Biomechanical Evaluation of Minimally Invasive Repairs for Complete Acromioclavicular Joint Dislocation

Background The conventional coracoclavicular ligament augmentation with a single polydioxanone loop has been shown to have some pivotal disadvantages. Hypothesis A minimally invasive flip button/polydioxanone repair provides similar biomechanical properties to the conventional polydioxanone cerclage around the coracoid. However, the authors expected a difference in linear stiffness, ultimate load, and permanent elongation between suture anchor repairs and polydioxanone repairs. Study Design Controlled laboratory study. Methods The tensile fixation strength of 4 different minimally invasive repairs was tested in a porcine metatarsal model: (1) 1.3-mm single polydioxanone cerclage with a subcoracoidal flip button fixation, (2) 1.3-mm single polydioxanone cerclage, (3) Twinfix Ti 3.5-mm/Ultrabraid 2-suture anchor, and (4) Twinfix Ti 5.0-mm/Ultrabraid 2-suture anchor. The testing protocol included cyclic superoinferior loading and a subsequent load to failure trial. Results The flip button repair (646 N) and the conventional polydioxanone banding (663 N) revealed significant higher ultimate loads than did the suture anchor repairs (295 and 331 N, respectively; P < .001), whereas no significant differences were found for the elongation behavior under cyclic loading. Conclusion There was no significant difference between the 2 polydioxanone repairs. The ultimate load of the flip button procedure reaches the level of the native coracoclavicular ligament complex as it has been quantified in the literature. Clinical Relevance Although the biomechanical results comparing a minimally invasive flip button procedure versus a conventional polydioxanone cerclage are similar, the authors recommend the flip button procedure because of its minimally invasive approach and the secure subcoracoidal fixation technique with a minimized risk of anterior loop dislocation and neurovascular damage.

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Biomechanical stability of complex coronal plane fracture fixation of the capitellum

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04126-1 ◽

2021 ◽

Author(s):

Paul Borbas ◽

Rafael Loucas ◽

Marios Loucas ◽

Maximilian Vetter ◽

Simon Hofstede ◽

...

Keyword(s):

Fracture Fixation ◽

Ultimate Load ◽

Locking Plate ◽

Distal Humerus ◽

Coronal Plane ◽

Fixation Strength ◽

Biomechanical Stability ◽

Significant Difference ◽

Load To Failure ◽

Headless Compression Screws

Abstract Introduction Coronal plane fractures of the distal humerus are relatively rare and can be challenging to treat due to their complexity and intra-articular nature. There is no gold standard for surgical management of these complex fractures. The purpose of this study was to compare the biomechanical stability and strength of two different internal fixation techniques for complex coronal plane fractures of the capitellum with posterior comminution. Materials and methods Fourteen fresh frozen, age- and gender-matched cadaveric elbows were 3D-navigated osteotomized simulating a Dubberley type IIB fracture. Specimens were randomized into one of two treatment groups and stabilized with an anterior antiglide plate with additional anteroposterior cannulated headless compression screws (group antiGP + HCS) or a posterolateral distal humerus locking plate with lateral extension (group PLP). Cyclic testing was performed with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure. Results There was no significant difference in displacement during 2000 cycles (p = 0.291), stiffness (310 vs. 347 N/mm; p = 0.612) or ultimate load to failure (649 ± 351 vs. 887 ± 187 N; p = 0.140) between the two groups. Conclusions Posterolateral distal humerus locking plate achieves equal biomechanical fixation strength as an anterior antiglide plate with additional anteroposterior cannulated headless compression screws for fracture fixation of complex coronal plane fractures of the capitellum. These results support the use of a posterolateral distal humerus locking plate considering the clinical advantages of less invasive surgery and extraarticular metalware. Level of evidence Biomechanical study.

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Continuous-Loop Tape Technique Has Greater Stiffness and Less Elongation Compared With Tied-Suture Fixation of Full-Thickness All–Soft Tissue Quadriceps Tendon Autografts

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211054108 ◽

2021 ◽

Vol 9 (11) ◽

pp. 232596712110541

Author(s):

Christopher M. Gibbs ◽

Philipp W. Winkler ◽

Robert T. Tisherman ◽

Calvin K. Chan ◽

Theresa A. Diermeier ◽

...

