Complications of locking plate fixation in complex proximal tibia injuries

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• Complex proximal tibia fractures present significant treatment challenges.
• Locking plates offer potential advantages in stabilizing these injuries.

Purpose of the Study:

• To evaluate the complications and pitfalls associated with using locking plates for complex proximal tibia fractures.

Main Methods:

• Retrospective case series of 37 patients with complex proximal tibia fractures (AO/OTA 41C1-3, 41A2, 42A2).
• All fractures were treated with locking plates (Less Invasive Stabilization System - LISS).
• Outcomes assessed included healing, alignment, infection, and other complications.

Main Results:

• 32% of fractures healed without complications.
• 22% developed deep infections, with 5 requiring hardware removal and 1 leading to amputation.
• 22% experienced postoperative malalignment (common: hyperextension), and 8% had loss of alignment into varus.

Conclusions:

• The complication rate, particularly infection, exceeded previous reports.
• Malalignment and hardware issues were comparable to historical data.
• Some complications may be technique-related and improve with experience, while others may be intrinsic to locking plate use in high-energy fractures.