Abstract
Introduction: Proximal tibial fractures continue to be problematic for orthopaedic surgeons.
Continued problems in their managment include infection, soft tissue problems, failure of fixation and joint stiffness.
Combining the concept of “biological plating” and locked internal fixators, the LISS (Less Invasive Stabilization System) has been developed.
Material and methods: The Lis-system is an extramedullary internal fixator that proposes the advantage of indirect reduction and percutaneous, submuscular implant placement.
The Lis-system is indicated for fractures of the proximal tibia that involve both the medial and lateral columns. They include AO/OTA Type A2, A3, C1, C2, C3 and type B in selected cases. For the reduction, we put the lower limb in the calcaneal-traction.
For intra-articular fractures the prime objective is to achieve anatomic reconstruction of the joint. This study is a prospective evluation of the Lis-System for the treatment of high-energy tibial plateau and proximal tibial fractures treated between October 2002 and Febrary 2004. Twenty-five patient (18 male and 7 female) were treated. The fracture were classified according to the AO classification.
The follow-up period between 3 months and 16 months (mean 8.9 months).
Results: The fractures treated were 10 intrarticular (AO 41C or 41B) and 15 metaphyseal (AO 41 A); two of these fractures presented with open soft tissue damage. The average age of the patients was 43 years. There were five cases of polytraumatized and four patinetsa with multiple fractures. The mean range of motion was 2 degree (R= 0–13) to 110 degree (R= 80–150). The mean time to full weight-bearing was 16.2 weeks (R= 10–19).
There where no non-union. In one case, there was a valgus malunion of about 5 degree, in 2 case a valgus malunion of less of 5 degree and anyone of more of 5 degree.
The tecnique of osteosyntesis with the LISS allows a minimally invasive approach, minimizing additional trauma to the soft tissue.
There were no cases of varus malunion, of failure or of loss of reduction. One patient developed superficial infection that we treat with antibiotics terapy. No syndrome compartiment were see.
Conclusion: In conclusion with the new methods of percutaneus plate osteosyntesis we see decreased soft tissue complication and the time of healing.
The Less Invasive Stabilizzation System in our opinion is the goal standard for multisegmentary or comminnuted fractures of the proximal tibia with distal long extensions in patients with politrauma.
The early clinical result optain in our experiance indicate that the Less invasive Stabilizzation System combine efficent bone stabilization with the advantage of minimally invasive operative technique.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
