Locking Compression Plate Fixation Research Articles

Evaluation of functional outcome in patients treated with locking compression plate for distal femur fractures

Distal femur fractures are always a challenge to an orthopedic surgeon. They may be unstable and comminuted. Thin cortex, wide medullary canal, relative osteopenia and short distal segment adds to the complexity. The present study assessed the functional outcome of using locking compression plate fixation for fractures of distal end of femur in patients admitted to JMMC orthopedics department satisfying the inclusion and exclusion criteria from December 2017 to may 2019. Twenty cases were taken in this study. Serial follow up was done at 4, 8, 12, 24 weeks and functional outcome was assessed at the end of 24 weeks using NEERS criteria. 18 patients were treated with open reduction and internal fixation. 2 of the fractures were stabilized via MIPPO technique. No patients had implant failure and none of the cases were complicated by deep infection. 5 of the 20 patients had ‘Excellent’ Neers scores and 14 had ‘Good’ scores. Only one patient had ‘Fair’ score.
 Conclusion: Locking compression plate fixation is a safe procedure for supracondylar fractures of distal femur with good functional outcome.  It can be done on a routine basis with a minimum risk of complications.
  Keywords: Functional Outcome, LCP, Open Reduction Internal Fixation, Prospective Study, Supracondylar Fracture.

Biomechanical analysis of combi-hole locking compression plate during fracture healing: A numerical study of screw configuration.

Locking compression plates (LCPs) have become a widely used option for treating femur bone fractures. However, the optimal screw configuration with combi-holes remains a subject of debate. The study aims to create a time-dependent finite element (FE) model to assess the impacts of different screw configurations on LCP fixation stiffness and healing efficiency across four healing stages during a complete fracture healing process. To simulate the healing process, we integrated a time-dependent callus formation mechanism into a FE model of the LCP with combi-holes. Three screw configuration parameters, namely working length, screw number, and screw position, were investigated. Increasing the working length negatively affected axial stiffness and healing efficiency (p < 0.001), while screw number or position had no significant impact (p > 0.01). The time-dependent model displayed a moderate correlation with the conventional time-independent model for axial stiffness and healing efficiency (ρ ≥ 0.733, p ≤ 0.025). The highest healing efficiency (95.2%) was observed in screw configuration C125 during the 4-8-week period. The results provide insights into managing fractures using LCPs with combi-holes over an extended duration. Under axial compressive loading conditions, the use of the C125 screw configuration can enhance callus formation during the 4-12-week period for transverse fractures. When employing the C12345 configuration, it becomes crucial to avoid overconstraint during the 4-8-week period.

Biomechanics and finite element analysis comparing posterior T-plates with LCP for fixation of posterolateral tibial plate fractures.

Objective: The treatment for posterolateral tibial plateau fractures (PTPF) have been subjects of controversy. We conducted a study to improve the fixation of PTPF through a lateral approach. Methods: We utilized 40 synthetic tibias and categorized the fracture models into five groups based on the locking compression plate (LCP) and T-distal radius plate (TPP) via various forms of fixation with screws through the posterolateral (PL) fracture fragments. I: Two-screw fixation using two locking screws (LPTL). Ⅱ: Two-screw fixation with both variable angle locking screws (LPTV). Ⅲ: One-screw fixation with one locking screw (LPOL). Ⅳ: One-screw fixation with one locking screw and two anteroposterior lag screws (LPOLTL). Ⅴ: a distal radius plate with three locking screws (TPP). Biomechanical tests were conducted to observe the axial compression displacement of the PL fracture fragments at force levels of 250N, 500N, and 750N, as well as to determine the failure load and the axial stiffness for each respective group. Results: Under a 750N load condition, the displacements within the five experimental groups exhibited the following trend: Ⅴ < Ⅱ < Ⅰ< Ⅳ < Ⅲ. However, there were no significant differences between Group V and Group II, Group I and Group IV (p > 0.05), and only Group Ⅲ demonstrated a displacement exceeding 3mm. The failure load and the axial stiffness exhibited the same trend. Conversely, statistical significance was identified among the remaining group compared with Group Ⅲ (p < 0.05). Regarding the finite element analysis, the maximum displacements for the five models under the load of 750N exhibited the following trend: Ⅴ < Ⅱ < Ⅰ< Ⅳ < Ⅲ. The following trends were observed in maximum von Mises stresses for these models under the load of 750N: Ⅴ < Ⅱ < Ⅳ< Ⅰ < Ⅲ. Conclusion: It is crucial to address the inadequate mechanical strength associated with single screw fixation of LCP for fixing PL fractures in a clinical setting. The biomechanical strength of two-screw fixation surpasses that of single-screw fixation. Introducing variable-angle screws can further enhance the fixation range. Furthermore, the addition of two lag screws threaded from anterior to posterior can compensate the mechanical stability, when PL fracture is fixed with single screw in clinic.

Evaluation of Intramedullary Olecranon Screw Fixation for Simple Olecranon Fractures: A Biomechanical Study

The purpose of this study was to biomechanically evaluate the stability of the 6.5 mm intramedullary (IM) olecranon screw compared to locking compression plate fixation for Orthopedic Trauma Association/AO Foundation (OTA/AO) 2U1B1 olecranon fractures under cyclic range of motion of the elbow. Twenty paired elbows were randomized to either IM olecranon screw or locking compression plate fixation of a simulated OTA/AO 2U1B1 fracture. Pullout strength was tested by increasing force applied to the triceps and proximal fragment. Fracture gap displacement was measured using differential variable reluctance transducers as the elbow was cycled through a 135° arc of motion using a servohydraulic testing system. Analysis of variance revealed significant interaction between group and load on fracture distraction after the 500th cycle in three settings: between the plate at 5-pound load and screw at 35-pound load, the screw at 5-pound load and screw at 35-pound load, and between the plate at 15-pound load and screw at 35-pound load. The difference in the rate of failure between plate (2 of 80 samples) and screw (4 of 80 samples) was not statistically significant. For OTA/AO 2U1B1 olecranon fractures, a single 6.5 mm IM olecranon screw demonstrated similar stability when compared to the locking compression plates throughout range of motion testing. From a biomechanical perspective, 6.5 mm IM screws and locking compression plates have similar ability to maintain fracture reduction following simulated elbow range of motion exercises in OTA/AO 2U1B1 fractures, giving surgeons another option in the management of these fractures.

The Efficiency of Locking Compression Plates versus Dynamic Compression Plates in the Treatment of Low Distal Fibula Fracture: A Randomized Clinical Trial

Background: Uncertainties remain as to which type of plate [locking compression plate (LCP) or dynamic compression plate (DCP)] is more efficient and cost-effective in fixing and stabilizing the fractures. We aimed to compare the clinical utility of the two types of plates including LCPs and 3.5-mm DCPs in the treatment of low distal fibula fracture (distal lateral malleolus fractures).&#x0D; Methods: This randomized single-blinded clinical trial was performed on 54 patients with distal fibula fractures who were candidates for surgical treatment using compression plate fixation. The patients were randomly assigned into two groups scheduled for treatment with fixation of LCPs or with 3.5-mm T-plates (DCPs). The patients were finally followed-up for two years to assess the clinical outcome of the procedures.&#x0D; Results: No difference was revealed between the two groups in the prevalence of postoperative infection, nonunion, wound dehiscence, skin reactions, and local surgical pain. The mean functional score [Olerud-Molander Ankle Score (OMAS)] in the DCP and LCP groups was 85.33 ± 4.92 and 84.85 ± 5.12, respectively, indicating no difference between the groups (P = 0.726).&#x0D; Conclusion: In the treatment of low distal fibula fractures, the use of LCPs and 3.5mm DCPs can similarly result in improving functional status with minimal postoperative complications. Due to the similarity of the consequences of using both plates and the fact that the DCP type is more cost-effective and available in remote and deprived areas, this type seems to be preferred.

Functional Outcomes of Varus Osteotomy with Locking Compression Plate Fixation in Legg-Calve-Perthes Disease

Purpose: Patients with Legg-Calve-Perthes disease are treated to preserve the roundness of the femoral head. Surgical treatment includes the proximal femur or acetabulum operations, however, remains controversial. Herein, we investigated the clinical findings and outcomes of varus osteotomy with locking compression plate fixation. Methods: We reviewed 19 children (20 hips) with Legg-Calve-Perthes disease who underwent varus osteotomy with locking compression plate fixation at our hospital. The time to re-ossification, Stulberg classification, and Harris hip score were recorded preoperatively and at the final follow-up. Results: We included 16 boys and two girls with unilateral hip involvement and one girl with bilateral hip disease. The mean age at the time of surgery was 7.9 years. Based on the Catterall classification, one, 10, and nine patients were classified as grades II, III, and IV, respectively. All patients were followed for 33 months. The mean time to re-ossification was 167 days. At final follow-up, based on the Stulberg classification, seven, nine, and four patients were categorized as class II, III, and IV, respectively. Based on the Harris hip score, 21.1%, 47.7%, and 31.6% of patients showed excellent, good, and fair functional outcomes, respectively. The Harris hip scores at the final follow-up were significantly improved compared to preoperative values. Following adjustment for sex and disease severity, age at disease onset and time of surgery were associated with Harris hip scores. Conclusions: Varus osteotomy with locking compression plate fixation yields good results and significantly improves functional outcomes, although patient age affects the outcomes.  

