Dynamic Compression Plate Research Articles

Clinico: Radiological outcome of diaphyseal fractures of both bone forearm in adults treated with dynamic compression plates: A prospective study

The diaphyseal fractures of radius and ulna in adults can result in significant loss of function if inadequately treated. Hence, they are usually managed by internal fixation and dynamic compression plates are the most commonly used implant for this purpose. We report the clinico-radiological outcome of both bone forearm fractures treated with Dynamic Compression Plate, through a prospective study done at Government Medical College, Thrissur from December 2014 to November 2015. The final outcome evaluated by Anderson criteria showed 62.5% excellent, 33.33% good results and only one poor outcome. Our series had 95.83% union rates with mean union duration of 13.8 weeks. We concluded that open reduction and internal fixation of adult forearm shaft fractures can be appropriately treated with Dynamic Compression Plating, which will give an excellent to good results and the results are worthy of comparison with those of the expensive newer implants.

A comparative study on the fixation of fracture shaft of humerus in adults by compression plate and intramedullary interlocking nail

The aim of the present study was to evaluate comparative analysis of two series in patients with diaphyseal fractures of humerus in the adults operated with dynamic compression plating and intra-medullary interlock nailing with focus on their functional outcome results using DASH score and complications. The present study was conducted in the Department of Orthopaedics, Osmania Medical College and Hospital, Hyderabad, Telangana, India for a period of one year. The study subjects consisted of n = 28 adult patients of fracture shaft of humerus with indications for surgical management. Among n = 28 subjects, n = 15 (53.57%) cases showed excellent results, n = 8 (28.57%) good, n = 3 (10.72%) fair and n = 2 (7.14%) poor results. Among n = 15 subjects with excellent results, n = 9 (60%) were of plating group and 6 (46.15%) interlocking nailing. In intramedullary nailing group, 4 (30.77%) patients showed good results, 2 (15.38%) fair and 1 (7.69%) poor results. In patients treated by plate fixation, 5 (33.33%) cases showed good results, 1 (6.67%) fair and 1 (6.67%) poor results. For all the subjects, DASH scoring was in the range of 21-30 in 50% subjects followed by 10 - 20 in 32.14%, 51 - 60 in 10.72% and 31 - 40 in 7.14% cases. In this series, both the methods of treatment i.e. dynamic compression plating and interlocking nailing showed good functional outcome results. We prefer dynamic compression plating method as the complications are less compared to the interlocking nailing method and also with respect to pain and function of the shoulder joint.

Evaluation of treatment of diaphyseal fracture of humerus: Dynamic compression plate versus interlocking nail: A prospective randomized controlled study

Fracture shaft of the humerus is a common injury in orthopaedic practice. Conservative management with plaster gives good result but this method cannot be applied in situations which necessitates internal fixation. There always a question arises which kind of implant to be used for surgical intervention. A prospective comparative study for the management of acute diphyseal humeral shaft fractures with dynamic compression plate and antegrade interlocking nail fixation was undertaken over a period of three years. In each category Twenty five patients had undergone above implant fixation after considering the inclusion and exclusion criteria. Rate and time of union, functional scoring criteria (ASES) and complication rate were used for postoperative assessment with an average follow-up period of one year. A higher rate of union with excellent to good functional outcome was seen with the plating group in our series.

Ender Nail versus Dynamic Compression Plating For Humeral Shaft Fractures

Aim: To compare ender nail with dynamic compression plating for humeral shaft fractures in terms of functional outcomes, union and complication rates. Methods: 30 men and 20 women aged >18 years with fresh humeral shaft fractures without neurological deficits underwent either ender nail (n=30) or dynamic compression plating (n=20). Functional outcome of the upper limbs, pain, rates of union, and complications in the 2 groups were compared. Results: Respectively in the nailing and plating groups, mean operating times were 65 and 112 minutes, mean blood loss volumes were 20 and 232 ml, complication rates were 20% and 24%, non-union rates were 13% and 8%, and delayed union rates were 7% and 4%. Conclusion: Both techniques were equally appropriate for treating humeral shaft fractures.

