Limited Contact Dynamic Compression Plate Research Articles

OPerative versus non-opERAtive management of isolated ULNAr diaphyseal fractures (OPERA-Ulna): protocol for a randomized controlled trial.

Isolated fractures of the ulnar diaphysis are uncommon, occurring at a rate of 0.02 to 0.04 per 1,000 cases. Despite their infrequency, these fractures commonly give rise to complications, such as nonunion, limited forearm pronation and supination, restricted elbow range of motion, radioulnar synostosis, and prolonged pain. Treatment options for this injury remain a topic of debate, with limited research available and no consensus on the optimal approach. Therefore, this trial aims to compare clinical, radiological, and functional outcomes of two treatment methods: open reduction and internal fixation (ORIF) versus nonoperative treatment in patients with isolated ulnar diaphyseal fractures. This will be a multicentre, open-label, parallel randomized clinical trial (under National Clinical Trial number NCT01123447), accompanied by a parallel prospective cohort group for patients who meet the inclusion criteria, but decline randomization. Eligible patients will be randomized to one of the two treatment groups: 1) nonoperative treatment with closed reduction and below-elbow casting; or 2) surgical treatment with ORIF utilizing a limited contact dynamic compression plate and screw construct. The primary outcome measured will be the Disabilities of the Arm, Shoulder and Hand questionnaire score at 12 months post-injury. Additionally, functional outcomes will be assessed using the 36-Item Short Form Health Survey and pain visual analogue scale, allowing for a comparison of outcomes between groups. Secondary outcome measures will encompass clinical outcomes such as range of motion and grip strength, radiological parameters including time to union, as well as economic outcomes assessed from enrolment to 12 months post-injury. This trial has been approved by the lead site Conjoint Health Research Ethics Board (CHREB; REB14-2004) and local ethics boards at each participating site. Findings from the trial will be disseminated through presentations at regional, national, and international scientific conferences and public forums. The primary results and secondary findings will be submitted for peer-reviewed publication.

Finite element analysis of the stability of retrograde intramedullary nail and plate-screw combinations for periprosthetic femoral fractures following total knee replacement.

Periprosthetic fractures following total knee replacement are rare but challenging. The goal of the treatment is to achieve the most stable fixation that allows early mobilization. Therefore, the aim of this study was to evaluate the biomechanical results of the use of different fixation systems in the treatment of distal femur periprosthetic fractures with finite element analysis. A total knee prosthesis was implanted in Sawbone femur models. A transverse fracture line was created in the supracondylar region and was fixed in four different groups. In group 1, fracture line fixation was fixed using retrograde intramedullary nailing. In group 2, fixation was applied using a lateral anatomic distal femoral. In group 3, in addition to the fixation made in group 1, a lateral anatomic distal femoral plate was used. In group 4, in addition to the fixation made in group 2, a 3.5 mm Limited Contact Dynamic Compression Plate (LC-DCP) was applied medially. Computed Tomography (CT) scans were taken of the created models and were converted to three-dimensional models. Axial and rotational loading forces were applied to all the created models. The least deformation with axial loading was observed in the double plate group. Group 3 was determined to be more advantageous against rotational forces. The greatest movement in the fracture line was found in group 2. The application of the medial plate was determined to reduce the tension on the lateral plate and increase stability in the fracture line. Combining a lateral anatomic plate with intramedullary nailing or a medial plate was seen to be biomechanically more advantageous than using a lateral plate or intramedullary nailing alone in the treatment of distal femoral periprosthetic fractures.

A Comparison of Anteromedial Plating Versus Anterolateral Plating for Humerus Shaft Fractures Using the Anterolateral Approach.

