Locking Compression Plate Group Research Articles

Clinical efficacy of internal fixation with locking compression plates in the treatment of patients with extremity fractures and the effect on the recovery of limb function.

The purpose of this study was to evaluate the clinical efficacy of internal fixation with locking compression plates (LCP) in the treatment of patients with extremity fractures and the effect on the recovery of limb function. A total of 488 patients with extremity fractures admitted to our hospital from June 2019 to December 2022 were retrospectively analyzed and divided into open reduction and internal fixation (ORIF) group (n = 236) and internal fixation with LCP group (n = 252) according to the surgical procedure. Outcome indicators included intraoperative bleeding, operative time, length of hospital stay, pain duration, quality of life, healing time of the fracture, postoperative complications, and restoration of limb function as per the X-ray examination results and Johner-Wruhs criteria. Self-rating Depression Scale and Self-rating Anxiety Scale were used to evaluate the changes of patients' negative emotions before and after treatment. LCP group was associated with significantly less intraoperative bleeding and shorter operative time, length of hospital stays, and pain duration compared with ORIF group (P < .05). Compared with ORIF group, LCP group provided more rapid fracture healing in tibial fractures, ulnar fractures, radial fractures, and external ankle fractures (P < .05). Compared with the ORIF group, patients in the LCP group showed better quality of life in terms of physical, psychological and social functions after surgery (P < .05). The incidence of postoperative complications in the LCP group was significantly lower than that in the ORIF group (19.92% vs 7.14%, P < .001). The Self-rating Depression Scale and Self-rating Anxiety Scale scores of the LCP group were lower than those of the ORIF group (P < .05). The recovery of limb function was significantly better in the LCP group than in the ORIF group (97.22% vs 85.17%, P < .001). The overall satisfaction rate of treatment in the LCP group was higher than that in the ORIF group (92.06% vs 81.90%, P < .001). Internal fixation with LCP in patients with extremity fractures can effectively promote the recovery of limb function, reduce the incidence of complications and improve the quality of life of patients.

New generation of superior single plating vs. low-profile dual minifragment plating in diaphyseal clavicle fractures: a biomechanical comparative study

Recently, a new generation of superior clavicle plates was developed featuring the variable angle locking technology for enhanced screw positioning and a less prominent and optimized plate-to-bone fit design. On the other hand, mini-fragment plates in dual plating mode have demonstrated promising clinical results. The aim of the current study was to compare the biomechanical competence of single superior plating using the new generation plate versus dual plating using low-profile mini-fragment plates. Sixteen paired human cadaveric clavicles were pairwise assigned to two groups for instrumentation with either a superior 2.7 mm Variable Angle Locking Compression Plate (Group 1), or with one 2.5 mm anterior combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture (AO/OTA 15.2C) was simulated by means of a 5mm osteotomy gap. Specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking. Initial construct stiffness was significantly higher in Group 2 (9.28 ± 4.40 N/mm) compared to Group 1 (3.68 ± 1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of axial and shear displacement, fracture gap opening and torsion, over the course of 12,500 cycles were significantly higher in Group 1 compared to Group 2, p≤0.038. Cycles to 2mm shear displacement were significantly lower in Group 1 (22792 ± 4346) compared to Group 2 (27437 ± 1877), p=0.047. From a biomechanical perspective, low-profile 2.5/2.0 dual plates can be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in less common unstable fracture configurations. 2.7 single superior variable angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in less common unstable fracture configurations.

Comparison of suprapatellar intramedullary nailing versus minimal invasive locked plating for proximal tibia fractures.

