title: Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating.
abstract: BACKGROUND
  Bicondylar tibial plateau fractures are complex injuries, historically associated with high complication rates. The purpose of this study was: 1) to evaluate the clinical use L.I.S.S plating system for stabilization of bicondylar tibial plateau fractures. 2) To compare the biomechanics of this plating system with a double plate construct.
  
  
  METHODS
  Thirty-eight patients who sustained a complex tibial plateau fracture (OTA type 41C) at one of three level-one trauma centers were stabilized using the Less Invasive Stabilization System (L.I.S.S.). The cohort of patients was evaluated clinically and radiographically for outcomes at a mean 15 months. In phase 2 of this study a model of a bicondylar tibial plateau fractures was made in six matched pairs of embalmed, human tibia and randomized to fixation with either a L.I.S.S plate or a standard double plate construct. The tibias were then subjected to an axial cyclic load of 500N for 10 cycles (3Hz) to approximate 2 months in vivo and displacements measured.
  
  
  RESULTS
  Thirty-six of /38 (95%) patients united at 4 months after surgery with no loss of fixation nor infection. Two patients underwent prophylactic autogenous bone grafting for bone loss and united by 3 months postgrafting. Significant loss of knee range of motion (<90) was seen in five patients.Biomechanically, no differences in permanent inferior displacement of the medial fragment were found in initial axial loading and after 10 cycles between the two plate constructs. However, when loaded to 500N the L.I.S.S plate construct demonstrated almost twice the displacement of the medial fragment compared with the dual plate construct. No specimen lost fixation during cycling.
  
  
  CONCLUSIONS
  The L.I.S.S plating system provides stable fixation of complex bicondylar tibial plateau fractures allowing early range of knee motion with favorable clinical results.
authors.affiliation: Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, New York, New York, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
authors.forename: Edward
authors.initials: E
authors.lastname: Su
authors.forename: Nirmal C
authors.initials: NC
authors.lastname: Tejwani
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Sims
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Kummer
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Koval
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001860:Bone Plates / Q000009:adverse effects / Q000592:standards*; D001863:Bone Screws / Q000009:adverse effects / Q000592:standards; D019245:Compressive Strength; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D013978:Tibial Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing