Conventional Reconstruction Plates Research Articles

The Two-Incision, Minimally Invasive Approach in the Treatment of Acetabular Fractures

To present a novel two-incision minimally invasive (TIMI) method for the treatment of anterior acetabular fractures. Prospective consecutive case series. Level I University Trauma Centre. Twenty-six patients (mean age, 67 ± 19 years). The first TIMI-incision is performed by a pararectal approach at the level of the proximal third of the arcuate line of the ilium. After transection of the abdominal wall, the iliac vessels are mobilized medially and the neuromuscular bundle laterally. The second approach lies above the medial pubic bone. The soft tissue is held using a retraction system. After fracture reduction and fixation by isolated screws, a conventional reconstruction plate is inserted for fracture neutralization. Perioperative course, postoperative radiological evaluation, functional outcome Harris hip score, and quality of life (EQ 5D). Mean operative time was 109 ± 30 mins. All incisions healed primarily. Postoperative radiological exam revealed an anatomic reduction in 20 fractures and a satisfactory reduction in 6. There were no local soft-tissue complications, and no revisions were needed. Follow-up examinations were performed after a minimum of 12 months in 19 patients (73%). The Harris hip score was 86,6 ± 8. Quality of life was comparable to persons in the same age group. The TIMI approach represents a viable alternative to the ilioinguinal approach. Despite the limited incisions, a comparable quality of fracture reduction is achieved. The authors believe this technique would be most useful in those patients with a higher risk for postoperative soft-tissue complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Der Zwei-Inzisions-Zugang in der Versorgung von Acetabulumfrakturen

To present a novel two-incision minimally invasive (TIMI) method for the treatment of anterior acetabular fractures. The first TIMI incision is performed using a pararectal approach at the level of the proximal third of the arcuate line of the ilium. After transection of the abdominal wall the iliac vessels are mobilized medially and the neuromuscular bundle laterally. The second approach lies above the medial pubic bone. The soft tissue is held back using a retraction system. After fracture reduction and fixation by isolated screws a conventional reconstruction plate is inserted for fracture neutralization. Since January 2008 we have performed the TIMI method in 88 cases with good results. Recently we have published the data of a first series with 26 patients that were seen at least 12 months after surgery. The mean operative time was 109 ± 30 min and all incisions showed primary healing. Postoperative radiological examination revealed an anatomic reduction in 20 fractures and a satisfactory reduction in 6. There were no local soft tissue complications and no revisions were needed. Follow-up examinations were performed after a minimum of 12 months in 19 patients (73%). The average Harris hip score (HHS) was 86.6 ± 8. Quality of life was comparable to control persons in the same age group. The TIMI approach represents a viable alternative to the ilioinguinal approach. Despite the limited number of incisions a comparable quality of fracture reduction is achieved. The authors believe this technique would be most useful in patients with a higher risk for postoperative soft tissue complications.

Are conventional reconstruction plates equivalent to precontoured locking plates for distal humerus fracture fixation? A biomechanics cadaver study

BackgroundThe optimal plate type and configuration for distal humerus fracture fixation has yet to be defined. Available biomechanical studies show conflicting results. No existing studies compare conventional reconstruction plates to newer precontoured distal humerus locking plates in both parallel and perpendicular configurations. MethodsThree groups of humerus specimens were compared via biomechanical testing in a cadaver model simulating metaphyseal comminution. Group 1 consisted of conventional reconstruction plates in a perpendicular configuration. Group 2 used precontoured locking plates in a perpendicular configuration. Group 3 used precontoured locking plates in a parallel configuration. Each group was tested for stiffness in anterior bending, posterior bending, axial compression, and torsion. The specimens then underwent cyclic loading followed by single load to failure in posterior bending. FindingsThere was no significant difference between the three groups for anterior bending, posterior bending, axial compression, or torsional stiffness. There was no significant difference in load to failure for any of the three groups. Screw loosening was significantly higher in Group 1 when compared to Groups 2 and 3 after cyclic loading. InterpretationIn the early postoperative period, less expensive perpendicular conventional reconstruction plate constructs provide similar stiffness and load to failure properties to newer precontoured locking plate systems regardless of plate configuration.

Biomechanical evaluation of the fixation methods for transcondylar fracture of the humerus:ONI plate versus conventional plates and screws.

