Locking Compression Plate Osteosynthesis Research Articles

Results of locking compression plate in closed diaphyseal forearm fractures in adults

Introduction: Diaphyseal fracture of ulna and radius present specific problems in Addition to those common to all fractures of shaft of long bones due to their anatomical Characteristics and conservative treatment of these fractures lead to poor functional outcome. Stoffel et al showed that plate osteosynthesis with rigid fixation has shown a high complication Rate including delayed or nonunion, infection, hardware failure and most importantly refracture after plate removal, primarily due to necrosis of bone under the plate.To evaluate results of locking compression plate in closed diaphyseal Forearm fractures in adults.Methods: In prospective study, 22 adults with (38 forearm bones= Radius-20 & Ulna-18) acute closed diaphyseal fractures were treated by open reduction and internal fixation with Locking Compression Plate. Follow up was obtained on all 22 patients. The average duration of follow up was 12 months.Results: The functional outcome was assessed with the grading system of Anderson et al.We had excellent results in all patients.Conclusion: Locking compression plate with a combihole provides fixation of fractures in a single implant with vast application according to the situation and useful in wedge or complex or osteoporotic or comminuted fractures because it preserves periosteal blood supply and provides a stable fixation ensuring early mobilisation. Studies having a larger number of fractures treated with different modes are needed to evaluate the outcome of locking compression plate osteosynthesis in forearm bones fractures, but the early results are promising.

Ankle Arthrodesis Nail Combined with Locking Compression Plate to Stabilize Two-Level Pathologic Tibial Fractures

Treatment of fragility fractures of the distal tibia in the elderly is demanding because of osteopenic bone quality, the delicate soft tissue cuff and frequent critical circulation. We report the case of two-level tibial pseudarthroses in an 83- year-old woman caused by multiple myeloma successfully stabilized by a long ankle arthrodesis nail combined with locking compression plate osteosynthesis. This case is unique, as to our best knowledge, herein diaphyseal fractures were treated for the first time using a technique reported hitherto primarily for fragility ankle and pilon fractures.

High Failure Rates of Locking Compression Plate Osteosynthesis with Transverse Fracture around a Well-Fixed Stem Tip for Periprosthetic Femoral Fracture

This study investigated the incidence of failure after locking compression plate (LCP) osteosynthesis around a well-fixed stem of periprosthetic femoral fractures (PFFs). We retrospectively evaluated outcomes of 63 Vancouver type B1 and C PFFs treated with LCP between May 2001 and February 2018. The mean follow-up duration was 47 months. Only patients with fracture fixation with a locking plate without supplemental allograft struts were included. We identified six periprosthetic fractures of proximal Vancouver B1 fractures with spiral pattern (Group A). Vancouver B1 fractures around the stem tip were grouped into seven transverse fracture patterns (Group B) and 38 other fracture patterns such as comminuted, oblique, or spiral (Group C). Vancouver C fractures comprised 12 periprosthetic fractures with spiral, comminuted, or oblique patterns (Group D). Fracture healing without complications was achieved in all six cases in Group A, 4/7 (57%) in Group B, 35/38 (92%) in Group C, and 11/12 (92%) in Group D, respectively. The failure rates of transverse Vancouver type B1 PFFs around the stem tip were significantly different from those of Vancouver type B1/C PFFs with other patterns. For fracture with transverse pattern around the stem tip, additional fixation is necessary because LCP osteosynthesis has high failure rates.

