The Less Invasive Stabilization System in the treatment of complex fractures of the tibial plateau: Short-term results

Objectives: To report on the use of a new plating system in the treatment of high-energy tibial plateau fractures using minimally invasive stabilization techniques. Design: Prospective, consecutive patient series. Setting: University Level I trauma center. Patients: Thirty-seven patients with 39 fractures of the tibial plateau were treated using specialty plates. All fractures were OTA class 41 C. Ten of the fractures were open, including eight Gustilo and Anderson Type IIIA and two Type IIIB. Thirty-three patients with 34 fractures had follow-up of at least 12 months. Intervention: Internal fixation with the Less Invasive Stabilization System (LISS, Synthes USA, Paoli, PA) using minimally invasive techniques. Main Outcome Management: To determine clinical outcome, time to union, fracture alignment, articular step-off, incidence of complications, Short Form-36 outcome scores, and Lysholm knee scores in patients with associated ligament injuries. Results: All 34 of the fractures healed without additional surgical intervention or bone grafting. The mean follow-up in our series was 21 months, with a range of 12 to 38 months. Twenty-nine patients with 30 fractures had follow-up of greater than 1 year. The average time to radiographic callus was 6.1 weeks, and the average time to complete union was 15.6 weeks. The articular step-off average was 0.8 mm, with a range of 0 to 5 mm. The postoperative alignment demonstrated 1 patient with a malalignment of 5degrees procurvatum and 1 patient with 4degrees of valgus. There were two superficial wound infections and no cases of deep infection or osteomyelitis. Conclusions: The use of LISS plates appears to stabilize complex fractures of the tibial plateau with a low incidence of complications. The LISS system functioned well in maintaining alignment and obtaining union in these high-energy fractures.