Clin Orthop Surg.  2015 Mar;7(1):8-14. 10.4055/cios.2015.7.1.8.

External Fixation Using Femoral Less Invasive Stabilization System Plate in Tibial Proximal Metaphyseal Fracture

Affiliations
  • 1Department of Orthopaedic Surgery, Ningbo Sixth Hospital, Ningbo, China. awei3@sohu.com
  • 2Department of Orthopaedic Surgery, University of Toledo, Toledo, OH, USA.

Abstract

BACKGROUND
The locking plates are often used for internal fixation of closed tibial fractures. The use of a locking plate as an external fixator is still controversial, particularly for closed fractures. The purpose of this study is to evaluate the results of external fixation using the femoral less invasive stabilization system (LISS) plate in proximal metaphyseal fractures of the tibia.
METHODS
We prospectively evaluated 35 patients (26 males and 9 females) with a mean age of 42 years (range, 21 to 62 years) who presented with fresh tibial proximal metaphyseal fractures. According to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, the fractures were identified as type 41-A2 in 18 cases and type 41-A3 in 17 cases, including 25 closed fractures and 10 open fractures. The femoral LISS plate was used to fix these fractures, which was placed on the anteromedial aspect of the tibia as an external fixator. The mean follow-up period was 18 months (range, 13 to 22 months).
RESULTS
All fractures healed in a mean time of 14 weeks (range, 10 to 20 weeks). There was no case of nonunion, deep infection, and loosening of screws and plates. One month after the appearance of cortical bridging on biplanar radiographs, the locking plate was removed within 3 minutes in the clinic without any difficulty. According to the Hospital for Special Surgery (HSS) knee scoring system and American Orthopaedic Foot & Ankle Society (AOFAS) ankle scoring system, the mean HSS score was 91 (range, 85 to 100) and 98 (range, 93 to 100), and the mean AOFAS score was 94 (range, 90 to 100) and 98 (range, 95 to 100) at 4 weeks postoperatively and final follow-up, respectively.
CONCLUSIONS
For proximal metaphyseal fracture of the tibia, external fixation using the femoral LISS plate is a safe and reliable technique with minimal complications and excellent outcomes. Its advantages include ease of performing the surgery, use of a less invasive technique, and convenience of plate removal after fracture healing.

Keyword

Tibia; Fracture; Surgery; External fixation; Locking plate

MeSH Terms

Adult
*Bone Plates
External Fixators
Female
Fracture Fixation/*instrumentation/methods
Humans
Male
Middle Aged
Prospective Studies
Tibial Fractures/radiography/*surgery
Young Adult

Figure

  • Fig. 1 Preoperative X-ray showing the tibial proximal metaphyseal fracture.

  • Fig. 2 Three months postoperative X-ray showing fracture healing.

  • Fig. 3 The wound and the plate in situ after the emergency operation.

  • Fig. 4 (A-C) Joint with full range of motion and wound after plate removal at 3 months postoperative.

  • Fig. 5 X-ray showing fracture healing at 6 months after plate removal.


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