Supracutaneous Locking Compression Plate for Grade I & II Compound Fracture Distal Tibia—A Case Series

S. K. Venkatesh Gupta, Shyam Prasad Parimala

Department of Orthopaedics, Mamata Medical College, Khammam, India.
Department of Orthopaedics, Mamata Medical College, Khammam, India..

DOI: 10.4236/ojo.2013.32021                

Abstract

Background: Supracutaneous plating using a locking compression plate (LCP) as an external fixator in compound periarticular areas is facilitated by the development of anatomical plates. The soft tissue around the distal tibia is easily compromised by trauma and subsequent operative fracture treatment posing a definitive challenge in the distal tibia compound fractures. The purpose of this report is to describe our successful results using the metaphyseal locking compression plate (LCP) as an external fixator in the treatment of Grade I & II compound fractures of distal tibia. Methodology: A total of five (05) patients underwent “supracutaneous plating” of the tibia using a metaphyseal locking compression plate. Average age was 36 years. Regular screw tract dressings were done. Average period of follow-up was 15 months. Results: The plate was in situ for an average of 24 weeks. There were no clinically significant screw site infections. In all five patients the plate was kept in place until there was complete consolidation both clinically and radiologically. At the latest follow-up (average 15 months), all patients were fully weight bearing with a fully healed tibia. All patients were infection-free with well-healed wounds. Conclusion: Routinely, after initial debridement and temporary bony stabilization is provided by external fixation in compound fractures of the distal tibia with significant soft tissue injury. Most external frames for the lower leg are bulky and cumbersome, causing significant problems for the patient. To circumvent these issues, we have successfully used an anatomically-contoured supracutaneous metaphyseal locking compression plate as external fixator in a series of five patients for grade I & II compound fracture of the distal tibia.

Keywords

Locking Compression Plate; Compound Tibial Fractures; External Fixation of LCP

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	P. A. McCann, M. Jackson, S. T. Mitchell and R. M. Atkins, “Complications of Definitive Open Reduction and Internal Fixation of Pilon Fractures of the Distal Tibia,” International Orthopaedics, Vol. 35, No. 3, 2011, pp. 413-418. doi:10.1007/s00264-010-1005-9
[2]	T. W. Lau, F. Leung, C. F. Chan and S. P. Chow, “Wound Complication of Minimally Invasive Plate Osteosynthesis in Distal Tibia Fractures,” International Orthopaedics, Vol. 32, No. 5, 2008, pp. 697-703. doi:10.1007/s00264-007-0384-z
[3]	J. J. Hutson, “Salvage of Pilon Fracture Nonunion and Infection with Circular Tensioned Wire Fixation,” Foot and Ankle Clinics, Vol. 13, No. 1, 2008, pp. 29-68. doi:10.1016/j.fcl.2007.11.004
[4]	L. Eralp and M. Kocaoglu, “Distal Tibial Reconstruction with Use of a Circular External Fixator and an Intramedullary Nail: Surgical Technique,” The Journal of Bone & Joint Surgery, Vol. 90, No. 2, 2008, pp. 181-194. doi:10.2106/JBJS.H.00467
[5]	P. C. Cavadas and L. Landín, “Treatment of Recalcitrant Distal Tibial Nonunion Using the Descending Genicular Corticoperiosteal Free Flap,” Journal of Trauma, Vol. 64, No. 1, 2008, pp. 144-150. doi:10.1097/01.ta.0000249347.35050.3f
[6]	M. E. Pannunzio, A. B. Chhabra, S. R. Golish, M. R. Brown and W. C. Pederson, “Free Fibula Transfer in the Treatment of Difficult Distal Tibia Fractures,” Journal of Reconstructive Microsurgery, Vol. 23, No. 1, 2007, pp. 11-18. doi:10.1055/s-2006-958696
[7]	D. Ring, J. B. Jupiter, B. S. Gan, R. Israeli and M. J. Yaremchuk, “Infected Nonunion of the Tibia,” Clinical Orthopaedics and Related Research, Vol. 369, 1999, pp. 302-311. doi:10.1097/00003086-199912000-00032
[8]	D. B. Thordarson, M. J. Patzakis, P. Holtom and R. Sherman, “Salvage of the Septic Ankle with Concomitant Tibial Osteomyelitis,” Foot & Ankle International, Vol. 18, No. 3, 1997, pp. 151-156. doi:10.1177/107110079701800307
[9]	C. L. Toh and J. B. Jupiter, “The Infected Nonunion of the Tibia,” Clinical Orthopaedics and Related Research, Vol. 315, 1995, pp. 176-191.
[10]	S. A. F. Tulner, G. R. Schaap, S. D. Strackee, P. P. Besselaar, J. S. Luitse and R. K. Marti, “Long-Term Results of Multiple-Stage Treatment for Posttraumatic Osteomyelitis of the Tibia,” Journal of Trauma, Vol. 56, No. 3, 2004, pp. 633-642. doi:10.1097/01.TA.0000112327.50235.0A
[11]	C. Collinge, J. Kennedy and A. Schmidt, “Temporary External Fixation of Lower Extremity,” Orthopedics-Healio, Vol. 33, No. 1, 2010, p. 4.
[12]	G. M. M. J. Kerkhoffs, M. M. Kuipers, R. K. Marti and C. Werken, “External Fixation with Standard AO-Plates: Technique, Indications, and Results in 31 Cases,” Journal of Orthopaedic Trauma, Vol. 17, No. 1, 2003, pp. 61-64. doi:10.1097/00005131-200301000-00010
[13]	T. Appivatthakakul and K. Sanapanich, “The Locking Compression Plate as an External Fixator for Bone Transport in the Treatment of a Large Distal Tibial Defect: A Case Report,” Injury, Vol. 38, 2007, pp. 1318-1325.
[14]	C. Y. L. Woon, M. K. Wong and T. S. Howe, “LCP External Fixation—External Application of an Internal Fixator: Two Cases and a Review of the Literature,” Journal of Orthopaedic Surgery and Research, Vol. 5, No. 1, 2010, p. 19. doi:10.1186/1749-799X-5-19
[15]	P. Kloen, “Supercutaneous Plating: Use of a Locking Compression Plate as an External Fixator,” Journal of Orthopaedic Trauma, Vol. 23, No. 1, 2009, pp. 72-75. doi:10.1097/BOT.0b013e31818f8de4