Dynamic Compression Plate Research Articles

Stabilization of diaphyseal fractures of both bones forearm with limited contact dynamic compression plate - A prospective study

Stabilization of diaphyseal fractures of both bones forearm with limited contact dynamic compression plate - A prospective study

Study of role of limited contact dynamic compression plates versus locking plates in long bone fracture management

<p class="abstract"><strong>Background:</strong> Present study was conducted to assess the functional, radiological, clinical factors associated with long bone fractures stabilized with limited contact dynamic compression plating (LC-DCP) and locking plates.</p><p class="abstract"><strong>Methods:</strong> In this retrospective observational study conducted over 2 years, 60 osteoporotic patients undergoing surgery for diaphyseal fractures of long bones at the study centre were studied. Two groups were formed on the basis of usage of LC-DCP plate or the locking plate in fracture management. Participants were thoroughly evaluated clinically. Radiographic assessments included evaluation of callus formation and fracture fragments after the functional load. Functional outcome was assessed based on the range of movements and the ability to carry out daily activities. Disabilities of the arm, shoulder and hand (DASH) score was also calculated. Post-operative follow-ups were conducted at 6 weeks, 12 weeks and 1 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> Radius or ulna were the commonest site of fracture with more than half (35, 58.33%) patients affected with 93.3% having middle 1/3<sup>rd</sup> diaphysis fracture. There were no significant differences between the genders for site or location of fractures. DASH scores were comparable in both groups. The mean union time was significantly higher among females (9.76±2 weeks) than males (8.59±1.21 weeks). Most patients took 14-16 weeks to achieve the functional outcome, with LC-DCP observed to provide faster functional recovery.</p><p><strong>Conclusions:</strong> Radius or ulna fractures are the commonest amongst long bone fractures, with middle 1/3<sup>rd</sup> diaphysis being the commonest site of affection. LC-DCP facilitates slighty faster fracture union and functional recovery than locking plates, with union time being significantly longer in females.</p>

Trochanteric femoral nonunion in patients aged over 60 years treated with dynamic condylar screw

IntroductionNonunions of trochanteric femoral fractures are uncommon due to a good blood supply of the cancellous bone of the trochanteric region. Nevertheless, if a nonunion occurs, complex revision procedures usually become necessary. The purpose of this study was to evaluate a series of aseptic trochanteric nonunions in patients aged 60 years or older, looking at outcomes regarding healing rate, implant-related complications and secondary surgeries. Material and MethodsWe conducted a retrospective chart review of patients with aseptic femoral trochanteric nonunions aged over 60 years. Nonunion treatment consisted of implant removal, debridement of the nonunion, and restoration of the neck shaft angle, followed by DCS plating. An additional 4.5-mm limited contact dynamic compression plate was placed in twelve patients anteriorly. The primary outcome measure was bony healing and time to healing in months. Secondary outcome measures included postoperative complications related to the index procedure, range of motion of the affected hip and postoperative mobility. ResultsA total of 21 patients with a mean age of 69.1 years met the inclusion criteria. After a mean follow-up of 21.62 months, 17 of the 21 nonunions healed successfully. The mean healing time was 6.59 months. A total of six of the 21 patients needed secondary revision surgery. At the final follow-up, a full range of motion of the hip was seen in 17 of the 21 hips. ConclusionsDCS treatment and preservation of the patient's femoral head can be successful for patients aged over 60 years with a well-preserved femoral head and acetabulum. However, preservation of the hip joint and revision plating might be associated with higher revision rates.

A comparative study of functional outcome of fractures of both bone forearm treated by locking compression plate and dynamic compression plate

A comparative study of functional outcome of fractures of both bone forearm treated by locking compression plate and dynamic compression plate

To evaluate the functional outcome after use of Limited contact dynamic compression plate in treating diaphyseal fractures of both bones of forearm

To evaluate the functional outcome after use of Limited contact dynamic compression plate in treating diaphyseal fractures of both bones of forearm

Biomechanical evaluation of peak reverse torque (PRT) in a dynamic compression plate-screw construct used in a goat tibia segmental defect model

