Compression Plate Fixation Research Articles

Ender Rod Versus Compression Screw Fixation of Hip Fractures

Eighty-seven matched pairs of patients with extracapsular hip fractures were treated with either Ender rod or compression screw and plate fixation. The data obtained both perioperatively and from one to 39 months postoperatively showed no significant differences with respect to infection rate, mortality, length of stay, or ultimate functional status. In the Ender rod group, 66.7% of the patients experienced technical problems, compared with 10.3% of patients in the compression screw group. The Ender technique offered few practical advantages and an unacceptably high level of problems, even when patients with only stable fractures were considered.

Stress analysis of compression plate fixation and its effects on long bone remodeling

A three-dimensional finite element model is generated for an intact plexiglass tube with an attached six-hole stainless steel compression plate. The results for a wide range of loads, including cyclic external loads and static tensile preloads in the plate and screws, are examined as specifically related to plate-induced osteopenia. The model demonstrates that disuse osteopenia, resulting from a reduction in magnitude of cyclic axial stress, should be limited to the central region between the inner screws. Also, the addition of a static preload negates any reduced axial stress levels in this region, thus raising questions on the relative importance of static and cyclic stresses for the internal remodeling of bone.

Stress analysis of a simplified compression plate fixation system for fractured bones

A three-dimensional finite element model was generated of a plexiglass tube with an attached six-hole stainless steel compression plate to study the mechanics of internal fixation of fractured long bones. To demonstrate the importance of the plate-bone interface, this interface was represented three different ways in the finite element model. A plated tube with a uniform transverse osteotomy gap was also examined to study the mechanics of plated fractured bones. To validate the model, the results for the intact plated tube were compared to composite beam theory and strain gauge data from an instrumented physical model. Applications of the finite element model data included the prediction of screw failure modes, plate-induced osteopenia, and multi-axial strains in an interfragmentary region. The addition of sliding motion between the plate and tube resulted in a deviation from composite beam theory and improved correspondence with strain gage data when compared to a model having the plate and tube securely bonded. Sliding motion resulted in a much smaller region of bone subjected to reduced axial stress levels, which may decrease the extent of plate-induced osteopenia. The complex nature of induced strains in an osteotomy gap was also demonstrated, along with the tendency for failure of the screws nearest the fracture site.

Compression Plate Position

Although compression plate fixation of diaphyseal long bone fractures is accepted treatment, surgical exposure and plate position in relation to the periosteum are controversial. Histologic, roentgenographic, and biomechanical methods were applied to investigate quality and chronology of healing in radial and ulnar fractures in adult dogs. Plate position was extraperiosteal in one limb and subperiosteal in the contralateral limb. There were no statistical differences in roentgenographic or histologic studies of healing between the two techniques, nor were significant statistical differences noted when comparing linear load, maximum load at failure, slope of the linear portion, energy absorbed to failure, stress, modulus of elasticity, strain at maximum linear load, strain at maximum load, and strain at failure. Thus, there was no appreciable difference in fracture healing between subperiosteal and extraperiosteal exposure with compression plate fixation of diaphyseal fractures in dogs. However, subperiosteal exposure is preferable because it is less likely to injure surrounding soft tissues.

Stress analysis of a simplified compression plate fixation system for fractured bones

A three-dimensional finite element model was generated of a plexiglass tube with an attached six-hole stainless steel compression plate to study the mechanics of internal fixation of fractured long bones. To demonstrate the importance of the plate-bone interface, this interface was represented three different ways in the finite element model. A plated tube with a uniform transverse osteotomy gap was also examined to study the mechanics of plated fractured bones. To validate the model, the results for the intact plated tube were compared to composite beam theory and strain gauge data from an instrumented physical model. Applications of the finite element model data included the prediction of screw failure modes, plate-induced osteopenia, and multi-axial strains in an interfragmentary region. The addition of sliding motion between the plate and tube resulted in a deviation from composite beam theory and improved correspondence with strain gage data when compared to a model having the plate and tube securely bonded. Sliding motion resulted in a much smaller region of bone subjected to reduced axial stress levels, which may decrease the extent of plate-induced osteopenia. The complex nature of induced strains in an osteotomy gap was also demonstrated, along with the tendency for failure of the screws nearest the fracture site.

A comparison of the effect of open intramedullary nailing and compression-plate fixation on fracture-site blood flow and fracture union.

We compared the effects of compression-plating and open intramedullary nailing after reaming on the vascular supply to a standard fracture site, on the rate of fracture union, and on the biomechanical quality of bone after union, and on the biomechanical quality of bone after union in dogs. The proper location of a compression plate in relation to the periosteum also was investigated. Bone blood flow reached higher levels and remained elevated longer in fractures that were fixed with a rod than in those fixed with a plate. Rod-fixed fractures healed by periosteal callus, whereas plate-fixed fractures healed by endosteal callus. The fracture gained mechanical strength more slowly in the rod-fixed group than in the plate-fixed group. Subperiosteal or extraperiosteal placement of a plate revealed similar effects on bone-healing. Decisions to use intramedullary rods or compression plates for internal fixation of fractures should be based on knowledge of the biological effects of these procedures on blood flow at the fracture site and on the mechanical strength of the healing fracture. This study defines in quantitative terms the advantages and disadvantages of intramedullary rods compared with compression plates in the internal fixation of fractures.

