Anatomical reduction first
Anatomical reduction of the articular surface is mandatory before fixation of the metaphyseal fracture fragment.
Not all complete articular fractures can be perfectly reduced through a medial and/or a lateral approach. Sometimes fractures with a flexion injury mechanism need to be approached posteriorly as well.
Generally speaking, the plates for the bridging technique should be rather long in order to distribute the forces, as well as to provide relative stability
The preoperative x-ray planning template is useful in determining the length of the LISS plate and the position of the screws.
Number of screws
In case of healthy bone structure, five well placed monocortical angular stable screws are applied to secure the LISS to the tibial shaft. As an alternative, three bicortical angular stable screws can be chosen, and are recommended in patients with osteoporosis.
If LISS with “combi” holes is used, regular screws opposed to angular stable screws can be used in good bone stock. In this case four regular bicortical screws were used in the distal fracture fragment.
Gautier E, Sommer C (2003) Guidelines for the clinical application of the LCP. Injury 34(Suppl 2):B63-76. Review