Lateral Locking Compression Plate Research Articles

Orthogonal plating for complex olecranon fractures: retrospective case series with patient-reported outcomes.

Treatment for complex olecranon fractures with metaphyseal comminution can be challenging. To improve reduction maneuvers and augment stability, we apply a small medial and/or lateral locking compression plate (LCP) prior to placing a posterior contoured 3.5mm-2.7mm LCP. The aim is to describe our technique and outcomes of this "orthogonal" plating technique. 26 patients were treated with orthogonal plating. Clinical outcome variables were available for all patients at a median of 27 months (IQR 6-54), and patient-reported outcomes (Q-DASH and MEPS) for 23 patients at 38 months (IQR 18-71). All fractures healed at a median of 2.0 months (IQR 1.5-3.8). The median elbow flexion was 120°, extension-deficit 15°, pronation 88°, and supination 85°. The median Q-DASH was 9 (IQR 0-22) and the median MEPS was 90 (IQR 80-100). Hardware was electively removed in seven patients. One patient had a late superficial infection that resolved with hardware removal and antibiotics, and one patient had two consecutive re-fractures after two hardware removals; and healed after the second revision surgery. Orthogonal plating with a posterior LCP and a small medial and/or lateral LCP is a safe technique that leads to excellent healing rates, and good clinical and patient-reported outcomes.

Potential problem and solution of lateral plate postposition for the posterolateral tibial plateau fracture

BackgroundThere has been controversial for the treatment of the posterolateral tibial plateau fractures (PTPF). This study aimed to evaluate clinic outcomes of the lateral locking compression plate (LCP) postposition, analyze the feasibility of LCP postposition through anatomical measurement, and address the potential problems of LCP postposition through the biomechanical assessment.Methods39 patients with PTPF undergoing LCP fixation between June 2019 and June 2022 were retrospectively evaluated. All cases were divided into two group: Group A (15 cases) employed plate transverse arm postpositioning with posterolateral (PL) fracture fixation using two raft screws, while Group B (24 cases) utilized non-postpositioning with fixation by a single raft screw. Surgical duration, intraoperative blood loss, the change of lateral tibial plateau angle (LTPA), lateral tibial plateau posterior slope angle (LPSA) and fracture collapse between immediate postoperative and last follow up, range of motion (ROM), HSS knee score, and Lysholm knee score were recorded. CT measurements of the fibular head superior space and LCP transverse arm were taken in 50 healthy adult knees to assess postposition feasibility. Finally, three fracture models were established using finite element analysis: Model A with plate postposition and PL split fracture fixed by two raft screws of transverse arm, Model B with plate non-postposition and PL split fracture fixed by one raft screw, and Model C with plate non-postposition and PL split fracture fixed by one raft screw and anterior–posterior tension screws. Loadings of 250N, 500N, and 750N were applied for the analysis of the displacement degree, von Mises stress distribution.ResultsResults indicate comparable operative duration and intraoperative hemorrhage between groups. Complications were minimal in both groups. Group A demonstrated superior outcomes in terms of radiographic parameters, functional scores, and fracture collapse prevention. CT measurements revealed compatibility in 72% of healthy knees with the postpositioning technique. Finite element analysis indicated favorable biomechanical stability.ConclusionNot all patients with PTPF were applicable to the management of the plate postposition and two raft screws fixation, even though this technique exerted good biomechanical stability and achieved satisfactory clinic outcomes. When the PL fracture was fixed by only raft screw through LCP owing to various reasons, two anterior–posterior tension screws might be necessitated to maintain the fracture stability.

Is augmented femoral lateral plating with helically shaped medial plates biomechanically advantageous over straight medial plates?

