Optimizing Surgical Management of Tibial Plateau Fractures: A Comparative Study of Minimally Invasive Versus Open Reduction Techniques.

BACKGROUND: Tibial plateau fractures pose a significant challenge to orthopedic surgeons due to their complex nature and potential for long-term morbidity. Surgical intervention is often necessary to restore anatomical alignment and optimize functional outcomes. This study aimed to evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) compared to open reduction and internal fixation (ORIF) in the management of tibial plateau fractures. MATERIALS AND METHODS: The present hospital-based observational study was conducted at Agartala Government Medical College for two years. Seventy adult patients with tibial plateau fractures were included, with surgical interventions performed based on fracture characteristics. Postoperative outcomes, including knee range of movements, functional recovery, and complication rates, were assessed at six months. RESULTS: MIPPO demonstrated superior outcomes compared to ORIF, with a higher proportion of participants achieving knee range of movements > 120 degrees (66.7% versus 36%; p = 0.030), excellent functional outcomes (66.7% versus 36%; p = 0.046), and lower postoperative complication rates (2.2% versus 28%; p = 0.001). Fracture union times were significantly shorter in MIPPO (12.49 weeks) when compared to ORIF (14 weeks) (p = 0.009). CONCLUSION: MIPPO offers advantages over conventional ORIF in terms of functional recovery and complication rates while demonstrating comparable fracture union times. These findings advocate for the adoption of MIPPO as a preferred surgical technique for tibial plateau fractures.

Short-term neurological and functional outcome of surgical intervention in spinal cord injuries: a single center prospective observational study.

Introduction: the management of an acute spinal cord injury remains controversial. The patient of acute spinal cord injury undergoes several phases of care beginning with the initial trauma management, surgical intervention, and perioperative medical management. The aim of this study was to evaluate the neurological and functional outcome of operative management of traumatic spinal cord injury patients admitted to a tertiary care centre in Northeast India. Methods: thirty patients with spinal cord injury admitted to a tertiary care centre from December 2019 to November 2021, and treated with instrumented stabilisation for spinal cord injury were evaluated until 6 months postoperatively. Patients were evaluated with validated neurological (American Spinal Injury Association scale) and functional outcome measures (Barthel index). Demographic details, mode of injury, morphology, patterns of fractures, neurological level, and management methods in the hospital were recorded and analysed using the Statistical Package for the Social Science (SPSS) version 27.0. Results: thoracolumbar spinal cord was more commonly injured with 16 (53.3%) patients compared to cervical spinal cord injury patients at 14 (46.7%). Eight patients had complete recovery, 7 patients had incomplete recovery and 15 patients had no recovery. At 6 months post-injury, 18 (60%) patients had favourable functional outcome. American Spinal Injury Association (ASIA) grade at admission was found to be significantly associated with the functional outcome. Conclusion: after surgery half of the patients had an improvement in their neurology, and functional outcome was favorable which suggests that surgery still holds the key to a better functional and rehabilitation outcome.