Anatomical Locking Compression Plate Research Articles

Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) for Distal Tibial Metaphyseal Fracture: A Better Option

Objective: The objective of this study was to evaluate the radiological and functional outcomes in of treatment of fracture distal tibial metaphysis fixed with pre-contoured anatomical locking compression plate using minimally invasive percutaneous plate osteosynthesis (MIPO) technique. Methods: This was a prospective study conducted at Department of Orthopedic Surgery, Services Hospital Lahore. Total of 58 closed distal tibial metaphyseal fractures (AO classification 43A) included in the study. All patients were operated using anatomical LCP with MIPO technique. The functional outcome was assessed by Tenny & Wiss criteria at 6 weekly intervals with final scoring at 24th week. Functional outcome was graded as excellent, good, fair and poor. Similarly, radiological outcome was also assessed at 6 week intervals using Hammer et al criteria and grade 3 labelled as union. Results: We observed excellent functional outcome in 48 patients (82.6%) and good outcome in 6(10.34%) at last follow-up. Radiological union was achieved in 100% (58) patients at 24th week. The average time of union was 16.5 weeks with a range of 12 to 23 weeks. Total 03 patients (5.17%) developed superficial wound infection which was successfully managed with antibiotic therapy and no surgical site deep infection reported. Conclusion: Results of this study advocate that treatment of distal tibial metaphyseal fractures with LCP by MIPPO technique is an effective modality resulting in low complication rate, high union rates and good functional outcome.

Functional outcome by using American Orthopaedic Foot and Ankle Society: Ankle and hind foot scale scoring system of distal fibula fractures with syndesmotic injury managed by distal fibula anatomical locking compression plate and syndesmotic suture-button fixation

Abstract Background: The study aimed to study the functional outcome by using American Orthopaedic Foot and Ankle Society (AOFAS)—ankle and hind foot scale scoring system of distal fibula fractures with syndesmotic injury managed by distal fibula anatomical locking compression plate and syndesmotic suture-button fixation. Objective: Solated fibula fractures are very common injuries. Diagnostic exams must rule out ankle instability. Surgical treatment must be considered in the case of associated ankle instability. Risk factors for wound related complications must be considered when choosing the surgical technique. Materials and Methods: The study was performed at the Ravindra Nath Tagore Medical College and Maharana Bhupal Government Hospital, Udaipur, in the Department of Orthopaedics and Traumatology. The type of the study is prospective. Inclusion criteria are as follows: Age above 18 years/skeletally matured; distal fibula fractures with Weber B and Weber C type of Danis–Weber classification; X-ray (stress view) suggestive of associated syndesmotic injury; and patients willing to give consent and willing for follow-up. Exclusion criteria are as follows: Weber A type fractures; distal fibula fracture without syndesmotic injury; pediatric and skeletally immature patients; compound injuries; and patients unfit for surgery. The sample size was 25. Results: Twenty-five cases were operated and followed up. A total of 22 cases (85%) had an excellent outcome, and three cases (15%) had a good outcome. The average AOFAS score is 92.84. All the patients at the end of 6 months were comfortable to do their day-to-day activities without any pains. No case required routine implant removal. Conclusions: Injuries to the syndesmosis are a diagnostic and therapeutic challenge to the orthopedic surgeon. The lack of clear radiographic parameters on which to make surgical decisions places greater importance on the physical examination and advanced imaging. Lack of injury to the deltoid ligament and posterior tibiofibular ligament based on magnetic resonance imaging is a reliable determinant to consider nonoperative treatment. Injury to the deltoid ligament or disruption of the relationship of the tibia and fibula typically is treated with surgical reduction and fixation. Use of the contralateral lower extremity is the most reliable in determining the normal relationship of the tibia and fibula for the patient both preoperatively and intraoperatively. Sagittal instability is more critical than coronal instability and must be taken into account when considering reduction of fixation of the syndesmosis. Further studies will determine the need for primary repair of the deltoid ligament and fixation of the posterior malleolus in the setting of ankle fracture and syndesmotic injuries. As the understanding of the longer term outcomes following injury to the syndesmosis advances, a logical algorithm to the treatment of these injuries should emerge.

