Dynamic Compression Plate Research Articles

Is double-crossed retrograde elastic stable intramedullary nailing an alternative method for the treatment of diaphyseal fractures in the adult humerus?

BackgroundThe aim of this study was to compare two techniques for the surgical treatment of diaphyseal fractures in the adult humerus: double-crossed retrograde elastic stable intramedullary nailing (DCR-ESIN) and limited-contact dynamic compression plate (LC-DCP).MethodsThis was a retrospective study conducted at a single hospital. We included 122 patients with diaphyseal fractures of the humerus who had received DCR-ESIN or LC-DCP from January 2011 to January 2017. We compared union rates, union times, disabilities of the arm, shoulder, and hand (DASH) scores at the postoperative 1-year follow-up, and complications between the two groups.ResultsPlating management was performed in 63 patients, while DCR-ESIN was performed in 59 patients. The union rate was higher in the DCR-ESIN group than in the LC-DCP group (100% vs. 90.5%; p = 0.052). The union time was shorter in the DCR-ESIN group than in the LC-DCP group (12.0 weeks vs. 14.8 weeks; p < 0.001). The intraoperative blood loss and operative time were less in the DCR-ESIN group than in the LC-DCP group (76.4 min vs. 129.5 min; p < 0.001; 60.9 ml vs. 244.8 ml; p < 0.001, respectively). The DCR-ESIN had superior results for the rate of overall complications (p = 0.006). At the 1-year follow-up, the DCR-ESIN group had better DASH scores than the LC-DCP group (p = 0.014).ConclusionsThe DCR-ESIN technique, used to treat diaphyseal fractures of the humerus, has shorter operative times, less intra-operative blood loss, shorter union times, and better functional outcomes at 1-year follow-up than the LC-DCP technique. DCR-ESIN may be an alternative method for the surgical treatment of diaphyseal humeral fractures in adults.

Comparison of Functional Outcome Like Range of Motion of Hip After Fixation of Trochanteric Fracture with Dynamic Hip Screw (DHS) and Proximal Femoral Locking Compression Plate (PF-LCP)

Trochanteric region of the femur is that part which connects the neck and shaft of femur. So head, neck, trochanter facilitates the movement at the hip joint causing the limbs to swing clear of the pelvis. Intertrochanteric fractures are divided into stable and unstable varieties. To assess the Comparison of functional outcome like range of motion of hip after fixation of trochanteric fracture with dynamic hip screw (DHS) and proximal femoral locking compression plate (PF-LCP) the present prospective randomized clinical trial was conducted in the Department of Orthopedic, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) between January 2009 to December 2010. A total of 20 patients with post traumatic trochanteric fractures and osteoporotic fractures within three weeks of incidence were included in the study. The age distribution of the patients was identical between the groups with mean age of the patients being 56.2 and 55.6 years in DHS and PF-LCP groups respectively (p=0.626). Males were predominant in both groups (each of 70%). In both groups fractures were primarily caused by RTA (60% in DHS and 50% in PF-LCP) (p=0.327) with all patients having closed type of injury. Sixty percent of the injuries in each group had right-sided involvement. (p = 0.675). All patients of either group required open surgical procedure. DHS required shorter operation time than that required by PF-LCP (72.5±5.4 min vs. 96.5±3.3 min. p&lt;0.001). Immediate postoperative outcome demonstrates that all of the patients in both groups had intact cut-out of lag-screw and implant failure did not occur. Thirty percent patients in DHS group needed blood transfusion, while only 10% patient needed the same in PF-LCP group (p = 0.291). At 4 weeks Follow up 30% of DHS group had infection as opposed to none in the PFL-CP group. Ninety percent of the patients in the former group had pain as opposed to none in the latter group (p&lt;0.001). Visible callus formation was ..........

