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The authors are from the Department of Orthopedics, Ningbo No. 6 Hospital, Ningbo, Zhejiang Province, China.
The authors have no relevant financial relationships to disclose.
Segmental tibial fractures feature a unique fracture type characterized by a completely isolated intercalary osseous fragment separated by at least 2 distinct fracture lines.1-3 These fractures are usually the result of high-energy trauma and are often associated with significant morbidity caused by severe soft tissue injury, nonunion, delayed union, malunion, and osteomyelitis.4-8 Treatment modalities include nonoperative management, fixation with plates and screws, intramedullary nailing, and external fixator devices, and each modality has significant morbidity.7-12 Currently, the optimal management of these injuries remains controversial.
A locking plate, such as the less-invasive stabilization system (LISS) plate (Synthes, Paoli, Pennsylvania), is advocated as an internal-external fixator given its angular stable screw fixation. These properties make locking plates good candidates for external plate fixation. The purpose of this study was to evaluate the use of the LISS locking plate as an external fixator for the management of segmental tibial fractures. Analogous to so-called submuscular plating, the authors have coined this technique supercutaneous plating.13
Materials and Methods
Between January 2009 and March 2012, twenty adult patients (12 men and 8 women) with segmental fractures of the tibia were treated at the authors' institution using supercutaneous plating. Mean patient age was 36.9 years (range, 22-67 years). The fracture site was at the proximal middle third of the tibial shaft in 9 patients, the proximal distal third of the shaft in 5 patients, and the middle distal third of the tibial shaft in 6 patients. The fractures were classified according to the AO classification (proximal fractures: 6 type A, 8 type B, 6 type C; distal fractures: 5 type A, 7 type B, 8 type C). Fractures were caused by car accidents in 13 patients, industrial injuries in 4 patients, and falling from heights in 3 patients. Six fractures were closed and 14 were open (6 grade IIIa, 2 grade IIIb, 4 grade II, 2 and grade I, according to the Gustilo classification). Multiple fractures were present in 4 patients, and 3 patients had multiple organ injury.
Treatment Protocol
The open segmental fractures were treated with immediate irrigation and debridement. If the condition of the patient was...