Tibial fracture treated by minimally invasive plating using a novel low-cost, high-technique system
Tóm tắt
The less invasive stabilization system (LISS) can effectively treat tibial fractures. However, the LISS is technically demanding, has a long learning curve, and presents a heavy economic burden to patients. The U-grooved locking compression plate (U-LCP), characterized by a U-groove at each end, is designed to treat tibial fractures. This paper reports the outcomes of tibial fractures treated using the U-LCP compared with the LISS. Seventy-eight patients with unilateral tibial fractures treated with either the U-LCP (group I) or LISS (group II) were enrolled. In group I, a U-LCP was inserted subcutaneously with two Kirschner wires embedded into the U-grooves to temporarily secure the plate. A second identical plate was placed over the first to guide screw insertion. In group II, the LISS was used to fix the tibial fractures. Patient age, sex, fracture type, severity of soft tissue injury, operative time, fluoroscopic time, complications, and functional recovery of affected limbs were recorded. The two groups were comparable in age, sex, fracture type, and severity of soft tissue injury (p > 0.05). The average operation and fluoroscopic times in group I were significantly less than those in group II (p < 0.05). At follow-up, all fractures healed. There were no significant differences between both groups in time to bony union, wound complication rate, or functional recovery of injured limbs (p > 0.05). The U-LCP can yield good outcomes in the treatment of proximal tibial fractures, with less radiation exposure, a shorter operation time, and a sustainable price compared with the LISS.
Tài liệu tham khảo
Krettek C, Schandelmaier P, Nliclau T et al (1997) Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury 28:20–30
Williams T, Schenk W (2008) Bridging-minimally invasive locking plate osteosynthesis (Bridging-MILPO): technique description with prospective series of 20 tibial fractures. Injury 39(10):1198–1203
Giri S, Dirga Raj R, Gurung B et al (2009) Minimal invasive percutaneous plate osteosynthesis of fracture of tibia. PMJN 2(7):17–23
Cole P, Zlowodzki M, Kregor P (2004) Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma 18(8):528–535
Ricci WM, Rudzki JR, Borrelli J Jr (2004) Treatment of complex proximal tibia fractures with the less invasive skeletal stabilization system. J Orthop Trauma 18(8):521–527
Boldin C, Fankhauser F, Hofer HP et al (2006) Three-year results of proximal tibia fractures treated with the LISS. Clin Orthop Relat Res 445:222–229
Schutz M, Muller M, Krettak C et al (2001) Minimally invasive fracture stabilization of distal femoral fractures with the LISS: a prospective multi-center study; results of a clinical study with special emphasis on difficult cases. Injury 32(suppl 3):48–54
Hak DJ, Stewart RL, Lee M (2004) Preliminary stabilization of the less invasive stabilization system. J Orthop Trauma 18(8):559–561
Grist BD, Rocca GJD, Murtha YM (2008) Treatment of acute distal femur fractures. Orthopedics 31(7):681–690
Chen W, Zhang Q, Su Y et al (2012) Minimally invasive plate osteosynthesis of tibial fracture using self-navigated plate. Eur J Orthop Surg Traumatol 22(2):163–166. doi:10.1007/s00590-011-0783-0
Gustilo R, Anderson J (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58(4):453–458
Oestern H, Tscherne H (1984) Pathophysiology and classification of soft tissue injuries associated with fractures. Fractures with soft tissue injuries. Springer-Verlag, Berlin, pp 1–9
Hou Z, Zhang Q, Zhang Y et al (2009) A occult and regular combination injury: the posterior malleolar fracture associated with spiral tibial shaft fracture. J Trauma 66(5):1385–1390
Ricci WM, Rudski JR, Borrelli J Jr (2004) Treatment of complex proximal tibia fractures with the less invasive skeletal stabilization system. J Orthop Trauma 18:521–527
Wu CC (2006) Salvage of proximal tibial malunion or nonunion with the use of angled blade plate. Arch Orthop Trauma Surg 126:82–87
Johner R, Wruhs O (1983) Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res 178:7–25
Toms AD, McMurtie A, Maffulli N (2004) Percutaneous plating of the distal tibia. J Foot Ankle Surg 43(3):199–203
Babst R, Hehli M, Regazzoni P (2001) LISS tractor. Combination of the "less invasive stabilization system" (LISS) with the AO distractor for distal femur and proximal tibial fractures. Unfallchirurg 104(6):530–535
Schütz M, Müller M, Kääb M et al (2000) Minimal invasive Frakturstabilisierung von distalen Femurfrakturen mit dem LISS-System-Ergebnisse einer prospektiven Multizenter-Studie. Acta Chir Austriaca 32(suppl 2):83–84
Jiang R, Luo CF, Wang MC, Yang TY et al (2008) A comparative study of less invasive stabilization system (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures. Knee 15(2):139–143
Gautier E, Sommer C (2003) Guidelines for the clinical application of the LCP. Injury 34(suppl 2):B63–B76
Boraiah S, Kemp T, Erwteman A et al (2010) Outcome following open reduction and internal fixation of open pilon fractures. J Bone Joint Surg Am 92(2):346–352
He W, Jakob R (1986) Zur Problematik der Plattenosteosynthese bei den bikondylären Tibiakopffrakturen. Der Unfallchirurg 89(7):304–311
Vallier HA, Hennessey TA, Sontich JK et al (2006) Failure of LCP condylar plate fixation in the distal part of the femur. A report of six cases. J Bone Joint Surg Am 88(4):846–853