CARPAL ARTHRODESIS IN DOGS

SUMMARY Nine dogs, each with a severe carpal sprain injury, were treated by arthrodesis (2 bilateral). The same surgical technique with articular cartilage curettage, autologous bone grafting and compression plate fixation was used for each carpus. Initial treatment with external coaptation had been unsuccessful, but arthrodesis always resulted in resolution of the lameness. Complications included fracture of the compression plate (1 case) and loosening of the implants (2 cases).

Rotatory contracture of the forearm.

We saw seven patients with an idiopathic progressive loss of rotation of the forearm, occurring primarily during adolescence and manifested principally by a gradual loss of supination. There were secondary developmental abnormalities of the radial head and of the ulna (distal bowing) in four patients. Six surgical procedures were performed on five of the seven patients, consisting of combinations of sectioning of the quadrate ligament, release of the interosseous membrane, and ostecotomy and compression-plate fixation of the distal end of the ulna. There was functional improvement in four patients. Release of the quadrate ligament provided the greatest improvement, but that release alone was of minimum value. We concluded that a contracted quadrate ligament may be an important deterrent to supination of the forearm, but distortion of the radial head, curvature of the ulna, and contracted soft tissues in the interosseus space and distal radio-ulnar joint also are contributory factors.

External fixation as an alternative when treating 2nd and 3rd degree open lower leg fractures.

The infection rate of open lower leg fracture is extremely high. Surgical treatment guarantees a reduced risk of infection when compared with conservative treatments. But even osteosynthetic methods such as screw or compression plate fixation show unsatisfactory results because of the additional traumatization of the primarily injured soft tissue combined with a reduction of blood circulation. From July 1973 till September 1976 we treated 57 2nd and 3rd degree open shank fractures with osteosynthetic methods: 46 with compression plate osteosynthesis and 11 primarily or secondarily with external fixation. The osteitis-rate was 14%, in addition to that there was a soft-tissue infection rate of 5%. In order to change our therapeutical procedure we stabilized 2nd and 3rd degree open lower limb fractures and lower leg fractures complicated by soft-tissue damages consequently by external fixation. From October 1976 till May 1978 we treated 39 open shank fractures; 24 of them were 2nd and 3rd degree open fractures. They were treated by external fixation. This change in our surgical treatment resulted in an osteitis-rate of 2.6%, there was no case of soft-tissue inflammation. These results underline the superiority of treating 2nd and 3rd degree open lower leg fractures and fractures combined with soft-tissue injuries consequently and chiefly with AO external fixation.

Compression Plate Fixation in the Treatment of Diaphyseal Fractures of the Radius and Ulna

Compression Plate Fixation in the Treatment of Diaphyseal Fractures of the Radius and Ulna

Changes in calcium and hydroxyproline content of cortical bone after compression and neutral plate fixation.

Calcium and hydroxyproline content of intact rabbit tibio-fibular bone was assay chemically 1 day to 36 weeks after compression and neutral plate fixation with a 4-hole stainless steel ASIF/DCP plate. During the first three postoperative weeks calcium content of the cortical bone decreased by an almost significant amount (P less than 0.05); thereafter, calcium values remained subnormal but did not differ significantly from initial postoperative values. Hydroxyproline content increased steadily throughout the experiment (P less than 0.001). The changes in chemical composition of the bone were of the same magnitude after compression and neutral plate fixation. The results suggest that the cancellous transformation of cortical bone, known to take place under rigid plates, reflects an active remodelling process of the bone in which the calcium and hydroxyproline content changes only slightly.

Treatment of Fractures of the Radius and Ulna with Compression Plates

An extended evaluation of the ASIF compression apparatus in the treatment of forearm fractures was begun in April 1965. One hundred and nineteen compression plates were applied in seventy-eight patients whose average follow-up was twenty-nine months. Plates were applied to both radius and ulna in twenty-eight patients with fractures of both bones; to the radius of thirteen patients whose fracture of the ulna was treated by closed reduction (six patients) or by an intramedullary rod (seven patients); to the radius in twenty-one patients with fractures in the distal one third of the radius (Galeazzi or Piedmont fractures); to the radius only in fourteen patients with other types of fracture of the radius; and to the ulna only in two patients with fractures of the ulna. All fractures primarily treated by compression plate fixation healed but two required subsequent bone-grafting for non-union. There were ten infections associated with compression plate fixation and loss of fixation occurred four times. Failure of fixation could be attributed to a technical error in four instances. Significant restriction of motion in the adjacent joint or joints occurred in seventeen patients; however, only seven of them did not return to their usual occupation. If the seven adult patients who had compression plate fixation of the radius and intramedullary fixation of the ulna are excluded, restriction of motion occurred in only ten of seventy-one patients and only five of seventy-one patients did not return to their usual occupation.

Clinical and Experimental Studies on Primary Fracture Healing (The 1st Report)

This report concerned to the primary fracture healing after K-U Compression plate fixation. We have had 270 clinical cases of fracture and treated with K-U compression plate.X-ray examinations showed that the majority of the cases were healed without accompaning the callus formation.Experimental studies of the above method were done using rabbits. Studies of X-ray, CMR, histology, microangiography, and tetracycline labelling were done every week after K-U compression plate fixation.Bony union was better on the case of intact periosteum than the injured one.

Compression Plate Fixation and the Effect of Different Types of Internal Fixation on Fracture Healing

Compression Plate Fixation and the Effect of Different Types of Internal Fixation on Fracture Healing