To compare the radiological alignment, union time, union rate, and complication rate between suprapatellar intramedullary nails and minimally invasive locking plate fixation in the treatment of proximal tibial fractures. We retrospectively analyzed 103 patients who underwent plate fixation (n = 50) or suprapatellar intramedullary nailing (n = 53) for proximal tibial fractures involving the meta-diaphyseal junction between November 2015 and October 2020 at our institution. The union rate, union time, radiologic alignments, and complications, such as malalignment, nonunion, and deep infection, were investigated. The demographic data did not differ between the plate and suprapatellar intramedullary nail groups. The alignment of the coronal plane was 0.24 ± 3.19 in the plate group and - 0.49 ± 2.22 in the intramedullary nail group (p = 0.196). Sagittal plane alignment was - 0.29 ± 4.97 in the plate group and 0.24 ± 4.12 in the intramedullary nail group (p = 0.571), and coronal malalignment (p = 0.196), sagittal malalignment (p = 0.57), deep infection (p = 0.264), nonunion (p = 0.695), union time (p = 0.329), and final union rate (p = 0.699) were not significantly different between groups. Compared with the minimally invasive locking compression plate group, the suprapatellar intramedullary nail group yielded comparable results in terms of radiological alignment and complications. Considering that proximal tibial fractures are associated with high-energy trauma and severe soft tissue damage, we believe that a suprapatellar intramedullary nail may be a good alternative. Level III.

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.

Comparison of locking compression plate and distal femoral replacement for periprosthetic distal femoral fractures: a retrospective study.

ObjectiveTo compare the clinical outcomes of locking compression plate (LCP) and distal femoral replacement (DFR) for periprosthetic distal femoral fractures (PDFFs) after total knee arthroplasty.MethodsThis retrospective study identified patients with PDFFs in an institutional database between January 2012 and December 2021. Demographic data and clinical outcomes, including postoperative complications, reoperation, 1-year mortality, Knee Society Scores (KSS) and Knee Society Functional Score (KSFS) were analysed.ResultsIn total, 12 patients treated with LCP and six patients treated with DFR were included. There was no significant difference between the LCP and DFR groups in terms of postoperative complications (25.0% versus 33.3%, respectively), reoperation (8.3% versus 0.0%), respectively, 1-year mortality (8.3% versus 16.7%, respectively) or mean ± SD KSS (80.3 ± 8.3 versus 78.0 ± 2.5, respectively). However, the mean ± SD KSFS was significantly better for patients with LCP than for those with DFR (51.8 ± 12.5 versus 37.0 ± 6.7, respectively).ConclusionDFR provides similar clinical outcomes compared with LCP for PDFFs. Patients with advanced age may benefit from DFR to allow early weight bearing.

What Is the Cost of Off-Axis Insertion of Locking Screws? A Biomechanical Comparison of a 3.5 mm Fixed-Angle and 3.5 mm Variable-Angle Stainless Steel Locking Plate Systems.

The aim of this study was to evaluate the effect of screw insertion angle and insertion torque on the mechanical properties of a 3.5 fixed-angle locking plate locking compression plate (LCP) and 3.5 variable-angle locking plate polyaxial locking system (PLS). In the LCP group, screws were placed abaxially at 0, 5 and 10 degrees. In the PLS group, screws were placed at 0, 5, 10, 15 and 20 degrees abaxially. The insertion torque was set to 1.5 and 2.5 Nm in the LCP and PLS groups respectively. A load was applied parallel to the screw axis, and the screw push-out force was measured until the locking mechanism was loosened. The 3.5 LCP showed higher push-out strength than the 3.5 PLS when the screws were placed at 0 degree regardless of the insertion torque. The off-axis insertion of 3.5 LCP locking screws resulted in a significant decrease in push-out strength (p < 0.05). A higher insertion torque value significantly increased the screw holding strength for the 3.5 LCP (p < 0.05). The 3.5 PLS system had a significantly higher push-out force when the screws are at 0 degree than at 5, 10 and 15 degrees, and 20 degrees (p < 0.05) at any given insertion torque. An increase in the insertion torque did not have a significant effect on the push-out strength of the 3.5 PLS locking system. The 3.5 PLS is more sensitive to the screw insertion angle than to the insertion torque, whereas the 3.5 LCP is affected by both factors. Placing 3.5 LCP locking screws off-axis significantly reduces the screw holding strength; therefore, this approach has to be avoided. The findings of our research indicate that a 1.5 Nm torque can be used for a 3.5 PLS.

