Proximal tibial fractures with intraarticular extensions are 1very difcult to manage . Complex biomechanics of weight bearing position, complex ligamentous stability and articular congruency are the main concerns to the surgeons in these type of fractures. The ideal treatment of high energy tibial plateau fracture is controversial. Open reduction and internal xation with plate and screws method helps to achieve good anatomical 2reduction ,but devitalize the soft tissue and the rate of wound infection is high. To prevent this complication the trend of treatment is towards biological xation with minimal soft tissue damage which can be accomplished by MIPPO technique MATERIALS & METHODS This prospective study was conducted from November 2017 to June 2019. In this 30 patients of proximal tibial fractures extending to diaphysis,closed fractures, schatzker type 2 to type 6 and patient's age more than 18 years were included. Patients with compound fractures, impending compartment syndrome, Schatzker type 1 and patient's age less than 18 years were excluded from the study. The consent of the patient for anesthesia and surgery was obtained. Patient was Immobilized and adequate limb elevation was given. Patient were placed in supine position, under MIPPO technique anterolateral approach skin incision was made in between gerdy's tubercle and anterior to head of bula. Fascia was incised,indirect reduction of fracture was done by manual traction and reduction was maintained with reduction clamps. Appropriate size locking compression locking plate was placed extra–periosteally and xed with K- wires temporarily. Alignment was checked and xed with both proximal and distal screw. Depressed fragments were elevated in some cases;void lled with bone grafting, 6.5mmscrews were xed proximally and 5mm cortical locking screw was applied through multiple mini stab incisions. K wires were removed . ndPostoperatively wound was inspected at 2 post operative day. Post-op X RAY was taken. Non-weight bearing and static stquadriceps exercises were started on the 1 post operative day .Knee range of movements and quadriceps strengthening ndwere started from 2 post operative day . Patient were followed at 6 weeks,3 months,6 months intervals 4for functional outcome by modied Rasmussen criteria . RESULTS: In our 30 patients,the mean age group was 44.23years , 22 (73. 33%) patients were male 8 (26.66%)patients were female.12 patients had right side tibial plateau fracture,18 patients had left side tibial plateau fracture.Road trafc accident was the most common mode of injury (26 patients).10 patient had schatzker type 2 fracture,12 patients had schatzker type 5, 8 patient had schatzker type 6 fracture.22 patients had knee range of movements > 120 degrees, 7 patients had >90- 120 degrees, 1 patient had knee range of movements of 80 degrees. In (gure 3 , 4) patient with schatzker type 6 with exion of > 120 degrees. The average time for bone union was 14.16 weeks .Functional outcome of 30 cases of proximal tibial fractures is provided in Table 1.Functional outcome was divided into 4 categories based on modied rassmusen criteria,18 patients had excellent outcome ,9 patients had good outcome, 3 patients had fair outcome.There was no poor outcome in our study.27(90%) patients had acceptable outcome which are comparable with other studies Complications were noted in 4 patients ,2 patients had knee stiffness,one patient had supercial skin infection,one patient had screw backout.(Fig:5) TABLE:1 MINIMALLY INVASIVE PERCUTANEOUS PLATE OSTEOSYNTHESIS FOR PROXIMAL TIBIAL FRACTURES-A PROSPECTIVE STUDY Original Research Paper Mohammed Irfankhan H Post Graduate Department Of Orthopaedics ,sri Venkateshwaraa Medical College And Research Centre, Puducherry , India Orthopaedics INTRODUCTION: Proximal tibial fractures are most common in road trafc accidents,are difcult to manage due to limited soft tissue coverage. Conventional method of plate and screws can devitalize soft tissue. To overcome such complications MIPPO TECHNIQUE is widely used. METHODS: The functional outcome of proximal tibial fractures in 30 patients treated by MIPPO technique has been evaluated. These patients were followed for 6 months postoperatively and assessed by modied Rasmussen score. RESULTS: In our analysis of 30 patients ,18(60%) patients had excellent results, 9(30%) patients had good results, 3(10%)had fair outcome. DISCUSSION: Fracture of proximal tibia involves lot soft tissue damage,this compromised soft tissue condition must be considered while treating them. MIPPO is more of biological xation with less soft tissue damage,hence wound healing is faster. ABSTRACT KEYWORDS : Minimally Invasive Percutaneous Plate