Awful Considerations with LCP Instrumentation: a New Pitfall

Introduction: Although the locking compression plate (LCP) system offers a number of advantages in fracture management, its successful use requires careful preoperative planning, consideration of soft tissue dissection principles, and good surgical technique. Failure to address these issues can lead to potential pitfalls. Therefore, there are many reports about potential pitfalls that can arise with inappropriate LCP instrumentation technique. Moreover, these studies may mislead the orthopaedic colleagues that the only important tip in LCP using is its mechanical considerations. But, there is no study about the potential soft tissue pitfalls that may occur. There is an attempt in this study to achieve this objective.

Methods: A prospective analysis was carried out on all patients who were hospitalized for metaphyseal fracture of tibia and LCP fixation was done for them in our trauma center over a 6-month period in 2003. Inclusion criteria included all patients with fracture of tibial metaphysis who were to undergo locking compression plating using long conventional incision (without percutaneus insertion). Therefore, 34 patients included.

Results: Many patients (23.5%) developed severe soft tissue damage with exposed plate, and all of them need flap coverage.

Conclusion: Locking compression plates have a higher profile in comparison to DCP, requiring careful attention to soft tissue. Therefore, inadvisable locking compression plating with conventional incision method and retaining anatomical reduction of the fracture can lead to a higher soft tissue complication in comparison to dynamic compression plating.