Plating for Intra-articular Fractures of the Distal Femur: Functional and Radiological Outcomes.

Background and objective Intra-articular fractures of the distal femur pose a significant surgical difficulty. These fractures are challenging to repair, and surgery is frequently advised for a successful outcome. The distal femoral fractures make up between 4-6% of all femoral fractures and account for less than 1% of all fractures. When compared to the single screw's axial stiffness or pullout resistance, as is the case with unlocked plates, the locking compression plate (LCP) is a single beam construct whose strength of fixation is equal to the sum of all screw-bone contacts. Against this backdrop, the current study was conducted for evaluating the functional outcomes of distal femoral fractures treated with LCP fixation. Methodology We conducted an observational study at a tertiary care facility in Kolar spanning a period of three years, from January 2019 to January 2022. We included all patients aged more than 18 years, who were diagnosed with distal femoral fractures [only those classified as type C according to theAOFoundation/Orthopedic Trauma Association (AO/OTA) classification]. Patients with terminal illnesses, revision of previous surgery, fractures with neurovascular injuries, and those diagnosed with pathological fractures were excluded from the study. The included patients were treated by LCP and discharged on postoperative day 10 after suture removal. The first follow-up was at the first month and subsequent follow-ups were done at threeand six months, and the functional outcomes were assessed by using Neer's score for straight leg raises. Radiographs with fading fracture lines and callus formation onthree-fourthsof the cortices were regarded as indicators of fracture healing. Results Among the 30 study participants,80% were males. The mean time for the radiological union was 15 weeks. In this study, there were no instances of infection or angular deformity greater than 5 degrees. About 80% of the study participants had ranges of motion (ROM) above 120 degrees at the end of the six-month follow-up period; 12 cases had an excellent score (40%), 15 cases (50%) had a satisfactory score, two cases (6.7%) had an unsatisfactory score, and only one case had poor score. Common complications observed were excessive bleeding, difficulty in reduction, superficial infections, and knee stiffness. Conclusion For patients with distal femoral fractures, the LCP treatment can result in good functional and radiological outcomes with fewer complications.

Locking Compression Plate Fixation of Feline Acetabular Fractures: Application, Complications and Perioperative Outcome.

The aim of this study was to report the use, complications and perioperative outcome of locking compression plates (LCP) for acetabular fracture fixation in feline patients. Medical records were reviewed for cats presented with acetabular fractures between 2011 and 2019. Only cases that involved open reduction and internal fixation with at least one LCP and had a minimum of 5-week postoperative follow-up were included. Long-term follow-up was based on the Feline Musculoskeletal Pain Index. Fifteen cats with 15 acetabular fractures met the inclusion criteria. Locking compression plates were used as a sole method of fixation in 11/15 cases, while with other ancillary implants in 4/15 cases. There were two minor complications related to the LCP consisting of a single screw backing out. Two major perioperative complications not related to the locking implants were described and required further surgical treatment. At the last clinical follow-up (median 46 days: 38-88 days), function was described as full for 7/15 cats, and acceptable for 8/15 cats. The Feline Musculoskeletal Pain Index questionnaire was completed by 9/15 owners at a median of 2,332 days; all owners reported their cats had minimal impairment. Based on our results, LCP is a suitable implant for acetabular fracture fixation in cats, associated with a satisfactory outcome. Complications were similar to previously reported with other methods.