Results of compression plating versus locked intramedullary nailing fixation in the treatment of humeral shaft fractures in adults

Background Most humerus shaft fractures can be treated successfully using the conservative methods. When choosing surgical fixation, there is a debate between the use of plate and screws and intramedullary nails. Aims The aim of this study was to compare the results of the dynamic compression plate and the antegrade interlocked humeral nail in the fixation of humerus shaft fractures. Patients and methods A total of 40 patients were selected by a randomized method to be treated by either method; there were 20 patients in each group and patients were followed up for at least 6 months until union. Result The results showed superiority of the plate in terms of the union rate and shoulder function and the use of the nail was better in terms of the infection rate and radial nerve palsy. Conclusion The plate is still the standard of treatment of the humerus shaft fracture and the nails better be used for more comminuted or open fractures. More future studies with large numbers required to overcome our relatively small number.

Does anatomic locking compression plate play a vital role in maintaining length of clavicle in comminuted fracture & enhance good functional outcome

Deformity following un-united and mal-united adult clavicle fractures is being increasingly recognised as the indications for operative treatment of displaced fractures of the clavicle. Various options include low contact dynamic compression plates, which are strong, but difficult to contour and cause soft tissue irritation. Recon plates are easier to contour, but lack sufficient mechanical strength. Anatomical Pre-contoured locking plates are now available, matching the shape of the adult clavicle. The purpose of this study is to assess the clinical and radiological outcome of a pre-contoured clavicle plate in the treatment of acute, displaced, mid-shaft clavicle fractures. This study presents the results of 26 patients treated with an anatomical congruent clavicle plate for acute displaced, mid-shaft fractures of the clavicle at a tertiary referral centre. All patients were managed with a precontured clavicle plate. The fracture united in all cases with no complication and high patient satisfaction on the Disability of the Arm and Shoulder (DASH) score and Pain Visual analogue score (VAS). The results were compareble with other published studies, and the pre contured clavicle plate represents one of the best operative management of these fractures.

Two cases of humeral fracture in Japanese Black calves treated with internal fixation using a dynamic compression plate

Two cases of humeral fracture in Japanese Black calves treated with internal fixation using a dynamic compression plate

Comparative study of titanium elastic nailing v/s dynamic compression plating for the management of fracture shaft of femur in adolescent age group

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Femoral fractures are one of the common long bones fractured in paediatric age group. Over the past 20 years, there has been a dramatic and sustained trend toward the operative stabilization of femoral shaft fractures in school-aged children. Femoral fracture demands stable fixation in adolescent.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A retrospective cohort study was conducted in a tertiary care hospital. All children’s between the age 11 to 18 years with femur fracture managed with either TENS or dynamic compression plating between march 2014 to march 2017 were included into the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">most common mode of injury was RTA. Middle third being the most common site for fracture. There was100% union in our study. The mean time of union in TENS group was 12 weeks and that of Plating group Was 13.1 weeks. Irritation at entry site was seen in 11 (22.9%) out of 48 patients. Malunion was seen in 9 out of 48 children’s in group a, whereas malunion in group b seen in 1 child. All the malunion was less than 5 degree and Varus being most common type of malunion. Limb length discrepancy in group A was observed in 5 patents (10.5%) out which 3 were shortening and 2 were lengthening. In group b 1pateint had shortening at end of follow up. In group B superficial infection was seen in 4 (15%) out of 33 children’s and in group A it was observed in 2 children’s (5%).</span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">we concluded that compression plating in adolescent age group especially older and obese children for the management fracture shaft of femur comparatively better than TENS.</span></p><p class="abstract"> </p>

Outcomes of the Ulnar Shortening Osteotomy Using a Dynamic Compression Plate on the Ulnar Surface of the Ulna.

