Technical pitfall while reducing the mismatch between LCP PLT and upper end Tibia in proximal Tibia fractures

Minimal invasive technique along with the widespread use of the new pre contoured locking plates (LCP PLT, LISS PLT) has given rise many alignment related problems in fractures of proximal tibia. A significant implant related problem with the use of pre contoured locking plate in proximal tibia fractures is the hardware irritation of the subcutaneous tissue by upper end of plate. This is caused by the large profile of the implant which sits off the bone at the proximal end. A general recommendation made by some is to try and reduce the bone and plate together with the help of pelvic reduction clamps. We have identified this as a source of error in our practice which has a potential to introduce malalignment in tibia, most often discovered post operatively. Here we will describe with relevant cases, the pitfall in the recommended technique and steps to be taken to avoid this error.