Finite element analysis of a novel anatomical locking plate for scapular neck fracture

ObjectivesReconstruction plates (RPs) are commonly used in scapular neck fractures (SNFs): however, RPs have many defects. In this study, we evaluated a newly designed scapular neck anatomical locking compression plate (SNALCP).MethodsAn SNF finite element model (Miller-type IIB) was constructed. Plates were subsequently implanted into the scapula and fixed with screws that were grouped according to the plate used: SNALCP (A) and RP (B). Finally, loads were applied to record and analyze performance.ResultsUnder lateral, anteroposterior, and vertical compression loads, the maximum von Mises stresses on the scapula and implants of group A were smaller than those of group B. There were some differences in stress distribution between the two groups.ConclusionsSNALCP can effectively reduce the stress of the scapula and implant, making stress distribution more uniform and continuous, and has mechanical conduction advantages. Compared to RP, it provides improved stability and more reliable fixation.

Outcome After Treatment of Distal Fibula Fractures Using One-Third Tubular Plate, Locking Compression Plate or Distal Anatomical Locking Compression Plate

Surgical treatment of lateral distal fibula fractures is associated with high risk of reoperation and complications. The primary aim was to report risks of surgical site infection (SSI) and reoperation ≤1 year after treatment with one-third tubular plate, locking compression plate (LCP) or distal anatomical LCP. Secondary to investigate associations between patient, fracture and operative factors and risk of SSI and reoperation. Retrospectively, we evaluated a consecutive cohort of 588 patients having osteosynthesis of distal fibula with a one-third tubular plate (n=417), LCP (n=115) or distal anatomical LCP plate (n=56) at Bispebjerg Hospital, Denmark from January 2010 to December 2015 with 1-year follow-up. The risk of SSI was 15% (95% confidence interval [CI] 12-18) after treatment with one-third tubular plate, 30% (95% CI 23-39) after LCP and 41% (95% CI 29-54) after distal anatomical LCP. We found a significant association of SSI and LCP (p=.005) and distal anatomical LCP (p < .001). Other factors associated with increased risk of SSI were age>70 years (p < .001), smoking (p=.004), DM (p=.007), surgery time ≥90 minutes (p=.006) and surgery delay of 3-6 days (p=.007). The risk of reoperation ≤1 year was 10% (95% CI 6-11) for one-third tubular plate, 21% (95% CI 14-29) for LCP and 25% (95% CI 16-38) for distal anatomical LCP. We found a significant association between distal anatomical LCP and risk of reoperation (p=.008). The only other risk factor associated with risk of reoperation was surgery delay of more than 7 days (p=.004). We conclude that LCP plate and the distal anatomical LCP plate should only be used after careful considerations.

Functional outcome of minimally invasive plate osteosynthesis using anatomical locking compression plate for distal tibia fractures: A prospective study

Background: Distal tibia fracture is a therapeutic challenge in modern orthopaedics. Due to fracture pattern, periarticular location, minimal soft tissue coverage, the surgical treatment is complex one. Various modality of surgical treatment such as closed intramedullary nailing, The newer technique of fixation of distal tibia fractures - minimally invasive percutaneous plate osteosynthesis involves less soft tissue handling and the minimal periosteal stripping resulting in low infection rate and faster healing.Materials and Methods: The prospective study was done at a tertiary care centre on 18 patients from June 2017 to June 2019. The functional outcome is evaluated by clinical and radiological (AP/LATERAL) aspects at 6th, 12th weeks, 3rd, 6th months and one year interval using Olerud-Molander Ankle Questionnaire/ Score (OMAS).Results: The results were excellent in 54%, good in 29% and fair in 17% of patients. The post-operative pain was minimal and the post-operative ankle function was very good.Conclusion: Minimally invasive plate osteosynthesis using LCP proves to be a safer technique in the management of distal tibial fractures without intra-articular comminution by providing good fracture healing, enabling rapid functional recovery and avoiding major skin complications.

