Nowadays, the use of minimally invasive plate osteosynthesis (MIPO) in the management of fracture of the distal tibia is common. The various advantages of the MIPO technique, namely, preserving blood supply and better bone healing, have been described extensively in the literature. However, this technique is not without complication. Among all the complications, infection is one of the commonest. In the last 3 years, we have performed 48 cases of MIPO in treating distal tibia fractures. Our study was to evaluate the clinical outcome of these cases, with special attention to the infection rate and our experience in managing these infection cases. Our results showed that the average time until the patient started to bear full weight was 9.4 weeks. The average time for bony union was 18.7 weeks. There were 7 cases of late infection among these 48 cases. The rate was 15%. The presence of late infection had no obvious effect on the time to bony union. Twenty-five patients (52%) had the implants removed and the most common reason was skin impingement by the implant. The clinical presentation and management of these late infections are discussed. In conclusion, MIPO fixation of distal tibia fractures using a metaphyseal locking plate is safe and efficient. However, complications such as late wound infection and impingement are relatively common. The overall clinical outcome is still good despite the presence of these complications.

The management of fractures of the proximal shaft of the humerus has been evolving since the development of new techniques and new implants in recent years. It seems that this kind of fracture has an increasing incidence in the older, osteoporotic population. In the last 2 years, we have operated on 17 patients, with an average age of 65, who had proximal humeral shaft fractures treated by minimally invasive percutaneous osteosynthesis (MIPO) technique using the metaphyseal locking compression plate. Our study evaluated the surgical technique used and the outcome for these patients with regards to their range of movement and shoulder function. Our results showed that all the patients could achieve at least 140 masculine of shoulder abduction in the first 6 months after the operation, except for three patients who had shoulder impingement. These patients had an average Constant score of 76.8. All fractures had bony union at 6 months, except one, which was probably due to poor reduction in the initial operation. Another complication that we encountered was radial nerve neuropraxia. The ways to prevent these complications are discussed. In conclusion, MIPO fixation using the metaphyseal locking compression plate is a good option for the management of proximal humeral shaft fractures. It provides early functional recovery, but we had to pay special attention to some of the surgical details in order to minimise complications.

The effect of delay of surgery on the geriatric hip fractures has been a subject of interest in the past two decades. While the elderly patients will not tolerate long periods of immobilization, it is still unclear how soon these surgeries need to be performed. A review of existing literature was performed to examine the effect of timing of surgery on the different outcome parameters of these patients. Although there is conflicting evidence that early surgery would improve mortality, there is widespread evidence in the literature that other outcomes including morbidity, the incidence of pressure sores, and the length of hospital stay could be improved by shortening the waiting time of hip fracture surgery. We concluded that it is beneficial to the elderly patients to receive surgical treatment as an urgent procedure as soon as the body meets the basic anesthetic requirements.