Osteosynthesis.,biological Fixation,proximal Tibia Fractures. VOLUME-9, ISSUE-2, FEBRUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Balasubramaniam R* Prof. Department Of Orthopaedics,sri Venkateshwaraa Medical College And Research Centre, Puducherry, India *Corresponding Author Manikandan A Asst Prof. Department Of Orthopaedics, Sri Venkateshwaraa Medical College And Research Centre, Puducherry, India. Functional Interpretation (modied Rasmussen Criteria) No Of Patients Percentage Excellent 18 60 Good 9 30 Fair 3 10 Poor 0 0 Total 30 100 28 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS FIGURE: 5 Complication: Screw back out. DISCUSSION: Treatment of proximal tibial fractures are challenging due to limited soft tissue cover and even a small irregularity on articular surface in the joint leads to early arthritis ,instability 3and stiffness . There are various treatment options from closed reduction and casting to open reduction internal xation with plate and screws. Open reduction and internal xation with plate and screws can cause extensive devitalization of soft tissue leading to delayed wound healing and infections. In our study we managed these fractures by minimally invasive percutaneous plate osteosynthesis (MIPPO). This technique is widely accepted for treatment for peri articular fractures in which we reduce and stabilize the facture without opening the fracture site with minimal incision providing favourable environment for fracture healing. In our study most of the patients were male who are in active age group as they involve in travel sports and motor riding activities. It shows high velocity nature of tibial plateau fracture.which 5can be compared with Albuquere et al study . In our series of 30 patients 77.33% of patients had knee range of movements of >120 degrees.Mean range of movements was 122.83 degrees which is comparable with Changwug oh 6et al study . In our study we used modied Rasmussen criteria for evalu ation of functional outcome. 90%of the patients had acce ptable outcome.which can be compared with Hassain Raza et 7 8al and Neil Rohra et al studies. In our study average time for bony union was 14.16 weeks. All the fractures united .There was no case of non union in our study. There were 4 complications noted in our study.Two patients had knee stiffness due to poor follow up,which recovered after physiotherapy. One patient had supercial skin infection which resolved following antibiotics. One patient had screw back out . CONCLUSION: MIPPO technique is simple and more effective compared to the conventional plating system.It is more of a biological xation with less soft tissue damage hence wound healing is faster. DECLARATION OF PATIENT CONSENT The authors certify that they have obtained all appropriate patients consent forms. In the form,the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that name and initial will not be published and due efforts will be made to conceal their identity,but anonymity cannot be guaranteed. FINANCIAL SUPPORT AND SPONSORSHIP: Nil CONFLICTS OF INTEREST: There are no conict of interest REFERENCES: 1. Campbells operative orthopaedics; Fractures of lower extremity:Tibial plateau 2094- 2111 Vol 3. 2. Kenneth. A. Egol and Kenneth J Koval , In: Fracture of proximal tibia: chapter 50, Rockwood and Green’s “Fracture in Adults”, Vol. 2, 6th edition, Lippincott Williams and Wilkins. pp. 1999. 3. Charles . M. Court-Brown, In: Fracture of tibia and bula. Chapter 52, Rockwood and Green’s “Fracture in Adults” , Vol. 2, 6th edition, Lippincott Williams and Wilkins, pp. 2080 4. Schatzkar J, McBroom R, Bruce D. The tibial plateau fractures. Toronto Experience. ClinOrthop 1979;138:94. 5. Albuquerque, RP e, Hara R, Prado J, Schiavo L, Giordano V, &AmaralNP do.Epidemiological study on tibial plateau fractures at a level I traumacenter. ActaOrtopédicaBrasileira. (2013): 21(2), 109-15. 6. Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung et all. Double plating ofunstable proximal t ibial fractures using minimally invasive percutaneousosteosynthesis technique. Injury ActaOrthopaedica 2006; 77(3):524-530. 7. Raza H, Hashmi P, Abbas K, Hafeez K. Minimally invasive plate osteosynthesis for tibial plateau fractures. J Orthopaedic Surgery. 2012;20(1):42–47 8. Rohra N, Suri HS, Gangrade K. Functional and Radiological Outcome of Schatzker type V and VI Tibial Plateau Fracture Treatment with Dual Plates with Minimum 3 years follow-up: A Prospective Study. J ClinDiagn Res. 2016;10(5):RC05–RC10. VOLUME-9, ISSUE-2, FEBRUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra FIGURE: 1 FIGURE: 2 FIGURE: 3 FIGURE: 4 PRE OP XRAY AT 6 MONTHS X 29GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS