Broad Dynamic Compression Plate Research Articles

A comparison of clinical outcomes between narrow and broad dynamic compression plate for femur fractures

Purpose: To review the short term performance 4.5/5.0mm Wise-Lock Narrow Dynamic Compression Plate with LC under cuts and 4.5/5.0mm Wise-Lock Broad Dynamic Compression Plate with LC under cuts for femur fractures in terms of postoperative complications and failure rates. Methods: The total number of 46 patients, 24 to 55 years’ age group, who underwent internal fixation with wise-lock narrow and broad dynamic compression plate for femur fractures were reviewed. These implants were manufactured at Auxein Medical Private Limited Sonipat (India). The wise-lock narrow dynamic compression plates were implanted to 24 patients (18 Male and 05 Female) and broad dynamic compression plates were implanted to 22 patients (15 Male and 08 Female). These plates were made up of SS 316L and Ti6Al4V alloy respectively. Clinical and radiological follow-ups were conducted at the end of 30 days, 90 days, 180 days, 270 days and 365 days after surgery to examine the bone union, non-union & other related complications. During the one year of follow-up by the surgeon the patient's health status was analysed by the American society of anesthesiologists grade and the visual analogue score (VAS) was also determined. Results: Patients were followed up for one year. Out of 24 patients who were treated with wise-lock narrow dynamic compression plate, stainless steel, 04 patients (03 males & 01 female) were faced the complications of pain. However, out of 22 patients who were treated with broad dynamic compression plate, titanium, 02 patients (02 males) developed complications of pain. No biomechanical issue related to screw loosening, corrosion, bending, or other factors was not detected in 46 patients. Conclusions: Femur plate fixation is feasible for the treatment of femur fracture. The clinical outcomes and prognosis of patients are dependent on the accuracy of intraoperative reduction and surgical expertise.

MANAGEMENT OF NEGLECTED MALUNION SHAFT FEMUR FRACTURE WITH OPEN REDUCTION AND FIXATION WITH DCP PLATE

Femoral shaft fractures occur in 10–37 / 100.000 patients per year, and mainly male young patients are affected (median age 27 years) compared to the fracture of the elderly in female patients (median age 80 years). Fracture of the femoral diaphysis is a common fracture which is seen frequently in orthopaedic department . Treatment can be operative and nonoperative. Usually operating managment is preferred and results are good. In developing countries patients suffer from low social economic conditions which cause problem in seeking treatment so malunion and non union are common. The problem treating malunion are related to restoring the axis; the limb length and joint mobility in the knee and hip Diaphyseal malunion poses a great challenge for the orthopedic surgeon, and an inundation of morbidity for the patient. Diaphyseal malunion can cause altered gait, adjacent joint osteoarthritis and body dissatisfaction. we present our experience in a case of 11month old malunited shaft of femur fracture which was treated with open reduction and internal xation using a broad dynamic compression plate (dcp). The object of surgery was to restore the function. The common indication for operating malunited shaft femur fracture are overlaping , angulation >10-15◦ and rotation > 45◦ with or without angulation (externally or internally) and relieve pain.

MANAGEMENT OF NEGLECTED MALUNION SHAFT FEMUR FRACTURE WITHOPEN REDUCTION AND FIXATION WITH DCP PLATE

Femoral shaft fractures occur in 10–37 / 100.000 patients per year, and mainly male young patients are affected (median age 27 years) compared to the fracture of the elderly in female patients (median age 80 years). Fracture of the femoral diaphysis is a common fracture which is seen frequently in orthopaedic department . Treatment can be operative and nonoperative. Usually operating managment is preferred and results are good. In developing countries patients suffer from low social economic conditions which cause problem in seeking treatment so malunion and non union are common. The problem treating malunion are related to restoring the axis; the limb length and joint mobility in the knee and hip Diaphyseal malunion poses a great challenge for the orthopedic surgeon, and an inundation of morbidity for the patient. Diaphyseal malunion can cause altered gait, adjacent joint osteoarthritis and body dissatisfaction. we present our experience in a case of 11month old malunited shaft of femur fracture which was treated with open reduction and internal xation using a broad dynamic compression plate (dcp). The object of surgery was to restore the function. The common indication for operating malunited shaft femur fracture are overlaping , angulation >10-15◦ and rotation > 45◦ with or without angulation (externally or internally) and relieve pain. ABSTRACT KEYWORDS : deformity; malunion; nonunion; femoral osteotomy ; plating; broad dcp ; diaphyseal malunion

Outcome of Management of Pediatric Subtrochanteric Femoral Fracture with Broad Dynamic Compression Plate and Proximal Cancellous Screw through the Femoral Neck

Introduction: Pediatric subtrochanteric femoral fracture can be managed with traction followed by spica, intramedullary elastic nailing, plating or external fixators. The prognosis largely depends on adequate reduction and stable fixation. Aims:The aim of this study was to evaluate functional outcome of pediatric subtrochanteric femoral fracture treated with broad dynamic compression plate. Methods: This prospective observational study consisted of 32 children between the age 7 to 15 years, with an average of 10.06 years ± 2.29, with subtrochanteric femoral fracture. Fractures were reduced by an open reduction through lateral approach and stabilized with a broad dynamic compression plate along with a proximal cancellous screw through the femoral neck. All patients were followed for 15 months and the results were evaluated on the basis of Flynn scoring system. Results: All fractures united with a mean duration of 12.6 weeks ± 0.91. Average hospital stay was 8.43 days (5 to 14 days). Functional outcome was excellent in 84.38% (27 patients) and satisfactory in 15.62% (5 patients). Full weight bearing was started after mean duration of 16.62 weeks ± 0.91. Implants were removed at an average of 11.21 months ± 1.06. There were no significant limb length discrepancies, deep infections, re-fracture, osteomyelitis and avascular necrosis. Conclusion: This prospective study showed good functional outcome in pediatric patients having subtrochanteric femoral fractures who were treated with a broad dynamic compression plate and a proximal cancellous screw through neck.

Treatment of femoral and tibial fractures aseptic nonunion after intramedullary nailing by plate augmentation and bone graft

Objective Intramedullary nailing is widely used in the treatment of femoral and tibial fractures. But some patients suffer from nonunion after treatment by intramedullary nails. This paper investigates the methods and effects of augmentative compression plate and bone graft in the treatment of femoral and tibial nonunion after intramedullary nailing. Patients and methods Twenty patients treated between July 2009 and December 2014 were included in this retrospective study. The nonunions included 12 femora and 8 tibiae. The duration of nonunion ranged from 6 to 28 months. There were 7 women and 13 men with a mean age of 40 years (range, 21–64 years). Broad and narrow dynamic compression plating combined with bone grafting was the procedure chosen to treat every cases of femoral and tibial nonunion, respectively, in this series. Results The mean follow-up duration was 31.5 months (range, 10–52 months). All the femoral and tibial fractures achieved radiological union. The mean time to union was 20.8 months (range, 12–36 months). One patient had refracture of femoral shaft fracture after removal of interlocking nail and broad dynamic compression plate with refixation by interlocking nail and broad dynamic compression plate again with full union after 18 weeks. Apart from that case of refracture after hardware removal there were no serious complications such as infection, breaking or loosening of the plate and screws during the follow-up period. Conclusion Augmentation plating with bone grafting is a highly effective treatment for aseptic nonunion of the femur and tibia after intramedullary nailing.

Management of Fibrous Dysplasia of Proximal Femur by Internal Fixation Without Grafting: A Retrospective Study of 19 Patients.

Introduction:This paper assesses whether treating patients with fibrous dysplasia of proximal femur by internal fixation with correction of the deformity, if present, without grafting is enough or not.Methods:This study is a retrospective study using patient's medical records, including analysis of 19 patients with fibrous dysplasia of proximal femur treated by internal fixation only and followed up between 2000 and 2017 for at least 2 years. Epidemiologic data, clinical manifestations, radiologic and histologic investigations, surgery, functional outcomes, and complications in these patients were analyzed.Results:The study included 12 male patients and 7 female patients, with a mean age of 20.74 years. Of these, two patients presented with pathologic fractures, two presented with shepherd's crook deformity, and the remaining presented with hip pain and limping. Implants used for internal fixation were intramedullary nail in four patients, dynamic hip screw in eight patients, cannulated screws in four patients, broad dynamic compression plate in two patients, and narrow dynamic compression plate in one patient. The mean follow-up period was 53.58 months. Four patients had postoperative complications. The mean Musculoskeletal Tumor Society score was 27.63 points.Discussion:The optimal management option for fibrous dysplasia of proximal femur is debatable. We suggest that internal fixation without grafting has a good local control and satisfactory functional long-term outcome.

Outcomes following osteosynthesis of periprosthetic hip fractures around cemented tapered polished stems

We retrospectively reviewed outcomes of 79 patients with periprosthetic hip fractures around cemented tapered polished stem (CTPS) implants treated with osteosynthesis between January 1997 and July 2011. All patients underwent open reduction and fixation using a broad dynamic compression plate (DCP).Seventy two (91%) of fractures united. There were seven (9%) non-unions with failure of metal work, three (4%) as a result of infection and four (5%) due to mechanical failure. Significant subsidence (>5mm) of the implant was seen in seven (9%) of cases. Ten (13%) cases developed post-operative infection. Non-anatomic reduction and infection were identified as predictors of poor outcome.This is the largest series of a very specific group of periprosthetic fractures treated with osteosynthesis. Open reduction internal fixation with a broad dynamic compression plate for patients with periprosthetic hip fractures around the tip of cemented tapered polished stems is a suitable treatment provided there is no bone loss and the fracture can be precisely, anatomically, reduced and adequately fixed.

A comparative study of fracture shaft of femur in adults treated with broad dynamic compression plate versus intramedullary interlocking nail

Background and Objectives: Diaphyseal femur fracture is one of the commonest fractures to present in an emergency room. The objective of the study was to compare femoral shaft fractures treated using nail with those using plate and screws. Patients and Methods: We studied a total of 62 patients of fracture shaft of femur admitted in the Bharatpur Hospital, Bharatpur, Chitwan and National Academy of Medical Sciences, BirHospital,Kathmandu. Two cases were lost to follow up. Thirty cases were treated with plating and 30 cases with nailing. The age group was from 16-30 years. Fifty-three were male and seven were females. Fifty-eight patients had closed fracture and two had Gustillo Anderson grade I openfracture. Result: Time from injury to surgery was 19 days on an average. Mean time for union was more in patients treated by plating, 19.46 weeks as compared to nailing 14.78 weeks. We found one case of infection with plating and breakage of plate in four patients. One patient with nailing did not show any signs of healing and two had failure in case of nailing. Our series revealed 23(38.3%) excellent, five (8.3%) good and two (3.3%) poor results in patients who had nailing while 15 (25.5%) excellent, nine (15%) good, one (1.7%) fair and five (8.3%) poor in patients who had plating out of 30 patients in each group. Conclusion:In our study we found that there was no significant difference in outcomes between plating and intramedullary nailing of femoral diaphysis fracture in terms of union, infection and implant failure.JCMS Nepal. 2016;12(2):66-9.

Posterior coronal plating for tibial fractures: technique and advantages

ObjectiveTibial shaft fractures are straightforward to treat but when associated with soft tissue injury particularly at the nail entry/plate insertion site or there is significant comminution proximally or a large butterfly fragment/a second split component in the posterior coronal plane, it is a challenge to the treating surgeon. The aim of the present report is to describe the technique of posterior coronal plating in such a scenario and its advantages. MethodsBetween July 2008 and June 2011, 12 patients were prospectively treated by this approach using 4.5mm broad dynamic compression plates. ResultsThe time of bony consolidation and full weight bearing averaged 21.7 weeks (range, 16-26 weeks). Patients were followed up for at least 24 months (range, 24-48 months). At 1 year postoperatively, no loss in reduction or alignment was observed. Mean Hospital for Lower Extremity Measurement Functional Score was 72.8 (range, 64-78). All patients were satisfied with their treatment outcomes. ConclusionDirect posterior approach and fixation using prone position helps to visualise the fracture fragments and provide rigid fixation. The approach is simple and extensile easily, apart from advantages of less soft tissue and hardware problems compared to standard medial or lateral plating.

Plate fixation for management of plantar instability of the distal tarsus/proximal metatarsus in 5 horses

To report plate fixation for management of traumatic injuries resulting in plantar instability of the proximal intertarsal (PIT) and tarsometatarsal (TMT) joints. Case series. Medical records (October 1988 to August 2007) of horses that had internal fixation of the distal aspect of the tarsus were reviewed. Horses that had a broad dynamic compression plate (DCP) or broad locking compression plate (LCP) applied on the plantar-lateral aspect of the tarsus extending from the proximal calcaneus to the proximal one third of the metatarsus were included. Signalment, clinical signs, radiographic findings, time to surgery, implant type, postoperative management and complications were recorded. Long-term (>1 year) outcome was obtained for 4 horses. Five horses were treated, 4 had DCP fixation and 1 had LCP fixation. Subluxation of the proximal intertarsal joint was treated in 3 horses and 2 horses had fractures of the distal tarsal bones or proximal aspect of the metatarsus. Perioperative complications included peroneus tertius rupture (2 horses) and postoperative infection.(1) Four horses were discharged and 1 year after surgery were considered sound at pasture; 3 horses were sound enough for limited riding. Plate fixation provides adequate strength and stability for successful management of injuries that result in plantar instability of the tarsus and proximal metatarsus.

Use of Bone Plate for Treatment of an Open Third Metacarpal Fracture in a Foal

A 7-month-old, 180-kg, female foal was presented with open diaphyseal fracture of the left third metacarpal bone. The fractured limb was stabilized preoperatively with external coaptation. Open reduction and internal fixation were done using 4.5-mm broad dynamic compression plate, which was applied in a neutralization manner. Postoperatively, external support with padded bandage reinforced with gutter splint made of fiber glass was provided. The incisional infection and the contaminated wound on medial aspect of the metacarpal were managed with regular dressing. Complete radiographic union and functional recovery were noticed by 4 months postoperatively. Open diaphyseal fractures can be managed by proper preoperative fracture stabilization, wound management, and fixation methods using bone plate and external coaptation.

Living in the shadow of fear

Correspondence: Dr. Gurinder Bedi, Senior Consultant Orthopedic Surgeon, Fortis Flt. Lt. Rajan Dhall Hospital, Sector B, Pocket 1 Aruna Asaf Ali Marg, Vasant Kunj, New Delhi – 110070. E-mail: gbedi24@aol.com doi: 10.1016/S0976-5662(11)60046-5 position while putting a femoral prosthesis in, has most likely lost his argument not to mention his composure. The case will eventually finish, but what he really ends up with is an immense amount of ill-will from his co-workers and a frozen group of people who will eventually never endeavor to help him out in a messy situation or point out any obvious flaws when the time comes. No suggestions will be forthcoming, no extra assistance will be made to ease the job, no nurturing of a fertile mind will happen in that kind of environment. Indifference will eventually creep in with a “WHY SHOULD I BOTHER?” attitude. With a lack of environment which allows praise and criticism in balanced amount, no progress or new learning will take place. The payback will happen when the same people will subsequently build a culture akin to this with their own junior colleagues when they are in a position of authority. Then there are also familiar cases of postgraduate students cringing to finish their thesis on subjects in which they have no interest but have been told by their guides to do so for various reasons. The threat of thesis rejection looms large on their heads everyday if they annoy their guides. All these are very common scenarios. Why should a postgraduate student not pick up a thesis of his or her choice, obviously in consultation with the guide? The lack of professional appreciation is endemic in our culture. The appreciation that a one time resident can be respected as a colleague seems totally lost. We are possibly fortunate that things are improving in our region but from tales coming from other regions we have a long way to go. It is time we realized that not having a scissor which cuts well, not having another bone clamp or not having a broad dynamic compression plate is not the fault of the scrub nurse. These issues need to be discussed at the time of indenting material the next time material is being procured, and submitting lists of instruments well in time so that the issues are not repeated. Have the courage to raise these issues with the owner of the nursing home or the director of your hospital rather than the poor nurse who has no say in the matter. Why do we keep hauling up residents for system failure in a hospital establishment, instead of addressing the administrative staff? Unless we realize this and start appreciating other professionals and the job they do, we will never build a good work environment which is mutually beneficial to all of us. It is neither befitting nor appropriate that any person coming to work should be abused either verbally or physically. Is it not reasonable to expect that they be granted a certain standard of respect and work appreciation, which they deserve? Being a junior should not put any person at a disadvantage or make them vulnerable to abuse. It is up to the team leaders, Senior Consultants, Heads of Departments to condone such behavior and if not able to, then there should be another option for the victim to get redressal. In most cases it just involves discussion with the perpetrator. If there is a valid reason for reprimanding an individual, it needs to be done in a civilized manner, and definitely not by shouting at them in the middle of a ward. We must develop the confidence in our colleagues to deliver a certain level of Living in the shadow of fear

In Vitro Biomechanical Comparison of Dynamic Compression Plates with a Rough Contact Surface and a Polished Contact Surface for Fixation of Osteotomized Equine Third Metacarpal Bones

To compare the number of cycles to failure of 4.5 mm broad dynamic compression plates (DCP), 4.5 mm broad limited-contact dynamic compression plates (4.5-LC-DCP), and 5.5 mm broad limited-contact dynamic compression plates (5.5-LC-DCP) having a rough (denoted by a prefix R-) versus a standard smooth contact surface for the fixation of osteotomized equine 3rd metacarpal (MC3) bones. Experimental. Fifteen pairs of adult equine cadaveric MC3 bones. Fifteen pairs of equine MC3 were divided into 3 test groups (5 pairs each) for comparison of (1) R-DCP fixation with DCP fixation, (2) R-4.5-LC-DCP fixation with 4.5-LC-DCP fixation, and (3) R-5.5-LC-DCP fixation with 5.5-LC-DCP fixation to repair osteotomized equine MC3 bones under palmarodorsal 4-point bending cyclic fatigue testing. For each group an 8-hole plate with rough contact surface was applied to the dorsal surface of one randomly selected bone from each pair and a corresponding 8-hole plate with smooth contact surface was applied dorsally to the contralateral bone from each pair. All plates and screws were applied using standard ASIF techniques. All MC3 bones had mid-diaphyseal osteotomies. Mean number of cycles to failure for each method were compared using a paired t-test within each group. Significance was set at P < .05. Mean cycles to failure ± standard deviation was significantly greater for the R-DCP fixation (230,025 ± 23,129) compared with the DCP fixation (103,451 ± 14,556), for the R-4.5-LC-DCP fixation (99,237 ± 14,390) compared with the 4.5-LC-DCP fixation (46,464 ± 6325) and for the R-5.5-LC-DCP fixation (65,113 ± 7796) compared with the 5.5-LC-DCP fixation (34,224 ± 3835). For the fixation of osteotomized MC3 bones, the constructs with plates having rough contact surface were superior to the corresponding constructs with plates having standard smooth contact surfaces in resisting cyclic fatigue under palmarodorsal 4-point bending.

An In Vitro Biomechanical Comparison of Dynamic Condylar Screw Plate Combined with a Dorsal Plate and Double Plate Fixation of Distal Diaphyseal Radial Osteotomies in Adult Horses

To compare stiffness and strength of a dynamic condylar screw plate combined with dorsal broad dynamic compression plate (DCS-bDCP) fixation with double broad dynamic compression plate (dbDCP) fixation used to repair oblique distal fractures of adult equine radii. Experimental. Adult equine radii (n=10 pair). An unconstrained three-dimensional loading-measurement system was used to determine stiffness of a 50 mm long intact, and then DCS-bDCP or dbDCP-plated osteotomized/ostectomized segment of radii when subjected to a nondestructive sequence of compression, torsion, and lateral-to-medial (LM), medial-to-lateral (ML), cranial-to-caudal (CrCa), and caudal-to-cranial (CaCr) bending. Uniform load over the entire length of construct identified its weakest characteristics during torsion and LM and CrCa bending to failure. No difference was observed between osteotomized/ostectomized DCS-bDCP and dbDCP construct stiffness for all 6 loading modes, and strength for all 3 failure loads. Ostectomized DCS-bDCP and dbDCP construct stiffness was significantly lower than osteotomized radii, the latter approaching intact for axial, LM, and CrCa bending. Most frequent failure was bone fracture through exit site of a screw located adjacent to osteotomy/ostectomy. DCS-DCP and dbDCP constructs had comparable strength and stiffness when repairing osteotomies/ostectomies in equine adult radius bone. Fracture reduction increased stiffness that approached intact bone for loads that placed the unplated side in compression. DCS-bDCP and dbDCP constructs are comparable in stiffness and strength when applied to oblique distal diaphyseal osteotomies/ostectomies in equine radius bone. However, the DCS's localized effect on distal epiphyseal structure because of additional bone removal remains to be investigated under in vivo articular loading conditions.

Mechanical Comparison of 3.5 mm Broad Dynamic Compression Plate, Broad Limited‐Contact Dynamic Compression Plate, and Narrow Locking Compression Plate Systems Using Interfragmentary Gap Models

To compare (1) pullout properties between 3.5 mm cortical and locking screws, and (2) mechanical properties and gap displacements between the 3.5 mm broad limited-contact dynamic compression plate (LC-DCP), broad dynamic compression plate (DCP), and narrow locking compression plate (LCP), during axial loading of plate-stabilized diaphyseal fragments with an interfragmentary gap. In vitro mechanical testing of implanted polyurethane foam (PUF) hollow cylinders that simulated compact or osteopenic diaphyseal bone. (1) Five cortical and locking screws and (2) 4 PUF-plate constructs for each plate type; using high- and low-density (0.8 and 0.32 g/cm(3)) cylinders. (1) Screws were completely extracted at 5 mm/min. (2) Plated constructs were axially compressed at 300 N/s for 10 cycles from 5 to 355 N to determine gap displacement during physiologic loading, followed by single cycle increasing load to failure. Pullout properties were not different between screw types. All plate constructs had yield loads over 3 times trotting loads. Gap closure occurred with LC-DCP and DCP constructs, but not LCP constructs. LCP construct properties were most similar to LC-DCP and DCP construct properties in the low-density model. All plate systems sustained physiologic limb loads. Only LCP constructs maintained some gap integrity, although LC-DCP and DCP screws were placed in neutral position. The LCP system is more likely than LC-DCP and DCP systems, with neutrally positioned screws, to maintain a planned interfragmentary gap, although gap strains range from 0% to 15% across the 2 mm gap during a trot load.

Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated

The aim of this study was to examine the results of minimally invasive plate osteosynthesis (MIPO) of the femoral shaft fracture in patients where intramedullary nailing is contraindicated and evaluate the proper number of the screws for stable fixation. This was a retrospective study of 36 closed femoral shaft fractures which underwent MIPO using a conventional 4.5 broad dynamic compression plate (DCP) with 14-18 holes fixed with three or four screws in the proximal and distal fragments. Thirty-three fractures had bony union in 21.0 weeks (range, 12-28 weeks), two had delayed union that required bone graft and union at 28 and 32 weeks. Malalignment occurred in five cases. Sixty-two fragments were fixed with three screws--40 in cluster and 22 in separated positions. Ten fragments were fixed with four screws--eight in cluster and two separated. Broken screws were found in three cases; all were in the group with three screws fixed in cluster group. MIPO of the femoral shaft fracture is an alternative treatment in the patient where intramedullary nailing is contraindicated. Malalignment is the common complication that must be carefully evaluated intraoperatively. We recommend using at least three separated screws in each fragment to reduce the risk of screw breakage.

Biomechanical Evaluation of Periprosthetic Femoral Fracture Fixation

A variety of methods are available for the fixation of femoral shaft fractures after total hip arthroplasty. However, few studies in the literature have quantified the performance of such repair constructs. The aim of this study was to evaluate biomechanically four different constructs for the fixation of periprosthetic femoral shaft fractures following total hip arthroplasty. Twenty synthetic femora were tested in axial compression, lateral bending, and torsion to determine initial stiffness, as well as stiffness following fixation of a simulated femoral midshaft fracture with and without a bone gap. Four fracture fixation constructs (five specimens per group) were assessed: construct A was a Synthes locked plate (a twelve-hole broad dynamic compression plate) with locked screws; construct B, a Synthes locked plate (a twelve-hole broad dynamic compression plate) with cables and locked screws; construct C, a Zimmer nonlocking (eight-hole) cable plate with cables and nonlocked screws; and construct D, a Zimmer nonlocking (eight-hole) cable plate with allograft strut, cables, and nonlocked screws. Axial stiffness, lateral bending stiffness, and torsional stiffness were assessed with respect to baseline intact specimen values. Axial load to failure was also measured for the specimens. Construct D demonstrated either equivalent or superior stiffness in all testing modes compared with the other constructs in femora with both a midshaft fracture and a bone gap. A comparison of constructs A, B, and C demonstrated equivalent stiffness in all test modes (with one exception) in femora with a midshaft fracture and a bone gap. A combination of a nonlocking plate with an allograft strut (construct D) resulted in the highest stiffness of the constructs examined for treating a periprosthetic fracture around a stable femoral component of a total hip replacement.

In Vitro Biomechanical Comparison of Locking Compression Plate Fixation and Limited‐Contact Dynamic Compression Plate Fixation of Osteotomized Equine Third Metacarpal Bones

To compare monotonic biomechanical properties and fatigue life of a broad locking compression plate (LCP) fixation with a broad limited contact dynamic compression plate (LC-DCP) fixation to repair osteotomized equine third metacarpal (MC3) bones. In vitro biomechanical testing of paired cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. Cadaveric adult equine MC3 bones (n=12 pairs). MC3 were divided into 3 groups (4 pairs each) for: (1) 4-point bending single cycle to failure testing; (2) 4-point bending cyclic fatigue testing; and (3) torsional single cycle to failure testing. The 8-hole, 4.5 mm LCP was applied to the dorsal surface of 1 randomly selected bone from each pair. One 8-hole, 4.5 mm LC-DCP) was applied dorsally to the contralateral bone from each pair. All plates and screws were applied using standard ASIF techniques. All MC3 bones had mid-diaphyseal osteotomies. Mean test variable values for each method were compared using a paired t-test within each group. Significance was set at P<.05. Mean yield load, yield bending moment, composite rigidity, failure load and failure bending moment, under 4-point bending, single cycle to failure, of the LCP fixation were significantly greater than those of the LC-DCP fixation. Mean cycles to failure for 4-point bending was significantly greater for the LCP fixation compared with LC-DCP fixation. Mean yield load, mean composite rigidity, and mean failure load under torsional testing, single cycle to failure was significantly greater for the broad LCP fixation compared with the LC-DCP fixation. The 4.5 mm LCP was superior to the 4.5 mm LC-DCP in resisting the static overload forces (palmarodorsal 4-point bending and torsional) and in resisting cyclic fatigue under palmarodorsal 4-point bending. The results of this in vitro study may provide information to aid in the selection of a biological plate for the repair of equine long bone fractures.

