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.
Endovascular Bariatric Surgery as Novel Minimally Invasive Technique for Weight Management in the Morbidly Obese: Review of the Literature
