Fixation of the articular surface
In simple fracture patterns lag screws are used to achieve absolute stability; whereas in complex fracture patterns, compression must be avoided. In complex fractures we use positioning screws to secure fixation of the articular fragments..
Additional implants such as lag screws should not compromise the subsequent application of the LISS plate. To avoid this, lag screws can be inserted through stab wounds from the medial side.
It should be noted that LISS is very effective for the fixation of metaphyseal region. However, for the articular surface, the locking screw only supports the anterior 2/3 of the plateau. Additional fixation is recommended if there is an independent intra-articular fracture in the posterior column.
Note: Care should be taken not to place the screws too close to the subchondral bone to prevent excessive stiffening and possible damage to the overlying articular cartilage.