Abstract
A non-union of the tibia developed after the use of a LISS with a long bridging segment as a pure relative stability device for a comminuted tibial fracture. It was treated primarily by stiffening the construct which led to union. It is suggested that the non-union developed because of strain concentration and healed when this was neutralised. The case illustrates an interesting failure mode, perhaps adds light to the biomechanical features of a LISS plate and suggests the role of strain in the process of bony healing.
Highlights
Complex tibial fractures are challenging to treat and offer a number of therapeutic options
While external fixation may minimize some of the complications associated with more invasive treatment it implies a high risk of pin site infections, prolonged treatment time and longterm disability that confers significant morbidity and poor patient acceptability
When used in bridging mode there is no consensus regarding the length of the bridging segment and the optimum stability to aim to provide to the fracture
Summary
Complex tibial fractures are challenging to treat and offer a number of therapeutic options. The Less Invasive Stabilization System (LISS) is easier to use in proximal fractures with a small proximal segment. We have observed a specific complication where use of this bridging technique resulted in a non-union at a single site of stress concentration following persisting motion at the fracture site [2,3].
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