BackgroundPeak reverse torque (PRT) is a valid method to evaluate implants’ secondary stability in the healing bone. The secondary stability is achieved by the implant over time and it has been positively correlated with the implants’ osseointegration level. In other words, peak reverse torque is the force required to break the bone-implant interface. The purpose of this study was to compare the peak reverse torque for the self-tapping and non-self-tapping screws used in a dynamic compression plate–screw–bone construct after 60 days of loading when used to stabilize 2.5-cm defects in the tibia of goats. The second objective was to compare the peak removal torque of the screws placed in the different positions to evaluate the impact of construct biomechanics on implants osseointegration.ResultsIn total, 176 non-self-tapping screws and 66 self-tapping screws were used to fix the 8-holes dynamic compression plates to the bones. The screws were placed in the tibiae from proximal (position sites 1,2, 3) to distal (position sites 4,5,6) and were removed 60 days post-implantation. The animals remained weight-bearing throughout the study period. The screws placed in the proximal diaphysis had significantly less peak reverse torque than screws placed in the distal diaphysis in both groups (p < 0.05). The peak reverse torque resistance was also significantly less for the non-self-tapping screws as compared with the self-tapping screws (p < 0.05). The intracortical fractures in the trans-cortex occurred significantly more frequently during the placement of non-self-tapping screws (p < 0.05) as compared with self-tapping screws (p < 0.05).ConclusionsBased on these results, we concluded that self-tapping screws may be expected to maintain a more stable bone-implant interface during the first 60 days of loading as compared with non-self-tapping screws. This should be a consideration for orthopedic surgeons and scientists using bone plates to stabilize non-load sharing fractures when a stable plate-screw-bone interface is needed to ensure prolonged stability.

Effect of the screw tightening sequence on the stress distribution of a dynamic compression plate: A pilot finite element study.

Although the optimal screw tightening sequence is a common question orthopaedists encounter during fractures fixation with a dynamic compression plate (DCP), the effect of the screw tightening sequence on the stability of the plate has never been explored. This study explores the effect of the screw tightening sequence on the stress distribution of a DCP using a finite element method. Idealized finite element analysis models of the femoral diaphysis with six-hole or eight-hole DCPs were constructed. The screw tightening preload was simulated using 'bolt load' in ABAQUS. Two screw tightening sequences were studied for the six-hole plate and six sequences were studied for the eight-hole plate. U magnitude and Von Mises stress were used to evaluate the deformation and stress distribution of the plate, respectively. Deformation and stress distribution plots from different sequences were compared. The different screw tightening sequences showed different deformation processes, while all had the same final deformation after all the screws were tightened. Each screw tightening step of different tightening sequences showed different stress distributions in the plate, while all had the same stress distribution after all the screws were tightened. Using different screw tightening sequences to fix the same DCP can produce the same stability, which means in terms of fixation stability, after the two screws nearest to the fracture line are tightened, surgeons do not need to hesitate about the order in which the rest screws should be inserted during the surgery.

The influence of mini-fragment plates on the mechanical properties of long-bone plate fixation.

Objective:Mini-fragment plates (MFPs) are increasingly used in fracture surgery to provide provisional fixation. After definitive fixation, the surgeon decides whether to remove the plates or leave them in place as additional fixation, based on the perceived biomechanical influence of the MFP. However, there are no current biomechanical studies to guide this decision. Therefore, the purpose of this study was to evaluate the influence of MFPs on the four-point bending and torsional stiffness of long bone transverse and simple wedge fracture fixation constructs.Methods:Fourth-generation composite bone cylinders were cut to produce transverse (AO-OTA classification 12-A3) and simple wedge (AO-OTA classification 12-B2) fracture models. The specimens were fixed using a low-contact dynamic compression plate (LC-DCP) and MFPs. Specimens were tested in four-point bending and torsion utilizing 3 different MFP orientations.Results:No statistically significant differences in bending stiffness were found between control and MFP groups for transverse fracture constructs. MFPs significantly increased the bending stiffness for wedge fracture constructs under certain loading conditions. This increase was observed when MFPs were positioned both orthogonal (85.1% increase, P = .034) and opposite (848.2% increase, P < .001) to the LC-DCP. MFPs significantly increased the torsional stiffness for both transverse and wedge fracture constructs when MFPs were positioned both orthogonal (transverse: 27.7% increase, wedge: 16.7% increase) and opposite (transverse: 28.4%, wedge: 24.2% increase) to the LC-DCP.Conclusions:Our results indicate that including MFPs in definitive fixation can increase the bending and torsional stiffness of a long-bone fracture fixation construct. This suggests that the biomechanical influence of MFPs should be considered. However, clinical studies will be required to test the applicability of these findings to the clinical setting.

