ABSTRACT
Background: The complex tibial fracture has been a big challenge in the orthopedic trauma as it is located anatomically, has damaged tissue envelope on the site and can result in malformation, lack of healing and infection. Minimally invasive surgical procedures have in the last few years gathered attention due to minimal disorientation of soft tissues, and faster recovery than the traditional open-reduction internal-fixation procedures.
Objectives: The purpose of the study was to compare clinical outcomes and the rate of complications and functional recovery of the minimally invasive and open techniques of reduction in treating complex tibial fractures.
Methods: This is a comparative type of study conducted between June 2024 and May 2025 at the PIMS Islamabad where 90 patients with a diagnosis of complex tibial fractures were used as a sample group. These patients were equally subdivided into Group A and Group B with the former having minimally invasive plate osteosynthesis (MIPO) and the latter having open reduction and internal fixation (ORIF). The outcome measures post-operatively involved the period of radiological union, infection rates and the length of stay in hospital and functional results with the Lower Extremity Functional Scale (LEFS) at three and six months after the procedure.
Results: The average hospital stay of patients in Group A was considerably less in length (5.2 1.1 days) than that of Group B (8.7 1.3 days). The average delayed union time according to radiology findings was quicker in the MIPO group (14.3 +/-2.6 weeks) as compared to ORIF group (17.8 +/-3.1 weeks). The superficial infection was less with Group A (6.7%) compared to Group B (17.8%). The LEFS functional assessment in MIPO group showed better scores in three and six months (68.5 7.2 vs. 58.4 6.9 and 82.3 5.8 vs. 73.1 6.2, respectively) after the operation.
Conclusion: Minimally invasive procedures had superior clinical outcomes, such as acceleration of bone healing with low infection rates, shorter hospitality and earlier recovery of function in treatment of complex tibial fractures compared to the open reduction approach. The obtained results recommend using MIPO as a favorable method when appropriate in patients and contributing to postoperative recovery and lessening the occurrences of complications.
Keywords: Complex tibial fractures, minimally invasive surgery, open reduction, MIPO, ORIF, fracture healing, functional outcome