Comparative analysis of tibial plateau fracture osteosynthesis: A finite element study

This study presents a comparative structural finite element analysis between two different fixation methods for high-energy tibial plateau fractures: limited contact dynamic compression plate (LC-DCP) and locking compression plate (LCP). Several computational methods were employed to obtain an accurate finite element bone model with non-homogeneous properties. The goal is to evaluate the mechanical behavior of the fractured bone under each type of treatment within the scope of a single case study. Based on Computed Tomography (CT) images from the human lower limbs, the bones and implants were modeled using Computer-Aided-Design (CAD) with Autodesk Fusion 360©. Afterwards, finite element analysis was carried out in both assemblies. Altair HyperWorks© was used for pre- and post-processing the analysis and Abaqus CAE© was chosen as solver. The finite element model was built considering the boundary conditions foreseen in the specific bibliography and the assembly was submitted to a vertical compressive load based on the human Body Weight (BW). The results of both simulations were compared regarding the independent motion of the bone fragments over the fracture site. Smaller relative displacement between the bone fragments leads to shorter recovery time since this condition provides more stability and low tissue strain, which are required to generate bone. The osteosynthesis with LCP achieved the best results since it presented reduced independent motion in the fracture site, as foreseen in literature.

A preclinical model of post-surgery secondary bone healing for subtrochanteric femoral fracture based on fuzzy interpretations.

Mechanobiology plays an essential role in secondary bone fracture healing. While the introduction of newer type of plates, e.g. locking plate (LP), is becoming increasingly popular for complex femoral fractures, the conventional technique involving dynamic compression plate (DCP) remains the standard choice. The difference between the two techniques lies primarily in their screw fixation mechanisms. The present study applied 3D dynamic fracture healing scheme modelled on a subtrochanteric femur fracture, regulated by both finite element (FE) analysis and Fuzzy logic control in order to understand the spatio-temporal healing phenomena for both LP and DCP. The study further examined the influence of the two screw fixation mechanisms in determining the comparative progression of fracture healing. The problem was solved iteratively in several healing steps running in loop and accordingly, the local tissue concentrations and material properties were updated. The predicted results accorded well with various previous experimental observations. The study found an initial delay in healing associated with DCP. However, as the healing progressed, there was no significant difference in overall callus modulus. The presented preclinical model may further help predict bone healing for different implantation techniques, and thus can serve as a non-invasive tool for evaluating relative merits of extramedullary plating techniques.

Functional outcome of dynamic compression plating and intramedullary nailing of diaphyseal fracture of both bones forearm

Background: Excellent results for plate fixation in displaced diaphyseal fractures of both bone of forearm have been reported by various authors, but only a few authors have focused on plate fixation in the management of open diaphyseal fractures of both the radius and ulna. Aim: This present study is aimed to assess the functional outcome of dynamic compression plating and intramedullary nailing of diaphyseal fracture of both bones forearm. Methods: This series consists of 50 cases of fracture both bone of forearm by open reduction and internal fixation with dynamic compression plate, closed reduction with intramedullary nailing by TENS between the period of 2 years at a tertiary care hospital after obtaining the clearance by the hospital ethical committee. Of the above cases 25 patients were treated by open reduction and internal fixation with dynamic compression plate and 25 cases were treated with closed reduction and internal fixation with TENS. Results: Even though, plate osteosynthesis is still the most commonly used form of fixation in adult both bone forearm fractures, both titanium elastic nail and interlocking nail fixation are relatively newer techniques which offer a viable and more efficient alternative especially in fixation of fractures involving shafts of radius and ulna. Conclusions: Increased incidence of forearm fractures was probably due to increasing road traffic accidents and fall. Forearm fractures occurs more commonly in second and third decade. Male predominance was seen. Open reduction and internal fixation can be considered as the treatment of choice if there is no contraindication. It is important to maintain length, opposition, axial alignment, and rotational alignment in order to restore good range of movement of forearm. This is achieved in the present study.

IS LOCKED COMPRESSION PLATE BETTER THAN LIMITED CONTACT DYNAMIC COMPRESSION PLATE IN TREATMENT OF CLOSED MIDDLE THIRD RADIUS AND ULNAR FRACTURES IN ADULTS: A SHORT-TERM COMPARATIVE STUDY