Early Return to Daily Life through Immediate Weight-Bearing after Lateral Malleolar Fracture Surgery.

Lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for weight-bearing has not been standardized. In the present study, we investigated the prognostic difference between immediate and delayed weight-bearing on lateral malleolus fractures. The medical records of matched patients in the immediate and delayed weight-bearing groups (50 and 50, respectively) were reviewed retrospectively. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate with a lag screw. In the immediate weight-bearing group (IWB), tolerable weight-bearing (i.e., what can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight-bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise was permitted in both groups, starting from the day after surgery. Radiographic assessment data and clinical outcomes were reviewed between the two groups. No significant differences in radiographic assessments and complications were found between the two groups. Significant differences in terms of a shortened length of hospital stay and time to return to work with the IWB rehabilitation protocol compared with DWB were confirmed (6.0 vs. 9.2 days, p = 0.02 and 6.1 vs. 8.3 weeks, p = 0.02, respectively). A significant difference in sport factor was observed in the Foot and Ankle Outcome Score at 3 months postoperatively (72.3 vs. 67.4, p = 0.02). We found no significant differences between the two groups concerning postoperative radiological outcomes and complications. The benefits of shortening the time to return to work and length of hospital stay associated with the IWB rehabilitation protocol were confirmed. In conclusion, immediate weight-bearing is recommended in patients with lateral malleolus fracture after anatomical reduction and firm fixation by surgery.

A prospective study of union rates of midshaft clavicle fractures with plate osteosynthesis

Introduction. Internal fixation is the current treatment approach for displaced clavicle fractures, which ensures firm immobilization and pain relief, thus preventing complications such as non-union, shortening and deformity. Aims. The aim of the study is to investigate the union rates with plate osteosynthesis, in order to be able to compare the clinical results obtained by several treatment modalities, in terms of movements, pain relief, return to normal activities and work. Materials and Methods. This is a prospective study on 30 patients with middle third clavicle fractures treated with plate osteosynthesis between December 2018 and October 2020, at Santiram Medical College and General Hospital, Nandyal. The study included patients older than 18 years. Results. The road accident was the most common cause of this fracture in our study, 70% being males and 63% with a right-sided injury. All patients were operated on within one week of the injury. Robinson Type-2B1 was the most commonly observed in our study and was approximately 53%. Twenty patients (66%) were treated with a Recon plate, nine patients (30%) were treated with an anatomical locking compression plate, one patient (3%) was treated with 1/3 tubular plate. All patients were immobilized in an arm sling, allowing a passive range of movements for 2-3 weeks. The duration of hospitalization was six to seven days, while the duration of the union varied from 8-14 weeks. Evaluation of functional outcome was based on Constant-Murley score, showing excellent results in 20 patients. Conclusions. In displaced midshaft clavicle fractures, open reduction with internal fixation has led to good union rates with excellent functional outcomes.

Functional outcome of proximal humerus fracture management with proximal humerus internal locking system plate

Background: Proximal humerus fractures are the 2nd most common fractures of upper extremity and one of the most common fractures in osteoporotic bone. 85% of these fractures are undisplaced or minimal displaced fractures which can be treated with conservative management. 15% fractures are displaced and unstable and which may need surgical management. The surgical procedure remains a challenging and unsolved problem to the surgeon especially because of its high complication rate. Internal locked plating becoming more popular, to maximize clinical outcome with our experience of surgical procedure in using system pate. In our study, the plate provides stable fixation with a goal of early restoration of a painless shoulder. Methods: A prospective study was conducted in department of orthopaedics in Adichunchanagiri institute of medical sciences, B.G. Nagara, mandya from June 2018 to August 2020. Displaced Neer’s part 2, part 3 or part 4 with age not less than 18 years and not more than 75 years. Twenty patients with proximal Humerus fractures were taken into study, all patients were fixed with PHILOS plate. Results: Functional outcome evaluated with CONSTANT – MURLEY score, we got excellent results in 04 cases, satisfactory in 09 cases, unsatisfactory in 05 and failure in 02 cases with a mean Constant-Murley score at the end of final follow-up period was around 80.2. Conclusion: Proximal humeral fractures managed by internal fixation with anatomic locking compression plates yields satisfactory results when provided the correct surgical technique. The anatomic locking compression plate is suitable for the stabilization of proximal humeral fractures (Neer’s 2-part, 3-part and 4-part fractures and osteoporotic fracture) and can lead to a good functional outcome.