Repair of a Comminuted Femur Fracture in a Komodo Dragon (Varanus komodoensis) Using a Double Plating Technique

This report describes double locking compression plate fixation of a moderately comminuted mid-diaphyseal right femur fracture in a Komodo dragon (Varanus komodoensis). The animal was restrained for a routine examination, during which the dragon struggled to escape restraint. When returned to the exhibit, the dragon did not use the right pelvic limb to walk. A right-sided, closed, mid-diaphyseal comminuted (type C3) femur fracture was diagnosed using palpation and radiographs, and the animal was transported to a specialty clinic within a few hours for fracture repair. Two locking compression plates (LCPs) were applied in bridging fashion for fracture repair. Radiographs performed at the four-month post-operative recheck revealed a healed fracture with significant callus formation and stable implants. The dragon was transitioned from cage rest in a restricted space to his normal large exhibit after healing was confirmed, no lameness was observed, and normal limb use was noted. After almost three years, he is still ambulating normally and without lameness. This is the first report of successful femur fracture stabilization using bone plate fixation in a Komodo dragon.

Evaluation of locking compression plate fixation of the distal phalanx to the hoof wall as a potential therapy for laminitis.

Surgical stabilisation of the distal phalanx (DP) is a potential therapeutic strategy for severe acute laminitis. To evaluate the effects of locking compression plate (LCP) fixation of the DP to the dorsal hoof wall. Ex vivo and in vivo experiments. A T-shaped LCP was applied to one limb per pair in six pairs of cadaver forelimbs subjected to a combination of thermally induced lamellar failure and vertical load to simulate severe acute laminitis. Standard radiographic measurements were used to compare DP displacement. The LCP was then applied to one forefoot in 12 healthy Standardbred horses either standing (n=6) or under general anaesthesia (n=6). Lameness was evaluated daily, then horses were euthanised (day 8) and lamellar tissue analysed using light microscopy, histomorphometery and molecular markers of apoptosis. In the cadaver limb model, LCP fixation prevented the significant changes in hoof-distal phalanx distance, coronary extensor process distance and sole depth that characterised DP displacement in untreated limbs (p < 0.05). Application of the construct in vivo was well tolerated with minimal lameness (10/12 horses were sound at the trot on day 8); however, histology revealed dorsal lamellar pathology consistent with laminitis, but with extensive keratinocyte apoptosis. Adjacent to the LCP, caspase-3 positive cell counts were approximately 20-fold higher than control (p < 0.001). Pathology was evaluated at a single time point. Microvascular perfusion was not evaluated. Rigid fixation of the DP to the hoof capsule was achieved with the LCP construct in a cadaver limb laminitis model. In live horses, LCP fixation caused regional lamellar pathology with extensive apoptosis, likely due to disturbed lamellar microvascular perfusion and/or mechanostasis. Understanding these mechanisms is critical for refinement of the technique in order to avoid iatrogenic lamellar damage.

A novel bone graft technique combined with plating for aseptic recalcitrant long bone nonunion

BackgroundTo evaluate the outcomes and efficacy of a new technique of autogenous iliac crest bone grafting combined with locking compression plate (LCP) vertical fixation for aseptic recalcitrant long bone nonunion.MethodsFrom July 2010 to September 2020, 36 aseptic recalcitrant long bone nonunions were treated with a bone-forming channel technique and internal LCP fixation. All the patients had received one or more failed treatments. The injury mechanism, nonunion type and duration, and prior treatments were recorded pre-operation. The routine treatment process included nonunion area exposure, previous implant removal, sclerotic bone debridement, LCP fixation, bone-forming channel creation, and iliac bone grafting, and a second LCP fixation when required. At follow-up, X-ray images were obtained to assess bone healing and implant failure. Visual analog scale (VAS), fracture site stability, limb function, activity, muscle strength, limb length, and complications were recorded.ResultsA total of 34 patients (24 males and 10 females) were finally enrolled, with a mean age of 49.8 ± 12.3 years. At a mean follow-up of 35.6 ± 22.0 months, 32 patients displayed bone union, with a healing rate of 94.1% and mean union time of 6.8 ± 2.4 months. The VAS score was 0.7 ± 1 at the final follow-up. The functional results showed that 19 patients were excellent, 11 patients were good, 2 patients were poor, and 2 patients did not heal.ConclusionBone-forming channel technique combined with LCP vertical fixation is an excellent option to treat recalcitrant long bone nonunion.Level of evidenceTherapeutic Level IV.

Comparison of the Effects of Intramedullary Nailing and Plate Fixation on Lower-Extremity Deep Vein Thrombosis after Tibial Fractures.

