The use of combined 3.5 LCP unicortical plate and nail fixation in proximal tibia fractures and prevention of valgus and anterior angulation

Introduction: Intramedullary nailing (IMN) of high tibia fracture has some mechanical and biological advantages over the other form of fixation. However, valgus, apex anterior malalignment and anterior displacement of proximal fragment commonly occur after isolated IMN fixation of proximal high tibia fracture. The purpose of this study is to determine the effectiveness of using 3.5-mm locking compression plate (LCP) with unicortical screws combined with IMN fixation to maintain the difficult reduction and prevent any displacement after classic nail insertion. Methods: This cross-sectional study was performed between 2010 and 2012, thirty-three open or closed tibia fractures involving the high proximal tibia metaphysis were operated using combined 3.5 mm LCP unicortical plate with the classic reamed intramedullary nailing technique. The clinical and radiological results of the study were collected on the basis of the time to unio‎n, nonunio‎n, malunio‎n, degree of angulations at the fracture site, and infection. Follow-up ranged from 24 to 36 months (mean 28 months). Results: The unio‎n rate was 100% on radiographs at 3.38 months postoperatively. No complications such as malunio‎n, delayed unio‎n, implant failure, prominent valgus, anterior angulation malalignment, or postoperative deep infection occurred. Conclusions: Although prominent malalignment occurs after IM nailing of proximal one-third tibia fractures, we can avoid it by using the medially inserted 3.5 LCP unicortical plate. The results are good even in open fracture type one or two.