Femoral Locking Compression Plate Research Articles

The functional outcome of surgical management of distal femur fractures using a distal femoral locking compression plate.

Objective: To evaluate the functional outcomes following surgical intervention for distal femur fractures using femoral locking compression plates. Study Design: Descriptive study an Observational study. Setting: Department of Orthopedics, MTI Mardan Medical Complex in Mardan. Period: January 2023 to December 2023. Methods: Was conducted on 86 patients with distal femur fractures treated with femoral locking compression plates at the Orthopedic Ward. The sampling method employed was non-probability consecutive sampling. All surgeries were performed using a standardized technique by an experienced surgeon. Functional outcomes were assessed using the Oxford Society score six weeks post-procedure. Data analysis was conducted using SPSS 23, with significance set at p ≤ 0.05. Results: Of total 86 patients, n=57(66.3%) were male while n=29(33.7%) were female. Mean age was 35.43±10.49. Overall, 39 patients (45.3%) had excellent functional outcomes, 22 patients (25.6%) had good functional outcomes, 13 patients (15.1%) had fair functional outcomes, and 12 patients (14.0%) had poor functional outcomes. After cross tabulation with functional outcomes, gender and BMI were found insignificant with p value of 0.584 and 0.399 respectively. While diabetes, hypertension and age was found to be significantly associated with functional outcomes with p value of <0.001,0.005 and <0.001 respectively. Conclusion: The use of locking compression plates for distal femur fractures resulted in predominantly favorable functional outcomes with minority of patients experiencing poor outcomes. Additionally, diabetes, hypertension, and age emerged as significant predictors of functional outcome.

Preliminary study on the stabilization of varus proximal femoral osteotomies using pediatric LCP plates in adults undergoing combined correction of proximal femoral and acetabular dysplasia.

Proximal femoral osteotomy (PFO) with periacetabular osteotomy (PAO) improves femoral head coverage in patients with proximal femoral and acetabular dysplasia. Historically, blade plates used in the PFO cause soft-tissue irritation and often lead to implant removal. Here we present a technique using a lower profile pediatric proximal femoral locking compression plate (LCP) for the PFO in a series of adults. The results from 13 hips in 11 patients ≥ 18years old (age 18-37) with > 10months of follow-up are presented. All patients had improved radiographic parameters, pain, and total Merle d'Aubigné-Postel scores postoperatively. Eleven hips (85%) had the LCP removed an average of 15.8 ± 8.6months postoperatively, often due to pain over the greater trochanter. The pediatric proximal femoral LCP is effective for PFO in combined PAO PFO procedures but has a high rate of lateral hip discomfort leading to implant removal.

Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures

BackgroundA locking compression plate (LCP) of the distal femur is used as an external fixator for lower tibial fractures. However, in clinical practice, the technique lacks a standardized approach and a strong biomechanical basis for its stability.MethodsIn this paper, internal tibial LCP fixator (Group IT-44), external tibial LCP fixator (Group ET-44), external distal femoral LCP fixator (Group EF-44, group EF-33, group EF-22), and conventional external fixator (Group CEF-22) frames were used to fix unstable fracture models of the lower tibial segment, and anatomical studies were performed to standardize the operation as well as to assess the biomechanical stability and adjustability of the distal femoral LCP external fixator by biomechanical experiments.ResultsIt was found that the torsional and flexural stiffnesses of group EF-44 and group EF-33 were higher than those of group IT-44 and group ET-44 (p < 0.05); the flexural stiffness of group EF-22 was similar to that of group IT-44 (p > 0.05); and the compressive stiffness of all three EF groups was higher than that of group ET-44 (p < 0.05). In addition, the flexural and compressive stiffnesses of the three EF groups decreased with the decrease in the number of screws (p < 0.05), while the torsional stiffness of the three groups did not differ significantly between the two adjacent groups (p > 0.05). Group CEF-22 showed the highest stiffnesses, while group ET-44 had the lowest stiffnesses (P < 0.05).ConclusionsThe study shows that the distal femoral LCP has good biomechanical stability and adjustability and is superior to the tibial LCP as an external fixator for distal tibial fractures, as long as the technique is used in a standardized manner according to the anatomical studies in this article.