Keyword(s):

Soft Tissue ◽

Ultimate Load ◽

Quadriceps Tendon ◽

Tendon Graft ◽

Suture Technique ◽

Suture Fixation ◽

Full Thickness ◽

Quadriceps Tendon Graft ◽

Significant Difference ◽

Permanent Elongation

Background: Many graft fixation techniques are utilized for full-thickness soft tissue quadriceps tendon autografts during anterior cruciate ligament reconstruction (ACLR). Purpose: To determine the tensile properties of all–soft tissue quadriceps tendon graft fixation using a tied-suture versus continuous-loop tape technique. It was hypothesized that the continuous-loop tape technique would have less cyclic elongation and greater ultimate load to failure and stiffness compared with a commonly used tied-suture technique. Study Design: Controlled laboratory study. Methods: Sixteen fresh-frozen human knee specimens were used to harvest a full-thickness all–soft tissue quadriceps tendon graft; half were secured using a Krackow suture technique with 2 braided sutures, and half were secured using a continuous-loop tape suspensory fixation button with a rip-stop stitch. Cyclic and permanent elongation, toe- and linear-region stiffness, and ultimate load were determined. Statistical analysis was performed at P <.05. Results: The tied-suture fixation group demonstrated significantly higher permanent elongation (11.7 ± 3.6 vs 4.2 ± 1.0 mm, P < .001) and cyclic elongation (5.9 ± 1.3 vs 2.0 ± 0.4 mm, P < .001) compared with the continuous-loop tape fixation group. There was a significantly higher linear-region stiffness with continuous-loop tape fixation compared with tied-suture fixation (98.8 ± 12.7 vs 85.5 ± 7.5 N/mm, P = .022). No significant difference in ultimate load between groups (517.1 ± 149.2 vs 465.6 ± 64.6 N) was found. The mode of failure was tendon pull-through for the continuous-loop tape group and suture breakage in the tied-suture group ( P < .001). Conclusion: Continuous-loop tape fixation is superior to tied-suture fixation in regard to elongation and stiffness for all–soft tissue quadriceps tendon grafts, but there was no significant difference in ultimate load. Clinical Relevance: Continuous-loop tape fixation of all–soft tissue quadriceps tendon grafts for ACLR is a valid technique with superior tensile properties.

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Biomechanical Study on the Treatment of Acromioclavicular Joint Dislocation by Coracoclavicular Ligament Reconstruction With a Novel EndoButton Plate Combined With Suture Anchor

10.21203/rs.3.rs-570889/v1 ◽

2021 ◽

Author(s):

Zhe Song ◽

Chen Wang ◽

Na Yang ◽

Yangjun Zhu ◽

Kun Zhang ◽

...

Keyword(s):

Internal Fixation ◽

Acromioclavicular Joint ◽

Suture Anchor ◽

Acromioclavicular Joint Dislocation ◽

Coracoclavicular Ligament ◽

Joint Dislocation ◽

Average Load ◽

Load To Failure ◽

Group A ◽

Group B

Abstract Purpose This study aimed to assess the biomechanical stability of a novel internal fixation system of EndoButton plate combined with suture anchor in treating acromioclavicular joint dislocation in the cadaveric specimens. In addition, it provides a new method for the clinical treatment of acromioclavicular joint dislocation. Methods Twelve complete shoulder joint specimens were randomly divided into groups A, B, C, and D (n = 3). Firstly, a quasi-static non-destructive circulation experiment was carried out of coracoclavicular ligament until its function failed. Four different internal fixation materials were used to reduce and fix the acromioclavicular joint. Group A was treated with 3.5 mm clavicular hook locking compression plates, Group B with 5 mm suture anchor Group C with 10 mm Endo-button plate, and Group D with a novel combination of 5 mm suture anchor and 10 mm Endo-button plate. Fluoroscopy was performed to undertake the X-ray of the restored acromioclavicular joint, to evaluate the internal fixation position and acromioclavicular joint reduction. Finally, the shoulder joint was fixed firmly on an electronic universal testing machine (100KN) with a self-made stationary fixture, to conduct a destructive static tensile mechanical test of each specimen vertically at a 100 mm/min load speed. The stress-deformation curve was recorded using a computer connected with the universal mechanical testing machine, and the failure strength and reasons for internal fixation were also recorded. Results The average load-to-failure of the coracoclavicular ligament in groups A, B, C, and D was 373.4 ±0.57 N, 373.6 ±0.62 N, 374.4 ±0.68 N, and 373.9 ±0.15 N, respectively (P>0.05). After internal fixation failure, Group A showed two specimens with clavicular fracture, and one with acromial fracture, with an average load-to-failure of 409.8 ±2.92 N. Group B and D showed three specimens with prolapse of anchor, with average load-to-failure of 293.5 ±4.10 N and 374.2 ±0.40 N, respectively. Group C showed three specimens with basilar coracoid fracture, with average load-to-failure of 373.2 ±2.35 N. Statistical differences existed in the biomechanical load of internal fixation failure among the four groups. Group D was statistically different from Group A and Group B, but not Group C. Conclusion The newly designed EndoButton plate combined with suture anchor for coracoclavicular ligament reconstruction was found to boast simple operation and has high feasibility. Thus it was found effective in the reduction of acromioclavicular joint and treatment of acromioclavicular joint dislocation and fitted the biomechanical characteristics of the acromioclavicular joint.