Background Plate osteosynthesis is the gold standard treatment for the management of humeral shaft fractures. In the present study, we performed plate osteosynthesis on the anteromedial and anterolateral surfaces using the anterolateral approach to compare the functional outcomes. Aims and objectives To study and compare the functional outcome, time to achieve union and associated complications of anteromedial and anterolateral plating in humerus shaft fracture by anterolateral approach. Methods This prospective, randomised control study was performed at Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India.This study had 46 patients in total, who were divided into two equal groups at random. All of the fractures in group A were treated using a limited contact dynamic compression plate (LCDCP) on the anterolateral surface using an anterolateral approach, while all of the fractures in group B were corrected using an anteromedial surface using an anterolateral approach using LCDCP. All the patients were followed for six months at regular intervals. At each follow-up, patients were assessed radiologically with X-rays and clinically by Rodriguez-Merchan criteria (RM criteria). Results and conclusions The union was achieved in the majority of the cases of the anteromedial plating group within 12 weeks (78.3%) with a mean union time of 11.7±1.5 weeks than the anterolateral group (56.5%) with a mean union time of 12.3±1.8 weeks. Based on functional assessment according to RM criteria, the excellent outcome was achieved in 69.6% and 65.2% of the anterolateral and anteromedial plating groups, respectively.There was no case of non-union and radial nerve palsy in anteromedial plating cases whereas in anterolateral cases one patient did not achieve union and two (8.7%) had radial nerve injury, which recovered completely by the end of the study.An anterolateral approach with anteromedial surface plating on the flat medial aspect of the humerus is a good technique for fixing humeral fractures.

Biomechanical comparison of composite and cadaveric humeri models in experiments on operated humeral shaft fractures

A study was undertaken to determine how well contacting fracture fragments of composite bone replicated the behavior of fracture fragments in real bone. Ten composite and ten real humeral diaphyses were transected and reconstructed with limited-contact dynamic-compression plates. Two screws were placed on each side of the transection site and a calibrated electronic sensor sheet was placed between the imitated fracture fragments. After insertion of the distal screws, pressure measurements were made during insertion of the first proximal screw in compression mode, during insertion of the second screw in compression mode after loosening the first screw, and finally after retightening the first screw. The process was repeated after bending the plate. The contact area, the net compression force and the average compressive stress were computed and statistically compared. The composite bone and cadaveric bone differed in contact area and compressive stress but not in net compressive force. Plate bending did not produce a significant difference between composite and cadaveric bone. The results indicate that composite bone does not reproduce all the local fracture fragment conditions so that hardware testing in composite bone should proceed carefully. A gap between fracture fragments as is often used in comminuted fracture tests may remain as the most appropriate situation for fracture hardware testing.

An assessment of the fixin tplo jig to generate effective compression using a transverse fracture model.

The objective of this study was to determine compressive loads that could be generated using a tibial plateau leveling osteotomy (TPLO) jig with a tensioned strand of 18-gauge stainless steel orthopedic wire in a simulated transverse fracture model. The wire was sequentially tensioned using heavy needle holders or an AO wire tightener. Recorded loads were subsequently compared to loads generated by applying a 3.5 mm limited contact-dynamic compression plate (LC-DCP) as a compression plate. Two segments of 2 cm diameter Delrin rod were placed in a testing apparatus and used to simulate a transverse fracture. A load cell was interposed between the two segments to measure the compressive loads generated during the application of the TPLO jig or the LC-DCP. Compression was generated by sequential tensioning a strand of 18-gauge wire secured through the base of the arms of the TPLO jig or by placing one or two load screws in the LC-DCP. Wires were tensioned using heavy needle holders or an AO wire tightener. Eight replicates of each construct were tested. Recorded loads were compared using a one-way repeated measures ANOVA and Tukey Honestly Significant Difference test. The wire being tensioned broke while attempting a second quarter rotation of the needle holders and when the crank handle of the AO wire tightener was advanced beyond two rotations. The mean + SD peak compressive loads recorded when tensioning the wire using the heavy needle holders and AO wire tightener was 148 ± 7 N and 217 ± 16 N, respectfully. The mean ± SD load recorded after placement of the first and second load screw in the LC-DCP was 131 ± 39 N and 296 ± 49 N, respectively. The compression generated by placing two load screws in the LC-DCP was superior to the compression generated using the jig. The maximum load recorded by tensioning the wire secured through the TPLO jig using the AO wire tightener was superior to the compression generated by placing a single load screw and tensioning the wire using needle holders. Our results demonstrate that the TPLO jig allows surgeons to compress transverse fractures or osteotomies effectively. Tensioning the AO wire tightener allows for sequential tensioning and generates superior compressive loads than tensioning wires with heavy needle holders.