Long Low-profile Proximal Tibial Locking Plate for the Fixation of Periprosthetic Femoral Fractures Above the Prosthesis: A Pilot Study

Background: Anatomic distal femoral plates locking compression plate (LCP) are generally used for the fixation of distal femoral fractures. However, they are not suitable for periprosthetic femoral fracture after total knee arthroplasty (TKA), mainly owing to the impingement with prosthesis. Objectives: In this case series, we report the outcome of proximal tibial LCP fixation in the treatment of periprosthetic femoral fracture after TKA. Patients and Methods: Twelve patients with a periprosthetic femoral fracture who underwent surgical treatment were included. According to Su et al. classification, all fractures were type II, originating from the femoral component with proximal extending. Fractures were managed with open reduction and plate fixation. The plate choice was either a long low-profile proximal tibial LCP (n=9) or a short anatomic distal femoral LCP (n=3). Results: The study population included one male and 11 females with a mean age of 74.5±9.3 years and a mean follow-up of 2.8±1.3 years. Union of fracture was observed in all fractures that were fixed with a long locking plate during a mean period of 3.1±2.1 months. Fixation failed in all three patients who were managed with a short plate. These patients underwent revision surgery with a long low-profile proximal tibial LCP. In one of them, the fixation failed again and finally fixed with tumor prosthesis. The other two fractures were united with no complications. Conclusion: Long low-profile proximal tibial LCP omits the problem of impingement by prosthesis, which is caused by short anatomic distal femoral LCP in the treatment of periprosthetic femoral fractures above the prosthesis. However, future large-scale comparative studies are required before we can recommend it for routine implications in these fractures.

Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty

IntroductionAdequate treatment for periprosthetic distal femur fractures is challenging because of various reasons, including severe osteoporosis and distal fragments that are too small or too distal. We have introduced a new surgical technique for dual plating of periprosthetic distal femur fractures following total knee arthroplasty (TKA) and determined the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with a dual locking compression plate (LCP).Materials and methodsBetween January 2010 and July 2019, 18 patients [mean age, 74.8 (68–89) years; average follow-up period, 14.8 (12–43) months] underwent MIPO with distal femoral LCP laterally and proximal humeral internal locking system (PHILOS) medially for periprosthetic distal femoral fractures following TKA. The minimum follow-up was 1 year. The clinical and radiological outcomes were assessed using the modified WOMAC scores, knee range of motion, time to callus formation, time to union, and complications of malunion, nonunion, and shortening.ResultsThe average time to union was 18.4 weeks (range, 10–51 weeks) and to callus formation was 7.8 weeks (range, 2–14 weeks). At the 1-year follow-up, the average JLETS was 37.6 (range, 24–53), average knee ROM was 110.3° (range, 80–135°), and average varus-valgus angles of the distal femur were 3.2° (range, −2.9–10.5°). No nonunion, broken plates, or implant failure occurred. Malunion occurred in three patients.ConclusionMIPO with dual LCP is a reliable method for stabilizing periprosthetic distal femoral fractures following TKA, with satisfactory bone union rates and low complication rates.

Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures.

Background:When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations.Materials and Methods:Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery.Results:All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture.Conclusions:Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

Investigation of a fatigue failure in a stainless steel femoral plate

Surgical implants are exposed to severe working conditions and therefore a wide range of failure mechanisms may occur, including fatigue, corrosion, wear, fretting and combinations of them. The mechanical failures of metallic implants may also be influenced by several other factors, including the design, material, manufacturing, installation, postoperative complications and misuse. An 83-year-old patient suffered an oblique femoral shaft fracture due to a fall at home. A stainless steel locking compression plate (LCP) employed in the fracture reduction failed after four months and was sent back to the producer. A second LCP of the same type was implanted and also failed after six months. A failure analysis of the second femoral LCP is performed in this paper. The results demonstrate that poor material quality was decisive to the failure. The chemical analysis revealed a high P content in the steel, which is not in accordance to the standards. A combination of factors lead to LCP fracture and these include: brittle crack initiation due to phosphorus, segregation at grain boundaries, crack propagation due to cyclic loading and final fast fracture favored by the loss of ductility due to cold work.