A comparative non-randomized study between locking compression plate and intramedullary nail-in the management of distal tibial fractures

37.8% of tibia fractures occur in the distal tibial region. Due to the poor soft tissue envelope and precarious blood supply in the distal tibial region, there is a very high incidence of complications like non-union, delayed union and wound dehiscence, with increased secondary procedure rate especially after implant failure. Literature review shows that there is no optimal treatment (implant) for the management of these fractures. Nailing provides lesser chances of wound dehiscence but fails in providing adequate stability. Compression plating provides increased complication due to bulky implants causing wound dehiscence. Some of it is offset by locking compression plate. Hence we decided to study which implant would be ideal to treat these fractures with the best functional outcome and low incidence of complications.This was a prospective study of 72 patients who had unilateral, displaced fracture of distal tibia. 41 patients where managed with intra-medullary interlocking nailing and 31 patients were managed with locking compression plate osteosynthesis.The incidence of complications was found to be higher in nailing when compared to that of plating. 2 of patients developed non-union in nailing. 4 of patients developed implant failure and required secondary procedures in nailing group when compared to 1in LCP group which was attributable to poor biomechanical construct.25 age matched pairs of patients were selected from each group and were assessed with the help of modified Klemm and Borner scoring system. Based on this scoring system the results were analyzed for the study group. Patients in the locking compression plate osteosynthesis group yielded scores that were significantly higher than the nailing group and were found to be statistically significant with a p value of < 0.05. 76% had excellent results, 16% had good results and 4% had fair results in the plating group when compared to 24% excellent results, 40% good results, 20% fair results and 16% poor results in the nailing group.The results of current study show statistically advantageous for locking compression plate osteosynthesis when compared to close intramedullary interlocking nailing for distal third of tibia fractures. With decreased incidence of complications &secondary procedure in LCP group. Particularly in MIPPO with LCP group did much better as no secondary procedures were required. A multicentric study with large population is necessary to confirm this.

Analysis of proximal plating versus intramedullary nailing in the treatment of extra-articular proximal tibial fractures

Extraarticular fractures of proximal tibia has been a challenging situation to most of the surgeons today. Treatment of these injuries is extremely challenging because of the inherent unstable fracture region, difficult reduction & fixation and severely compromised blood supply at the region. For the past decades, closed reduction and minimally invasive plating and intramedullary nailing have both become widely used treatment modalities for proximal and distal tibial metaphyseal fractures. This study was performed to compare the functional and radiological results of locking compression plateosteosynthesis over intramedullary nailing. This randomized prospective clinical study was conducted on 29 patients with a closed extra-articular fracture of the proximal tibia treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) or intramedullary nailing by Tibia interlocking nail at a tertiary trauma center. Postoperative hospital stay, time to full weight-bearing, and union time were significantly less in the IMN group than in the PTP group, but there was no clear advantage of either technique in terms of operative time, infection rate, range of motion of the knee, or degrees of malunion and nonunion. Both implants have shown promising results in extra-articular proximal tibial fractures, and provide rigid fixation that prevents secondary fracture collapse.

Delayed union of humeral shaft fractures: comparison of autograft with and without platelet-rich plasma treatment: a randomized, single blinded clinical trial.

Despite an adequate orthopedic treatment with functional bracing, some patients develop a delayed union in humeral shaft fractures. The objective of the present study was to determine the bone consolidation time among patients with delayed union of diaphyseal humeral fractures who were managed with locking compression plate (LCP) fixation combined with an iliac crest autograft using platelet-rich plasma (PRP) as a co-adjuvant. This study was a controlled, randomized, experimental, longitudinal, comparative, prospective, blind clinical trial. Patients diagnosed with delayed union of a diaphyseal humeral fracture with at least 4months of evolution were treated with an open reduction and LCP osteosynthesis combined with an iliac crest autograft. The experimental group also received PRP. The patients were assessed radiographically until 36weeks of evolution. A total of 16 patients were included. Both groups had similar demographic characteristics. The patients treated with PRP had an earlier beginning of bone consolidation. Furthermore, these same patients exhibited bone consolidation at 19.9weeks, on average, in contrast to 25.4weeks in the control group. The use of PRP promotes earlier bone consolidation in patients with delayed union of the humeral shaft.

