect reduction techniques. Further advancements in imaging and navigation aim to enhance MIO for better fracture repair outcomes.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Surgical Innovation
Background:
- Minimizing iatrogenic damage is a key surgical goal.
- Minimal invasive osteosynthesis (MIO) principles include unopened fracture zones, indirect reduction, small incisions, and imaging assessment.
- Techniques like external fixation and intramedullary nailing predated formal MIO definitions.
Purpose of the Study:
- To highlight the importance of MIO in modern trauma surgery.
- To discuss the evolution and current status of MIO, particularly minimal invasive plate osteosynthesis (MIPO).
- To identify challenges and future directions in MIO.
Main Methods:
- Review of historical and current MIO techniques, including percutaneous plate osteosynthesis (MIPO).
- Discussion of enabling technologies such as angular stable screw-plate systems (LISS, LCP).
- Analysis of MIPO's primary challenges: reduction and intraoperative assessment.
Main Results:
- MIPO has gained acceptance, driven by advanced implant systems.
- Reduction and visualization remain significant challenges in MIPO.
- Balancing invasivity with reduction quality is multifactorial, depending on fracture type, patient factors, and surgeon experience.
Conclusions:
- MIO, especially MIPO, represents a significant advancement in trauma surgery.
- Future improvements in imaging, navigation, and reduction tools are expected to further minimize invasivity in fracture repair.
- Continued development of MIO techniques is crucial for optimizing patient outcomes in trauma care.
