Segmental tibial fractures usually follow a high-energy trauma and are often associated with many complications. The purpose of this report is to describe the authors’ results in the treatment of segmental tibial fractures with supercutaneous locking plates used as external fixators. Between January 2009 and March 2012, a total of 20 patients underwent external plating (supercutaneous plating) of the segmental tibial fractures using a less-invasive stabilization system locking plate (Synthes, Paoli, Pennsylvania). Six fractures were closed and 14 were open (6 grade IIIa, 2 grade IIIb, 4 grade II, and 2 grade I, according to the Gustilo classification). When imaging studies confirmed bone union, the plates and screws were removed in the outpatient clinic. Average time of follow-up was 23 months (range, 12–47 months). All fractures achieved union. Median time to union was 19 weeks (range, 12–40 weeks) for the proximal fractures and 22 weeks (range, 12–42 weeks) for the distal fractures. Functional results were excellent in 17 patients and good in 3. Delayed union of the fracture occurred in 2 patients. All patients’ radiographs showed normal alignment. No rotational deformities and leg shortening were seen. No incidences of deep infection or implant failures occurred. Minor screw tract infection occurred in 2 patients. A new 1-stage protocol using supercutaneous plating as a definitive fixator for segmental tibial fractures is less invasive, has a lower cost, and has a shorter hospitalization time. Surgeons can achieve good reduction, soft tissue reconstruction, stable fixation, and high union rates using supercutaneous plating. The current patients obtained excellent knee and ankle joint motion and good functional outcomes and had a comfortable clinical course.
- 1.Melis GC, Sotgiu F, Lepori M, Guido P. Intramedullary nailing in segmental tibial fractures. J Bone Joint Surg Am. 1981; 63(8):1310–1318. Google Scholar
- 2.Rommens PM, Coosemans W, Broos PL. The difficult healing of segmental fractures of the tibial shaft. Arch Orthop Trauma Surg. 1989; 108(4):238–242.
10.1007/BF00936208Crossref, Google Scholar
- 3.Woll TS, Duwelius PJ. The segmental tibial fracture. Clin Orthop Relat Res. 1992; (281):204–207. Google Scholar
- 4.Beardi J, Hessmann M, Hansen M, Rommens PM. Operative treatment of tibial shaft fractures: a comparison of different methods of primary stabilisation. Arch Orthop Trauma Surg. 2008; 128(7):709–715.
10.1007/s00402-008-0619-5Crossref, Google Scholar
- 5.Langård O, Bo O. Segmental tibial shaft fractures. Acta Orthop Scand. 1976; 47(3):351–357.
10.3109/17453677608992004Crossref, Google Scholar
- 6.Reynders P. Open acute segmental tibial fracture fixation using the less invasive stabilisation system (LISS): study of 23 consecutive cases. Injury. 2009; 40(4):449–454.
10.1016/j.injury.2008.09.007Crossref, Google Scholar
- 7.Sarmiento A, Gersten LM, Sobol PA, Shankwiler JA, Vangsness CT. Tibial shaft fractures treated with functional braces: experience with 780 fractures. J Bone Joint Surg Br. 1989; 71(4):602–609. Google Scholar
- 8.Wu CC, Shih CH. Segmental tibial shaft fractures treated with interlocking nailing. J Orthop Trauma. 1993; 7(5):468–472.
10.1097/00005131-199310000-00010Crossref, Google Scholar
- 9.Huang CK, Chen WM, Chen TH, Lo WH. Segmental tibial fractures treated with interlocking nails: a retrospective study of 33 cases. Acta Orthop Scand. 1997; 68(6):563–566.
10.3109/17453679708999027Crossref, Google Scholar
- 10.van der Linden W, Larsson K. Plate fixation versus conservative treatment of tibial shaft fractures: a randomized trial. J Bone Joint Surg Am. 1997; 61(6):873–878. Google Scholar
- 11.Oztürkmen Y, Karamehmetoglu M, Karadeniz H, Azboy I, Caniklioglu M. Acute treatment of segmental tibial fractures with the Ilizarov method. Injury. 2009; 40(3):321–326.
10.1016/j.injury.2008.07.013Crossref, Google Scholar
- 12.Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984; 24(8):742–746.