Evaluation of functional outcome following open reduction and internal fixation of clavicle fractures with anatomical locking compression plate

Evaluation of functional outcome following open reduction and internal fixation of clavicle fractures with anatomical locking compression plate

Is Immediate Weight Bearing Safe for Lateral Malleolus Fracture after Surgery?

Category:Trauma; AnkleIntroduction/Purpose:Isolated lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for the weight bearing has not been standardized. In the present study, we investigated the prognostic difference between the immediate and delayed weight bearing on isolated lateral malleolus fractures.Methods:Retrospectively, the medical records of matched 50 and 41patients in the immediate and delayed weight-bearing groups were reviewed. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate. In the immediate weight-bearing group (IWB), tolerable weight bearing (i.e., that can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise were permitted in both groups since postoperative day. Radiographic assessment data and the clinical outcomes were reviewed.Results:There were no significant differences noted in the radiographic assessments and complications between the two groups. Significant differences of shortening the return to work and hospital stays of IWB rehabilitation protocol were confirmed(5.7 vs. 8.0 days, 6.0 vs. 8.0 days in the IBW and DWB groups, respectively). In FAOS, there was a significant difference in the sport factor evaluated at postoperative 3 months(75.5 vs 68.5, respectively).Conclusion:There were no significant differences between the two groups in the postoperative radiological outcome and complications. And benefits of shortening the return to work and hospital stays of IWB rehabilitation protocol were confirmed. Conclusively, immediate weight bearing is recommended in patients with isolated lateral malleolus fracture, following anatomical reduction and firm fixation through surgery.

Prospective study of clavicle fractures treated with precontoured locking compression plate

Background and Objectives: Clavicle fracture is one of the most common fracture in human body. From past many years its been treated conservatively with good results. This study is conducted to know role of compression locking plate plate in unstable comminuted clavicle fracture. Materials and Methods: We included 20patients in our study. All were subjected for surgical treatment with LCP and followed up for 1 year. Study is conducted in period between January 2018 and January 2019. Result: 17 patients out of 20 who were treated with Anatomic locking compression plate shows union at average duration of 3 months (12 weeks). Delayed union was seen in 3 patients, plate loosening in one patient and 3 patients had plate prominence. According to Constant and Murley score after fracture union, 15 patients show excellent functional outcome, 4 patients shown good outcome and fair outcome was seen in 1 patient. Conclusion: Our study concluded that precontoured locking compression plates in unstable displaced comminuted fractures in middle third of clavicle give fracture stability, allows early mobility and there by prevents shoulder stiffness. Keywords: Unstable, LCP (locking compression plate), Delayed unionUnstable.

Predrilled locking compression plate is more accurate than tension band wiring in restoring articular geometry of the ulnar greater sigmoid notch after olecranon Chevron osteotomy

