Locked plating as an external fixator in treating tibial fractures

Abstract

Objectives:This article is a systematic review of the published literature about the biomechanics, functional outcomes, and complications of a locked plate as an external fixator in treating tibial fractures.Methods:We searched the PubMed, Ovid Medline, Embase, ScienceDirect, and Cochrane Library databases to retrieve the relevant studies. Studies published in English and Chinese which assessed adult patients and more than 4 cases who had sustained any type of fresh tibial fracture treated with the external locking plate, provided that they reported functional outcomes, range of motion (ROM), union or complication rates, and the biomechanical studies of external locked plating are also included.Results:The electronic search strategy revealed 248 studies, and 2 studies were identified as relevant through manual search of references. Finally, 12 studies were included in this systematic review. These consist of 3 pure biomechanical studies, 8 case series, and 1 study including both of biomechanics and case series. Due to the heterogeneity of biomechanical studies, we can only conclude that external locked plate shows inferior structural stiffness than internal locked plate. The clinical studies reported that external locked plating gave a satisfactory ROM of the knee and ankle, functional outcomes, union rate, and low complication rate.Conclusions:We can only conclude that external locked plate shows inferior structural stiffness than internal locked plate because of the heterogeneity of biomechanical studies. The clinical studies showed locked plating as an external fixator in treating tibial fractures can be considered as a safe and successful procedure. However, as yet, there is unconvincing evidence that it is superior to standard techniques with regards to clinical and functional outcomes. More and well-designed studies about this technique should be carried out.

Investigating the biomechanical function of the plate-type external fixator in the treatment of tibial fractures: a biomechanical study

“…Traditionally, external fixators have been selected as osteosynthesis devices for the treatment of open tibial fractures and certain closed tibial fractures with severe injury to soft tissue [1,2]. External fixation devices provide a promising and satisfactory alternative for better soft tissue care and for preserving periosteal perfusion to the regions of fracture [3,4]. They can also be selected for use as interim or definite devices of fracture fixation [4].…”

Supracutaneous plating in tibial metadiaphyseal fractures with compromised soft tissue using LCP as an external fixator

“…Comparison of axial and torsional stiffness of externalized LCP and standard unilateral external fixator was studied by the Ang B H, Chen J Y et al and they found that mean axial stiffness was comparable between two and torsional stiffness was statistically higher in externalized LCP than standard unilateral external fixator [23]. Systematic review of literature on supracutaneous plating also concluded that though internal fixation by LCP is stronger than externalized LCP but there was no significant difference between externalized LCP and traditional external fixator in terms of biomechanics [7,24].…”

“…Hence the evolution of surgical techniques was to stabilize these fractures with minimal invasiveness to maintain the biology of soft tissue and bone [4,5]. Tibial diaphyseal fractures could easily be treated with closed interlocking nails but metaphyseal areas at both ends had surgical dilemma in choosing the implant and technique so as not to violate already traumatized soft tissue [6,7]. MIPO technique and low profile anatomical locking compression plating reduced the risk of skin breakage and infection to some extent with promising results [8].…”

Investigating the biomechanics function of the plate-type external fixator in the treatment of tibial fractures: a biomechanical study

“…Traditionally, external fixators have been selected to be osteosynthesis devices in the treatment of open tibial fractures and certain closed tibial fractures with severe injury of soft tissue [1,2]. External fixation devices provide a promising and satisfactory alternative for better soft tissue care and preserving periosteal perfusion to the regions of fracture [2,3]. They can be a choice for interim or definite device of fracture fixation [4].…”