Open Reduction of Pediatric Femur Fracture: A Technical Trick

Open Reduction of Pediatric Femur Fracture: A Technical Trick

Comparison of ulnar shortening osteotomy for idiopathic ulnar impaction syndrome using conventional or ulnar osteotomy plates and with or without interfragmentary screw fixation

Purpose This study investigated the impact of plate type on the clinical and radiological outcomes of ulnar shortening osteotomy (USO) by comparing conventional and ulnar osteotomy plates. The effect of interfragmentary screw fixation (ISF) during USO was also assessed.Methods Seventy-eight patients were divided into three groups according to the type of plate: 3.5-mm dynamic compression plate (DCP), 3.5-mm limited contact DCP, and 2.7-mm locking compression plate ulna osteotomy system (all from Depuy-Synthes). The patients were also divided into two groups according to whether ISF was performed. Clinical and radiological outcomes, including time to bone union, presence of delayed union, and refracture after hardware removal, were analyzed. Other factors that might affect bone union, such as smoking and underlying diseases, were also evaluated.Results No significant differences were found in clinical and radiological outcomes according to the type of plate. Eight of 51 patients (15.7%) in the without-ISF group showed delayed bone union. Forty-three patients in the without-ISF group underwent hardware removal, and refracture due to low-energy trauma after hardware removal was observed in five of those 43 patients (11.6%). Bone union time was significantly shorter in the with-ISF group (7.6±2.7 weeks vs. 9.8±6.6 weeks). Diabetes mellitus and ISF were associated with the delayed bone union.Conclusion The plate type had no influence on the clinical and radiological outcomes of USO in patients with idiopathic ulnar impaction syndrome. However, ISF during USO has several advantages, such as early bony union and prevention of refracture after hardware removal.

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

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

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

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

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

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

Evaluation of the results of anterior minimally invasive plate osteosynthesis in treating humeral shaft fractures

Background The advantages of minimally invasive plate osteosynthesis (MIPO) are less soft tissue dissection and less blood loss with excellent results. This study aims to assess the outcomes of MIPO in treating humeral shaft fractures. Patients and methods Anterior MIPO was performed on 30 patients from March 2017 to January 2019. The inclusion criteria for this prospective study included a fracture located at the middle third of the humeral shaft, a fracture with polytrauma, and fractures with early conservative treatment failure. Type A fracture was the most common according to the AO-OTA classification (13 cases), followed by type B (11 cases) and type C (six cases). The space between biceps and brachialis was identified, and a locking compression plate or limited contact dynamic compression plate was used. The minimum follow-up period was 1 year. The outcome measurements included fracture union, alignment, infection, range of motion, functional assessment as per the University of California at Los Angeles shoulder score, and elbow function as evaluated using the Mayo elbow performance index. Results The mean operation time was 90.30 min (range, 80–180 min), and mean radiation exposure was 204 s (range, 110—420 s). All fractures united. The mean fracture union time was 15.3 weeks (range, 10–18 weeks). There was no incidence of implant failures. The mean University of California at Los Angeles end-result score was 34 points (range, 32–35). The mean Mayo elbow performance index was 98 points (range, 90–100). The mean range of motion was 135° (range, 100–140°). The functional outcome was satisfactory. Conclusion MIPO is an excellent method for treating humeral shaft fractures. It might decrease the perioperative complications with a reduced operation time.

A Novel Case of Neglected Monteggia Fracture Dislocation

&#x0D; &#x0D; &#x0D; &#x0D; Background: The Monteggia fracture-dislocation is a rare condition among children, and its treatment is still controversial. The treatment can become quite complicated when the diagnosis is delayed. There is a broad range of surgical treatments with various complications like subluxations, degenerative changes, and radial head deformity. The present case was reported as a novel surgical treatment choice for neglected Monteggia fracture-dislocation.&#x0D; Case Report: A 16 year-old boy presented with left elbow severe range of motion (ROM) limitation and pain who was diagnosed with neglected Monteggia fracture-dislocation. The patient went through open reduction beside internal fixation of the ulnar shaft via Limited Contact Dynamic Compression Plate (LC-DCP) and radio-capitellar joint reduction and provisional fixation by a pin. The patient recovered after three months with a significant increase in elbow ROM without any complications.&#x0D; Conclusion: This method could be an appropriate treatment of choice for neglected Monteggia fractures which indeed had excellent outcomes without complication.&#x0D; &#x0D; &#x0D; &#x0D;