IntroductionThe olecranon Chevron osteotomy (OCO) is commonly used to approach complex intra-articular fractures of the distal humerus. Predrilled tension band wiring (TBW) has historically been used to fix OCO. However, clinical outcomes are burdened by secondary loss of reduction and up to 21.3% non-union rates. The biomechanical stability of anatomic locking compression plate (LCP) was reported to be superior to TBW in olecranon fracture fixation. We hypothesised that this implant may also be superior to TBW in the anatomic reconstruction of the articular surfaces of the ulnar greater sigmoid notch after OCO by predrilling the holes of the angular stable plate with the threaded drill guide prior to osteotomy. Materials and methodsLateral standardised and calibrated radiographs of twenty synthetic ulnar bones were obtained using a custom-made holder prior to preparation by a senior orthopaedic trauma surgeon. Ten specimens were then predrilled using the threaded drill bit guide of an olecranon LCP, while the other ten samples were predrilled with two 1.6 mm Kirschner wires. A distal “V” OCO was performed using a 0.6 mm oscillating saw. After repositioning and fixation with the corresponding device, lateral radiographs were repeated. Two independent observers used the TraumaCad planning software to document the articular geometry of the ulnar greater sigmoid notch pre- and postoperatively. The diameter of the best-fitting circle (diameter), the distance between the tip of the coronoid and the olecranon processes (distance) and the maximum articular depth were measured. ResultsWith the TBW technique, after OCO and fixation, all three postoperative measurements were significantly (p≤0.001) different from preoperative measurements. The diameter and distance increased by a mean of 1.5±0.5 mm and 0.9±0.3 mm, respectively, while the depth decreased by a mean of 0.2±0.1 mm. In contrast, no significant differences between pre- and postoperative measurements were observed with the LCP technique (p≥0.13). Inter and intra-observer measurement reliability was strong to very strong (intraclass correlation coefficients≥0.793) for all three variables. ConclusionOur study reveals that the predrilled LCP technique is more accurate than the predrilled TBW in restoring the anatomic articular geometry of the ulnar greater sigmoid notch after OCO.

EVALUATION THE SIGN OF UNION, DURATION OF SURGERY AND POST-OPERATIVE SKIN COMPLICATION IN MID SHAFT CLAVICLE FRACTURE.

INTRODUCTION: It is impossible to support and immobilize a fracture of middle 3rd of clavicle in an adult by external means with figure-of-eight bandages. Clavicle fractures accounts for approximately 2.6% of all fractures in adults2 10% to 15% in children and comprise about 30 -40% of all shoulder girdle injuries and 5% fractures occurs in medial end. The goal of clavicle fracture treatment is to achieve bony union while minimizing dysfunction, morbidity, and cosmetic deformity. Definitive indications for acute surgical intervention include skin tenting, open fractures, the presence of neurovascular compromise, multiple trauma, or floating shoulder. Outside of these indications, the management of displaced fractures of the mid shaft (Edinburgh type 2B) remains somewhat controversial. Recent literature is challenging the traditional belief that mid- shaft clavicle fractures uniformly heal without functional deficit. &#x0D; MATERIAL AND METHODS: Patients included were cases of mid shaft clavicle fractures. 30 patients with mid shaft clavicle fractures were included in the study.All patients above 18 years of age were included in the study falling into Robinson’s type 2 B1 (Mid shaft simple displaced and single butterfly fragment fracture), type 2 B2 (Mid shaft segmental fracture) classification. The patients were selected randomly and were divided in the following two groups of 15 patients each: Group A: 15 patients treated by anatomical locking compression plate (LCP) by open technique. Group B: 15 patients treated by minimal invasive percutaneous osteosynthesis (MIPO) technique. All patients were operated as early as possible once the patient was declared fit for the surgery by the physician. Open reduction and internal fixation with LCP was done.&#x0D; RESULTS: A total of 30 patients were included in the study. In group A 15 patients treated by anatomical locking compression plate (LCP) by open technique and in group B 15 patients treated by minimal invasive percutaneous osteosynthesis (MIPO) technique. In Group A, 7 (46.7%) patients had operative time of 80-100 minutes whereas 6 (40%) and 2 (13.3%) patients had operative time of 100-120 and 120-140 minutes respectively. The mean operative time was 104.9 ± 13.52mins. In Group B, 6 (40%) patients had operative time of 80-100 minutes whereas 8 (53.4%) and 1 (6.6%) patients had operative time of 100-120 and 120-140 minutes respectively. The mean operative time was 106.5 ± 11.72mins. The mean duration for radiological union in Group A was 12.7 ± 4.61 weeks. Majority of the patients (60%) achieved radiological union in &lt;12 weeks while 6 (40%) patients achieved union in 12-24 weeks. In Group B, majority of the patients (66.7%) achieved radiological union in &lt;12 weeks while 5 (33.3%) patients achieved union in 12-24 weeks. The mean duration for radiological union in Group B was 12.1 ± 6.68 weeks.&#x0D; CONCLUSION: MIPOs can used to preserve the biology at the fracture site, to maximise the healing potential of the bone, and to facilitate early and pain free recovery and MIPPO technique with the application of LCP offered an ideal combination in terms of bone fixation and soft-tissue sparing.

