Less invasive stabilization system versus open reduction and internal fixation of closed proximal tibial fractures in adults

ObjectiveThe aim of this study was to compare the clinical and radiological outcome between less invasive stabilization system (LISS) and open reduction with internal fixation (ORIF) for the treatment of extra-articular proximal tibia fractures through the lateral approach.BackgroundProximal tibial fractures present a difficult treatment challenge with historically high complication rates. ORIF has been in vogue for long time with good outcome. However, it is associated with problems, especially overlying skin conditions, delayed recovery, and rehabilitation with limited functional outcome. LISS is an emerging procedure for the treatment of proximal tibial fractures. It preserves soft tissue and the periosteal circulation, which promotes fracture healing.Patients and methodsThirty patients with closed proximal tibial fractures were included in this study. They were randomly divided into two groups. Group I (n = 15) patients were treated with LISS and group II (n = 15) with ORIF. Major characteristics of the two groups were similar in terms of age, sex, mode of injury, fracture location, and associated injuries. All patients were followed up at least 6 months.ResultsIn each group, 12 patients showed union, two patients showed nonunion, and one patient showed delayed union. The mean operative time in LISS patients was 79.3 min, whereas in ORIF patients it was 122 min. All patients of the LISS group were exposed to radiation, whereas only 40% of patients in the ORIF group were exposed to radiation. The mean time of union in LISS patients was 10.87 weeks. However, in ORIF patients, the mean time of union was 21.13 weeks. There was no significant difference between the two groups as regards the postoperative complications. Functional outcome was satisfactory in both groups.ConclusionLISS achieves comparable results with ORIF in extra-articular fractures of the proximal tibia. Although LISS potentially has the radiation hazard, it reduces the perioperative complications with a shortened operation time and minimal soft tissue dissection.