Bending properties of additively manufactured commercially pure titanium (CPTi) limited contact dynamic compression plate (LC-DCP) constructs: Effect of surface treatment

Additive manufacturing of metallic materials, a layer-wise manufacturing method, is currently gaining attention in the biomedical industry because of its capability to fabricate complex geometries including customized parts fitting to patient requirements. However, one of the major challenges hindering the full implementation of additively manufactured parts in safety-critical applications is their poor mechanical performance under cyclic loading. This study investigated both quasi-static bending properties (bending stiffness, bending structural stiffness, and bending strength) and bending fatigue properties of additively manufactured (AM) commercially pure titanium (CPTi) limited contact dynamic compression plate (LC-DCP) constructs based on ASTM International standard for metallic bone plates (ASTM F382). In addition, the effect of post surface treatment methods including single shot-peened (SP), dual shot-peened (DP), and chemically assisted surface enhancement (CASE) on bending fatigue performance was also evaluated. Results indicated that bending stiffness and bending structural stiffness of AM CPTi LC-DCPs are comparable to conventionally manufactured (CM) counterparts; however, the bending strength of AM CPTi LC-DCPs is lower than CM counterparts. While the fatigue strength of as-built AM CPTi LC-DCPs is lower compared to the CM counterparts, AM CPTi LC-DCPs after post surface treatments (SP, DP, and CASE) exhibit statistically comparable fatigue strength to the CM CPTi LC-DCPs.

Comparison of forces generated using compression plating versus a magnetic lengthening nail in a sawbones femur model

BackgroundThe purpose of this study is to compare compression generated by a Precice magnetic lengthening intramedullary nail and a 5.0 mm limited contact dynamic compression plate. MethodsTransverse osteotomy sites were created in the femoral shaft of ten Sawbones fourth generation composite femurs. Antegrade 10-degree trochanteric Precice nails and 8-hole, 5.0 mm plates were used for fixation. The plates were compressed by placing a neutral screw and three eccentrically drilled compression screws on alternating sides of the osteotomy. Average compression and distribution of compression were compared, and P-values <0.05 were considered statistically significant. FindingsThe Precice nail generated an average of 2.38 megapascal across the osteotomy sites. The plate generated an average of 0.70 megapascal (P < 0.001) with the initial compression screw, 0.93 megapascal (P < 0.001) after the second screw, and 1.04 megapascal (p < 0.001) after the final screw. The distribution of compression was assessed utilizing a polar transformation to compare pressure values. We found that the distribution of compression was more circumferentially uniform in the Precice nail group (P = 0.046). InterpretationThis study demonstrates that an electromagnetic intramedullary device is capable of generating significantly higher compression, in a more uniform distribution, than a 5.0 mm limited contact dynamic compression plate in a Sawbones model. The results indicate that electromagnetic intramedullary nail systems may be an ideal alternative to compression plating for treatment of at-risk fractures, nonunions, delayed unions, and intercalary allograft reconstruction.

“Comparing Locking Compression Plate with Limited Contact Dynamic Compression Plate for the Treatment of Adult Diaphyseal both Bone Forearm Fractures”

Introduction: The human forearm serves an important role in upper extremity function, facilitating placement of the hand in space, thus helping to provide the upper extremity with its unique mobility Fractures involving the bones of forearm present unique problem not encountered with fractures of other long bones. Objective: To evaluate and compare the outcomes of locking compression plate (LCP) with limited contact dynamic compression plate (LC-DCP) for the treatment of adult diaphyseal both bone forearm fractures. Material and Methods: This study conducted in the Department of orthopedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to December 2020 included 20 patients with 40 fractures in each group. Patients were selected randomly to receive either LCP (20 patients, 40 fractures) or LC-DCP (20 patients, 40 fractures). Operative time, callus formation, functional outcome and complications were recorded. Results: Mean operative time did not differ significantly in the LCP and LC-DCP group (71.25 and 75.70 minutes respectively) .There was some difference in callus formation and mean time to bone union between the two groups which was significant. However, overall functional outcome did not differ significantly between both the groups. One case had delayed union in the (LC-DCP) group while one patient in each group developed superficial infection. Conclusion: In this prospective study comparing LCP with LC-DCP, the outcomes were equal in terms of final functional outcomes and mean operating time but LCP showed slight advantage in terms of callus formation and mean time to bone union.