An In Vitro Biomechanical Comparison of a 5.5 mm Limited‐Contact Dynamic Compression Plate Fixation with a 4.5 mm Limited‐Contact Dynamic Compression Plate Fixation of Osteotomized Equine Third Metacarpal Bones

To compare monotonic biomechanical properties and fatigue life of a 5.5 mm broad limited-contact dynamic compression plate (5.5-LC-DCP) fixation with a 4.5 mm broad LC-DCP (4.5-LC-DCP) fixation to repair osteotomized equine third metacarpal (MC3) bones. In vitro biomechanical testing of paired cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. Adult equine cadaveric MC3 bones (n=18 pair). MC3 were divided into 3 test groups (6 pairs each) for: (1) 4-point bending single cycle to failure testing; (2) 4-point bending cyclic fatigue testing; and (3) torsional single cycle to failure testing. The 8-hole, 5.5 mm broad LC-DCP (5.5-LC-DCP) was applied to the dorsal surface of 1 randomly selected bone from each pair. One 8-hole, 4.5 mm broad LC-DCP (4.5-LC-DCP) was applied dorsally to the contralateral bone from each pair. Plates and screws were applied using standard ASIF techniques. All MC3 bones had mid-diaphyseal osteotomies. Mean test variable values for each method were compared using a paired t-test within each group. Significance was set at P<.05. Mean yield load, yield bending moment, composite rigidity, failure load and failure bending moment under 4-point bending, single cycle to failure, of the 5.5-LC-DCP fixation were significantly greater (P<.024) than those of the 4.5-LC-DCP fixation. Mean cycles to failure for 4-point bending was significantly (P<.05) greater for the 4.5-LC-DCP fixation compared with the 5.5-LC-DCP fixation. Mean yield load, mean composite rigidity, and mean failure load in torsion for the 5.5-LC-DCP fixation was not significantly different (P>.05) than those with the 4.5-LC-DCP fixation. 5.5-LC-DCP fixation was superior to 4.5-LC-DCP fixation in resisting the static overload forces under palmarodorsal 4-point bending. There was no significant difference between 5.5-LC-DCP fixation and 4.5-LC-DCP fixation in resisting static overload forces under torsion; however, the 5.5-LC-DCP offers significantly less stability (80% of that of the 4.5-LC-DCP) in cyclic fatigue testing. The results of this in vitro study may provide information to aid in the selection of a biological plate for long bone fracture repair in horses.

Unstable recent intracapsular femoral neck fractures in young adults: Osteosynthesis and primary valgus osteotomy using broad dynamic compression plate

Background:Displaced intracapsular femoral neck fractures continue to be a difficult problem to treat. Various treatment modalities and their modifications have been proposed to improve the outcome. Osteosynthesis and primary valgus angulation osteotomy is one of them. Technique and outcome in a consecutive series of recent intracapsular femoral neck fractures in young adults, from a single center, is presented.Materials and Methods:Fifty-five patients of recent (<3 weeks old) displaced intracapsular fracture neck femur (Garden III and IV, Pauwels III, with or without comminution) in the age group 20-50 years (mean 35.4±10.4 years) were subjected to osteosynthesis and primary valgus intertrochanteric osteotomy using contoured broad dynamic compression plate (DCP). The patients were followed up from two to six years (mean 4.6 years).Results:Fifty-one fractures united by six months of the index procedure (92.7% union range). Avascular necrosis (AVN) developed in six patients (11%). The other complications were shortening (six), coxa vara (two), infection (two) and delayed union at osteotomy site (one). Excellent results were achieved in 48, good/fair in four and poor in three patients.Conclusion:Osteosynthesis with cancellous screw and primary valgus intertrochanteric osteotomy stabilized by a contoured broad DCP is a simple, easy to perform, biological treatment. Failure in a particular case can be treated with any appropriate second procedure.Level of Evidence:IV