Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures.
OBJECTIVE
To summarize the surgical experience and clinical results of the first 89 fractures of the proximal tibia treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA).


METHODS
Retrospective analysis of prospectively enrolled patients into a database.


METHODS
Academic level I trauma center.


METHODS
Eighty-seven consecutive patients with 89 proximal tibia fractures (AO/OTA type 41 and proximal type 42 fractures) treated by 2 surgeons. Seventy-five patients with 77 fractures were followed until union. The mean follow-up was 14 months (range: 3-35 months). There were 55 closed fractures and 22 open fractures.


METHODS
Surgical reduction and fixation of fractures, followed by rehabilitation.


METHODS
Perioperative and postoperative complications, postoperative alignment, loss of fixation, time to full weight bearing, radiographic union, and range of motion.


RESULTS
Seventy of 77 fractures healed without major complications (91%). There were 2 early losses of proximal fixation, 2 nonunions, 2 deep delayed infections, and 1 deep peroneal nerve palsy. Other complications included a superficial wound infection and 3 seromas. Postoperative malalignment occurred in 7 patients with 6 degrees to 10 degrees of angular deformity (6 flexion/extension and 1 varus/valgus malalignments), and an eighth patient had a 15 degrees flexion deformity. In 4 patients, the hardware was removed at an average of 13 months because of irritation (5%). The mean time for allowance of full weight bearing was 12.6 weeks (range: 6-21 weeks), and the mean range of final knee motion was 1 degrees to 122 degrees .


CONCLUSIONS
The LISS provides stable fixation (97%), a high rate of union (97%), and a low (4%) rate of infection for proximal tibial fractures. The technique requires the successful use of new and unfamiliar surgical principles to effect an accurate reduction and acceptable rate of malalignment.
Cole
Peter A
PA
Department of Orthopedic Surgery, University of Minnesota, Regions Hospital, St. Paul, MN, USA. peter.a.cole@healthpartners.com
Zlowodzki
Michael
M
Kregor
Philip J
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000145:classification / Q000534:rehabilitation / Q000601:surgery*; D014193:Trauma Centers; D016896:Treatment Outcome