Minimally Invasive Surgery by Angular Stability Systems in Proximal Tibia Fractures - Biomechanical Characteristics and Preliminary Results

Complex fractures of the proximal tibia are difficult to treat. Minimally invasive plate osteosynthesis (MIPO) has determined the result improvement while the angular stability plate type Less Invasive Stabilization System - proximal lateral tibia (LISS-PLT) or Locked Compression plate (LCP-PLT) were specially created for this kind of fractures. The purpose of this study was to emphasize the design and biomechanical characteristics of these systems as well as to evaluate the results following the treatment of the complex fractures on the proximal tibia by MIPO with these plates with angular stability. The authors emphasize the design of the plate, the concept of the internal fixator and the importance of the aiming device for percutaneous insertion. There were investigated 8 fractures of the proximal tibia in 8 patients, with a mean age of 39.5 years. Fractures were classified according to AO/ASIF in 2 type A3, 2 type C1, 2 type C2 and 2 type C3). There were three open fractures (1 type I and 2 type II) according to Gustilo. In all 8 cases we have performed minimally invasive plate osteosynthesis, using a LISS-PLT system in 5 cases or a LCP-PLT in 3 cases. All fractures healed after a mean time of 13 weeks and the knee mobility was considered as good (mean flexion of 105 degrees). Due to major biomechanical and biological advantages, the authors consider that, despite the high prices, the internal fixator type LISS-PLT or LCP-PLT represent the ideal implants for the complex fractures of proximal tibia.