Tibial plafond fractures are difficult to manage and may have serious complications. We identified more complications, more secondary procedures, and worse outcomes in patients with articular and metaphyseal comminution (type C3). ORIF was associated with fewer complications and less post-traumatic arthritis when compared to EF, possibly reflecting a selection bias for open injuries and more severely comminuted fractures to be managed with EF. ORIF with appropriate soft tissue handling resulted in acceptable results in most patients. Severely damaged soft tissues and highly comminuted C3 fractures may be safely treated with EF. Loss of function and progression to post-traumatic arthritis are common after tibial plafond fractures. Assessment of long-term results and the efficacy of additional reconstructive procedures will refine the treatment algorithms for these fractures.

he treatment of comminuted, intra-articular distal femoral fractures (Orthopaedic Trauma Association [OTA] classification 1 33-C3) is challenging. Many of these injuries are the result of high-energy trauma, which generates severe soft-tissue damage and articular and metaphyseal comminution. Bone loss resulting from open fracture and poor bone quality may decrease the stability of fixation. Traditional devices for internal fixation have included the 95° condylar blade-plate, the dynamic condylar screw with a 95° side-plate, and intramedullary nails. However, coronal fractures or extensive distal comminution may preclude the use of these devices. In such cases, a lateral buttress or neutralization plate may be used. The condylar buttress plate was the first implant designed to serve this function. Unfortunately, when this device is applied in the presence of medial comminution or bone loss, failure of fixation and varus collapse may eventually result 2,3 .Recent advances in technology for the treatment of distal femoral fractures include the Less Invasive Stabilization System (LISS; Synthes, Paoli, Pennsylvania) and the Locking Compression Plate (LCP) condylar plate (Synthes) 4-15 . Each of these implants offers multiple points of fixed-angle contact between the plate and screws in the distal part of the femur, theoretically reducing the tendency for varus collapse that is seen with traditional lateral plates. The LISS differs from the LCP condylar plate in composition, shape, and placement. Early clinical studies of the LISS have demonstrated a high frequency of fracture union with low rates of malalignment 7-9,15 . Few cases of failure of the LISS have been reported 11,12,16 . To our knowledge, there have been no published studies focusing specifically on the LCP condylar plate and no reported cases of failure of this implant in the distal part of the femur. The purposes of this report were to describe and critically examine six cases of failure of the LCP condylar plate and to discuss the limitations of this implant for the treatment of distal femoral fractures. The patients were informed that data concerning the cases would be submitted for publication. Materials and Methodse retrospectively reviewed the cases of all forty-six patients who had been treated primarily with the LCP condylar plate for a distal femoral fracture during a thirty-sixmonth period at our hospital, and we identified six implant failures. Fracture care was provided by fellowship-trained traumatologists at a level-I trauma center. Information on these patients can be found in Table I and the Appendix. Indications for the use of this implant included a coronal plane fracture, osteopenia, and/or extensive distal fracture comminution precluding insertion of a conventional 95° condylar blade-plate or a dynamic condylar screw. All forty-six patients underwent assessment and resuscitation according to Advanced Trauma Life Support (ATLS) guidelines 17 . Open wounds were inspected, and dressings were applied. Intravenous antibiotics and tetanus ...

Distraction osteogenesis in combination with free tissue transfer is a powerful technique that allows limb salvage, particularly when local and regional flaps are unavailable or inadequate. For infected nonunion of the tibia, it permits a staged approach that allows underlying osteomyelitis to declare itself and provides vascularized healthy soft-tissue coverage that facilitates repeated operations for the purpose of distraction.