Dual plating of comminuted distal femoral fractures allows for early patient mobilization. An additional helically shaped medial plate avoids the medial vital structures of the thigh. The aim of this study is to investigate the biomechanical competence of an augmented lateral locking compression plate distal femur (LCP-DF) using an additional straight versus a helically shaped medial LCP of the same length. Ten pairs of human cadaveric femora were instrumented with a lateral anatomical 15-hole LCP-DF. Following, they were pairwise instrumented with either an additional medial straight 14-hole LCP (group 1) or a 90°-helical shape LCP (group 2). All specimens were biomechanically tested under quasi-static and progressively increasing combined cyclic axial and torsional loading until failure. Initial interfragmentary axial displacement and flexion under static compression were significantly smaller in group 1 (0.11 ± 0.12 mm and 0.21 ± 0.10°) versus group 2 (0.31 ± 0.14 mm and 0.68 ± 0.16°), p ≤ 0.007. Initial varus deformation under static compression remained not significantly different between group 1 (0.57 ± 0.23°) and group 2 (0.75 ± 0.34°), p = 0.085. Flexion movements during dynamic loading were significantly bigger in group 2 (2.51 ± 0.54°) versus group 1 (1.63 ± 1.28°), p = 0.015; however, no significant differences were observed in terms of varus, internal rotation, and axial and shear displacements between the groups, p ≥ 0.204. Cycles to failure and load at failure were higher in group 2 (25,172 ± 6376 and 3017 ± 638 N) compared to group 1 (22,277 ± 4576 and 2728 ± 458 N) with no significant differences between them, p = 0.195. From a biomechanical perspective, helical double plating may be considered a useful alternative to straight double plating, demonstrating ameliorated damping capacities during flexion deformation and safer application as the medial neurovascular structures of the thigh are avoided.

Biomechanical analysis of bridge combined fixation system as a novel treatment for the fixation of type A3 distal femoral fractures.

To compare the biomechanical parameters of AO/OTA type A3 distal femoral fractures fixed bilaterally with a bridge combined fixation system (BCFS) and lateral locking compression plate + locking reconstruction plate (LCP + LRP). Twelve A3 distal femoral fracture models with medial cortical defects of the distal femur were created using synthetic femoral Sawbones. BCFS and LCP + LRP were used for bilateral fixation, with six in each group. Axial compression and torsion tests were performed on the two groups of fracture models to determine their stiffness during axial compression and the Torsional stiffness during torsion tests. Axial compression failure tests were performed to collect the vertical loads of the ultimate failure tests. In the test conducted on the fixed type A3 distal femoral fracture models, the axial stiffness in the BCFS group (group A) (1,072.61 ± 113.5 N/mm) was not significantly different from that in the LCP + LRP group (group B) (1,184.13 ± 110.24 N/mm) (t = 1.726, P = 0.115), the Torsional stiffness in group A (3.73 ± 0.12 N.m/deg) was higher than that in group B (3.37 ± 0.04 N.m/deg) (t = 6.825, P < 0.001),and the ultimate failure test of type A3 fracture model showed that the vertical load to destroy group A fixation (5,290.45 ± 109.63 N) was higher than that for group B (3,978.43 ± 17.1 N) (t = 23.28, P < 0.05). Notably, intertrochanteric fractures occurred in groups A and B. In the fixation of type A3 distal femoral fractures, the anti-axial compression of the BCFS group was similar to that of the LCP + LRP group, but the anti-torsion was better.

Locking compression plate combined with medial buttress plate for the treatment of osteoporotic comminuted proximal humerus fractures

To explore clinical effect of lateral locking compression plate combined with medial buttress plate in treating osteoporotic comminuted fractures of proximal humerus. From May 2017 to December 2021, 12 patients with osteoporotic comminution of proximal humerus were treated by lateral locking compression plates combined with medial buttress plates, including 5 males and 7 females, aged from 55 to 78 years old, bone mineral density(BMD) less than -2.5 g/cm3, the time from injury to operation was from 2 to 6 days. According to Neer classification, 7 patients were type Ⅲ, 4 patients were type Ⅳ and 1 patient was type Ⅵ. Postoperative complications, fracture healing and internal fixation were observed and Constant-Murley score of shoulder joint was used to evaluate clinical effects at 6 months after operation. Postoperative wound healed well at stage I. All patients were followed up from 6 to 18 months. Humeral head collapse and necrosis occurred in 1 patient and humeral head varus in 1 patient. No impact of shoulder joint, internal fixation loosening occurred. Constant-Murley score at 6 months ranged from 45 to 90 points, and 6 patients got excellent result, 3 good, and 3 poor. Locking compression plate combined with medial buttress plate could effectively reconstruct medial humeral column support and enhance fracture stability, and receive satisfactory clinical results. However, no control group was established in this study, and function of shoulder joint has not been evaluated many times after operation, so it cannot dynamically reflect changes of shoulder joint function.