A comparative study of functional outcome of distal tibial extra-articular fracture fixed with intramedullary interlocking nail versus locking compression plate

Background: Distal metaphysical fracture of the tibia has been a challenging situation when mostly treated with Plaster of Paris casts, resulting in ankle and knee stiffness and prolonged immobilization. This affecting quality of life of the patient. For the past decade, nailing and plating for fracture reduction has been successful in treating fractures of lower extremity especially distal tibia Objectives: To compare the functional and radiological results of locking compression plate osteosynthesis over intramedullary nailing. Methods: Patients with closed extra articular distal tibial fractures admitted under orthopedics in KIMS hospital will be randomly divided into 2 groups of 10 patients each. Group-1 was operated by Closed reduction and internal fixation with Intramedullary interlocking nail and Group-2 was operated by Locking compression plate done using MIPPO technique. Patients was followed up at regular intervals of 6 weeks for 6 to 10 months and assessed clinically, functionally and radiologically based in IOWA knee evaluation and ankle evaluation rating system. Conclusion: All fractures united well. Rate of union in patients who underwent plate fixation with LCP had lesser average union time (26 weeks) compared to IMIL nailing (27 weeks). In our study valgus union of >5degrees in two patients and varus union of >5 degrees in two patient in IMIL nail group. But in plating group no malunion was noted. In both groups we achieved good anatomical reduction, stable internal fixation and early mobilization and functional outcome in both groups are comparable with statistically significant difference.

Management of Open Fractures of Tibial Diaphysis by External Fixation Followed by Locking compression Plate Osteosynthesis in hemodynamically Unstable Patients: A prospective study

Management of Open Fractures of Tibial Diaphysis by External Fixation Followed by Locking compression Plate Osteosynthesis in hemodynamically Unstable Patients: A prospective study

Evaluation of the Outcome of Proximal Femoral Locking Compression Plate for the Treatment of Comminuted Trochanteric and Subtrochanteric Femoral Fractures in Lateral Decubitus Approach without Peroperative Image Intensifier

Introduction: The Comminuted trochanteric and subtrochanteric femoral fractures are considered as one of the most difficult fractures to treat in the orthopaedic surgery and they associated with high incidence of nonunion, malunion. Various implants, both intramedullary and extramedullary, are available for their fixation.Objective: To assess the success rate of proximal femoral locking compression plate osteosynthesis in comminuted trochanteric and subtrochanteric femoral fracture in lateral decubitus approach without per operative image intensifier.Method: 20 consecutive patients with comminuted Trochanteric and subtrochanteric fractures were operated upon with PF-LCP. Detailed clinical conditions of all patients, duration of operation, technical difficulty with the implant, hospital stay period were recorded. Patients were visited at 6 weeks interval till union then 3 monthly. The Harris Hip Score was used to document hip function at final follow-up.Result: There were fifteen excellent (75%), two good (10%), two fair (10%) and one poor (5%) results according to Harris hip score. No instance of implant failure was recorded.Conclusion: Fixation of comminuted subtrochanteric fractures with PF-LCP in lateral decubitus approach without per operative image intensifier provides stable fixation with high union rate and fewer complications.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 179-185

Treatment of Distal Femur Fracture with Minimally Invasive Locking Compression Plate Osteosynthesis

13 통신저자:박 기 철 경기도 구리시 교문동, 249-1 한양대학교 의과대학 구리병원 정형외과학교실 Tel:031-560-2318ᆞFax:031-557-8781 E-mail:kcpark@hanyang.ac.kr 접수: 2011. 7. 21 심사 (수정): 1차 2011. 8. 8, 2차 2011. 10. 30 게재확정: 2011. 11. 15 Address reprint requests to:Ki-Chul Park, M.D. Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of medicine, 249-1, Gyomoon-dong, Guri 471-701, Korea Tel:82-31-560-2318ᆞFax:82-31-557-8781 E-mail:kcpark@hanyang.ac.kr 최소 침습적 잠김 압박 금속판 고정술을 이용한 대퇴 원위 골절의 치료

Stainless Steel 2.0-mm Locking Compression Plate Osteosynthesis System for the Fixation of Comminuted Hand Fractures in Asian Adults

