title: Complications of locking plate fixation in complex proximal tibia injuries.
abstract: OBJECTIVE
  To report the complications and pitfalls in the treatment of complex injuries of the proximal tibia when locking plates are used.
  
  
  METHODS
  This was a retrospective case series conducted at a university Level I trauma center. Thirty-seven patients with complex proximal tibia fractures (41C1, 41C2, 41C3, 41A2, 42A2) were treated with locking plates.
  
  
  METHODS
  All fractures were treated with locking plates (Less Invasive Stabilization System (LISS); Synthes, Paoli, PA).
  
  
  METHODS
  Healing, alignment, infection, and other complications.
  
  
  RESULTS
  Twelve fractures (32%) healed without any complications. Eight patients (22%) developed deep infections that required operative debridements, and 5 of them had a hardware removal; 1 eventually required an above-knee amputation. Eight cases (22%) had postoperative malalignment, with hyperextension as the most common deformity. Three cases (8%) had loss of alignment into varus during healing. Other complications were 1 superficial wound dehiscence, 1 delayed soft-tissue breakdown, 4 hardware irritations, 1 peroneal nerve injury at the distal part of a 9-hole plate, 1 tibial tubercle nonunion, and 1 postoperative compartment syndrome.
  
  
  CONCLUSIONS
  The complication rate, particularly infection, was higher than in previous reports. Other complications such as hardware prominence, malalignment, and loss of alignment were similar to those of historical controls. Some of the complications may reflect the techniques that were used and should decrease with more experience; however, some may be inherent in the treatment of high-energy fractures using locking plates.
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. pphisitkul@hotmail.com
authors.forename: Phinit
authors.initials: P
authors.lastname: Phisitkul
authors.forename: Todd O
authors.initials: TO
authors.lastname: McKinley
authors.forename: James V
authors.initials: JV
authors.lastname: Nepola
authors.forename: John L
authors.initials: JL
authors.lastname: Marsh
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D013978:Tibial Fractures / Q000601:surgery*; D014945:Wound Healing