Double fixation for complex distal femoral fractures.

For complex distal femoral fractures, a single lateral locking compression plate or retrograde intramedullary nail may not achieve a stable environment for fracture healing.Various types of double fixation constructs have been featured in the current literature. Double-plate construct and nail-and-plate construct are two common double fixation constructs for distal femoral fractures.Double fixation constructs have been featured in studies on comminuted distal femoral fractures, distal femoral fracture with medial bone defects, periprosthetic fractures, and distal femoral non-union.A number of case series reported a generally high union rate and satisfactory functional outcomes for double fixation of distal femoral fractures.In this review, we present the state of the art of double fixation constructs for distal femoral fractures with a focus on double-plate and plate-and-nail constructs.

A prospective study of functional outcome of comminuted metaphyseal distal femur fracture treated with lateral locking compression plate and medial augmentation with TENS

Background: Distal femur fractures are complex injuries producing long term disability and present considerable challenges in management. These fractures poses challenges to the treating surgeon because of thin cortex of the femoral condyles, wide medullary canal, relative osteopenia, short condylar fragment and comminution involving articular surface. Distal femur fracture disrupts normal knee joint functioning, hence needed anatomical reduction and stable internal fixation to prevent crippling disabilities and hardware failure. Objective: To evaluate the functional and radiological outcome of comminuted metaphyseal fracture of distal femur treated by Lateral locking compression plate and medial TENS nail using NEER’S score. Methods: In this study, 20 cases of comminuted metaphyseal fracture of distal femur were operated between November 2018 to April 2020 with distal femur lateral locking compression plate and medial augmentation with tens nail. Patients were selected based on inclusion and exclusion criteria and were followed up for 12 months. The results were analysed with NEER’S score. Results: Out of 20 patients with comminuted metaphseal distal femur fractures AO-Muller type A3 -subtypes 15 and C2 subtypes 5 patients were studied. Mean age of the patients was 45.5 years with age ranging from 20 years to 80 years. Right sided fractures were predominant. In 65% cases mode of injury was road traffic accident and rest were self-fall. 2 cases were operated under MIPPO technique and rest all were operated on with standard open lateral approach. Average surgical procedure timing was 119.5 minutes in our study. Average duration of radiological union was 18.6 weeks and average duration of weight bearing was 20.5 weeks. Complications such as superficial wound infection, knee pain and stiffness were observed in 9 patients. The NEER’S score was excellent in 45%, good-fair in 50% and 5% poor outcome. Conclusion: Comminuted distal femur fracture needs dual column fixation to achieve bone healing and restore function of the affected limb in shortest time without compromising stability. The advantage medial augmentation with TENS is active range of motion can be started earlier, stable internal fixation that does not allow varus collapse, mal-union and further implant failure.

COMPARATIVE STUDY BETWEEN MEDIALAND LATERAL DISTAL TIBIAL LOCKING COMPRESSION PLATES FOR DISTAL THIRD TIBIAL FRACTURES

Aim and objectives:to compare both the ways of xation in randomly selected cases in distal third tibia fractures to known the best way of xation technique &amp; implant. Material and methods: In our study we have selected 40 patients with fractures of the distal third tibia, who attended the department of orthopaedics treated by open reduction and internal xation with using Medial/Lateral distal locking compression plates, in Mahatma Gandhi Medical College &amp; Hospital, Jaipur during the year January 2019 to June 2020. The duration of follow-up to evaluate result was six months. We divided the distal leg bone fractures into two groups. Group 1: Include the distal third tibial fractures which are simple or comminuted treated as open reduction &amp; internal xation with lateral locking compression plate. Group 2: Includes the distal third tibial fractures which are simple or comminuted, treated as open reduction &amp; internal xation with medial locking compression plate. Results: There was no signicant difference in duration of surgeries and suture removal.In there were 3 cases of nonunion 1 case in lateral plating group and 2 cases in medial plating group. Group 1 were show 20% excellent, 45% good, 30% fair &amp; 5% poor result. Group 2 were show 15 % excellent, 30% good, 45% fair &amp;10% poor result according to Tenny &amp; Wiss criteria. Conclusion: Lateral plating was much better in as a procedure and outcome wise.