Background: Forearm bone fracture is a commonly encountered fracture. The inception of locking compression plate (LCP) has revolutionized fracture management. With their dramatic success for articular fractures, there is a speculation that they might be more appropriate for diaphyseal fractures as well. Objective: To compare internal fixation of closed, middle third forearm fractures with LCP and limited contact dynamic compression plate (LC-DCP) in adults with respect to union rate, implant failure, functional outcome, and infection rate. Methods: Twenty-two patients with closed, middle third fractures of both the forearm bones were involved in this prospective, randomized, controlled study, which took place between February 2019 to January 2021. They were segregated into two groups based on open reduction and internal fixation with LCP (n=11) and with LC-DCP (n=11). Postoperative follow-up intervals of 1, 2, 6 weeks and 3, 6 months. The patients were assessed for implant failure, fracture union and function outcome of Andersons’ criteria to assess union, forearm rotation, and wrist flexion-extension, and disabilities of the arm, shoulder and hand (DASH) score for patient related outcome at the latest follow up. Results: The mean age of the patients was 30.9 years (range 19-47 years) with mean follow up about of 2 years. The union rate in LCP group was (100%) whereas in LC-DCP was (81.8%), the p value was (0.4), which is not statistically significant. The p value for Quick DASH score and Anderson’ criteria were (0.8 and 0.43), respectively which is also not statistically significant. No incidence of implant failure in both groups. Conclusion: Although LCP is an effective treatment alternative and may have a subtle edge over LC-DCP in the management of these fractures, their supremacy could not be certified. We deduce that surgical planning and expertise rather than the choice of implant are more pivotal for outstanding results. Keywords: Limited contact dynamic compression plate, locking compression plate, closed, middle third fractures, both bones of forearm Citation: Chhaily ZA, Joda AI, Abd Ali AS, Ali ZH. Is locked compression plate better than limited contact dynamic compression plate in treatment of closed middle third radius and ulnar fractures in adults: A short-term comparative study. Iraqi JMS. 2022; 20(1): 146-153. doi: 10.22578/IJMS.20.1.19

Risk of Radial Nerve Injury in Anterolateral Humeral Shaft Plating.

The purpose of this study was to evaluate and compare the risk of iatrogenic radial nerve injury between arm positionings of 45° and 60° abduction in anterolateral humeral plating using a 4.5-mm narrow dynamic compression plate. Fifty-six humeri of cadavers in the supine position with 45° of arm abduction were exposed through the anterolateral approach. A hypothetical fracture line was marked at the middle of the humerus, and a precontoured ten-hole 4.5-mm narrow dynamic compression plate was applied and fixed to the anterolateral surface. After the fixation, the radial nerve was exposed through a triceps-splitting approach. Screws in contact with or which had penetrated the radial nerve were deemed to be injuries. Then, the screws and plate were removed, the arm changed to the 60° arm abduction position, and the steps of applying the plate and inserting the screws were followed as in the 45° arm abduction step. The screws which could potentially injure the radial nerve were those of the second to sixth screw holes in both the 45° and 60° of arm abduction positions. The incidences of iatrogenic radial nerve injury of the second to sixth screw holes in the 45° position were 5.36%, 39.29%, 80.36%, 60.71%, and 10.71%, respectively, and at the 60° position were 5.36%, 53.57%, 83.93%, 60.71%, and 7.14%, respectively. There were no statistically significant differences in risk of injury between the two positions in all screw holes (all P-values > 0.05). In anterolateral humeral shaft fixation, arm abduction position did not affect the risk of iatrogenic radial nerve injury, with the main risk from certain screw holes. The surgeon should be careful in screw insertion, especially at the fourth and fifth screw holes. IV; cadaveric study.

Osteosynthesis Metal Plate System for Bone Fixation Using Bicortical Screws: Numerical-Experimental Characterization.

Simple SummaryThis study addresses an important issue concerning the evaluation of stresses in bone shafts stabilized by osteosynthesis metal plates, following routine surgical procedures to repair severe fractures in bone. It is recognized that bone regeneration following fracture is highly dictated by the stress state in the damaged regions. Since metallic inserts, like plates and screws, are usually employed to assure the stabilization of fractures in bone, it is important to evaluate the effect of those parts on the developed stresses in bone tissue. In the present work fracture was induced in a femoral bone of an animal model, which was suitably stabilized with a dynamic compression plate (DCP) using bicortical screws. This system was submitted to bending to trigger damage in bone tissue in the vicinity of metal inserts. Finite element modelling was then performed to mimic damage initiation and propagation in bone, thus simulating the results observed experimentally. Stress distributions in the vicinity of the screwed regions due to fastening of DCP allowed to identify very significant differences, which can affect bone hilling processes. It can be concluded that the developed procedure may be used to help surgeons to support decisions regarding bone repair using standard DCP.This study reports the numerical and experimental characterization of a standard immobilization system currently being used to treat simple oblique bone fractures of femoral diaphyses. The procedure focuses on the assessment of the mechanical behavior of a bone stabilized with a dynamic compression plate (DCP) in a neutralization function, associated to a lag screw, fastened with surgical screws. The non-linear behavior of cortical bone tissue was revealed through four-point bending tests, from which damage initiation and propagation occurred. Since screw loosening was visible during the loading process, damage parameters were measured experimentally in independent pull-out tests. A realistic numerical model of the DCP-femur setup was constructed, combining the evaluated damage parameters and contact pairs. A mixed-mode (I+II) trapezoidal damage law was employed to mimic the mechanical behavior of both the screw–bone interface and bone fractures. The numerical model replicated the global behavior observed experimentally, which was visible by the initial stiffness and the ability to preview the first loading peak, and bone crack satisfactorily.