10.1097/00005373-198408000-00009Crossref Medline, Google Scholar
- 13.Kloen P. Supercutaneous plating: use of a locking compression plate as an external fixator. J Orthop Trauma. 2009; 23(1):72–75.
10.1097/BOT.0b013e31818f8de4Crossref, Google Scholar
- 14.Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing: its application to comminuted fractures of the femur. J Bone Joint Surg Am. 1985; 67(5):709–720. Google Scholar
- 15.Dellinger EP, Miller SD, Wertz MJ, Grypma M, Droppert B, Anderson PA. Risk of infection after open fracture of the arm or leg. Arch Surg. 1988; 123(11):1320–1327.
10.1001/archsurg.1988.01400350034004Crossref, Google Scholar
- 16.Kakar S, Tornetta P. Segmental tibia fractures: a prospective evaluation. Clin Orthop Relat Res. 2007; (460):196–201. Google Scholar
- 17.Robertson A, Giannoudis PV, Matthews SJ. Maintaining reduction during unreamed nailing of a segmental tibial fracture: the use of a Farabeuf clamp. Injury. 2003; 34(5):389–391.
10.1016/S0020-1383(01)00195-4Crossref, Google Scholar
- 18.Ricci WM, O’Boyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws. J Orthop Trauma. 2001; 15(4):264–270.
10.1097/00005131-200105000-00005Crossref, Google Scholar
- 19.Chapman MW. The role of intramedullary fixation in open fractures. Clin Orthop Relat Res. 1986; (212):26–34 Google Scholar
- 20.Maurer DJ, Merkow RL, Gustilo RB. Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation. J Bone Joint Surg Am. 1989; 71(6):835–838. Google Scholar
- 21.Ricci WM, O’Boyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws. J Orthop Trauma. 2001; 15(4):264–270.
10.1097/00005131-200105000-00005Crossref, Google Scholar
- 22.Kim KC, Lee JK, Hwang DS, Yang JY, Kim YM. Provisional unicortical plating with reamed intramedullary nailing in segmental tibial fractures involving the high proximal metaphysis. Orthopedics. 2007; 30(3):189–192. Google Scholar
- 23.Matthews DE, McGuire R, Freeland AE. Anterior unicortical buttress plating in conjunction with an unreamed interlocking intramedullary nail for treatment of very proximal tibial diaphyseal fractures. Orthopedics. 1997; 20(7):647–648. Link, Google Scholar
- 24.Dendrinos GK, Kontos S, Katsenis D, Dalas A. Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator. J Bone Joint Surg Br. 1996; 78(5):710–717. Google Scholar
- 25.Perren SM. Evolution and rationale of locked internal fixator technology: introductory remarks. Injury. 2001; 32(suppl 2):B3–B9.
10.1016/S0020-1383(01)00120-6Crossref, Google Scholar
- 26.Frigg R. Locking Compression Plate (LCP). An osteosynthesis plate based on the Dynamic Compression Plate and the Point Contact Fixator (PC-Fix). Injury. 2001; 32(suppl 2):63–66.
10.1016/S0020-1383(01)00127-9Crossref, Google Scholar
- 27.Tulner SA, Strackee SD, Kloen P. Metaphyseal locking compression plate as an external fixator for the distal tibia. Int Orthop. 2012; 36(9):1923–1927.
10.1007/s00264-012-1585-7Crossref, Google Scholar
- 28.Ma CH, Wu CH, Yu SW, Yen CY, Tu YK. Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures. Injury. 2010; 41(2):190–196.
10.1016/j.injury.2009.08.022Crossref, Google Scholar
- 29.Ma CH, Yu SW, Tu YK, Yen CY, Yeh JJ, Wu CH. Staged external and internal locked plating for open distal tibial fractures. Acta Orthop. 2010; 81(3):382–386.
10.3109/17453674.2010.487244Crossref, Google Scholar
- 30.Ma CH, Tu YK, Yeh JH, Yang SC, Wu CH. Using external and internal locking plates in a two-stage protocol for treatment of segmental tibial fractures. J Trauma. 2011; 71(3):614–619.
10.1097/TA.0b013e3182041175Crossref, Google Scholar
- 31.Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop. 2008; 32(5):697–703.
10.1007/s00264-007-0384-zCrossref, Google Scholar