STUDY ON FUNCTIONAL OUTCOME OF TIBIAL PLATEAU FRACTURES TREATED WITH LOCKING COMPRESSION PLATE

Proximal tibial fractures, one of the commonest intra articular fractures. Incidence of these fractures is increasing due to road trafc accidents. At the same time surgical treatment options for the same are also being modied continuously. Any fracture around the weight bearing joint like knee joint is of paramount importance as it would result in signicant morbidity. Hence the treatment of proximal tibial fractures has become a challenge for the orthopaedic surgeons. Methods: During the study period 31 patients were treated with locking compression plate on lateral side through anterolateral approach for varying types of tibial plateau fractures. Out of 31, 28 patients were available at nal follow up. The functional and radiological outcome assessed with Rasmussen scoring system. At the end of study stability of the knee joint assessed with standard stability tests. Results: Most of the patients were sustained injury following major road trafc accidents and most of them were males. At nal follow up the functional outcome was excellent in 65 % of patients and good to fair in 35% of patients. No patient had poor functional outcome, though 10% of patients had poor radiological outcome. At the end of study 3 patients had posterior laxity, 2 patients had lateral meniscal injury and 4 patients had varus laxity. Conclusion: The functional outcome of tibial plateau fractures treated with single lateral locking compression plate was satisfactory in all our patients. All patients had acceptable clinical outcome though few patients had poor radiological outcome. We found 32% of patients with instability at the end of our study

Evaluation of results of surgical management of lateral tibial condyle fractures using locking compression plate

Introduction: Tibial plateau fractures are the common injuries that may be associated with poor outcomes and a high rate of complications. The problem rise significantly in high energy trauma and severe soft tissue injuries. Locked compression plating system has clear biomechanical advantages and avoids iatrogenic tissue damage when compared with conventional plating. The purpose of surgical management is to restore and preserve normal knee function. It can be accomplished by anatomical restoration of articular surfaces, maintaining mechanical axis, restoring ligamentous stability and preserving a functional pain free range of motion of knee. Materials and Methods: This is a prospective study of 36 patients with tibial plateau (Schatzker type I, II and III) fractures fixed with lateral locking compression plate over lateral surface of tibia and followed for a minimum period of 6 months and evaluated by using Rasmussen knee score system. Results: All patients were followed properly but two patients were lost to follow up so only remaining 34 patients were finally evaluated for functional outcome. Mean age of patient was 38.8 years with range of 19 to 70 years. All fractures united by average of 17.5 weeks (range 14-25 weeks) with delayed union observed in 6 cases. Three patients had wound dehisence, three varus deformity, one deep vein thrombosis, four arthritis and five cases of each knee joint pain & stiffness. According to Rasmussen's scoring system, 52.94% patients had excellent results, 32.35% patients had good, 8.22% fair and 5.88% poor result. Conclusions: Locking plates are good option for lateral tibial condyle fractures with minimum complications. Anatomical reduction can be easily maintained with locking plates, which also helps in early mobilization and hence obtaining good functional outcome in tibial condylar fractures. Keywords: Tibial plateau fractures, Schatzker (type I, II and III) classification, Locking compression plate, Rasmussen knee score

Twisted Plating - A Method of Distal Fibula Fixation.

Objective The literature entails various intramedullary and extramedullary methods for distal fibula fracture fixation; with no consensus yet over the ideal method of fixation. We have retrospectively analyzed the results of using a twisted and contoured 3.5 mm locking compression plate (LCP) as a posterior buttress plate. Methods Of the 62 cases with ankle fractures managed at our institute by the senior author from 1 st January 2012 to 31 st December 2015, 41 patients met our inclusion criteria (Danis-Weber types B and C). Results All 41 distal fibular fractures healed uneventfully, at a mean of 10.4 weeks (8–14 weeks) (Figs. 6, 7, 8 to 9) with no complications. The mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 92.6 (86–100) at a mean follow-up of 31.5 months (14–61 months). Conclusions We have achieved excellent clinical and radiological outcomes using a twisted 3.5 mm LCP as a posterior buttress by combining the advantages of posterior antiglide plating and lateral LCP.