Retrospective Comparison of Titanium Hybrid Locking Plate with Stainless Steel Hybrid Dynamic Compression Plate for Pancarpal Arthrodesis: 23 Dogs

The aim of this study was to evaluate outcomes and complications of dogs that had pancarpal arthrodesis (PCA) using a titanium hybrid advanced locking plate system (ALPS) and stainless steel hybrid dynamic compression plate (HDCP). Retrospective observational study. Medical records (2007-2020) were reviewed for cases that had PCA performed using ALPS or HDCP. Implant characteristics including metacarpal coverage (MCov), metacarpal width occupied by screw diameter percentage and carpal arthrodesis angle (CAA), complications and outcomes were recorded. Pancarpal arthrodesis was performed with ALPS on 15 limbs from 12 dogs, and HDCP on 14 limbs from 11dogs. Median follow-up time was 1,157 days (range: 62-1,902 days) for ALPS group and 340 days (range: 43-1,465 days) for HDCP. Median MCov for ALPS group was 74% (range: 60-87.5%) compared with 56.5% (range: 49.7-91.3%) for HDCP (p = 0.001). There was no difference in CAA and metacarpal width to screw diameter percentage between ALPS and HDCP group. Major and minor complications and surgical site infection rates were not statistically different between the two groups. Plate fracture occurred in 2/15 ALPS PCA and screw loosening occurred in 4/14 HDCP PCA. Full function was achieved in 8/12 AND 8/11 OF ALPS AND HDCP: cases, respectively, which was not statistically different (p = 0.76). The use of ALPS offers comparable performance to HDCP for PCA.

To Study Functional Outcome of Humeral Shaft Fractures Treated by Intramedullary Nailing Versus Dynamic Compression Plating at a Tertiary Health Care Centre

Background: The proportion of humeral shaft fractures being treated conservatively reportedly varies from 33% to 95%. Nonsurgical treatment results in higher incidence of union and fewer complications than open reduction and internal fixation. Aims and Objectives: To study and compare the functional outcome of Dynamic Compression Plating and Interlock Nailing for humeral shaft fractures. Material and Methods: After taking approval of ethics committee of our institute, we studied a total of sixty cases over a span of 36 months – October 2018 to December 2020. Study was carried out on cases of humeral shaft fractures requiring operational intervention in department of orthopaedics of tertiary care centre in Maharashtra. Results: A total of 76.7% cases in plating group had excellent outcome as compared to 56.7% in nailing group. Also poor to fair outcome was noted more in nailing group (13.4% vs 10%). Conclusion: Statistically comparable results have been observed for patients undergoing surgical intervention for humeral shaft fractures among locking plating and intramedullary nailing. Both provide excellent and favourable results in terms of union and function, however a higher rate of excellent results and tendency for union was seen with dynamic compression plating group.

BIOMECHANICAL EVALUATION OF LOCKING COMPRESSION PLATE (LCP) VERSUS DYNAMIC COMPRESSION PLATE (DCP): A FINITE ELEMENT ANALYSIS

Internal fixators are commonly used to treat long bone fractures, its aim is to provide interfragmentary compression, allow limited micromotion and provide stability to the bone for ambulation. However, complications such as non-unions, malunions and broken implant, can occur due to the complexity of mechanical force acting on the bone-plate models. Therefore, this study is proposed to investigate the biomechanical characterization of plate design on a tibia bone using finite element method. Two different designs; 1) locking compression plate (LCP) and dynamic compression plate (DCP) were simulated by using Marc.Mentat software. From the findings, the LCP have lower peak von Mises stress (VMS) distribution of 160 MPa compared to DCP with VMS value of 232 MPa. Surprisingly, the VMS of DCP plate system have exceed the yield strength of stainless steel (215 MPa) which translate to higher risk of failures. Moreover, the DCP plate system shows 50% lower stability compared to the LCP plate system, which has the peak displacement at 0.98 mm compared to the DCP bone at 1.53 mm. In conclusion, the LCP provides better stability and stress distribution up to 45% differences as compared to the DCP.