Background The purpose of this study is to evaluate the results of patients with ulnar impaction syndrome treated with diaphyseal osteotomy using freehand technique and fixation with ulnar osteotomy compression plate placed on the ulnar surface of the ulna. Materials and Methods A retrospective chart review of patients with ulnar impaction syndrome between 2010 and 2014 identified 38 patients. The following clinical data were observed: patient age, sex, range of motion, grip strength, visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiological assessment, and complications. The mean follow-up period is 30 months. Eleven patients were excluded from the study. Results Compared with the contralateral side, the 27 patients included in this study attained 93 to 96% of wrist and forearm motion and 81% of the grip strength. The average DASH score was 18 in a mean follow-up period of 30 months. Three patients required plate removal and one case showed nonunion and a further operation was needed. Two patients reported persistent ulnar-sided wrist pain. Conclusion We concluded that placing the ulnar osteotomy plate on the ulnar surface of the ulna is a quicker procedure, with less soft tissue dissection and irritation, and very high union rate. Level of Evidence Level IV.

Plate versus intramedullary fixation of two-part and multifragmentary displaced midshaft clavicle fractures – a long-term analysis

IntroductionSurgical fixation of displaced midshaft clavicle fractures is predominantly achieved with intramedullary (IM) or plate fixation. Both techniques have potential pitfalls: plate fixation involves greater periosteal stripping and protuberance of the implant, whereas IM fixation may be associated with implant-related complications, such as migration or skin irritation, which may lead to further surgery for implant removal.The aim of this study was to compare these two methods in simple (Robinson 2b.1) and multifragmentary (Robinson 2b.2) displaced midshaft clavicle fractures. MethodsA total of 133 consecutive patients who underwent surgical fixation for a displaced midshaft clavicle fracture with either IM fixation using a 2.5-mm Kirschner wire or plate fixation using an 8-hole Dynamic Compression Plate (DCP) were retrospectively reviewed. Follow-up was a minimum of 1 year. The patients were allocated into two injury groups: displaced simple 2-part fractures (64 IM vs. 16 DCP) and displaced multifragmentary fractures (27 IM vs. 26 DCP). The major observed outcome measures were: infection rate, non-union rate, reoperation rate and postoperative range of motion (ROM). ResultsRates of non-union for displaced 2-part fractures were 2/64 (3.13%) with IM fixation and 0/16 (0.00%) with plate fixation (p = 0.477). For displaced multifragmentary fractures, rates of non-union were 2/27 (7.41%) with IM fixation and 0/26 (0.00%) with plate fixation (p = 0.161). No significant difference was observed between the two fixation modalities in patient-reported time to regain ROM on the injured side for displaced 2-part fractures (p = 0.129) and displaced multifragmentary fractures (p = 0.070). Deep infection rate was zero (p = 1.000) overall in the study, and reoperation rate for IM and plate fixation, respectively, was 3.13% and 6.25% in the Robinson 2b.1 group (p = 0.559) and 7.41% and 7.69% in the Robinson 2b.2 group (p = 0.969). ConclusionIM fixation of displaced midshaft clavicle fractures (Robinson 2b.1) has an equivalent non-union rate to plate fixation and similarly low complication and reoperation rates. For displaced midshaft multifragmentary clavicle fractures (Robinson 2b.2), the higher non-union rates observed with IM fixation leads us to recommend consideration of plate fixation for Robinson 2b.2 fractures.

Management of Humeral Shaft Fracture: A Comparative Study between Interlocking Nail and Dynamic Compression Plating

Management of Humeral Shaft Fracture: A Comparative Study between Interlocking Nail and Dynamic Compression Plating

Functional outcome in patients treated with interlocking nailing and dynamic compression plating for fracture shaft of humerus in adults

Fractures of the humeral shaft accounts for 1 to 3% of all fractures and it is one of the common fractures. They are caused by high energy trauma and most commonly seen in Middle third of the shaft. Traditionally humeral shaft fractures have been treated non-operatively with hanging cast or brace. But the non-operative treatment has disadvantages of prolonged immobilization in cast or brace which sometimes may be required as long as 6 months resulting in huge morbidity. So various Surgical options were made available including Plate osteosynthesis, Intramedullary nailing and External fixation. In this study we are reporting functional outcome of various surgical fixation available for managing Fracture Shaft of Humerus.