FUNCTIONAL OUTCOME FOLLOWING ANATOMICAL LOCKING COMPRESSION PLATE BY OPEN TECHNIQUE AND MINIMAL INVASIVE PERCUTANEOUS OSTEOSYNTHESIS (MIPO) TECHNIQUE IN MID SHAFT CLAVICLE FRACTURE

INTRODUCTION: Clavicle fractures are common injuries in adults, accounting for 5% of all fractures and 44% of all shoulder fractures. Furthermore, there is an increasing incidence of complex fracture patterns after high-energy trauma. Incidence in males is usually highest in second and third decade which decreases thereafter as per age. Clavicles mid shaft fractures have classically been treated non-operatively. However, factors including severity of displacement, degree of comminution, and greater than 2 cm of shortening have been reported in the literature to predispose patients to unsatisfactory outcomes with non-operative treatment. Minimally invasive surgery is increasingly being used for the treatment of mid shaft clavicle fracture. The two most commonly used implant are titanium elastic nail (TEN) and locking compression plate (LCP). Minimally invasive percutaneous plate osteosynthesis (MIPPO) is widely used for long bone fracture.&#x0D; MATERIAL AND METHODS: The patients were selected randomly and were divided in the following two groups of 15 patients each: Group A: 15 patients treated by anatomical locking compression plate (LCP) by open technique. Group B: 15 patients treated by minimal invasive percutaneous osteosynthesis (MIPO) technique. Follow up period were 1 months, 2months and 6months. Functional outcome was evaluated using the constant shoulder score, which is scored from 0 to 100, with a lower score representing a higher level of functional disability.&#x0D; RESULTS: Majority of the patients (40%) in Group A were in the age group of 31-40 years followed by 26.7% in the age group of 21-30 years, 20% in the age group 41-50 years and 13.3% in the age group of 51-60 years. The mean age of the patients was 36.2 ± 9.09 years. Majority of the patients in both groups were male. There were 80% and 73.3% male patients in Group A and Group B respectively whereas female patients constituted 20% and 26.7% of the study group respectively. In Group A, 7 (46.7%) patients had operative time of 80-100 minutes whereas 6 (40%) and 2 (13.3%) patients had operative time of 100-120 and 120-140 minutes respectively. The mean operative time was 104.9 ± 13.52mins. In Group B, 6 (40%) patients had operative time of 80-100 minutes whereas 8 (53.4%) and 1 (6.6%) patients had operative time of 100-120 and 120-140 minutes respectively. The mean operative time was 106.5 ± 11.72mins. There was no significant association between the groups as per Student t-test (p&gt;0.05).&#x0D; CONCLUSION: Operative treatment with a LCP for clavicle shaft fractures can be used to obtain stable fixation. Particularly, MIPPO of displaced mid shaft clavicular fractures resulted in a better cosmetic than conventional open reduction, although the functional outcomes were no different between the two groups.

Comparison of clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by either parallel or orthogonal double plating

Objective To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate. Methods From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery. Results The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P 0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P 0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05). Conclusions In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients. Key words: Humeral fractures; Young people; Elderly; Fracture fixation, internal; Bone plates

Treatment of distal humerus fracture with unexposed ulnar nerve medial elbow incision and anatomical locking compression plate