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

Efficacy and Safety Evaluation of Intramedullary Nail and Locking Compression Plate in the Treatment of Humeral Shaft Fractures: A Systematic Review and Meta-analysis.

Objective The surgical treatment scheme of humeral shaft fracture is still controversial with no consensus reached. This meta-analysis was aimed at comparing the efficacy and safety of intramedullary nail (IMN) and locking compression plate (LCP) in the treatment of humeral shaft fractures. Methods PubMed, Medline, Embase, Ovid, Cochrane Library, ISI Web of Science, Clinical Trials, and Chinese databases, including China National Knowledge Infrastructure Project, Wanfang database, and China biomedical abstracts database, were used to search the literature. Review Manager software was employed for statistical analysis and establishing forest and funnel maps. Categorical variables were measured by relative risk (RR), and standardized mean difference (SMD) was used to measure continuous variables. 95% confidence intervals were used for each variable. The modified Jadad scale, Newcastle-Ottawa scale, and Cochrane's bias risk tools were used to evaluate the bias and risk of eligible studies. Results A total of 14 studies were included in the analysis with a total of 903 patients with humeral shaft fracture. Significant differences with regard to operation time (Std = −1.18, 95% CI: -2.14, -0.22, Z = 2.41, P = 0.02), blood loss (Std = −2.97, 95% CI: -4.32, -1.63, Z = 4.34, P < 0.001), and postoperative infection rate (RR = 0.32, 95% CI: -0.15, 0.68, Z = 2.98, P = 0.003) were noted between the IMN group and LCP group. In addition, the American Shoulder and Elbow Surgeon (ASES) score (Std = −0.22, 95% CI: -0.44, 0.01, Z = 2.08, P = 0.04) and the rate of shoulder and elbow function limitation (RR = 1.88, 95% CI: 1.06, 3.33, Z = 2.17, P = 0.03) between the 2 groups were also statistically significant. There were no significant differences in the rate of radial nerve injury, nonunion, delayed healing, and secondary operation between the two groups. Conclusion IMN is superior than the LCP in terms of the operation time, intraoperative bleeding, and postoperative infection, suggesting its superiority in the humeral shaft fracture fixation. However, IMN is inferior to LCP in ASES score and shoulder elbow function limitation rate, indicating poor early postoperative functional recovery. More studies are required to evaluate and analyze the clinical efficacy between IMN and LCP regarding long-term function after artificial graft removal.

Comparison of three different surgical treatment methods in humeral shaft fractures.

Introductionin this study, we aimed to compare the clinical and radiological results of single 4.5 mm locking compression plate (LCP), dual 3.5 mm LCP and intramedullary nailing (IMN) methods applied to the surgical treatment of humeral shaft fractures.Methodsthe study included 77 patients (41 males, 36 females; mean age 46.38 years; range 18-74 years) with humeral shaft fractures treated with a single 4.5 mm LCP, dual 3.5 mm LCP and IMN between January 2016 and December 2020. Single 4.5 mm LCP (Group A) was applied to 31 (40.3%) patients, dual 3.5 mm LCP (Group B) to 20 (26%) patients and IMN (Group C) to 26 (33.8%) patients. The preoperative and postoperative data of the patients were analyzed from the hospital registry system. A short version of the disabilities of the arm, shoulder and hand (QuickDASH) questionnaire was used to evaluate functional outcomes.Resultsas a result of the comparison of the rates of nonunion between the groups, a significantly lower rate of nonunion was observed in group B patients (p=0.027). While the rate of nonunion was 14% in the cases included in the study, no cases of nonunion were encountered in group B. There was no difference between the three groups in terms of demographic data and other postoperative complications.Conclusiondual 3.5 mm LCP method is a suitable alternative to other surgical methods in the treatment of humeral shaft fractures, due to similar functional results and lesser nonunion.