Use of antibiotic-cement coated locking plates in the setting of periprosthetic infection and infected nonunion

IntroductionIn the setting of periprosthetic total hip and knee arthroplasty (THA/TKA) infection, plating of the femur may be necessary for fracture fixation, prophylactic fixation of the femur, poor bone quality, or infected femoral shaft nonunion. The purpose of this study was to investigate infection control rates and fracture healing in patients receiving antibiotic cement coated plates in the setting of infected nonunion and periprosthetic infections. MethodsWe retrospectively reviewed a series of ten patients who had an antibiotic coated plate placed in the setting of periprosthetic infection or infected nonunion with a minimum follow-up of six months. 80 g of Simplex bone cement (Stryker, Mahwah, NJ) were mixed with 4 g of powdered vancomycin and 4.8 g of powdered tobramycin and applied to a dynamic compression plate with locking screw guides in every hole. The antibiotic loaded cement was allowed to harden before implantation. Outcome measures were designed to assess for fracture healing defined as three out of four cortices united on radiographs along with bearing full weight without pain and evidence of infection control defined as normalized erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the absence of antibiotic treatment with no clinical signs of infection. ResultsTen patients were treated with an antibiotic cement coated plate in the settings of infectious nonunion and periprosthetic infection and followed for an average of three years (mean 21.4 months, seven months to 61 months). Eight patients (80%) went on to successful control of infection after initial procedure. Two patients developed chronic drainage and had a second antibiotic spacer with antibiotic cement coated plate placed before the infection was controlled. All patients obtained successful control of infection at latest follow-up showing no clinical signs of infection, normalized laboratory markers, and negative culture results. There were no reported mechanical failures of the implant, fractures of the femur, or soft tissue complications. ConclusionAn antibiotic cement coated plating technique is a viable option for periprosthetic THA and TKA infections requiring plating of the femur or in patients with an infected nonunion.

Cement arthrodesis of the knee using combined intramedullary nail, plate and screws after wide excision in huge chondromyxoid fibroma of proximal tibia, a case report.

Introduction and importanceChondromyxoid fibroma is a rare benign cartilaginous neoplasm, a mixture of benign cartilage and fibrous and myxoid tissue. It usually affects young people, commonly in the second and third decades of life with male being predominant. Differential diagnosess in chondromyxoid fibroma, are giant cell tumor, bone cyst, enchondroma, osteoblastoma, and low-grade chondrosarcoma.Case presentationWe present a case of an 18-years-old male, with chief complaint of pain on the right knee since 3 year ago with an increasing size reaching diameter of 55 cm within three years. The radiograph and MRI revealed lytic blastic expansile multiloculated lesion, with wide transitional zone, and periosteal reaction on the epymetadiaphyseal part of right proximal tibia. The surgical procedure was performed consist of wide excision, reconstruction by cement knee arthrodesis using Kuntscher-nail, dynamic compression plate, bone cement and gastrocnemius flap.Clinical discussionAfter 3 months of surgery follow-up, there was no sign of recurrence, the patient walked partially weight bearing with a crutch. In 1 years post operative follow up, the Muscukoskeletal Tumor Society Scoring (MSTS) was 80%. There was no sign of recurrence.ConclusionIn cases with large tumor size, wide excision with bone and soft tissue reconstructive surgery is required as mechanical and biological reconstruction. The cement arthrodesis provides a faster duration of surgery, lower risk of infection, and good functional outcome.

Development and initial validation of a novel thread design for nonlocking cancellous screws.