Comparision of locked compresion plate and limited contact dynamic compresion plate for internal fixation of both bone forearm

Background: The locking compression plate (LCP) is a newer modality for fracture fixation of both bone forearm fractures. The aim of the study is to compare this modality with the conventional Limited contact dynamic compression plate for Diaphyseal fractures of both bone forearm. Materials and methods: It is a prospective type of comparative study involving 40 patients, 20 in each group. The functional outcome was assessed using the criteria of Anderson et al. The quality of reduction of the fractures was assessed using the criteria of Leung et al. The patient rated outcome was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: The mean duration of surgery and the time for union were discovered to be less in LCP group as compared to LC-DCP though statistically insignificant. No significant differences were found between two groups with respect to functional outcomes (Anderson’s creiteria and DASH score) Conclusion: LCP is an effective alternative treatment over LC-DCP in the management of these fracture but their superiority could not be certified. We conclude that surgical planning and technique for plate fixation is more important than the choice of implant.

Comparative study of operative management of humeral shaft fractures by dynamic compression plating versus locked intra-medullary nailing

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Operative management of humeral shaft fractures is mostly accomplished by surface plating or intra-medullary nail osteosynthesis. Both the treatment options have been variably reported to give good rates of union and functional outcome. We compared both the options to know the better one in multitude of variables.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Thirty patients with fracture shaft of humerus were followed up for a period of 12 to18 months. 15 patients each underwent open reduction and internal fixation with dynamic compression plate and closed antegrade locked intra-medullary nailing. All patients were clinically and radiologically assessed till fracture union</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Diaphyseal humeral fractures in all the patients treated with nailing united and had a tendency to unite early compared to plating. Shoulder pain was initially complained by 2 patients from the nailing group and got subsided later on. The incidence of complications was more in the plate osteosynthesis group. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">In our study Intra-medullary nailing turned out to be superior to plating for amenable diaphyseal fractures of humerus in terms of higher rate of union, early union and lesser complications.</span></p>

Comparative study of functional outcome of dynamic compression plating and interlocking intramedullary nailing for fructure shaft of humerus

<p class="abstract"><strong>Background:</strong> Fracture of the diaphysis of humerus and its complications are a major cause of morbidity in trauma patients. Fracture of the humeral shaft account for 20% of humeral fractures & about 3% of all fractures. There is a debate between the choices of operation in humeral shaft fractures.</p><p class="abstract"><strong>Methods:</strong> A comparative study of management of acute humeral shaft fractures treated by Dynamic Compression Plate (DCP) and Intra Medullary Interlocking Nail (IMILN) fixation over a period of one half years. 18 patients of IMILN and 20 patients of DCP were included after considering inclusion and exclusion criteria. Functional scoring criteria were used for postoperative assessment & the average follow up period was one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> A high rate of excellent & good results & a tendency for early union was seen with the plating group than nailing group.</p><strong>Conclusions:</strong> Plating shows better results than nailing.

Interventions for humeral shaft fractures: mixed treatment comparisons of clinical trials.

Nowadays, five main therapeutic options are used in treating humeral shaft fractures: external fixation, open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), dynamic compression plate (DCP), and intramedullary nail (IMN). Aiming to provide reliable evidence for clinical selection, we designed a network meta-analysis (NMA) to evaluate the efficacy of these treatments. NMA was conducted on Bayesian framework with software R 3.3.2 and STATA 13.0. Nonunion rate, radial nerve palsy rate, union time, complication rate, and infection rate were considered as primary outcomes. Mean operation time was the secondary outcome. The outcomes were measured by odds ratio (OR) value and corresponding 95% credible intervals (CrIs) or mean difference (MD) with 95% CrIs. Surface under cumulative ranking curve (SUCRA) was calculated to show the ranking probability of each treatment. Our results indicated that ORPO had a higher risk of radial nerve palsy than MIPO (OR=2.83, 95% CrIs=1.28-6.23), and DCP had a better performance in preventing complications than IMN (OR=0.31, 95% CrIs=0.11-0.84); no other significant difference were observed. According to the SUCRA results, MIPO had a high-ranking probability in almost all outcomes, while external fixation had lowest values in the majority of outcomes. We recommended MIPO as the optimal treatment for humeral shaft fractures after taking all outcomes into consideration; IMN was also recommended for its relatively good performance, but its complication still needed to be noticed.