Efficacy of Hook-Type Locking Plate and Cancellous Screw in the Treatment of Displaced Medial Malleolar Fractures in Elderly Patients

Category:Trauma; AnkleIntroduction/Purpose:We aimed to compare the midterm radiologic and clinical results between hook-type LCP and conventional malleolar screws for elderly medial malleolar fractures. We hypothesized that elderly patients treated with the hook- type locking compression plate (LCP) would have better fracture healing and clinical outcomes than those treated with cancellous lag screws, with fewer postoperative complications.Methods:In total, 258 patients treated with a hook-type locking plate (hook LCP group: 121 patients) or partially threaded cancellous lag screws (screw group: 137 patients) over 65 years of age with at least 36 months' follow-up were included in this retrospective study. Radiographic assessments included the union rate and interval to fracture union. Clinical assessment was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Olerud and Molander score (OMAS), visual analog scale (VAS) pain score, and postoperative complications.Results:The comminuted fracture rate was higher in the hook LCP group than in the screw group (p < .001). The interval to fracture union was significantly shorter in the LCP group than in the screw group (10.2 +- 7.0 vs. 12.3 +- 6.7, p =.015). There were no significant differences between the two groups regarding AOFAS, OMAS, and VAS pain scores at the final follow- up. There was a trend toward a lower rate of complications, including revision procedures, in the hook LCP group than in the screw group (19.9% vs. 28.5%, p =.107 and 6.6% vs. 13.9%, p =.074). The overall cost in the hook LCP group was 5.8% lower than that of the screw group despite the higher cost of the hook-type LCP.Conclusion:Hook-type LCP may be an alternative option for treating medial malleolar fractures with comminution in elderly patients.

“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.

“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.

Efficacy of hook-type locking plate and partially threaded cancellous lag screw in the treatment of displaced medial malleolar fractures in elderly patients.

Traditionally, partially threaded cancellous lag screws (PTCS) are used for most medial malleolar fractures but are often challenging to execute in elderly patients because of the high risk of postoperative complications. Limited literature explores whether hook-type locking compression plates (LCPs) reliably offer better outcomes than PTCS in elderly patients. We aimed to compare the midterm radiologic and clinical outcomes between hook-type LCP and PTCS for medial malleolar fractures in an elderly population. We included 258 patients, aged 65years and above, treated with either a hook-type locking plate (hook LCP group: 121 patients) or PTCS (screw group: 137 patients), and with follow-ups of at least 36months in this retrospective study. Radiographic assessments included the union rate and interval to fracture union. Clinical assessment included the postoperative complications and revision procedures. Although a significantly higher rate of comminuted fractures was observed in the hook LCP group than in the screw group (p < .001), no significant difference in the union rate was observed between the two groups (hook LCP group: 93.4% vs. screw group: 89.8%, p = .151), and a significantly shorter interval to union was observed in the hook LCP group (10.2 ± 7.0 vs. 12.3 ± 6.7weeks, p = .015). There was a trend toward a lower rate of complications, including revision procedures, in the hook LCP group than in the screw group (19.9% vs. 28.5%, p = .107 and 6.6% vs. 13.8%, p = .074). Hook-type LCP may be an alternative option for treating medial malleolar fractures with comminution in elderly patients.

Comparison of the effect of interlocking intramedullary nail and internal fixation with locking compression plate in the treatment of tibial fracture

Objective To analyze and compare the effect of interlocking intramedullary nail and locking compression plate in the treatment of tibial fracture. Methods 56 patients with tibial fracture nonunion admitted to the Department of Orthopedics of our hospital from January 2019 to December 2020 were retrospectively analyzed, including 34 males and 22 females, aged from 15 to 65 years old, with an average age of 36 years old. According to different surgical methods, they were divided into interlocking intramedullary nail group (30 cases) and locking compression plate internal fixation group (26 cases). The therapeutic effect, surgical indexes and fracture healing time were compared between the two groups. Results The mean operation time of the interlocking intramedullary nail group was shorter than that of the locking compression plate group, and the amount of bleeding in interlocking intramedullary nail group was less than that of the locking compression plate group (P < 0.05). However, there was no significant difference in the mean healing time and curative effect between the two groups (P >0.05). Conclusion Both interlocking intramedullary nail and locking compression plate internal fixation are effective methods for the treatment of nonunion of tibial fractures, but the former can reduce the amount of bleeding and shorten the operation time.