We biomechanically evaluated the bone fixation rigidity of an ONI plate (Group I) during fixation of experimentally created transcondylar humerus fractures in cadaveric elbows, which are the most frequently observed humeral fractures in the elderly, and compared it with the rigidity achieved by 3 conventional fixation methods:an LCP reconstruction plate 3.5 using a locking mechanism (Group II), a conventional reconstruction plate 3.5 (CRP) with a cannulated cancellous screw (Group III), and a CRP with 2 cannulated cancellous screws (CS) in a crisscross orientation (Group IV). In the axial loading test, the mean failure loads were:Group I, 98.9+/-32.6;Group II, 108.5+/-27.2;Group III, 50.0+/-7.5;and Group IV, 34.5+/-12.2 (N). Group I fixations failed at a significantly higher load than those of Groups III and IV (p<0.05). In the extension loading test, the mean failure loads were:Group I, 34.0+/-12.4;Group II, 51.0+/-14.8;Group III, 19.3+/-6.0;and Group IV, 14.7+/-3.1 (N). Group IV fixations showed a significantly lower failure load than those of Group I (p<0.05). The fixation rigidities against mechanical loading by the ONI plate and LCP plate were comparable. These results suggested that an ONI system might be superior to the CRP and CS method, and comparable to the LCP method in terms of fixation rigidity for distal humerus fractures.

Mechanical Comparison in Cadaver Specimens of Three Different 90-Degree Double-Plate Osteosyntheses for Simulated C2-Type Distal Humerus Fractures With Varying Bone Densities

To investigate the bone-implant-anchorage of 90-degree double-plate osteosynthesis in simulated complete intra-articular distal humerus fractures using conventional reconstruction plates (CRP), locking compression plates (LCP), and distal humerus plates (DHP), depending on the bone mineral density (BMD) of the cadaver specimens. Groups (CRP, LCP, DHP, n=8; LCP, DHP, n=13) in distal humerus cadaver bones were created based on BMD. The fracture model was an unstable intraarticular distal humerus fracture with a transverse osteotomy gap representing metaphyseal comminution (AO type 13-C2.3). Flexion and extension stiffness as well as cycles until failure due to screw pullout under cyclic loading were evaluated. Estimates of BMD values, below which failure was likely to occur, were determined. Stiffness values were not significantly different between groups (extension: P=0.881, flexion: P=0.547). Under cyclic loading, consistent screw pullout failure occurred at BMD values below about 400 mg/cm for CRP and below about 300 mg/cm for LCP constructs. Comparing BMD-matched groups of 8 and 13 specimens respectively, the failure rate was significantly lower for the DHP (0/8) than for the CRP (5/8; P=0.026) and tended to be lower for the DHP (0/13) as compared to the LCP (4/13; P=0.096). Bone-implant anchorage was different between locking and nonlocking plate constructs and depended on BMD. While in good bone quality implant choice was not critical, both locking plates provided superior resistance against screw loosening as compared to the CRP at low BMD values (<420 mg/cm). Based on our laboratory results, we conclude that locking plates such as the LCP and DHP are constructs designed to keep anatomical reduction in the presence of comminution and poor bone quality in a low intra-articular fracture of the distal humerus.

Rigid Fixation of Vascularized Bone Grafts in Mandibular Reconstruction

To evaluate the nature of complications and complication rates with the use of three different reconstruction plates for the rigid fixation of vascularized bone grafts in oromandibular reconstruction. We conducted a case series of 95 patients over a 6-year period, with a minimum follow-up of 6 months and a maximum follow-up of 66 months. Academic tertiary referral medical center. Forty-eight patients had vascularized bone grafts fixated to native mandible with AO stainless steel reconstruction plates; 25 patients, with AO titanium plates; and 22 patients, with titanium hollow screw reconstruction plates (THORPs). Types of vascularized flaps, mandibular defects to be reconstructed, and use of radiation therapy were similar among the three groups. The surgical approach involved oromandibular reconstruction with a vascularized bone graft rigidly fixated with a reconstruction plate. Clinically and radiographically noted complications and resultant treatment. In the grafts fixated with AO stainless steel reconstruction plates, three plate fractures, seven instances of loose screws, eight plate exposures, and two cases of nonunion occurred. No cases of plate fracture or nonunion occurred in the titanium or THORP groups. One titanium plate and two THORPs were exposed during the study period. One instance of loose screws occurred in the titanium group; none in the THORP group. Seventy-four percent of those complications occurred within 12.4 months (the mean follow-up time of the THORP group). The incidence of complications in the stainless steel group was significantly greater than that in the titanium or THORP groups. No statistically significant increase in the rate of complications was noted when radiation therapy was used as a component of treatment. To our knowledge, this is the first study to compare three different reconstruction plates for fixation in vascularized bone reconstruction of the mandible. AO THORPs are now used almost exclusively to rigidly fixate vascularized bone grafts because of their advanced design and their potential for osseointegration and because fewer screws are necessary to attain adequate fixation than with conventional AO reconstruction plates.

The lingual application of a reconstruction plate: A new method in bridging lower jaw defects

The bridging of mandibular defects following tumor resection presents special problems. This stimulated us to look for a stable implant fixation method, particularly for use in irradiated tissues. We therefore developed the titanium hollow screwreconstruction plate system (THRP system) and have used it successfully during the last four years. I-4 The application of the THRP system as well as other conventional reconstruction plates is done on