Diaphyseal fractures of the forearm in adults, comparative study of dynamic compression plate versus intramedullary nail

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Forearm fractures are common nowadays because of road traffic accident. It is important to achieve anatomical reduction of both bone forearm fractures to regain function of upper limb. This study is undertaken to observe functional and radiological outcome using two different surgical modalities like dynamic compression plating (DCP), and intramedullary nailing in both bone forearm fractures and also to indivualize the optimal treatment method for different fracture pattern.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Our study included 60 patients with diaphyseal forearm fractures in adults presenting to orthopaedic outpatient department. Among 60 patients, 30 patients underwent open reduction and internal fixation by dynamic compression plate and other 30 patients underwent closed reduction/open reduction by square nail after detailed pre-operative evaluation.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study average union time in DCP group is 23.39 weeks and square nail group is 28.89 weeks. Union in DCP group was 27 (90%) and square nail group 22 (73.33%). Delayed union in DCP group was 03 (10%) and in Square nail group was 6 (20%), non-union in DCP group was 0 (nil) and in square nail group was 2 (06%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Open reduction and internal fixation with DCP plates for both bone diaphyseal forearm fractures gives good results with early union rates. We also found that in open fractures and complex fracture like segmental fractures square nailing was better option compared to dynamic compression plate to reduce infection rates, retain periosteal blood supply from soft tissue. Thus we conclude that both implants are equally important and we should prioritize based on preoperative planning.&lt;/p&gt;

Sliding Hip Screw for Fixation of Fracture Through a Previously Arthrodesed Hip

Hip arthrodesis is a treatment option for painful chronic hip conditions. Hip fractures through a previously arthrodesed hip are relatively uncommon as indications for hip arthrodesis are rare. The following case reports on the use of a sliding hip screw and a pelvic reconstruction plate to address arthrodesed hip fracture in an 81-year-old man. The use of a dynamic hip screw in this setting gave us a stable fixed-angle construct with compression across the fracture site, and the addition of a trochanteric side plate added to the stability. The dynamic compression plate with limited bone contact was used to neutralize the construct. This case describes the successful treatment of such an injury in a way not previously described in the literature with the intent of giving the orthopaedic traumatologist another method to approach this rare injury.

Dynamic Compression Plate: A useful procedure for sub-trochanteric femur fracture with osteopetrosis.

Introduction: Osteopetrosis is an un common disease. It is of infantile and adult type. With adult type osteopetrosis, bones are vulnerable to fracture even with minimal injury. As there is increased bone density and small medullary canal, therefore, these fractures are challenging for orthopedic surgeons.Objective: To evaluate the results of Dynamic Compression Plate (DCP) for the fixation of sub-trochanteric fractures of femur with osteopetrosis in term of union malunion, non-union and post-operative infection.Methodology: This prospective study was conducted in the department of Orthopedic surgery at Muhammad Medical College Mirpur Khas from March 2015 to February 2017. Patients, with sub-trochanteric fractures of femur having osteopetrosis, between the age of 20-60 years of either gender were included in this study. All fractures were fixed with DCP. Post-operatively patients were mobilized with crutches in 1st week, followed by partial weight bearing in 3rd week and full weight bearing in 6 weeks.Results: Union of fractures occur in 98 %patients. Mal union in one patient and nonunion in one patient. Post-operative infection was observed in one patient.Conclusion: This study shows management of sub trochanteric fractures of femur in patients with osteopetrosis are best treated with DCP with little or no complications.Key words: Osteopetrosis, sub trochanteric fractures, DCP.

Clinical outcomes and complications of pancarpal arthrodesis stabilised with 3.5 mm/2.7 mm locking compression plates with internal additional fixation in 12 dogs

ABSTRACTAimsTo report the clinical outcomes and complications after the use of 3.5 mm/2.7 mm locking compression plates (LCP) with additional internal fixation for pancarpal arthrodesis (PCA) in dogs.MethodsThis was a retrospective study using medical records from a single orthopaedic referral hospital between December 2015 and April 2018. The inclusion criteria were the use of a dorsally applied LCP for PCA in dogs with a minimum follow-up period of 12 months. Additional crossed 2.7 or 3.5 mm cortical screws or Kirschner wires were placed in all limbs to further stabilise the joints. A light dressing without external coaptation was applied postoperatively to all limbs. Postoperative lameness assessment was recorded at the last clinical evaluation.ResultsTwelve dogs with 13 arthrodesed limbs were included, with carpal hyperextension injury being the most common indication for surgery (4/13; 31%). One dog was recorded with a minor complication, which was a metacarpal fracture distal to the bone plate. Major complications were observed in 4/13 (31%) limbs, with surgical site infection being recorded in all four limbs and screw loosening in one limb. No implant failure was reported. At the final clinical evaluation (43–437 days after surgery), none or mechanical lameness was recorded in 9/13 (69%) limbs, mild lameness in 3/13 (23%) limbs, and moderate lameness in one 1/13 (8%) limb.Conclusions and clinical relevanceLocking plate and screw fixation with additional internal fixation resulted in comparable complication and infection rates in canine PCA to previous published studies using hybrid dynamic compression plates. No implant failure was reported for any of the limbs despite the use of a light dressing without external coaptation.

Management of fracture both bone of forearm with dynamic compression plating and its outcomes

Introduction: Forearm fractures are one of the most common injuries encountered by an orthopaedic surgeon. Before AO (Association for Osteosynthesis), they were treated with cast immobilization and also other fixation techniques which were described such as intramedullary k-wire, intramedullary nail, external fixator etc. Though still relevant today, however they have been demonstrated to be successful only in selected cases, with high rate of non-union, malunion and with ill effects on the functions of the forearm. The most effective method of producing rigid internal fixation by the use of compression plates was developed by AO School in Switzerland. Objective: The aim of this study is to assess the results of fixation of fractures of shaft of both bone of forearm with dynamic compression plating (DCP) and its advantages and its complications Setting: This study was conducted at the orthopedics department of a teaching hospital in India. Design: This was 2 years prospective, longitudinal, hospital based, observational study, and its outcomes. Participants: The study was done in 30 patients (22 males and 8 females) with fracture both bone of the forearm, who were treated with open reduction and internal fixation with dynamic compression plate and screws at Mahatma Gandhi Memorial Hospital (attached to Kakatiya Medical College, Warangal), between January 2017 to January 2019. Results: Anderson’s criterion was employed to categorize the functional results. Good or full range of mobility of elbow and wrist joints, with excellent and satisfactory results was present in 28 patients (94%), 1 patient (3%) having restriction of elbow motion and pronation and supination and 1 patient (3%) with non-union of ulna, who recovered with bone grafting. Conclusion: Based on our experience and results, we conclude that with anatomic open reduction and rigid internal fixation with dynamic compression plate is a good fixation procedure for displaced diaphyseal fractures of both bone of the forearm. Adherence to strict asepsis, AO principles, proper post-operative rehabilitation and patient education are more important to obtain excellent results.

A comparative study of internal fixation of forearm fractures using locking compression plate and dynamic compression plate