Lower-extremity deep vein thrombosis (DVT) is prone to occur after internal fixation of tibial fractures. This study analyzed the effect of intramedullary nailing (IMN) and plate fixation (PF) on lower-extremity DVT, providing reliable reference and guidance for future clinical treatment of tibial fractures. Sixty-eight patients with tibial fractures admitted to Honghui Hospital, Xi'an Jiaotong University, between February 2019 and October 2020 were selected as research participants, of which 32 cases treated with open reduction and locking-compression plate fixation were assigned to the FP group and 36 cases treated with closed reduction and interlocking IMN were included in the FN group. The two groups were compared regarding the following items: clinical efficacy, operation, rehabilitation, joint function, pain, inflammatory factors (IFs), incidence of adverse reactions (ARs), blood loss, prognosis, and quality of life (QoL). The related factors affecting the occurrence of DVT were analyzed. The results identified no evident difference in the overall response rate between the two groups (P > 0.05). The FN group showed longer operation time, higher incidence of ARs, and better rehabilitation, while there were lower incision length, VAS score, and IF levels (P < 0.05). The results revealed no significant difference in estnimated blood volume(EBV) and the incidence of DVT between the two groups(P > 0.05); however, the total blood loss (TBL), hidden blood loss (HBL), and blood transfusion rates in FN group were higher while the visible blood loss (VBL) was lower compared to the FP group (P < 0.05). Logistic regression analysis identified that blood transfusion, VBL, HBL, TBL, and treatment methods were independent risk factors affecting the occurrence of lower-extremity DVT (P < 0.05). In addition, the prognostic QoL was better in the FN group (P < 0.05). Therefore, closed reduction and interlocking IMN are more effective than open reduction and locking-compression plate fixation in the treatment of tibial fractures, but patients are more likely to suffer from lower-extremity DVT. In the future, it is necessary to carefully choose the treatment method in the treatment of tibial fracture patients to ensure their rehabilitation.

Functional outcome of midshaft humerus fracture treated with minimally invasive anterior plate osteosynthesis

Introduction: Humeral shaft fractures make up approximately 1% of all fractures. Typically, they are the result of direct trauma. Though open reduction and plating technique of humerus shaft fracture is prevailing, Minimally invasive plate osteosynthesis technique also gives favorable outcome. This techniques are challenging and have the benefitof reducing soft- tissue damage.Materials and Methods: Twenty two patients with humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with locking compression plate fixation in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, and fracture union time were noted. The constant Murley score for shoulder and Mayo elbow performance score for elbow were used for assessing the shoulder and elbow function.Results: Of the twenty two patients in the study, 54.4% were males and 45.5% were females. The mean age was 45.8 years (range 21 to 85 years). 59.1% patients had the left side fractured. RTA was most common mode of injury. Mean surgical time in minutes was 71.36 mins. The mean fracture union time was 12.82 weeks. At the end of 1-year follow-up, mean constant score was 87.9 and mean Mayo score was 97. 20 patients had no post-op complications and 2 had delayed union.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique should be considered as an effective, cosmetically advanced surgical option. It is a safe and less time consuming method for simple types of humeral shaft fracture.

Functional outcome of distal tibia fracture fixation with locking compression plate (LCP) using MIPO technique in a tertiary care hospital in eastern India

Background: The precarious blood supply and the scarcity of soft tissue envelope and the proximity to ankle joint makes the treatment of distal tibia fractures challenging. Over the years multiple modalities ranging from conservative measures to surgical interventions have been marred by an array of complications. Minimally Invasive Plate Osteosynthesis minimises soft tissue compromise while maintaining vascular integrity of the fractured fragments and the preserves the osteogenic haematoma. While using locking compression plate allows uncomplicated fracture healing and early return to function by providing a rigid biomechanical construct. Methods: A total of 32 patients with distal tibial fractures treated by MIPO technique with LCP fixation were studied from August 2017 to May 2019 and were followed up at regular intervals for a period of 36 weeks. Result: All fractures united within a range of 14-24 weeks and the mean time of radiological union/ weight bearing was 16.72 weeks. Superficial skin infection was observed in two patients (5.5%) which settled down well with antibiotics and antiseptic dressing. Conclusion: MIPO technique using LCP offers an attractive option for the management of closed fractures of the distal tibia while preserving the blood supply of soft tissue and bone as compared to the other treatment options. This study recommends its usage in such complex injuries.

