Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures.
High-energy proximal tibial fractures are complex injuries that may lead to significant complications. Staged treatment of these injuries using a spanning external fixator across the knee joint in the acute setting decreases the incidence of complications. This article is a prospective evaluation of outcomes using a two-stage procedure for treatment of 15 patients who sustained open proximal tibial fractures between April 2006 and January 2008. In the first stage, we used low profile, less-invasive stabilisation system (LISS) plates for temporary external fixation to immobilise the fractures after anatomic reduction, followed by soft-tissue reconstruction. In the second stage, we applied LISS plates for definitive internal fixation, using minimally invasive percutaneous osteosynthesis. All fractures were monitored for a mean of 20.4 months (range, 12-32 months). All fractures united at a mean of 38.6 weeks (range, 18-66 weeks). Knee motion ranged from a mean of 1 degrees (range, 0 degrees to 5 degrees ) to 125 degrees of flexion (range, 100 degrees to 145 degrees ). The reduction was scored as good in 13 patients and fair in two patients. At follow-up, 10 patients had excellent, and five had good knee scores. The complications included minor screw-track infections in three patients. In conclusion, the two-stage technique was well suited for treating these difficult injuries, and for patients who needed longer periods of external fixation. Surgeons were able to achieve gross anatomy restoration, soft-tissue reconstruction, stable fixation and high union rates. Patients obtained good-to-excellent motion, function and comfort after treatment.
Ma
Ching-Hou
CH
Department of Orthopedics, E-Da Hospital/I-Shou University, No. 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung 824, Taiwan.
Wu
Chin-Hsien
CH
Yu
Shang-Won
SW
Yen
Cheng-Yo
CY
Tu
Yuan-Kun
YK
D000328:Adult; D002985:Clinical Protocols; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D005597:Fractures, Open / Q000145:classification / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009984:Orthopedic Fixation Devices; D010043:Outcome and Process Assessment, Health Care; D016059:Range of Motion, Articular; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000145:classification / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult