A TECHNICAL NOTE ON SAFE DEFINITIVE EXTERNALIZED LOCKED PLATING FOR BIOLOGICAL FRACTURE HEALING IN COMPLEX TIBIAL FRACTURES

Abstract

Purpose. This technical note describes a minimally invasive surgical technique for early appropriate care in patients with high-energy, multifragmentary tibial fractures by means of safe one-stage external stabilization with angle-stabled plates. The purpose of the presented prospective case series study was, to explore the clinical feasibility and research the biomechanical parameters and of externalized locked plating and, to test the functional result and clinical outcomes following the novel technique for definitive surgical treatment for complex - meta-diaphyseal multifragmentary, proximal (with simple intra-articular) and distal (multifragmentary metaphyseal), fractures of the shin bone. Methods: Thirty-three patients participated in the prospective feasibility study, carried out from August 2012 to September 2023. The precise inclusion criteria were:sustained high-energy tibial trauma and severe soft tissue injury, with complex proximal and distal meta-diaphyseal tibial fractures, stabilized with externalized locked plating. Results: Eighteen of the patients from the prospective cohort included in the study were followed up for an average of 21.4 ± 12.3 months, union rate of 94,7%. All fractures healed by means of secondary bone union and with minor complications. We reached a significantly shorter mean union time was 21.1 ± 4.6 weeks, for patients with proximal extra- versus intra-articular meta-diaphyseal tibial fractures, p = 0.04. According to HSS and AOFAS scores, good and excellent functional results in knee and ankle joints’ range of motion were accomplished among 90 percents of the patients. However, there were no registered implant de-bricolage, non-union or severe deep infection. We had two patients with re-fracture between the fourth and sixth week after external plate removal, who underwent secondary surgical procedure for successful bone healing. Several screws were loosened in nine patients from the cohort, with no negative effect on the bone union process. Conclusions. The currently reported technique for one–stage supercutaneousfracture stabilization by means of externalized locked plating is a novel surgical procedure for a safe external fracture fixation with LISSDF plate. The definitive externalized fracture plating is a viable surgical solution for natural bone union in complex – multifragmentary meta-diaphyseal tibial fractures with injured soft tissue envelope.

Keywords

• tibia
• open fractures
• soft tissue injury
• externalized supercutaneous plating