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Concomitant Tricuspid Valve Repair during Minimally Invasive Mitral Valve Repair

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1700506 ◽

2019 ◽

Vol 68 (06) ◽

pp. 486-491

Author(s):

Bettina Pfannmueller ◽

Martin Misfeld ◽

Piroze Davierwala ◽

Stefan Weiss ◽

Michael Andrew Borger

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Minimally Invasive ◽

Tricuspid Valve ◽

Early Mortality ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Invasive Approach ◽

Cardiopulmonary Bypass Time ◽

Significant Difference

Abstract Background Concomitant use of tricuspid valve (TV) surgery and minimally invasive mitral valve (MV) repair is debatable due to a prolonged time of surgery with presumably elevated operative risk. Herein, we examined cardiopulmonary bypass times and 30-day mortality in patients who underwent MV repair with and without concomitant TV surgery. Methods We retrospectively evaluated 3,962 patients with MV regurgitation who underwent minimally invasive MV repair without (n = 3,463; MVr group) and with (n = 499; MVr + TVr group) concomitant TV surgery between 1999 and 2014. Preoperative parameters between the groups were significantly different; therefore, propensity score matching was performed. Results Mean cardiopulmonary bypass time for all patients was 125.5 ± 55.8 minutes in MVr and 162.0 ± 58.0 minutes in MVr + TVr (p < 0.001). Overall 30-day mortality was significantly different between these groups (4.8 vs. 2.1%; p < 0.001); however, after adjustment, there was no significant difference (3.3 vs. 1.2%; p = 0.07). Backward logistic regression revealed that cardiopulmonary bypass time was not a significant predictor for early mortality within the MVr + TVr cohort. Conclusion Concomitant TV repair using prosthetic rings through a minimally invasive approach is safe and does not lead to elevated early mortality in our patient cohort. Therefore, prolonged cardiopulmonary bypass time should not be the sole reason to rule out MV repair with concomitant TV repair and to prefer the use of suture techniques, which saves only a few minutes compared with prosthetic ring implantation.

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The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer: A single center experience

Acta chirurgica iugoslavica ◽

10.2298/aci1003029p ◽

2010 ◽

Vol 57 (3) ◽

pp. 29-35 ◽

Cited By ~ 29

Author(s):

I. Popescu ◽

C. Vasilescu ◽

V. Tomulescu ◽

S. Vasile ◽

O. Sgarbura

Keyword(s):