Functional outcome of displaced middle third clavicular fractures treated by plate osteosynthesis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Clavicle fracture is a common traumatic injury around the shoulder girdle due to its subcutaneous position. Recent studies have shown a higher rate of nonunion and shoulder dysfunction in subgroups of patients with clavicle fractures. The purpose of the study was to prospectively analyse the functional outcome of mid-third displaced clavicular fractures treated by open reduction and internal fixation with plate osteosynthesis. To study the outcome of displaced middle-third clavicular fracture streated by plate osteosynthesis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective comparative on-randomized study was conducted in Government District Head Quarters Hospital Nagapattinam with a follow-up ranging from September 2018 to January 2019 5 months. Thirty-four cases of middle third displaced (Robinson type 2b1 and 2b2) clavicular fractures are treated with plate osteosynthesis. We used a reconstruction plate, a locking compression plate, and a 1/3&lt;sup&gt;rd&lt;/sup&gt; tubular plate for study.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean time to union was 9.5 weeks. At the latest follow-up, the entire patients returned to the pre-injury activity level. One case had a superficial infection which was treated with intravenous antibiotics. There is no difference between the reconstruction group and the locking compression plate group in terms of functional outcome and union rate. We also noticed that road traffic accident and direct injury to the shoulder causes Robinson type 2b2 fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Open reduction and rigid internal fixation of displaced midshaft clavicular fracture have resulted in a good fracture union rate and excellent functional outcome.&lt;/p&gt;

Evaluation of the Outcome of Different Surgical Techniques in the Treatment of Distal Femur Intra-articular Fractures: A Retrospective Study

Background: A preferred surgical approach to distal femur intra-articular fractures is still controversial. Objectives: In the current study, we assessed the outcome and complications of three different surgical techniques, including screw fixation, Retrograde Intramedullary Nailing (RIN), and Locking Compression Plate (LCP). Methods: A total of 63 patients with distal femur intra-articular fractures were included in this retrospective study. AO/OTA fracture and dislocation classification was used to categorize patients. Type B fractures were treated with screw fixation and type C fractures were treated using LCP and RIN. Outcome measures, including the knee range of motion (ROM) and pain level, were Results: The mean±SD age of patients was 36.7±15.7 years. The fracture types B and C were detected in 22 (32.4%) and 46 (67.6%) patients. The mean follow-up period was 27.2±15.9 months. Mild knee pain was the only complication of screw fixation that was observed in 21% of patients. LCP was associated with some complications, including pain (19.4%), infection (9.7%), limited ROM (47.4%), malunion (47.4%), and nonunion (6.5%). RIN was also associated with several complications, including pain (44.4%), infection (11.1%), limited ROM (33.3%), and malunion (41.2%). A comparison of the outcome in matched fracture types of LCP and RIN groups revealed no superiority of each technique. Conclusion: Screw fixation alone results in a satisfactory outcome in the treatment of type B distal femur intra-articular fractures. LCP and RIN are associated with a variety of complications with no superiority over each other.

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.

Clinical outcome and operative cost comparison: Locked compression plate versus reconstruction plate in midshaft clavicle fractures.

