ABSTRACT
Background: Complex fractures posed a major dilemma in orthopedic trauma care since they were complicated in their pattern, involvement with soft tissues, and associated complications. Many of those injuries involved high-energy injuries (road traffic crashes or falls) and required not only expert surgical care but complex postoperative care. Developments in fixation methods, imaging modalities, and the multidisciplinary approach had made success in treating such injuries more likely to occur; in fact, optimum functional recovery continued to be elusive.
Purpose: This paper served to assess the methods of managing complex fractures in cases of orthopedic traumas with regard to the surgical intervention conducted, the complications, and resultant functionality.
Methods: The study was done at the Department of Orthopaedic Surgery, People University of Medical & Health Sciences (PUMHS) Nawabshah June 2024 to May 2025. Eighty patients with complex fractures were included. They included patient selection using clinical assessment and radiological confirmation, of complex patterns of fracture with multiple fragments, including joint injuries or gross displacement. Complete demographic, mechanism of injury, type of fracture and other injuries were documented. Depending on the patterns of fracture and its severity surgical intervention was intended to consist of open reduction, and internal fixation (ORIF), minimally invasive plate osteosynthesis (MIPO), and external fixation in cases when needed. Six-month follow-up was implemented to evaluate the possibility of union, the range of motion, pain scores, and complications.
Results: Eighty-nine percent of study participants were males, 11 percent females with a mean age of 38.6 +/- 12.4 years. The most common reason (65%,) was road traffic accidents, followed by falls of height (25%) and, other (10%). In 60 percent the cases, ORIF was performed, 25 percent by MIPO and 15 percent by external fixation. Meaning the mean fracture healing time was 16.2 + 3.4 weeks. The functional results with a Modified Harris Hip Score or DASH Score (based on the location of the fracture) showed an excellent to good recovery in 72 percent of patients. Infected (8%), delayed union (6%), and implant failure (4%) were a complication.
Conclusion: Treatment of complex fractures was done with a patient-specific surgical approach depending on the kind of fracture, condition of the patient, and the resources available. ORIF was the most reliable and common procedure, whereas MIPO also provided good results when arriving at specific cases. The use of early intervention, careful surgical method of operation and scheduled rehabilitation greatly influenced the chances of functional recovery and lowered the rate of complications.
Keywords: Orthopaedic trauma, complex fractures, fracture management, ORIF, MIPO, external fixation, functional outcomes.