Dynamic Compression Plate versus Locking Compression Plate Fixation in Adult Forearm Fractures: A Prospective Interventional Study

Introduction: Injuries resulting from traffic accidents, industrial accidents, natural disasters, and assault are the cause of most fractures of the forearm and it is very important to regain the length, apposition, axial alignment, and rotational alignment of the radius and ulna while treating diaphyseal fractures to achieve a good range of motion. In such cases, open reduction and internal fixation are recommended. Aim: To determine the effectiveness of Locking Compression Plates (LCP) and Dynamic Compression Plates (DCP) in treating adult forearm fractures. Materials and Methods: A prospective interventional study was conducted from September 2020 to September 2021 in which 30 patients with both bone forearm fractures underwent open reduction and internal fixation with a Locking Compression Plate(n=15) or a Dynamic Compression Plate(n=15) at the Dr.D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India. For each LCP and DCP operated patient, radiographic findings regarding fracture union and functional outcomes regarding elbow joint range of motion was evaluated. Appropriate parametric tests (Chi-square test, Independent t-test) were conducted to identify significant differences in functional outcomes between the two interventions. Results: Out of total, 13 patients (86.7%) each who underwent both the DCP and LCP fixation had excellent outcomes, though the results were not significant according to Anderson LD et al., grading system. Although it was statistically insignificant (p-value= 0.18), patients who received LCP took less time to heal their fractures than those who received DCP. There was no significant difference between patients treated with DCP and those treated with LCP when it comes to achieving a complete range of motion (p-value=0.99). Conclusion: In terms of functional outcome, both the patient groups who were operated on with DCP as well as LCP had no significant difference. Proper preoperative planning, good patient care, proper surgical technique with minimal adjacent soft tissue damage, strict aseptic conditions, proper follow-up, and rehabilitation along with patient education are all required for good functional outcomes.

Nonunion of clavicle treated with precontoured locking compression plate fixation and bone grafting: A long-term outcome

Background: Plate fixation with bone grafting is the treatment of choice for nonunion of the clavicle and the use of precontoured locking compression plate (LCP) has been proposed to have an advantage of minimal hardware prominence and low rate of implant removal surgery. Materials and Methods: The retrospective analysis was performed to assess the long-term efficacy of precontoured LCP and bone grafting in nonunion of the clavicle. Fifteen patients who had undergone the surgery were assessed retrospectively in terms of clinical and radiological outcome for 4.1 years (range 2–7 years). The outcome was assessed using clinical and functional assessment by QuickDASH scoring and visual analog scale (VAS) system, radiological assessment in terms of union, time of return to previous activities, and any adverse results during the surgery or in the postoperative follow-up. Results: The radiological consolidation was achieved in all patients in a mean period of 18 weeks (range14–20 weeks). All patients returned to their previous activity level in a mean period of 5.9 months (range 2.5–9 months). There was a statistically significant improvement in QuickDASH and VAS scores (P < 0.05); however, one patient had symptomatic hardware prominence. Conclusion: The use of precontoured LCP in nonunion clavicle is a well-tolerated surgery giving promising results with most patients returning to previous activity level with the advantage of minimal hardware prominence and low rate of implant removal surgery.

RETROGRADE INTRAMEDULLARY SUPRACONDYLAR NAILING AND DISTAL FEMORAL LOCKING COMPRESSION PLATE IN THE MANAGEMENT OF DISTAL FEMUR FRACTURES – A COMPARATIVE STUDY

Objectives: The objective of the study is to assess the efficacy of retrograde intramedullary interlocking supracondylar nailing and distal femoral locking compression plate in the management of distal femur fractures. Methods: The present prospective study consists of a total of 36 cases with extra-articular supracondylar fractures of the femur between the age group of 21–70 years. Participants were randomly allocated to group 1 treated with distal femoral locking compression plate fixation and group 2 treated with retrograde intramedullary interlocking supracondylar nailing technique. Post-operatively, all the cases were followed up in regular intervals to assess the functional outcome using the American Knee Society score. Results: Road traffic accidents (80.56%) were the most common cause of injury. The average surgical duration (108 min and 90.14 min), duration of fracture union (12.48 weeks and 11.08 weeks), and blood loss (339.8 ml and 236.6 ml) was better in the nailing group than the plating group, respectively. The overall outcome was comparable between the two study groups. Conclusion: The supracondylar nailing technique has better functional outcomes in terms of less fracture union time, less operative duration, and minimal operative blood loss. Supracondylar nailing technique was effective and better in soft tissue damage control.

