LCP external fixation--external application of an internal fixator: two cases and a review of the literature

Abstract

The locking compression plate (LCP) is an angle-stable fixator intended for intracorporeal application. In selected cases, it can be applied externally in an extracorporeal location to function as a monolateral external fixator. We describe one patient with Schatzker V tibial plateau fracture and one patient with Gustillo IIIB open tibia shaft fracture treated initially with traditional external fixation for whom exchange fixation with externally applied LCPs was performed. The first case went on to bony union while the second case required bone grafting for delayed union. Both patients found that the LCP external fixators facilitated mobilization and were more manageable and aesthetically acceptable than traditional bar-Schanz pin fixators.

Figure 1

a - Selection of a LCP of appropriate length to span the fracture fragments. The LCP may be contoured or twisted to facilitate soft tissue coverage. b - A stack of folded towels functions as a spacer of uniform thickness. c - The spacer is secured to limb with elastic bandage. The most proximal and distal screw holes are drilled first. The bar-Schanz pin construct provides the reduction and is left in situ until completion.

Figure 2

a - External appearance of proximal tibia LCP applied as an external fixator. b - Postoperative radiograph showing proximal tibia LCP external fixation.

Figure 3

a - Comminuted Gustillo-Anderson IIIB open diaphyseal fractures of the right tibia and fibula. b - Exchange external fixation performed with LCP contoured to facilitate soft tissue coverage. c - Postoperative radiograph of LCP external fixation.