Repair of Fractures of the Lateral Aspect of the Humeral Condyle in Skeletally Mature Dogs with Locking and Non-Locking Plates

The aim of this study was to report the functional outcome and complications following transcondylar screw and epicondylar plate fixation of skeletally mature dogs with fractures of the lateral aspect of the humeral condyle using a string of pearls, limited contact dynamic compression plate (LC-DCP) or locking compression plate (LCP). This study was a retrospective review of clinical records, radiographic images and canine brief pain inventory evaluation with a supplementary non-validated questionnaire. Thirty-one fractures in 29 dogs were included. The majority of dogs were Spaniels (23/29). Thirty fractures had evidence of humeral intracondylar fissure. Sixteen fractures had string of pearls, eight LCP and seven LC-DCP. There were two minor complications and three major complications. Perioperative (median: 6 weeks, range: 6-12) outcome was considered fully functional for 24 fractures and acceptable for 6 fractures. One dog had an unacceptable outcome due to the failure of an LCP that healed following revision surgery. Fractures with radiographic follow-up had a persistent visible intracondylar fracture line in 20/26. Twenty-six of twenty-seven owners perceived an excellent outcome (median: 135 weeks, range: 25-246). Repair of fractures of the lateral aspect of the humeral condyle with a transcondylar screw and epicondylar plate has a good perioperative, mid- and long-term outcome with 10% major complication rate, despite incomplete or non-union of the intracondylar fracture in 20/26 elbows.

A Case Series: Non-vascularized Autologous Fibular Graft in the Treatment of Major Segmental Bone Defect after Post-traumatic at Diaphyseal Femur

BACKGROUND&#x0D; In the management of bony defects, autologous bone grafts can be used as the mechanical structure for reconstruction to restore aesthetics and function, Non-vascularized autologus fibular graft are often used to the treat large post traumatic defects caused by high-energy trauma with open fracture and nonunion cases for 1st and 2nd cases. Here we would like to present a 16-year-old woman and a 37-year-old man patients of major bone defect at the right femoral shaft region using 9 cm and 10 cm non-vascularized fibular autogenous grafts.&#x0D; &#x0D; OBJECTIVE&#x0D; The purpose of this case report was to determine the effectiveness of non-vascularized autologus fibular graft for major bone defect at the regio femoral shaft for the reconstruction of post traumatic case.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; We treat post traumatic of the major bone defect at the regio femoral shaft with 9 cm and 10 cm femoral non-vascularized autologus fibular graft and fixed by a limited contact dynamic compression plate and femoral locking plate methode by routine phisioteraphy.&#x0D; &#x0D; RESULTS&#x0D; The Patient have a good result with good functional outcome after open reduction internal fixation (ORIF) and using a non-vascularized autologus fibular graft for treating the major bone defect after post traumatic femoral shaft fracture.&#x0D; &#x0D; CONCLUSION&#x0D; Complete and comperhensive open reduction internal fixation (ORIF) with autologous non- vascularized fibular graft, stabilized fracture by limited contact dynamic compression plate for 1st patient and femoral locking plate for 2nd patient allowing with an early rehabilitation is an acceptable, Phisioteraphy and early mobilisation resulting better outcome for the patient, all of this are less expensive, can be accepted at the hospitals that limited facilities and health professionals for professional subspeciality and widely reproducible option to manage bone defects in open shaft femoral fractures to achieving union, preserving length and motion with no donor site morbidity, giving patients good functional outcome and radiologic result.&#x0D; &#x0D; KEYWORDS&#x0D; Major bone defect, non-vascularized autologus fibular graft, autologous bone grafts, femoral shaft fracture, Open Fracture, Muskuloskeletal Reconstruction, Bone Loss, Nonunion.