To study outcomes in patients with schatzker type V and VI tibial plateau fracture treated with single 4.5mm lateral locking compression plate

To study outcomes in patients with schatzker type V and VI tibial plateau fracture treated with single 4.5mm lateral locking compression plate

Medial Buttress Plating for Humerus Fractures With Unstable Medial Column.

The purpose of this study was to report surgical tips and techniques on the use of additional medial buttress plate fixation in proximal humeral fractures with unstable medial column restoration after lateral locking compression plate fixation. Between April 2011 and January 2017, 17 patients with medial cortical deficiency were treated using this technique. The average follow-up period was 30 (range, 12-81) months. Successful fracture healing was achieved in all 17 cases. The mean neck-shaft angle change was 1.33 degree (range, 0-7.4 degree). Anterior glenoid rim erosion occurred in 1 patient. No avascular necrosis of the humeral head or significant loss of reduction, and no implant failure or screw perforation occurred. In the first part of this study, we described in detail the indications and surgical technique applied to these fractures. In the second part, we reviewed the clinical and radiographic outcomes of these patients. Supplemental medial buttress plate fixation after lateral locking compression plate fixation was effective in preventing varus collapse and implant failure for proximal humeral fractures with an unstable medial column.

Inverted V–Shaped High Tibial Osteotomy for Medial Osteoarthritic Knees With Severe Varus Deformity

A hemi–closing-wedge and hemi–opening-wedge, inverted V–shaped high tibial osteotomy with local bone graft has been reported to be an effective surgical procedure for medial osteoarthritis of the knee. In this procedure, an inverted V–shaped osteotomy is made and a thin wedged bone block is resected from the lateral side and implanted in the medial opening space created after valgus correction. This procedure can provide sufficient valgus correction of the knee with severe varus deformity more easily than can closing-wedge high tibial osteotomy. The inverted V–shaped osteotomy does not change the posterior tibial slope, the patellar height, or the length of the lower limb at all because the center of tibial alignment correction by the inverted V–shaped osteotomy is located near the center of rotation of angulation of the lower-limb deformity. We recently modified this procedure by performing biplanar osteotomy, developing useful cutting guides, and fixing the tibia with a lateral locking compression plate. The surgical technique is described to enable the reproducible creation of the hemi–closing-wedge and hemi–opening-wedge, inverted V–shaped osteotomy with the locking plate for medial osteoarthritic knees with moderate or severe varus deformity.

Locking compression plate plus small locking plate with short screws through limited posteromedial approach for complex tibial plateau fractures

Objective To explore locking compression plate plus small locking plate with short screws through limited posteromedial approach for complex tibial plateau fractures. Methods We re-viewed 36 patients with complex tibial plateau fracture who had been treated from January 2010 to January 2015 and fully followed up at our department. They were 21 men and 15 women, 23 to 62 years of age (average, 42.3 years). By Schatzker classification, 21 cases were type Ⅴ and 15 type Ⅵ. The fractures were fixated by lateral locking compression plate plus small locking plate with short screws (3.5 mm) through limited posteromedial approach. The internal fixation was assessed by measuring the tibial plateau angle (TPA) and posterior slope angle (PA) on the X-ray films at immediate postoperation and 12 months after operation. At the final follow-ups, the knee flexion and extension were measured and functional recovery of the knee assessed using the Hospital for Special Surgery (HSS) score. Results The follow-up lasted from 12 to 33 months (mean, 15.8 months) in the 36 patients. No implant loosening or breakage or incision infection was observed. Fracture healing time ranged from 4.0 to 6.5 months (average, 4.6 months). No fracture failed to unite; the fracture alignment was fine without loss of reduction. The average TPA and PA at imme-diate postoperation (86.5°±1.3° and 9.5°±1.4°) were not significantly different from those at 12 months postoperation (85.8°±1.5° and 10.6°±1.2°) (P >0.05). According to the HSS scores at final follow-ups, 23 cases were rated as excellent, 8 as good, 4 as fair and one as poor, giving an excellent to good rate of 86.1%. At final follow-ups, the range of motion of the affected knee averaged 126.5° (from 95° to 140°). Conclusion Locking compression plate plus small locking plate with short screws through limited posteromedial approach is a fine treatment for complex tibial plateau fractures, resulting in reliable fixation, satisfactory functional recovery and limited complications. Key words: Tibial fractures; Knee joint; Fracture fixation, internal; Bone plates

