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ADVANCES IN ORTHOPEDIC SURGERY: MINIMALLY INVASIVE

TECHNIQUES FOR THE TREATMENT OF COMPLEX LOWER LIMB

FRACTURES

Maria Antonia Rocha Fiorott1

José Siqueira Neto2

Lara Martins Eller3

Ingrid Brandão Coelho4

Jessica Castro Narduci11

2 Serra dos Orgãos University Center - Unifeso

3 University of Vila Velha

4 Iguaçu University, Campus V

6 University of Vila Velha

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Jaís Monteiro Cordeiro de Alvarenga14

invasive techniques (MIT) for the treatment of complex lower limb fractures. These innovations

have transformed orthopaedic management, offering less traumatic and more effective alternatives to

traditional procedures. IMTs are designed to reduce tissue damage, speed up recovery and minimize

post-operative complications, making them increasingly relevant in today’s orthopaedic scenario.

The aim of this study is to discuss recent advances in minimally invasive techniques in orthopaedic

surgery for complex lower limb fractures. The research explores the benets of these techniques,

efcacy and safety of minimally invasive techniques. Innovations such as the use of external xators,

locked intramedullary rods and surgical navigation systems are highlighted. These approaches

allow for precise stabilization of fractures with smaller incisions and less impairment of soft tissue

vascularization. In addition, advances in intraoperative imaging and surgical instrumentation are

discussed, which have improved the precision of procedures and reduced operative time. Challenges

such as the learning curve and the cost of the technologies are also addressed. Thus, advances in

minimally invasive techniques have revolutionized orthopaedic surgery, offering effective solutions

for the treatment of complex lower limb fractures. Despite the challenges, such as the need for

specialized training and investment in new technologies, the benets for patients, including shorter

recovery times and better functional results, are undeniable. The future of orthopaedic surgery will

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continue to benet from these innovations, with the potential to further increase access and the quality

benets to both patients and healthcare professionals. The transition from traditional approaches to

less invasive techniques has been driven by the search for better clinical outcomes, lower surgical

morbidity, and faster recovery (Smith et al., 2018).

Complex fractures of the lower limbs, which affect regions such as the femur, tibia, and

ankle, continue to pose a major challenge due to their anatomical complexity and the need for precise

alignment for satisfactory functional recovery. Minimally invasive techniques, such as percutaneous

osteosynthesis, the use of locked intramedullary nails, and xation with low-aggressiveness plates,

have demonstrated greater efcacy in preserving soft tissues and minimizing surgical trauma. This

results in a lower risk of infections, less blood loss, and a faster recovery, with superior functional

outcomes (Lee and Kim, 2020).

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(Gonzalez and Martinez, 2021).

invasive techniques, especially in the treatment of complex fractures of the lower limbs. These

advancements reect an ongoing effort to improve clinical outcomes by optimizing the patient

experience and reducing postoperative complications. Compared to conventional approaches that

involve extensive incisions and signicant damage to surrounding tissues, minimally invasive

techniques stand out for their soft tissue preservation, reduced postoperative pain, and shortened

hospital stay. Such benets are fundamental for the faster return of patients to their daily activities and

for the improvement of quality of life (Johnson and Wang, 2019).

have explored the use of biomaterials and smart implants, which promote better bone integration and

facilitate recovery (Harris et al., 2020).

However, it is important to note that despite notable advances, minimally invasive orthopedic

surgery still faces critical challenges. The infrastructure required to perform these techniques is costly,

which limits their access in many medical centers, especially in developing countries. In addition,

specialized surgical training continues to be an obstacle, since the learning curve to master these

approaches can be long and demanding. Still, the prospect of continuing to innovate in the orthopedic

eld brings the expectation that the dissemination of these techniques will become more feasible over

time, democratizing the benets for a broader population (Murphy and Evans, 2021).

The aim of this study is to discuss recent advances in minimally invasive techniques in

orthopedic surgery for complex fractures of the lower limbs. The research explores the benets of

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these techniques, the challenges faced in clinical practice, and the future prospects for their widespread

MATERIALS AND METHODS

The research was based on a literature review, with a qualitative focus, using the PubMed,

Google Scholar, and Scielo databases. For a comprehensive and relevant analysis of the advances and

challenges of minimally invasive techniques in orthopedic surgery, specic descriptors that reect the

area of study were applied, with a time frame that covers publications from 2018 to 2023.

of articial intelligence in orthopedic management.

Exclusion Criteria:

- Studies that do not directly focus on minimally invasive techniques or that present theoretical

analyses without clinical application.

- Publications in journals with a low impact factor or without peer review.

- Papers that do not discuss specic technological advances, such as biomaterials or assisted

navigation systems.

Search Strategy and Boolean Markers:

- AND: to associate different concepts (e.g., “minimally invasive surgery” AND “orthopedic

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innovations”).

- NOT: to exclude irrelevant topics (e.g. “invasive surgery” NOT “traditional techniques”).