“Comparing Locking Compression Plate with Limited Contact Dynamic Compression Plate For the Treatment of Adult Diaphyseal Both Bone Forearm Fractures”

Introduction: The human forearm serves an important role in upper extremity function, facilitating placement of the hand in space, thus helping to provide the upper extremity with its unique mobility Fractures involving the bones of forearm present unique problem not encountered with fractures of other long bones.&#x0D; Objective: To evaluate and compare the outcomes of locking compression plate (LCP) with limited contact dynamic compression plate (LC-DCP) for the treatment of adult diaphyseal both bone forearm fractures.&#x0D; Material and Methods: This study conducted in the Department of orthopedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to December 2020 included 20 patients with 40 fractures in each group. Patients were selected randomly to receive either LCP (20 patients, 40 fractures) or LC-DCP (20 patients, 40 fractures). Operative time, callus formation, functional outcome and complications were recorded.&#x0D; Results: Mean operative time did not differ significantly in the LCP and LC-DCP group (71.25 and 75.70 minutes respectively) .There was some difference in callus formation and mean time to bone union between the two groups which was significant. However, overall functional outcome did not differ significantly between both the groups. One case had delayed union in the (LC-DCP) group while one patient in each group developed superficial infection.&#x0D; Conclusion: In this prospective study comparing LCP with LC-DCP, the outcomes were equal in terms of final functional outcomes and mean operating time but LCP showed slight advantage in terms of callus formation and mean time to bone union.

An experimental study on stress-shielding effects of locked compression plates in fixing intact dog femur

BackgroundIn orthopedic application, stress-shielding effects of implant materials cause bone loss, which often induces porosis, delayed bone healing, and other complications. We aimed to compare the stress-shielding effects of locked compression plate (LCP) and limited-contact dynamic compression plate (LC-DCP) in dogs with plate-fixed femurs.MethodsBilateral intact femurs of 24 adult dogs were fixed by adult forearm 9-hole titanium plates using minimally invasive plate osteosynthesis (MIPPO) technology, with LCP on the left and LC-DCP on the right femurs. Dogs were sacrificed at 6 weeks, 12 weeks, and 24 weeks after surgery, and bone specimens were used to evaluate the efficacies of different fixing methods on bones through X-ray, dual-energy X-ray absorptiometry (DEXA), histology, MicroCT, and biomechanics analyses.ResultsX-ray results showed significant callus formation and periosteal reaction in the LC-DCP group. Bone cell morphology, degree of osteoporosis, and bone mineral density (BMD) changes of the LCP group were significantly better than that of the LC-DCP group. MicroCT results showed that the LCP group had significantly reduced degree of cortical bone osteoporosis than the LC-DCP group. Tissue mineral density (TMD) in the LCP group was higher than that in the LC-DCP group at different time points (6 weeks, 12 weeks, and 24 weeks). Biomechanics analyses demonstrated that the compressive strength and flexural strength of bones fixed by LCP were better than that by LC-DCP.ConclusionsStress-shielding effects of LCP are significantly weaker than that of LC-DCP, which is beneficial to new bone formation and fracture healing, and LCP can be widely used in clinic for fracture fixation.

A prospective study of surgical management of diaphyseal shaft fracture of bones of forearm in adults with limited contact dynamic compression plate

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 in the usual activities of daily living. The forearm serves an important role in upper extremity function. Decisive management is required after fractures of the shafts of the radius and ulna if function is to be restored. The Limited Contact Dynamic Compression Plate, was developed by Perren S. M. et to release the new concept of biological internal fixation. Grooves on the undersurface of the LC-DCP improved blood circulation. There is decreased damage to contact between plate and bone. It also allows for a small bone bridge beneath the plate at the most critical area, which is otherwise weak due to a stress concentration effect. This study is undertaken to assess the results of diaphyseal fractures of Bones of Forearm using LCDCP to study the advantages and its complications.Materials and Methods: Patients admitted to Cg Hospital and Bapuji Hospital between 2019 July to 2020 September were taken into the study after taking informed consent.Results: This study consists of 30 cases of fracture Both Bone Forearm Fractures. All cases were openly reduced and internally fixed with 3.5 mm LCDCP. Fracture was common in second and third decade. In our study, male preponderance was found with 73.3% males and 26.7% female patients. Side affected 24(80%) Left side and 6 patients (20%) right side. Mode of injury in the present study was RTA (33.3%) and fall (66.6%). An average time for union was around 5 months. Results were evaluated by Andersons scoring system. In present study, we had 24 patients (80%) with excellent results, 5 case (16.6%) as satisfactory and 1 case (2%) as unsatisfactory. No case needed refixation. In the present study there was 3 case (10%) of superficial infection, 1 case (3.3%) of Posterior Interosseous Nerve injury. Conclusion: LC-DCP can be considered the best mode of treatment for closed diaphyseal fractures of both bones forearm.