High failure rates have been associated with nonlocking cancellous screws with a typical buttress thread in patients with osteoporotic bone. This study aimed to develop a novel thread design and compare its fixation stability with that of a typical buttress thread. Nonlocking cancellous screws with a novel thread design (proximal flank angle of 120 degrees, a flat crest feature, a tip-facing undercut feature) and nonlocking cancellous screws with a typical buttress thread were manufactured using stainless steel. Fixation stabilities were evaluated individually by the axial pullout and lateral migration tests, and they were evaluated in pairs together with a dynamic compression plate in an osteoporotic bone substitute (10 PCF polyurethane foam per ASTM F1839) under cyclic craniocaudal and torsional loadings. Pullout strength and lateral migration resistance for the individual screw test and the force, torque, and number of cycles required to achieve specific displacement and torsion for the multi-screw test were comparatively analyzed between both screw types. A finite element analysis model was constructed to analyze the stress distributions in the bone tissue adjacent to the threads. The biomechanical test revealed the novel undercut thread had superior axial pullout strength, lateral migration resistance, and superior fixation stability when applied to a dynamic compression plate under cyclic craniocaudal loading and torsional loading than those in the typical buttress thread. The finite element analysis simulation revealed that the novel thread can distribute stress more evenly without high-stress concentration at the adjacent bone tissue when compared to that of a typical buttress thread.

Management of Long Bone Fractures Using Diverse Fracture Fixation Techniques in Small Animals

Total 11-cases of different breeds of dogs and one case of Persian cat having long bone fractures were successfully managed using totally intravenous anaesthesia (TIVA). For TIVA, combination of xylazine and ketamine were used for induction whereas sole ketamine was used for maintenance and atropine sulphate was used as preanaesthetic and anticholinergic agent. TIVA found suitable for orthopaedic surgeries in this study. Intramedullary pinning, bone-plating (Dynamic compression plating and Reconstruction plating), external skeletal fixation system (using jess clamps and epoxy) or combination of two different fracture fixation techniques were performed for surgical management of presented fracture cases. For combination of two orthopaedic techniques, either bone plating with supplementary IM-pinning or ESF with IM-pinning were used in this study. All cases were evaluated by radiographs as well as clinical performance of operated limbs. Radiographs were taken at regular interval for assessment of radiographic bone healing and in those cases where radiographs were not possible owner contacted telephonically.

Comparative Study of Fracture Outcome by Dynamic Compression Plating and Locking Compression Plating in Distal Tibial Fracture

Abstract Introduction Distal tibia fracture with or without fracture of fibula is very commonly encountered in young adults. The treatment protocol is mainly surgical with open reduction and internal fixation (ORIF) with plate and screw—contoured dynamic compression plating (DCP) or precontoured locking compression plating (LCP). In spite of advanced surgery, the outcome is not satisfactory with complications arising in 20 to 50% of patients. The purpose of this study was to determine the outcome and compare the two different modalities. Materials and Methods The study includes 30 patients having distal tibial metaphyseal fracture without articular involvement treated with ORIF with plate and screw, contoured intraoperatively DCP and precontoured LCP in the Department of Orthopaedics. Patients were followed up for 12 to 24 months. Results were analyzed clinically (pain, alignment, range of motion, and complication) and radiologically. The patients were assessed according to time of full weight bearing, time of union of fracture, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Foot Functionality Index score. Results The time of full weight bearing and time of union were found to be statistically significant in DCP and LCP. According to the grading of AOFAS score, in DCP, excellent: 3 cases (20%), good: 6 cases (40%), and fair: 6 cases (40%). In LCP, excellent 3 cases (20%), good 8 cases (53.33%), fair 4 cases (26.66%) were observed. Conclusion LCP offers stability with early weight bearing and quicker fracture healing. But both groups had the same score at the final follow-up.

Comparative Study of Functional Outcome of Dynamic Compression Plating With Interlocking Nailing For Fracture Shaft of Humerus in Adult

Comparative Study of Functional Outcome of Dynamic Compression Plating With Interlocking Nailing For Fracture Shaft of Humerus in Adult