Background: Fractures of forearm bones are common in direct trauma often while protecting one’s head, road traffic accidents, fall from height and sports activities. Open reduction and internal fixation are the treatment of choice in these cases. Locking Compression Plate (LCP) is a new fixation device in treating these fractures. This study has been carried out to compare the role of Locking Compression Plate (LCP) with Dynamic Compression Plate (DCP) in treating these fractures. Methods: A prospective study was done from September 2017 to March 2019, including forty eight patients with fractures of radius and ulna. In Group I (DCP group), twenty four patients were subjected to open reduction and internal fixation with 3.5 mm stainless steel DCP and non-locking screws. In Group II (LCP group), 24 patients were managed by open reduction and internal fixation using 3.5mm stainless steel LCP and locking head/non-locking screws. All patients were followed up at monthly interval until union. Clinical assessment regarding functional outcome was done at the final follow-up.Results & Conclusion: The mean union time in Group I (DCP group) was 13.67 weeks (range, 8-24 weeks, SD3.67). In Group II (LCP group), the mean union time was 16.25 weeks (range, 12-24weeks, SD3.14). Excellent & satisfactory results were observed in 87.5% cases in Gp I and 91.67% cases in Gp II. On statistical analysis, there was no significant difference in the mean union time and functional outcome in Gp I and Gp II. Both internal fixation devices were equally effective in treating diaphyseal fractures of forearm.

A study of functional outcome of humeral diaphyseal fractures treated with dynamic compression plate

Fractures of the humerus comprise approximately 5% to 8% of all extremity fractures, and shaft fractures account for approximately 3% of all long-bone fractures. Majority of humerus shaft fracture can be treated with conservative management but nowadays surgical indications in humerus fracture are increasingly being adopted. In this study 20 patients of humerus shaft fractures has been rated with 4.5 dynamic compression plate with posterior approach in SSG Hospital Baroda. After one year follow up 19 patients out of 20 having good functional result.

The comparative study of diaphyseal fracture of shaft of humerus treated with dynamic compression plate (DCP) versus intramedullary interlocking nailing

The comparative study of diaphyseal fracture of shaft of humerus treated with dynamic compression plate (DCP) versus intramedullary interlocking nailing

A clinical study of anterior bridge plating for humerus shaft fractures by minimal invasive technique

Introduction: Diaphyseal fractures of humerus treated with bridge plating are showing superior results in view of post-operative pain and union time. In our study we have evaluated the clinical, radiological, and functional outcome of such fractures in 15 patients, all of them were managed with dynamic compression plate over an average follow up period of 12 months. Though open reduction and plating technique of humerus shaft fracture is gold standard, this technique also gives good outcome.Materials and Methods: Fifteen patients with humerus shaft fractures were managed by anterior bridge plating using Minimum invasive osteosynthesis technique between Jan 2017 and Jan 2018 were included in this study. All cases were managed with closed reduction and 4.5mm dynamic compression plate fixation over anterior aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow scores were used for assessing the shoulder and elbow function. Results: Out of the fifteen patients in the study, eleven were males and four were females. The mean age was 40.2 years (range 25 to 60 years). Ten out of fifteen patients (66.67%) had the dominant side fractured. Mean surgical time in minutes was 90min (range: 60–120 minutes). The mean fracture union time was 10.6 weeks (range: 10–18 weeks). However Shoulder function was excellent to good in 13 cases (86.6%), fair in 1 case (6.67%) & poor 1 case (6.67%) on the UCLA score. Conclusion: In our study, small incision percutaneous anterior bridge technique for fracture shaft humerus results in good functional outcomes. It is based on relative stability which provides healing, and subsequent formation of the bone callus, and reduces the possibility of infection and non-union.it requires experience and a good assistance.

Adequacy of Three Dimensional Miniplate In Treatment Of Mandibular Fracture In Interforaminal Region

Background: Mandible is one of the commonly fractured bone due to trauma, assault and falls. Treatment includes closed and open methods. Methods of open reduction and internal fixation have changed and di­versified enormously in the past few years. Champy’s miniplate fixation, dynamic compression plating has become a standard approach. More recently, three dimensional miniplates have been developed by Farmand which may be effectively used in mandibular fractures. The aim of this study was to check the adequacy of three dimensional miniplate in man­agement of mandibular fracture occurring in the interforaminal region.&#x0D; Methods: A prospective clinical study was carried out in patients attend­ing Emergency Department and Department of Oral and Maxillofacial Surgery, Nobel Medical College and Teaching Hospital (NMCTH) suffer­ing from mandibular fractures in interforaminal region from May 2018 to January 2019.&#x0D; Results: A total of 17 patients with 18 fracture in interforaminal region, all male were included in the study. The age ranged from 16 to 50 years with a mean of 29.17 ± 9.48. Road traffic accident was the leading cause of injury with 15 out of 17 patients (88.23%). There was no incidence of wound infection, wound dehiscence, malunion, nonunion, plate fracture within the follow up period of 3 months. One fracture was unstable on 1st postoperative day and also had mildly deranged occlusion which was man­aged with intermaxillary fixation for two weeks.&#x0D; Conclusions: Three dimensional plates fulfills the treatment goals of ad­equate stabilization and fixation of mandibular interforaminal fractures.

Optimization of process parameters of wire electro discharge machining for Ti49.4Ni50.6 shape memory alloys using the Taguchi technique

PurposeTi49.4Ni50.6 (at. %) shape memory alloy (SMA) is a unique class of smart materials because of unbeatable property which given a wide variety of their applications across a broad range of fields including an orthopedic implant. It plays a very important role in the constructions of novel orthopedic implants application (like dynamic compression plate) because of lower Young’s modulus compared to other biomedical implant materials, high mechanical strength, excellent corrosion resistance and unique property like shape memory effect. Conventional machining of Ti-Ni yields poor surface finish and low dimensional accuracy of the machined components. Hence, wire electro-discharge machining (WDEM) of Ti-Ni has been performed. The purpose of this paper is to investigate the effect of variation of five process parameters, namely, a pulse-on time, pulse-off time, spark gap set voltage (SV), wire feed and wire tension on the material removal rate, surface roughness (SR), kerf width (KW) and dimensional deviation (DD), in the WDEM of Ti49.5Ni50.6 SMA.Design/methodology/approachThe effect of machining parameters on Ti49.4Ni50.6 has been fully explored using WEDM with zinc coated brass wire as an electrode. In this work, L18 orthogonal array based on Taguchi method has been used to conduct a series of experiments and statically evaluate the experimental data by the use of the method of analysis of variance. Scanning electron microscope images of the machined surface, at the highest and lowest pulse-on time, have been taken to evaluate the quality of surface in terms of their SR values.FindingsFor the highest pulse-on time, it is observed that blow holes, cracks, melted droplets and craters have been formed on the machined surface with an SR of 2.744 µm, while for the lowest pulse-on time, these are not formed with an SR of 0.862 µm. It is seen that the pulse-on time is the most significant process parameter for MRR, SR and KW, while the DD is significantly affected by spark gap SV. The optimal values of the process parameters have been obtained by the method of analysis of mean and the confirmatory experiments have been carried out to validate results of optimization. Energy dispersive spectroscopy analysis of the machined surface of Ti49.4Ni50.6 has shown a certain amount of deposition of material on the machined surface.Originality/valueThis is an original paper.

Are proximal screws necessary for osteosynthesis of stable-stem periprosthetic femoral fractures fixed with non-locking plate and cable?

IntroductionThe purpose of this study was to assess the effectiveness of the cable-plate-cable technique which comprises fixation of the proximal fragment using cable loops without additional proximal screws on the plate for the treatment of stable-stem periprosthetic femoral fractures around hip prostheses. MethodsWe retrospectively reviewed Vancouver types B1 and C periprosthetic femoral fractures treated with a dynamic compression plate combined with Dall-Miles cable between 2010 and 2016 at a single institution and followed for at least 12 months. Patients were treated with proximal fragment fixation using cable combined with screws (Group I) or with proximal fragment fixation using cable alone (Group II). Demographic data, fracture types, and clinical and radiological outcomes were analyzed. ResultsA total of 50 patients were included (Group I, n = 23 patients; Group II, n = 27). Fracture union was achieved in 49 patients with one case of non-union in Group I and no cases of non-union in Group II. Mean time to union was 5.4 months in Group I and 5.1 months in Group II (P = 0.624). Mean Harris hip score at latest assessment was 69.5 in Group I and 69.4 in Group II (P = 0.919). Regarding complications, there was one deep wound infection, one stem subsidence, and one loss of reduction in Group I, and one stem subsidence in Group II. No significant difference in clinical and radiological outcomes between groups was observed. ConclusionsThe cable-plate-cable technique sufficiently treats Vancouver types B1 and C periprosthetic femoral fractures without use of additional screws in the proximal fragment.