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.
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.
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.
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.