The aim of this study was to compare the clinical outcomes and operative cost of a locked compression plate (LCP) and a nonlocked reconstruction plate in the treatment of displaced midshaft clavicle fracture. From January 2013 till March 2018, a total of 55 patients with acute unilateral closed midshaft clavicle fracture were treated with either a 3.5-mm pre-contoured LCP [32 patients; 25 men and 7 women; mean age: 35 years (range: 19-63 years)] or a 3.5-mm nonlocked reconstruction plate [23 patients; 20 men and 3 women; mean age: 31.4 years (range: 17-61 years)]. The clinical outcomes in terms of fracture union, Quick Disability of Arm, Shoulder and Hand (DASH) score, implant irritation, failure rate, and reoperation rate were evaluated retrospectively. The patient billing records were reviewed to obtain primary operation, reoperation, and total operative cost for midshaft clavicle fracture. These values were analyzed and converted from Malaysia Ringgit (RM) to United States Dollar (USD) at the exchange rate of RM 1 to USD 0.24. All patients were followed up for at least one-year duration. The mean time to fracture union, implant irritation, implant failure, and reoperation rate showed no significant difference between the two groups of patients. The mean Quick DASH score was significantly better in the reconstruction plate group with 13 points compared with 28 points in the LCP group (p=0.003). In terms of total operative cost, the LCP group recorded a cost of USD 391 higher than the reconstruction plate group (p<0.001). The 3.5-mm reconstruction plate achieved not only satisfactory clinical outcomes but was also more cost-effective than the LCP in the treatment of displaced midshaft clavicle fractures. Level III, Therapeutic study.

Evaluation of Outcome of ORIF by DCP Vs LCP in Mid-Shaft Fractures of Radius – Ulna in A Secondary Level Hospital of Bangladesh

Purpose: To compare the result of mid-shaft fracture radius and ulna treated by small DCP and LCP.&#x0D; Methods: Prospective interventional study, done in the Department of Orthopaedic Surgery, 250 Bedded General Hospital, Tangail from January, 2017 to December, 2018. The study was carried out with sample size 30 patients of mid-shaft fracture of radius and ulna. Out of them 15 were treated by DCP and screws and 15 patients were treated by LCP and screws.&#x0D; Results: In this study mean age in group I was 32.63±9.42 and in group II was 37.54+7.12. Male patients were 17 and female were 13 in number. Motor vehicle accident was the commonest cause of fracture found in 60% in group-I and 73.33% in group-II. In group-I, out of 15 cases all cases (100%) united with mean time of 15.87 ± 3.89 weeks. In group-II, out of 15 cases all (100%) cases united with the mean time of 14.0 ± 2.27 weeks. There was no major complication in both groups. Regarding the final outcome, excellent results in group-I were achieved with 11 (73.33%) cases while in group-II with 12 (80.00%) cases. Satisfactory results were seen in 04 (26.67%) cases in group-I and 03 (20.00%) cases in group-II.&#x0D; Conclusion: On the statistical point of view there was no significant difference between dynamic compression plate group and locking compression plate group for the treatment of mid-shaft fracture radius and ulna.&#x0D; J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 106-109

A prospective comparative study between interlocking nail and locking compression plate for management of diaphyseal fractures of the humerus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of this study was to compare the outcomes between open reduction and internal fixation by locking compression plate (LCP) and closed reduction and internal fixation with anterograde interlocking nail (ILN) for the treatment of diaphyseal fractures of the humerus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective comparative study, with diaphyseal fractures of the humerus treated by LCP in 30 patients and with ILN in 30 patients. Patients were followed up to 18 months. The clinical and radiographic outcomes were assessed in terms of union, complications, reoperation rate and functional outcome using the American shoulder and elbow surgeons’ score (ASES) and Stewart and Hundley’s criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Union was achieved in 93.3% of patients in LCP group and 90% in ILN group. The mean blood loss in LCP group was 280±22.10 ml (160-400 ml) and in ILN group was 110±17.62 ml (70-150 ml) (p=0.001). The ASES score was 42.47±5.532 in LCP group and 40.93±6.330 in nailing group (p=0.320; p&amp;gt;0.05). Stewart Hundley criteria showed excellent and good results in 26/30 and 17/30 patients in LCP group and ILN group respectively (p=0.070; p&amp;gt;0.05). Complications and re-operation rate were higher in ILN group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study concludes that LCP can be considered a better surgical option for the management of diaphyseal fractures of the humerus as it had lower incidence of complications, less re-operation rate and better union rate. However, there is no difference between the two groups in terms of union time and functional outcome.&lt;/p&gt;