To investigate the feasibility and effectiveness of unexposed ulnar nerve medial elbow incision, open reduction and internal fixation of anatomical locking compression plate (LCP) for distal humerus fractures. Fourteen patients with distal humerus fracture were treated between January 2014 and June 2017. There were 5 males and 9 females, aged 18-85 years (mean, 65.5 years). The causes of injury included falling from height in 12 cases and traffic accident in 2 cases, all were closed fractures. Fractures were classified according to the AO/Association for the Study of Internal Fixation (AO/ASIF): 3 cases of type A2, 2 cases of type A3, 4 cases of type B2, 2 cases of type C1, 2 cases of type C2, and 1 case of type C3; without ulnar nerve damage. The time from injury to operation was 4-15 days, with an average of 7 days. The type B2 fractures were treated with unexposed ulnar nerve elbow medial incision and anatomic LCP internal fixation, the rest patients were all treated with unexposed ulnar nerve medial plus conventional lateral approach and bilateral LCP internal fixation. The operation time was 50-140 minutes (mean, 80 minutes), and the intraoperative blood loss was 20-200 mL (mean, 70 mL). There was no blood vessels or nerve damage during operation. All incisions healed by first intension, and no incision infection occurred. All the 14 cases were followed up 9-24 months (mean, 13 months). X-ray films showed that all fractures healed within 4 months without complications such as nonunion and osteomyelitis. No ulnar nerve injury, cubitus varus deformity, and ossifying myositis occurred during follow-up. At last follow-up, the elbow function was assessed by Mayo Elbow Performance score (MEPS), the results were excellent in 8 cases, good in 4 cases, fair in 1 case, and poor in 1 case (type C3 fracture), with the excellent and good rate of 85.7%. The unexposed ulnar nerve medial elbow incision can be used effectively to reduct the fracture, and it is not prone to ulnar nerve injury. Combined with the lateral approach to treat the distal humerus fracture, which has the advantages of short operation time, few trauma, little bleeding, and reliable effectiveness.

A prospective study of functional outcome of distal fibula fractures with syndesmotic injury managed by anatomical locking compression plate and syndesmotic suture button fixation

Syndesmotic injury can occur after trauma to the ankle, both with and without a fracture. In fractures of the ankle, syndesmotic injury occurs in about 50% of type Weber B and in all type Weber C fractures. Syndesmotic diastasis left unnoticed can lead to persisting pain, instability and progressive arthritis. This study focusses on the application of syndesmotic suture button anchor as a fixation method for the syndesmotic joint diastasis. The syndesmotic button fixation does not convert the joint into a rigid articulation and still allows micro motion to happen. In this study, Distal fibular fractures with syndesmotic injuries are selected and anatomically precontoured locking compression plate is applied for fracture fixation and syndesmotic suture button fixation is done for the syndesmotic injury and their functional outcomes studied by various modalities.

Evaluation of functional outcomes in clavicle fracture treated with anatomical locking compression plate

Background: The aim of this study to assess the functional outcome in clavicle fracture treated with anatomical locking compression clavicle plate conducted at Dhiraj Hospital, Vadodara Gujarat. The patient history and examination findings were recorded and then radiological investigation were ordered to confirm the diagnosis. The findings and plan of management were discussed with operating consultant and recorded in 2 separate profoma. Any change in opinion between the consultant were noted in the profoma. Result: The result evaluated by DASH SCORE in our study. Out of 34 patients 20(58.9%) patients had good result, 12(35.3%) had excellent result and 2(5.8%) had poor result Conclusion: We conclude that Anatomical Locking Clavicle Plate is preferred for the treatment of displaced or non-united clavicle fractures with better functional outcome and faster recovery compared to other modes of treatment.

Efficacy and safety of proximal femoral anatomical locking compression plate and proximal femoral nail antirotation for long-segment comminuted subtrochanteric fractures of the femur: a non-randomized controlled trial

