Aims. In order to limit the amount of both medial and lateral dissection, the MIPO technique was developed for extraarticular fractures of the femur. In this prospective study we have evaluated the outcome of 34 cases of supracondylar or subtrochanteric fractures of the femur treated by MIPO technique via exclusive proximal and distal incisions, using a DCS.

Material and methods. Between July 2000 and March 2003, 34 acute fractures (14 supracondylar and 20 subtrochanteric) in 33 patients were included in this study. The technique consisted of 5 major steps: 1. the insertion of the condylar screw using minimal incision; 2. the selection of DCS-plate by fluoroscopy; 3. the insertion of the DCS-plate beneath the vastus lateralis; 4. an additional minimal proximal or distal incision allows plate positioning and its slipping onto the condylar screw; 5. after the limb axis, length and rotation are confirmed by reliable clinical and radiological techniques, the plate was fixed to the shaft with 3 or 4 screws placed divergently.

Results. All fractures healed within a mean time of 14 weeks (range 8–24 weeks). 1 late implant failure (plate screw breakage) in an extremely cominutive fracture did not required repeat fixation. At follow-up, there were 5 varus-valgus deformities above 5°, 4 leg length discrepancies over 15 mm and 1 malrotation of 20°. According to the Neer score there were 22 excellent, 10 satisfactory and 2 unsatisfactory results.

Discussion. The key to MIPO is the use of 2-part and 2-plane alignment achieved by a DCS inserted in a sub-muscular fashion.

Conclusions. The MIPO technique with proximal and distal incisions minimizes surgical trauma and has the advantages of a faster rate of union, with no need for bone grafting. Care should be taken to ensure adequate axial and rotational alignment.