Rectal Cancer ◽

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Invasive Surgery ◽

Metastatic Lymph Node ◽

Robotic Approach ◽

Invasive Approach ◽

Significant Difference

Background: Robotic approach for rectal cancer competes with laparoscopy in centers dedicated to minimally invasive surgery (MIS) due to the technologic advantage. This is a report of our experience with MIS for rectal cancer. Methods: A series of 84 consecutive patients with laparoscopic resection (between 1995-2010) and 38 consecutive patients with robotic resection (between 2008-2010) for primary rectal cancer were analyzed. Hartmann's procedures were excluded. Clinical and pathologic outcomes were reviewed retrospectively. Results: In the laparoscopic group (LG), 50 anterior rectal resections (ARR), 34 abdominal perineal resections (APR) were performed while in the robotic group(RG) there were 30 ARR and 8 APR. The median operative time was 182 min (140-220 min) in LG and 208 min (180- 300 min) in RG (p=0.0002). No statistically significant difference was noticed between the groups in terms of conversion, morbidity, anastomotic leak and postoperative stay rates. Margin clearance was obtained in all patients and the median number of removed lymph nodes was similar: 11.37 in RG vs 11.07 in the LG (p=0.65) with a higher rate of metastatic lymph node involvement in laparoscopy (p=0.0012). Blood loss was higher in LG (150 ml vs. 100 ml; p=0.0001). There were 5 (5.9%) local recurrences in the LG at a median follow- up of 27.5 months and 2 (5.2%) in the RG at a median follow-up of 13 months (p=0.43). Conclusions: Minimally invasive surgery for rectal cancer proved to be safe and efficient with similar results in the two groups. Technological advances of robotic approach compared to laparoscopy allowed better ergonomics, more refined dissection, easier preserving of hypogastric nerves and less blood loss. Long term outcomes are to be assessed in prospective randomized studies.

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Biomechanical Comparison of 2 Common Techniques of Minimally Invasive Hallux Valgus Correction

Foot & Ankle International ◽

10.1177/1071100720959029 ◽

2020 ◽

pp. 107110072095902

Author(s):

Amiethab Aiyer ◽

Dustin H. Massel ◽

Noman Siddiqui ◽

Jorge I. Acevedo

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Ultimate Load ◽

Biomechanical Testing ◽

Osteotomy Site ◽

Yield Load ◽

Chevron Osteotomy ◽

Significant Difference ◽

Load To Failure ◽

Biomechanical Strength

Background: Hallux valgus is one of the most common surgically corrected forefoot deformities. Compared to open procedures, minimally invasive (MIS) treatment of hallux valgus has resulted in decreased operative time, reduced complication rates, and greater patient satisfaction. Historically, distal chevron osteotomies are the standard for moderate hallux valgus correction. To our knowledge, no studies have evaluated biomechanical strength of transverse and chevron distal first metatarsal osteotomy (DMO) constructs. The purpose of this study was to evaluate the biomechanical strength of these techniques. Methods: Eighteen cadaveric specimens (9 matched pairs) were randomized to transverse or chevron DMO. Each technique was performed by a separate fellowship-trained orthopedic foot and ankle surgeon. Radiographic images were analyzed. Biomechanical testing was performed using Instron Mechanical System. Ultimate load to failure, yield load, and stiffness were assessed. A 10-N preload was applied to the sesamoid bones for stability. A coaxial compression rate (10 mm/min) was applied until failure was observed. Mean and standard deviations were compared. All cadaveric specimens were male. Results: There was no significant difference in percent metadiaphyseal shift between osteotomies ( P = .453). The most common mode of failure was fracture at screw insertion site (55.6%), followed by failure at osteotomy site (44.4%). A trend toward increased ultimate load to failure ( P = .480), yield load ( P = .054), and stiffness ( P = .438) among transverse compared to chevron osteotomy was observed, but this difference was not statistically significant. Conclusion: Biomechanical testing demonstrated no significant difference in ultimate load, yield load, and stiffness between MIS transverse and chevron osteotomy constructs; a trend toward increased strength in the transverse osteotomy cohort was observed. Chevron osteotomies may result in early failure by relative ease of cutout through cancellous bone compared to transverse osteotomies in which failure requires cortical cutout. Clinical Relevance: Use of MIS techniques for hallux valgus correction is gaining clinical traction. Although various clinical studies have evaluated outcomes of these MIS techniques, biomechanical studies have been minimal. Specifically, the potential biomechanical benefits of various MIS hallux valgus osteotomy techniques have not been delineated to date. The content of this manuscript is quite timely, given the rise in use of these MIS techniques.

