Awful considerations with LCP instrumentation: a new pitfall

Area of Science:

• Orthopaedic Surgery
• Trauma Management
• Biomaterials Engineering

Background:

• Locking compression plate (LCP) systems offer advantages in fracture fixation but demand meticulous preoperative planning and surgical technique.
• Existing literature often emphasizes mechanical aspects of LCP, potentially overlooking critical soft tissue considerations.
• Soft tissue complications associated with LCP use, particularly with conventional surgical approaches, are not well-documented.

Purpose of the Study:

• To investigate the incidence and nature of soft tissue complications following locking compression plating (LCP) for tibial metaphyseal fractures.
• To highlight the importance of soft tissue management in LCP procedures, beyond mechanical fixation considerations.

Main Methods:

• A prospective analysis of 34 patients undergoing LCP fixation for tibial metaphyseal fractures over a 6-month period.
• Inclusion criteria focused on patients treated with a long conventional incision, excluding percutaneous techniques.

Main Results:

• A significant rate of severe soft tissue damage (23.5%) was observed, characterized by exposed plates.
• All patients experiencing severe soft tissue damage required subsequent flap coverage for wound management.

Conclusions:

• The higher profile of locking compression plates compared to dynamic compression plates necessitates heightened attention to soft tissue handling.
• Injudicious use of LCP with conventional incisions, without adequate soft tissue consideration, increases the risk of complications compared to dynamic compression plating.