Introduction. Being challenging, multifragmentary proximal tibial fractures in patients with severe soft tissue injuries and/or short stature can be treated using externalized locked plating. A recent finite element study, investigating the fixation stability of plated unstable tibial fractures with 2-mm, 22-mm and 32-mm plate elevation under partial and full weight-bearing, reported that from a virtual biomechanical point of view, externalized plating seems to provide appropriate relative stability for secondary bone healing under partial weight-bearing during the early postoperative phase. The aim of the current study was to evaluate the clinical outcomes of using a LISS plate as a definitive external fixator for the treatment of multifragmentary proximal tibial fractures. Methods. Following appropriate indirect reduction, externalized locked plating was performed and followed up in 12 patients with multifragmentary proximal tibial fractures with simple intraarticular involvement and injured soft tissue envelope. Results. Among all patients, the average follow up period was 22 months (range14–48 months), revealing uneventful healing in all of them. Time to fracture union was 21.8 weeks on average (range 16–28weeks). The mean HSS knee score was 87 (range 72–98) at 4 weeks postoperatively and 97 (range 88–100) at the final follow up. The average AOFAS score was 92 (range 84–100) at 4 weeks postoperatively and 98 (range 94–100) at the final follow up. Conclusions. Externalized locked plating seems to be a successful surgical alternative treatment in selected cases with unstable proximal tibial fractures and severe soft tissue injury, following appropriate indirect fracture reduction

Abstract. Objective. To compare the clinical and radiological outcome between less invasive stabilization system (LISS, Synthes, Paoli, PA.) and open reduction with internal fixation (ORIF) for the treatment of extraarticular proximal tibia fractures through the lateral approach. Background. Proximal tibial fractures present a difficult treatment challenge with historically high complication rates. ORIF has been in vogue for long time with good outcome. But these are associated with problems especially overlying skin conditions, delayed recovery and rehabilitation with limited functional outcome. LISS is an emerging procedure for the treatment of proximal tibial fractures. It preserves soft tissue and the periosteal circulation, which promotes fracture healing. Patients and methods. Thirty patients with closed proximal tibial fractures were included in this study. They were randomly divided into 2 groups. Group I (n=15) patients were treated by LISS and group II (n=15) by ORIF. Major characteristics of the two groups were similar in terms of age, sex, mode of injury, fracture location, and associated injuries. All patients were followed up at least 6 months. Results. In each group, 12 patients were united, 2 patients were non- united and one patient showed delayed union. The mean operative time in LISS patients was 79.3 min, while in ORIF patients; it was 122 min. All patients of LISS group were exposed to radiation, while only 40% of ORIF group were exposed. The mean time of union of LISS patients was 10.87weeks. While in ORIF patients, the mean time of union was 21.13 weeks. There was no significant difference between both groups regarding the postoperative complications. Functional outcome was satisfactory in both groups. Conclusion. LISS achieves comparable results with ORIF in extraarticular fractures of the proximal tibia. Although LISS potentially has the radiation hazard, it reduces the perioperative complications with a shortened operation time and minimal soft tissue dissection. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Summary Statement. Objectifying postoperative recovery of patients with comminuted tibial plateau fractures treated with a unilateral plate trough the use of a gait analysis system. Introduction. Gait analysis has been a proved method for assessing postoperative results in patients with different orthopedic afflictions of the lower limb such as hallux valgus, ankle instabilities, knee osteoarthritis and arthroplasties but it has rarely been used for postoperative assessment of proximal tibial fractures. The more traditional means of quantifying postoperative articular step-off and limb axis deviations such as conventional X Rays and CT scanning and the clinician and patient completed scores that subjectively assess the outcome are complemented by the analysis of gait patterns set to objectify the most important patient related factor - the gait. As controversy exists in literature regarding the optimal treatment for severe tibial plateau fractures we proposed a gait study to evaluate locked angle unilateral plate osteosynthesis. Patient & Method: A computerised motion analysis system and a sensor platform were used to gather gait data from 15 patients with unilateral tibial plateau fractures graded Shatzker V and VI treated with a angular stable locked lateral plate osteosynthesis. Gait analysis was performed postoperatively based on patient availability and as soon as ambulation was possible and permitted without auxiliary support (crutches) at 4 (mean of 4,6), 6 (mean of 6,2) and 12 (mean of 11,7) months respectively, at a naturally comfortable walking. All patients were evaluated using classic anteroposterior and lateral knee radiography and were asked to fill the KOOS score questionnaire at the time of the gait analysis session. Results. The spatial-temporal and angular parameters revealed the expected postoperative decrease in ROM in both flexion and extension of the knee. Step and stance time objectively decreased between measuring session with an increase in single support of 3,7% mean value. A constant increase in walking speed was noted from a mean of 42 cm/sec (cadence of 31 st/min) at 4 months to a speed of 90 cm/sec (mean of 49 st/min cadence). We also determined a asymmetrical and wider walking base, increased area of support during single leg standing, decreased stance and increased swing phases for the injured knee compared to contralateral. Discussion. All patients in the study were subjectively satisfied with the results of the treatment, however we were able to detect quantifiable differences of gait parameters such between the injured and the contralateral knee such as step, stance and swing time and in knee flexion and adduction, combined with a modified, wider walking base. Ground reaction forces were strongly related to score improvement and thus directly reflected the healing at the fracture site

We used a rabbit model to investigate the mechanism by which the angulation of fractures is corrected in children. We produced a transverse proximal tibial fracture in one leg of 12 eight-week-old New Zealand white rabbits and measured bone alignment and length and the patterns of bone growth and remodelling. The angle between the joint surfaces changed rapidly to correct the alignment of the limb as a result of asymmetrical growth of epiphyseal plates. In an adult with closed plates, the angle between the joint surfaces cannot therefore improve. The angle at the fracture itself showed slow improvement because of bone drift and the asymmetrical growth of the epiphyseal plates. Remodelling corrected the shape of the bone in the region of the fracture. Periosteal division on the convex side increased the growth of the epiphyseal plate on that side, thus slowing the correction. The effect was relatively small, providing an indication that factors other than the periosteum are important in inducing correction. External torsional deformities developed because of helical growth at the plate. This was probably caused by abnormal posture which induced a torque at the growth plate. Helical growth is the mechanism by which rotational deformities can occur and correct