High union rates of locking compression plating with cortical strut allograft for type B1 periprosthetic femoral fractures.

Unified classification system (UCS) type B1 periprosthetic femoral fractures are associated with many complications, and management decisions continue to be controversial. The purpose of this study was to evaluate outcomes of UCS type B1 periprosthetic femoral fractures treated by locking compression plating with strut allograft augmentation. We retrospectively reviewed 17 consecutive UCS type B1 periprosthetic femoral fractures treated by open reduction and internal fixation using a lateral locking compression plate supplemented with an anterior cortical strut allograft. There was one man and 16 women with an average age of 74years (range, 57-92years). All had a cementless hip arthroplasty, and eight of the arthroplasties were revisions. The mean duration of follow-up was 28months (range, 12-74months). All 17 fractures healed successfully at a mean of 20weeks (range, 12-30weeks). The mean post-operative Harris hip score was 86 points (range, 77-95 points). No mechanical complications such as failure of plate or screws and malalignment were noted. According to the graft-remodeling classification of Emerson et al., a partial bridging was observed in nine and a complete bridging in eight. Two patients required a removal of the plate due to irritation of the iliotibial band. No femoral stem loosening or deep infection was observed. Our findings indicate that open reduction and internal fixation of UCS type B1 periprosthetic femoral fractures using a lateral locking compression plate supplemented with anterior cortical strut allograft provides adequate mechanical stability of fracture fixation and enhances the fracture healing.

Periprosthetic and interimplant femoral fractures: Biomechanical analysis

The requirements for treatment of femoral fractures are increasing with the rising age of the patients. The aim of this study was to evaluate femoral stiffness and the fracture risk after inserting different implants and implant combinations. A total of 48 cadaveric femors were harvested and 8 groups were randomized on the basis of the bone mineral density (BMD). Different osteosyntheses following prosthetic stem implantation (hip and knee prostheses) were performed and compared with native femurs. All specimens were biomechanically tested in a four-point bending until fracture. The insertion of a femoral stem decreases the stiffness by approximately 33%. Ipsilateral retrograde nailing reduces the force to failure even more. This instable situation can be stabilized by a lateral locking compression plate. The most stable situation occurred in the presence of two cemented stems. Taken together these results clearly indicate that a hip prosthesis significantly weakens the femur, whereas two stems produce the most stable situation at all. The situation of a hip prosthesis and an retrograde nail should be avoided or covered by a bridging-osteosynthesis. In clinical practice an extramedullary fixation technique for distal femoral fractures should be preferred.

Three kinds of internal fixations for treatment of complex tibial plateau fractures: a comparative biomechanical study

Objective To evaluate the biomechanism of three kinds of internal fixations in treatment of complex tibial plateau fractures. Methods Eighteen human antiseptic cadaver tibial plateau specimens were used to make models of complex tibial plateau fracture (type Ⅵ fractures of Schatzker classification). The models were fixated with a lateral Golf-buttress plate (GP), modified dual plate (a lateral Golf-buttress plate plus a medial five-hole one-third tubular antiglide plate) (DP) or a lateral locking compression plate (LCP) respectively to compare strength, rigidity and stability of different fixation methods. Results The biomechanical strength, rigidity and stability in DP group and LCP group were better than those in GP group (P 0.05). Conclusions Locking compression plate and modified dual plate are fairly ideal internal fixators for treatment of complex tibial plateau fractures. In the meantime, locking compression plate emphasizes conservation of soft tissues and blood supply, can better meet the requirement of the biological fixation of fracture and is the most ideal internal fixator at present. Key words: Tibial fractures; Fracture fixation; internal; Biomechanics