A systematic review of the rehabilitation of LISS plate fixation of proximal tibial fractures

This study aimed systematically to review the evidence-base to determine the optimal rehabilitation for patients following Less Invasive Stabilization System (LISS) plate fixation for proximal tibial fractures. The electronic databases AMED, Cinhal, Medline and EMBASE were reviewed from their inception to October 2008, sources of grey literature and a pertinent hand search of specialist orthopaedic and physiotherapy journals was undertaken. Study methodology was assessed using the Critical Appraisal Skills Programme (CASP) tool. A total of nine publications including 391 patients with 398 proximal tibial fractures after LISS management were reviewed. The results suggested that range of motion exercises have been commenced immediately post-operatively; braces and casts are sometimes used, particularly for patients with concomitant ligamentus injury; and weight-bearing status has been initially restricted as either non- or toe-touch. There did not appear to be a substantial difference in clinical, radiological outcomes or complication rates between differing exercise or weight-bearing protocols. The literature, however, exhibited numerous methodological weaknesses such as reviewing small, underpowered samples, and poorly detailing the physiotherapy strategies used. It is therefore recommended that randomized controlled trials are now undertaken to compare different post-operative rehabilitation programmes for patients following LISS fixation of proximal tibial fractures.