Mechanical analysis of transversal iliac fracture stabilization using dynamic compression plate or screws and PMM in polyurethane bone model

ABSTRACT Pelvic fractures correspond to 20 to 30 % of the fractures observed in dogs. Complete fractures, especially with bone axis deviation should be surgically treated. The mechanical study of surgical techniques is of utmost importance to assess the best way of treating these injuries. This study compared, biomechanically, the use of a dynamic compression plate (DCP) and screws (group 1) or screws and polymethylmethacrylate (PMMA) (group 2) to stabilize an iliac fracture using a static test. Sixteen canine synthetic hemi-pelvises (test specimens) with a transverse iliac osteotomy were used. After fixation with implants, a load was applied to the acetabulum until failure. Group 1 maximal compressive load was 133.9±18.60 N, displacement at yield 21.10±3.59mm and stiffness 125.22±12.25N/mm. Group 2 maximal compressive load was 183.50±27.38N, displacement at yield 16.66±5.42mm and stiffness 215.68±33.34N/mm. The stabilization with polymethylmethacrylate was stronger than dynamic compression plate since it resisted a greater load in all test specimens.

A biomechanical comparison of conventional dynamic compression plates and string-of-pearls\u2122 locking plates using cantilever bending in a canine Ilial fracture model

BackgroundFracture of the ilium is common orthopedic injury that often requires surgical stabilization in canine patients. Of the various methods of surgical stabilization available, application of a lateral bone plate to the ilium is the most common method of fixation. Many plating options are available, each having its own advantages and disadvantages. The purpose of this study was to evaluate the biomechanical properties of a 3.5 mm String-of-Pearls™ plate and a 3.5 mm dynamic compression plate in a cadaveric canine ilial fracture model. Hemipelves were tested in cantilever bending to failure and construct stiffness, yield load, displacement at yield, ultimate load, and mode of failure were compared.ResultsThe mean stiffness of dynamic compression plate (116 ± 47 N/mm) and String-of-Pearls™ plate (107 ± 18 N/mm) constructs, mean yield load of dynamic compression plate (793 ± 333 N) and String-of-Pearls™ plate (860 ± 207 N) constructs, mean displacement at yield of dynamic compression plate (8.6 ± 3.0 mm) and String-of-Pearls™ plate (10.2 ± 2.8 mm) constructs, and ultimate load at failure of dynamic compression plate (936 ± 320 N) and String-of-Pearls™ plate (939 ± 191 N) constructs were not significantly different. No differences were found between constructs with respect to mode of failure.ConclusionsNo significant biomechanical differences were found between String-of-Pearls™ plate and dynamic compression plate constructs in this simplified cadaveric canine ilial fracture model.

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 randomized controlled study of dynamic compression plate (DCP) versus limited contact dynamic compression plate (LC-DCP) in treatment of forearm bone fractures in adults (age 18-60 years)

Background and objectives: Fracture of forearm bone are one of the most common injuries seen in day to day practice. The forearm, in combination with the proximal and distal radioulnar joints, allows pronation and supination movements that are important to all of us in the usual activities of daily living. The forearm serves an important role in upper extremity function, facilitating positioning the hand in space, thus helping to provide the upper extremity with its unique mobility. Exacting and decisive management is required after fractures of the shafts of the radius and ulna if function is to be restored. Methods: A prospective randomized controlled study comprising of 50 cases of Fracture of forearm bone with equal distribution of cases (using randomization list) i.e. 25 cases with Dynamic Compression Plating (DCP) (Group A) and 25 cases with Limited contact dynamic compression plating (LC-DCP) (Group B) was done with patients admitted to Sri Siddhartha Medical College, Hospital & Research Centre, Tumkur from April 2015 and April 2017. Results: The Limited contact dynamic compression plating of diaphyseal bones produced excellent Results, the advantages being early mobilization, rigid fixation and hence prevention of fracture disease. The only disadvantage is that it is more expensive than the DCP. Conclusions: The conclusion of our study was that Limited contact dynamic compression plate (LC-DCP) has a definite advantage over Dynamic compression plate (DCP) with respect to time to union and screw placement in comminuted fractures and in case of osteoporotic bone, but the complications, duration of surgery and surgical technique virtually remains unchanged.