Single Lateral Locked Screw Plating of Bicondylar Tibial Plateau Fractures

We prospectively followed a case series of 68 patients with 69 AO/ASIF 41-C-type fractures treated with the Less Invasive Stabilization System for the proximal lateral tibia. We assessed malreduction, secondary loss of reduction, and infection rates in patients with a locked screw plate for unilateral fixation of bicondylar fractures. Sixty-two (91%) patients returned for final followup (range, 11-13 months). Malreduction and malalignment were defined as an intraarticular step-off of 2 mm or greater, or as a malalignment in the frontal or sagittal plane greater than 5°. Fourteen fractures were open. Primary bone grafting was done in 13 patients. Significant malreduction was seen in 16 patients. There were four superficial infections and one deep infection. One fracture did not heal, and nine patients had substantial loss of reduction. Unilateral locked screw plating is a good alternative for treatment of problematic fractures of the tibial plateau that are associated with soft tissue damage and metaphyseal comminution. The reduction technique for exact alignment is demanding. Level of Evidence: Therapeutic Study, Level IV (case series). See Guidelines for Authors for a complete description of levels of evidence.

[1]  M. Evans,et al.  The Use of Combination Internal Fixation and Hybrid External Fixation in Severe Proximal Tibia Fractures , 1995, Journal of orthopaedic trauma.

[2]  R. Jakob,et al.  [Plate osteosynthesis in bicondylar fractures of the tibial head]. , 1986, Der Unfallchirurg.

[3]  C. Burri,et al.  [Results of surgical treatment of 225 tibial-head fractures]. , 1975, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[4]  M. Blauth,et al.  [Osteosynthesis of fractures of the head of the tibia in advanced age. A matched-pair analysis]. , 2001, Der Unfallchirurg.

[5]  H. Nötzli,et al.  Treatment of tibial plateau fractures with small fragment internal fixation: a preliminary report. , 2000, Journal of orthopaedic trauma.

[6]  W. Mills,et al.  Complications Associated With Internal Fixation of High-Energy Bicondylar Tibial Plateau Fractures Utilizing a Two-Incision Technique , 2004, Journal of orthopaedic trauma.

[7]  J. Alonso,et al.  Fracture stabilization of proximal tibial fractures with the proximal tibial LISS: early experience in Birmingham, Alabama (USA). , 2003, Injury.

[8]  P. D. M. E. Müller,et al.  The Comprehensive Classification of Fractures of Long Bones , 1990, Springer Berlin Heidelberg.

[9]  P. Regazzoni,et al.  [LISS tractor. Combination of the "less invasive stabilization system" (LISS) with the AO distractor for distal femur and proximal tibial fractures]. , 2001, Der Unfallchirurg.

[10]  R. Barrack,et al.  Complications of internal fixation of tibial plateau fractures. , 1994, Orthopaedic review.

[11]  M. Saleh,et al.  Outcome of complex fractures of the tibial plateau treated with a beam-loading ring fixation system. , 2003, The Journal of bone and joint surgery. British volume.

[12]  M. Zlowodzki,et al.  Less Invasive Stabilization System (LISS) for fractures of the proximal tibia: indications, surgical technique and preliminary results of the UMC Clinical Trial. , 2003, Injury.

[13]  M. Müller,et al.  Manual of Internal Fixation , 1970, Springer Berlin Heidelberg.

[14]  B. Bai,et al.  Effect of Articular Step-off and Meniscectomy on Joint Alignment and Contact Pressures for Fractures of the Lateral Tibial Plateau , 2001, Journal of orthopaedic trauma.

[15]  J. Harvey,et al.  Tibial Plateau Fractures: Definition, Demographics, Treatment Rationale, and Long‐Term Results of Closed Traction Management or Operative Reduction , 1987, Journal of orthopaedic trauma.

[16]  A. Bhave,et al.  Deformity planning for frontal and sagittal plane corrective osteotomies. , 1994, The Orthopedic clinics of North America.

[17]  H. Tscherne,et al.  Pathophysiology and Classification of Soft Tissue Injuries Associated with Fractures , 1984 .

[18]  H. Kataria,et al.  Small Wire External Fixation for High-Energy Tibial Plateau Fractures , 2007, Journal of orthopaedic surgery.

[19]  C. Krettek,et al.  Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. , 1997, Injury.

[20]  M. Schütz,et al.  Stabilization of proximal tibial fractures with the LIS-System: early clinical experience in Berlin. , 2003, Injury.

[21]  V. M. Santoro,et al.  Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol. , 1992, Journal of orthopaedic trauma.

[22]  S E Honkonen,et al.  Indications for surgical treatment of tibial condyle fractures. , 1994, Clinical orthopaedics and related research.

[23]  R. Frigg,et al.  Locking Compression Plate (LCP). An osteosynthesis plate based on the Dynamic Compression Plate and the Point Contact Fixator (PC-Fix). , 2001, Injury.

[24]  A. Mallik,et al.  Hybrid External Fixation of Comminuted Tibial Plateau Fractures , 1996, Clinical orthopaedics and related research.

[25]  D. Stamer,et al.  Bicondylar Tibial Plateau Fractures Treated with a Hybrid Ring External Fixator: A Preliminary Study , 1994, Journal of orthopaedic trauma.

[26]  C Krettek,et al.  Minimally invasive fracture stabilization of distal femoral fractures with the LISS: a prospective multicenter study. Results of a clinical study with special emphasis on difficult cases. , 2001, Injury.

[27]  C Krettek,et al.  Distal femoral fractures and LISS stabilization. , 2001, Injury.

[28]  R. Gustilo,et al.  OTD classic article review - Gustillo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses , 2002, The Journal of bone and joint surgery. American volume.

[29]  H. Tscherne,et al.  Tibial plateau fractures. Management and expected results. , 1993 .

[30]  A. Kumar,et al.  Treatment of complex (Schatzker Type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review. , 2000, Journal of orthopaedic trauma.

[31]  S. Raikin,et al.  Combined limited internal fixation with circular frame external fixation of intra-articular tibial fractures. , 1999, Orthopedics.

[32]  T. Miclau,et al.  A minimally invasive medial approach for proximal tibial fractures. , 2001, Injury.

[33]  K. Bachus,et al.  A biomechanical analysis of internal fixation of complex tibial plateau fractures. , 1999, Journal of orthopaedic trauma.

[34]  D. N. Williams,et al.  Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. , 1984, The Journal of trauma.

[35]  C. Krettek,et al.  Less Invasive Stabilization of Complex Tibial Plateau Fractures: A Biomechanical Evaluation of a Unilateral Locked Screw Plate and Double Plating , 2004, Journal of orthopaedic trauma.

[36]  J Cordey,et al.  Biomechanical Evaluation of the Less Invasive Stabilization System for the Internal Fixation of Distal Femur Fractures , 2001, Journal of orthopaedic trauma.

[37]  E. Frankenburg,et al.  Bicondylar Tibial Plateau Fractures: A Biomechanical Study , 2003, Clinical orthopaedics and related research.

[38]  L. Klenerman,et al.  The results of surgical management of displaced tibial plateau fractures in the elderly. , 1995, Injury.

[39]  C. Krettek,et al.  LISS PLT: design, mechanical and biomechanical characteristics. , 2003, Injury.

[40]  R. Szyszkowitz.  Patella and Tibia , 1992 .

[41]  S. Gilbert,et al.  The development of the distal femur Less Invasive Stabilization System (LISS). , 2001, Injury.

[42]  K. Koval,et al.  Indirect Reduction and Percutaneous Screw Fixation of Displaced Tibial Plateau Fractures , 1992, Journal of orthopaedic trauma.