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Impact of Minimally Invasive Esophagectomy in Post-Operative Atrial Fibrillation and Long-Term Mortality in Patients Among Esophageal Cancer

Cancer Control ◽

10.1177/1073274820974013 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482097401

Author(s):

LaiTe Chen ◽

BinBin Li ◽

ChenYang Jiang ◽

GuoSheng Fu

Keyword(s):

Atrial Fibrillation ◽

Esophageal Cancer ◽

Minimally Invasive ◽

Odds Ratio ◽

Minimally Invasive Esophagectomy ◽

Invasive Approach ◽

Invasive Esophagectomy ◽

Significant Difference ◽

Long Term Mortality

Aims: Postoperative Atrial fibrillation (POAF) after esophagectomy may prolong stay in intensive care and increase risk of perioperative complications. A minimally invasive approach is becoming the preferred option for esophagectomy, yet its implications for POAF risk remains unclear. The association between POAF and minimally invasive esophagectomy (MIE) was examined in this study. Methods: We used a dataset of 575 patients who underwent esophagectomy. Multivariate logistic regression analysis was performed to examine the association between MIE and POAF. A cox proportional hazards model was applied to assess the long-term mortality (MIE vs open esophagectomy, OE). Results: Of the 575 patients with esophageal cancer, 62 developed POAF. MIE was negatively associated with the occurrence of POAF (Odds ratio: 0.163, 95%CI: 0.033-0.801). No significant difference was observed in long-term mortality (Odds ratio: 2.144, 95%CI: 0.963-4.775). Conclusions: MIE may reduced the incidence of POAF without compromising the survival of patients with esophageal cancer. Moreover, the specific mechanism of MIE providing this possible advantage needs to be determined by larger prospective cohort studies with specific biomarker information from laboratory tests.

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Repair of Longitudinal Meniscal Tears by Single or Double Vertical Loop Sutures: In vitro Biomechanical Study under Cyclic Loading

The Journal of Knee Surgery ◽

10.1055/s-0039-1700571 ◽

2019 ◽

Vol 33 (03) ◽

pp. 314-318 ◽

Cited By ~ 1

Author(s):

Recep Kurnaz ◽

Murat Aşçı ◽

Selim Ergün ◽

Umut Akgün ◽

Taner Güneş

Keyword(s):

Cyclic Loading ◽

Ultimate Load ◽

Biomechanical Properties ◽

Meniscus Repair ◽

Biomechanical Study ◽

Meniscal Tears ◽

Pull Out ◽

Meniscus Tissue ◽

Significant Difference

AbstractOne of the factors affecting the healing of a meniscus repair is the primary stability of the tear. The purpose of this study is to compare single and double vertical loop (SVL vs. DVL) meniscal suture configurations by measuring elongation under cyclic loading and failure properties under ultimate load. We hypothesized that DVL configuration would have superior biomechanical properties than SVL. Twenty-two intact lateral menisci were harvested from patients who required total knee arthroplasty. A 20-mm longitudinal full-thickness cut was made 3 mm from the peripheral rim to simulate a longitudinal tear. Two groups were formed and group randomization was done according to patient age and gender (SVL group: mean age 68.3 years [range, 58–78 years], five males, six females; DVL group: mean age 67.4 years [range, 59–77 years], six males, five females). Cyclic loading was performed between 5 and 30 N at a frequency of 1 Hz for 500 cycles. Then, the meniscus repair construct was loaded until failure. Statistical analysis was performed using the t-test and the Mann–Whitney's U-test. During the early phases of cyclic loading, three specimens from each group failed because of suture pull out and are excluded from the study. At the end of 500 cycles, there was significantly less displacement in the DVL group than the SVL group (6.13 ± 1.04 vs. 9.3 ± 2.59 mm) (p < 0.05). No significant difference was found between groups regarding ultimate load to failure measurements (p > 0.05). All specimens in SVL and five specimens in DVL groups failed in the form of suture pull out from the meniscus tissue. Longitudinal meniscal tears repaired with DVL configuration had less elongation value under cyclic loading compared with SVL configuration. Because of its superior biomechanical properties, it would be more secure to repair large and instable longitudinal meniscal tears by the DVL technique. This is a level II study.

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Surgical management of pleural empyema in the very elderly

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13171221592212 ◽

2012 ◽

Vol 94 (5) ◽

pp. 331-335 ◽

Cited By ~ 10

Author(s):

M Schweigert ◽

N Solymosi ◽

A Dubecz ◽

M Beron ◽

L Thumfart ◽

...

Keyword(s):

Minimally Invasive ◽

Elderly Patients ◽

Hospital Mortality ◽

Surgical Therapy ◽

Pleural Empyema ◽

Very Elderly ◽

Tertiary Referral Hospital ◽

Invasive Approach ◽

Co Morbidity ◽

Significant Difference

INTRODUCTION Parapneumonic pleural empyema is a critical illness. Age is an acknowledged risk factor for both pneumonia and pleural empyema. Furthermore, elderly patients often have severe co-morbidity. In the case of pleural empyema, their clinical condition is likely to deteriorate fast, resulting in life threatening septic disease. To prevent this disastrous situation we adapted early surgical debridement as the primary treatment option even in very elderly patients. This study shows the outcome of surgically managed patients with pleural empyema who are 80 years or older. METHODS The outcomes of 222 consecutive patients who received surgical therapy for parapneumonic pleural empyema at a German tertiary referral hospital between 2006 and 2010 were reviewed in a retrospective case study. Patients older than 80 years were identified. RESULTS There were 159 male and 63 female patients. The mean age was 60.5 years and the overall in-hospital mortality rate was 7%. Of the 222 patients, 37 were 80 years or older (range: 80–95 years). The frequencies of predominantly cardiac co-morbidity and high ASA (American Society of Anesthesiologists) grades were significantly higher for very elderly patients (p<0.001). A minimally invasive approach was feasible in 34 cases (92%). Of the 37 patients aged over 80, 36 recovered while one died from severe sepsis (in-hospital mortality 3%). There was no significant difference in mortality between the very elderly and the younger sufferers (p=0.476). CONCLUSIONS Early surgical treatment of parapneumonic pleural empyema shows excellent results even in very elderly patients. Despite considerable co-morbidity and often delayed diagnosis, minimally invasive surgery was feasible in 34 patients (92%). The in-hospital mortality of very elderly patients was low. It can therefore be concluded that advanced age is no contraindication for early surgical therapy.

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The Internal Fixator Principle Applied to Proximal Tibial Fractures - An Early Gait Analysis Study

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.430.213 ◽

2013 ◽

Vol 430 ◽

pp. 213-216

Author(s):

Dan Crisan ◽

Dan Ioan Stoia ◽

Radu Prejbeanu ◽

Dinu Vermeşan ◽

Horia Hărăgus

Keyword(s):

Minimally Invasive ◽

Gait Analysis ◽

Movement Analysis ◽

Ct Scanning ◽

Clinical Results ◽

Minimally Invasive Technique ◽

Internal Fixator ◽

Invasive Technique ◽

Invasive Approach ◽

Significant Difference

The internal fixator principle is a novel, minimally invasive approach to epiphyseal fractures of the long bones. It has been advocated to provide a stable fixation of fracture fragments with the preservation of the osseous blood supply due to the lack of periosteal decortication. The aim of this minimally invasive technique is to allow for early rehabilitation, so in theory patients that went trough minimally invasive internal fixation osteosynthesis should have better clinical results with higher scores than patients that had classic ORIF technique. We investigated a number of 18 tibial plateau fractures in 18 patients that were matched by fracture classification and patient sex and age, 9 were treated by conventional plating techniques and the other 9 were treated by using an internal fixator. The patients were evaluated pre and postoperatively by conventional radiographic means and by CT scanning with 3D reconstruction, they were evaluated with the KOOS score at 3 and 6 months postoperative. Gait analysis was performed in the lab using a Zebris FDM System and a Zebris CMS 10 3D Movement Analysis System. Gait analysis was performed based on patient availability as soon as ambulation was possible and permitted without auxiliary support (crutches). KOOS scores increased from 3 to 6 months, the initial evaluation showed a mean value of 27,5 (19,7 to 39,4) for the ORIF group and a value of 33,9 (24,1 to 42,4) for the internal fixator group at 3 months, and increased to 64,8 (55,3 to 73,1) for the ORIF group and 69,8 (59,7 to 82,7) for the internal fixator group. The difference between stance and swing times, knee flexion angles and was found not to be statistically significant (p<0.05) at either 3 or 6 months postoperatively. The data shows no clear advantage in using an internal fixator over the classic plating methods at 6 months postoperatively. The minimally invasive technique provided for faster wound healing with better KOOS scores at 3 months but there was no statistically significant difference at 6 months postoperative. Limitations of the current study are the relatively small number of matched patients and the heterogeneity in patient physical characteristics such as patient weight and height and the level of preoperative fitness.

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