Background and objective: The proximal femoral anatomical locking compression plate and proximal femoral nail antirotation device are commonly used in the treatment of long-segment comminuted subtrochanteric fractures of the femur. However, few studies have evaluated the difference in efficacy and safety between these two implants. The present study is being performed to compare the efficacy and safety of the proximal femoral anatomical locking compression plate versus proximal femoral nail antirotation in the treatment of long-segment comminuted subtrochanteric fractures of the femur. The results will be used to identify the optimal implant treatment plan. Participants and methods: This prospective, single-center, non-randomized controlled clinical trial will include 180 patients with long-segment comminuted subtrochanteric fractures of the femur from Sanya Traditional Chinese Medicine Hospital, China. The patients will be equally divided into a locking compression plate group and a proximal femoral nail antirotation group. All patients will be followed up at 2 and 10 months postoperatively. Patient recruitment and data collection will begin on June 30, 2019 and end on June 30, 2020. Analysis of the results will be performed from 1 to 30 July 2020. This study will be scheduled to end on August 1, 2022. This study was approved by the Medical Ethics Committee of Sanya Traditional Chinese Medicine Hospital in China in March 2013 (approval No. (2013) (02)). Study protocol version is 1.0. This study will be performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. Written informed consent regarding the study protocol and surgery procedure will be obtained from the participants. Results: The primary outcome measure is the rate of excellent and good Harris hip scores at 10 months postoperatively; this rate will be used to evaluate the recovery of hip function after repair. The secondary outcome measures are the rate of excellent and good Harris hip scores preoperatively and 2 months postoperatively, intraoperative blood loss, operation time, incision length, hospital stay, fracture healing time, hip morphology on radiographs preoperatively and 2 months postoperatively, and incidence of adverse events 2 and 10 months postoperatively. Our pilot study involved 80 patients with long-segment comminuted subtrochanteric fractures of the femur from February 2013 to February 2016 (locking compression plate group, n = 40; proximal femoral nail antirotation group, n = 40). The 10-month follow-up results showed that the intraoperative blood loss, operation time, incision length, hospital stay, and fracture healing time were lower in the proximal femoral nail antirotation group than in the locking compression plate group (P 0.05). These pilot study results verified higher efficacy and safety of proximal femoral nail antirotation than locking compression plate fixation in the treatment of long-segment comminuted subtrochanteric fractures of the femur. Conclusion: The results of the present study will provide evidence indicating whether proximal femoral nail antirotation in the treatment of long-segment comminuted subtrochanteric fractures of the femur can facilitate better recovery of hip function and higher safety than anatomical locking compression plate fixation. Trial registration: This study was registered with the Chinese Clinical Trial Registry on February 3, 2019 (registration number: ChiCTR1900021251).

Minimally invasive plate osteosynthesis with locking compression plate for proximal and distal diametaphyseal tibial fracture

Background: The treatment of proximal and distal diametaphysealtibial fractures remains controversial. This study was performed to evaluate the results of Locking compression plate using MIPO technique in the management of proximal and distal diametaphysealtibial fracture.Aims and Objective: To analyse and observe the result of management of metaphyseal fractures of tibia with respect to operative technique, stability of fixation, union of fracture, post-operative range of motion and complication. Materials and Methods: The study was prospective study. Forty two patients who sustained fractures of proximal and distal dia-metaphyseal tibial fractures with or without articular involvement were included in the study and treated by employing the concept of Minimally invasive plate osteosynthesis during period of August 2015 to December 2017 and followed up at regular interval with minimum six months to thirty months. Intervention: Surgical reduction and fixation of fracture using proximal and distal anatomical locking compression plate followed by rehabilitation. Main outcome measure: Radiological outcome, perioperative and postoperative complication, postoperative alignment, range of motion.Results: All fractures got united with the average duration of 22.7 weeks for proximal metadiaphyseal tibia and 19.9 weeks for distal diametaphysealtibia. There were 3 delayed union cases which got united without any surgical intervention. Deep peroneal nerve palsy was seen in 2 cases with proximal tibia fracture treated with longer plate. 2 cases of superficial infection and one deep infection seen with proximal diametaphyseal fracture and 2 superficial infection with one case of wound dehiscence and implant prominent seen with distal diametaphyseal tibia fracture. No malalignment or angulation of more than 10 degree occurred in any plane for both proximal and distal diametaphyseal fractures.Conclusion: MIPO provides stable fixation with excellent union rate with minimal complication for both proximal and distal diametadiaphysealtibial fracture.Asian Journal of Medical Sciences Vol.9(6) 2018 76-83