Comparison of Dynamic and Locking Compression Plates in Humeral Shaft Fractures

Objectives: To compare the functional outcome of shoulder in humeral shaft fractures fixed with dynamic compression plate versus locking compression plate. Design: This was an RCT (randomized controlled trial). Study Settings: It was conducted at the Orthopedic Department of Sir Ganga Ram Hospital Lahore over 1 year from March 2018 to February 2019. Study Procedure: This study involved 62 both male and female patients aged between 18-60 years presenting in orthopedic emergency with humeral shaft fracture. These patients were assigned into two treatment groups randomly. Fracture in Group-A was fixed with dynamic compression plate while locking compression plate was used in Group-B. Outcome variable was functional shoulder outcome which was assessed after 12 weeks of treatment using Modified Constant and Murley Score. An informed written consent was gained from every patient. Results: The mean age of the patients was 42.6±12.7 years. There were 45 (72.6%) male and 17 (27.4%) female patients in the study group with a male to female ratio of 2.6:1. The mean BMI of these patients was 27.9±3.4 Kg/m2 and 17 (27.4%) patients were obese. Left side was more frequently involved (53.2%) as compared to the right side (46.8%). Upon follow-up, the Modified Constant and Murley score was significantly higher in patients treated with DCP as compared to LCP (91.3±7.4 vs. 85.8±8.3; p-value=0.008). The frequency of excellent functional shoulder outcome was significantly higher in patients treated with DCP as compared to LCP (87.1% vs. 54.8%; p-value=0.005). When stratified similar difference was observed across various subgroups of patients based on patient’s age, gender, side involved, duration since injury and BMI. Conclusion: Dynamic compression plate was associated with significantly better functional shoulder outcome as compared to locking compression plate in patients with humeral shaft fractures regardless of patient’s age, gender, duration since injury, side involved and BMI which along with cheaper hardware cost advocates its preferred use in future practice. Keywords: Humeral Shaft Fracture, Locking Compression Plate, Dynamic Compression Plate, Functional Shoulder Outcome

Screwed Plate Treatment for Diaphyseal Fractures of Humerus: Case of 15 Patients

Therapeutic arsenal for humeral diaphyseal fractures is huge. It ranges from non-operative treatment to various osteosynthesis techniques by exofixation or endofixation. The goal of our study is to determine the place of screwed plate on diaphyseal fractures of the humerus. We gathered 15 cases of humeral diaphyseal fractures treated by screwed plate out of 106 (14%). The average age of our patients was 37.13 years. The fracture was isolated in six (6) cases and associated with other fractures of 9 patients. The site of the fracture line was at the middle third in 73.3% of cases. The line was transversal in 53.3% of cases, oblique in 20% and comminuted in 6.7% of cases. The average operating time was 13.2 days. All of our patients were treated by dynamic compression plates (DCP). Consolidation was obtained in all of patients over an average time of 74 days. The mean evaluation follow up is 22.2 months. Results, according to the STEWART and HUNDLEY score, were judged excellent in 93.3% of patients. The scar was unaesthetic in 33.3% of cases. Three complications noted were mal union, radial nerve palsy and the infection of the operating site. Osteosynthesis by screwed plate of humeral diaphyseal fractures, though appropriate for specific fractures, gives good clinical results.

Dynamic Compression Plate versus Locking Compression Plate Fixation in Adult Forearm Fractures: A Prospective Interventional Study

Introduction: Injuries resulting from traffic accidents, industrial accidents, natural disasters, and assault are the cause of most fractures of the forearm and it is very important to regain the length, apposition, axial alignment, and rotational alignment of the radius and ulna while treating diaphyseal fractures to achieve a good range of motion. In such cases, open reduction and internal fixation are recommended. Aim: To determine the effectiveness of Locking Compression Plates (LCP) and Dynamic Compression Plates (DCP) in treating adult forearm fractures. Materials and Methods: A prospective interventional study was conducted from September 2020 to September 2021 in which 30 patients with both bone forearm fractures underwent open reduction and internal fixation with a Locking Compression Plate(n=15) or a Dynamic Compression Plate(n=15) at the Dr.D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India. For each LCP and DCP operated patient, radiographic findings regarding fracture union and functional outcomes regarding elbow joint range of motion was evaluated. Appropriate parametric tests (Chi-square test, Independent t-test) were conducted to identify significant differences in functional outcomes between the two interventions. Results: Out of total, 13 patients (86.7%) each who underwent both the DCP and LCP fixation had excellent outcomes, though the results were not significant according to Anderson LD et al., grading system. Although it was statistically insignificant (p-value= 0.18), patients who received LCP took less time to heal their fractures than those who received DCP. There was no significant difference between patients treated with DCP and those treated with LCP when it comes to achieving a complete range of motion (p-value=0.99). Conclusion: In terms of functional outcome, both the patient groups who were operated on with DCP as well as LCP had no significant difference. Proper preoperative planning, good patient care, proper surgical technique with minimal adjacent soft tissue damage, strict aseptic conditions, proper follow-up, and rehabilitation along with patient education are all required for good functional outcomes.