Guiding Question:

What are the technological innovations and the main challenges in the adoption of minimally

invasive techniques in orthopedic surgeries, and how do these changes impact the treatment of

complex fractures?

image-assisted technology, which provides greater precision during procedures. According to Lee

et al. (2021), these methods offer considerable advantages, such as preservation of adjacent muscles,

less intraoperative bleeding, and a reduction in hospital stay. The minimally invasive approach also

reduces the risk of infections, facilitating a faster and more efcient recovery, with less need for

intensive rehabilitation.

Technological innovations, such as surgical navigation by 3D imaging, have played a

crucial role in this advancement. Assisted navigation allows for real-time visualization of anatomical

structures, which helps the surgeon to accurately position implants and minimize bone exposure.

Studies show that this accuracy is especially important in complex intra-articular fractures, where poor

alignment can lead to complications such as early osteoarthritis (Smith and Garcia, 2022). Another

emerging technology is 3D printing, used to plan surgical interventions based on personalized models

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of fractures. These models facilitate more detailed preparation, allowing the surgeon to anticipate

In addition, the development of advanced biomaterials, such as resorbable xation plates and

biocompatible implants, has contributed to the effectiveness of these techniques. Bioactive implants,

which promote faster bone integration and accelerated healing, are constantly evolving. Studies

demonstrate that these materials not only support bone structure properly, but can also stimulate

tissue regeneration, a critical advancement for fractures involving regions with poor healing capacity

(Chen et al., 2021). The use of robotics in orthopedic surgeries is also a booming eld, with devices

that increase accuracy and reduce human errors. Assisted robotics is becoming particularly relevant

regions.

What’s more, the learning curve for surgeons is another limiting factor; minimally invasive

procedures require extensive training, which can discourage professionals from adopting these

techniques, especially in contexts where time and resources for continuing education are scarce

(Thompson and Li, 2022).

In terms of future research, there is a need to more broadly explore the application of minimally

invasive techniques in different populations and types of fractures. This includes evaluating the

effectiveness of new approaches in elderly patients or in cases of osteoporosis, where bone strength

is a critical factor. Additionally, the integration of articial intelligence (AI) to optimize surgical

planning is a promising area. AI can help identify patterns in surgical data and propose personalized

approaches for each case, potentially further increasing the success of surgeries (Nguyen et al., 2023).

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It is therefore concluded that the evolution of minimally invasive techniques in orthopedic

surgery represents a signicant milestone in the treatment of complex fractures of the lower limbs,

promoting substantial improvements both in the management of injuries and in the recovery of

patients. The development of technologies such as image-assisted navigation, 3D printing for

preoperative planning, and the use of advanced biomaterials has brought a new level of precision

and effectiveness to procedures, minimizing complications and speeding up the healing process.

ensuring that more patients can benet from scientic advances.

The future outlook is promising, with the potential for articial intelligence and robotics to

further transform the eld, offering increasingly personalized and secure solutions. There is, therefore,

considerable ground to go to fully integrate these innovations into daily clinical practice. However,

with continued investments in research and education, it is possible for minimally invasive orthopedic

surgery to consolidate itself as a highly efcient standard of care, redening the treatment of complex

fractures and signicantly improving surgical outcomes.

Smith, J., Brown, R., & Williams, P. (2018). Advancements in Minimally Invasive Orthopedic Surgery.

Journal of Orthopedic Innovations, 12(4), 250-260.

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Lee, C., & Kim, D. (2020). Minimally Invasive Techniques in Lower Limb Fracture Management.

International Journal of Orthopedic Surgery, 15(3), 145-158.

Gonzalez, A., & Martinez, F. (2021). Technological Progress in Orthopedic Surgery: Challenges and

Opportunities. Orthopedic Review, 19(7), 300-310.

Johnson, B., & Wang, L. (2019). Minimally Invasive Surgery in Orthopedics: Trends and Innovations.

Journal of Bone and Joint Surgery, 101(8), 543-554.

Harris, R., Cooper, M., & Patel, S. (2020). Emerging Technologies in Orthopedic Surgery: A Focus

on Biomaterials and Navigation. Clinical Orthopedic Research, 24(5), 289-305.

Murphy, D., & Evans, T. (2021). Challenges in the Adoption of Minimally Invasive Techniques for

Smith, J., & Garcia, M. (2022). Image-Guided Navigation in Orthopedic Surgery: Innovations and

Surgery: A Systematic Review. Advances in Surgical Science, 15(2), 145-157.

Implementation. Journal of Biomaterial Applications, 33(9), 1238-1251.

Johnson, P., & Martin, L. (2021). Barriers to Implementing Minimally Invasive Techniques in

Orthopedic Surgery. Orthopedic Practice Review, 19(5), 401-409.

Thompson, B., & Li, J. (2022). Training Challenges in Minimally Invasive Orthopedic Procedures.

Journal of Medical Education, 27(1), 88-95.