Comparing Single-locking and Double-locking Plate Fixation Methods in Patients With Proximal Tibial Fractures

Background: Proximal tibial fractures account for 1% of all fractures. Different treatments have been proposed for this fracture. Objectives: The present study aims to evaluate the clinical and radiological results of single-locking and double-locking plate fixation methods in patients with proximal tibial fractures. Methods: The present study was carried out on 40 patients with proximal tibial fractures referred to Imam Khomeini Hospital in Sari, Iran. They were divided into two groups of double-locking fixation with 3.5-mm Locking Compression Plate (LCP) and single-locking fixation with 4.5-mm LCP. They were followed up for at least 6 months after surgery. At the time of admission, they were assessed using Lysholm Knee Scoring Scale and Visual Analogue Scale. Radiographs were taken from all patients and the articular surface, and fracture healing,. Results: Of 40 patients, 17 and 23 were treated with 3.5-mm and 4.5-mm LCPs, respectively. The mean Lysholm score in the groups with 3.5-mm and 4.5-mm LCPs was 84±8.2 and 78.3±16.2, respectively. There was no statistically significant difference between the two groups (P&gt;0.5). Conclusion: The radiological and functional outcomes were almost the same for single-locking and double-locking plate fixation methods. Both methods can be used to treat the tibial plateau fracture. The treatment can be selected according to the surgeon and the patient’s request

Excellent clinical and radiological outcome following locking compression plate fixation of displaced medial clavicle fractures

BackgroundTreatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons. An increasing number of symptomatic non-unions following conservative treatment of displaced fractures led to the development of various surgical approaches. Aim of this study was to evaluate the clinical and radiological outcome following operative treatment of displaced medial end clavicle fractures.MethodsPatients who presented with a displaced fracture of the medial clavicle between September 2012 and December 2019 were retrospectively enrolled in this study. All patients were operatively treated with open reduction and internal fixation (ORIF) using an anatomically precontoured locking compression plate (LCP) originally designed for the lateral clavicle (Synthes®, Umkirch, Germany). Functional outcome was recorded using the American Shoulder and Elbow Surgeons (ASES) Score, the Munich Shoulder Questionnaire (MSQ), Shoulder Pain and Disability Index (SPADI) and Constant Score.ResultsOverall 18 patients with a mean age of 54.5 ± 23.5 years suffering from a displaced fracture of the medial clavicle were identified. The mean follow-up was 40.9 ± 26.2 months. The mean ASES accounted for 88.3 ± 20.8 points, the mean MSQ was 83.1 ± 21.7 points, the mean SPADI was 85.6 ± 22.5 and a mean normative age- and sex-specific Constant Score of 77.5 ± 19.1 points resulted. No minor or major complications were observed. Radiologic fracture consolidation was achieved in all patients after a mean of 6.4 months.ConclusionSurgical treatment of displaced medial clavicle fractures using an anatomically precontoured locking plate originally designed for the lateral clavicle led to very good to excellent clinical and functional results.Trial registrationNo: DRKS00024813, retrospectively registered 19.03.2021 (www.drks.de).

Lateral distal tibial locking compression plate fixation through single lateral incision technique is biologically superior and mechanically equivalent alternative to medial plate fixation for lower third tibia-fibula fractures

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; A number of surgical options for management of distal tibia fractures makes scenario confusing and available techniques are associated with complications. Recently lateral plating of tibia has shown good promise. To compare results between medial and lateral distal tibial locking compression plate for treatment of distal third tibia fractures&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective clinical study was carried out among 24 patients presenting with distal third tibia fractures. Patients were randomized into two groups of 12 each. One group was allocated into medial distal tibial LCP and second group was allocated into lateral distal tibial LCP. In first group, approach taken was medial or anteromedial while in second group, approach taken was lateral. Follow up was done for six months after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 10 cases in medical group and eight cases in lateral group which had fracture due to road traffic accidents. All cases in medical group had concomitant fibula fracture while such cases were 10 in lateral group. One case in each group developed infection after surgery. There was one case of superficial skin dehiscence and one case of hardware problem in medial group compared to none in lateral group. Two cases from medial group required removal of implant compared to none from medial group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Lateral distal tibial LCP seems to provide biological advantage than medial distal tibial LCP without difference in biomechanical properties of implants. Single lateral incision technique is an ingenious, biologically sound, and cosmetically superior for fixation of both lower third tibia &amp;amp; fibula fractures together.&lt;/p&gt;