Objective The aim of this retrospective study was to analyse the clinical outcome of the application of stainless steel 2.0-mm locking compression plate (LCP) system for the treatment of comminuted hand fractures in Asian adults. Methods Six patients who had comminuted hand fractures were treated by open reduction and internal fixation with the application of stainless steel 2.0-mm LCP (AO Compact Hand System; Synthes, Oberdorf, Switzerland) from December 2009 to October 2010. The total arc of motion of fingers, grip power, complications, and additional surgery were recorded. Results Three out of six patients eventually restored good hand functions in terms of the total arc of finger motion (>220°) and grip power. The commonest complication was skin impingement in finger region by the implant (4 cases). Another common complication was restricted range of motion (3 cases). One patient had minimal degree of malrotation of his left little finger. Additional surgery was required in all the patients for implant removal (6 cases), tenolysis (3 cases), and capsulotomy (2 cases). Conclusions The stainless steel 2.0-mm LCP is useful for the fixation of unstable comminuted hand fractures, especially in metacarpal bones, because of its advantage of better stability, which allows more aggressive rehabilitation. However, its design is not very versatile and, therefore, limits its use in the finger region. Its bulkiness frequently causes implant impingement. The patients must be informed about the chance of implant removal later.

Treatment of type 2 and 4 olecranon fractures with locking compression plate osteosynthesis in horses: A prospective study (2002–2008)

This prospective study describes a series of 18 olecranon fractures in 16 horses that were treated with locking compression plates (LCP). Twelve of the 18 fractures were simple (type 2), whereas six were comminuted (type 4). Six fractures were open and 12 were closed. Each horse underwent LCP osteosynthesis consisting of open reduction and application of one or two LCP. Complete fracture healing was achieved in 13 horses. Three horses had to be euthanatized: two because of severe infection and one because of a comminuted radial fracture 11 days after fixation of the olecranon fracture. Complications encountered after discharge of the horses from the Equine Hospital at the Vetsuisse Faculty (University of Zurich) included implant infection (n=2) and lameness (n=3), which were successfully treated with implant removal. Despite being easier to use, LCP osteosynthesis resulted in a clinical outcome similar to DCP osteosynthesis.

Ulnar osteotomy for treatment of cubital subluxation, following locking compression plate osteosynthesis of a radius fracture in a foal

SummaryA closed mid‐diaphyseal fracture in a one‐day‐old foal was treated using a 3.5 mm locking compression plate on the cranial aspect of the radius. The foal showed good fracture healing, but a radio‐ulnar synostosis developed despite the absence of transfixation by any implant into the ulna. Four months after surgery the radiographs revealed a cubital subluxation, which was managed by an osteotomy of the ulna at the time of plate removal, allowing the ulna to adjust into a normal position. One year after surgery the foal was clinically sound; the radiographs showed good healing of the osteotomy gap as well as good remodelling of the radius; however, a slight elbow subluxation was present.

Treatment of posterior pelvic ring injuries with minimally invasive percutaneous plate osteosynthesis

From January 2004 to July 2007, 21 patients with injuries at the posterior pelvic ring were treated with locking compression plate osteosynthesis through a minimally invasive approach and followed up for a mean of 12.2 months. Preoperative and postoperative radiography was conducted to assess the reduction and union. The mean operation time was 60 minutes (range: 40-80). Intraoperative blood loss was 50-150 ml. All patients achieved union at the final follow-up. The overall radiological results were excellent or good in 17 patients (85%). The functional outcome was excellent or good in 18 patients (90%). There was no iatrogenic nerve injury, deep infection or failure of fixation. We believe that fixation with a locking compression plate is an effective method for the treatment of injuries of the posterior pelvic ring in view of its convenience, minimal traumatic invasion and lower morbidity.

Locking compression plate osteosynthesis of complicated mandibular fractures in six horses

Complicated mandibular fractures were recognised in one foal, one pony and four horses. The foal was two months old while the adult animals ranged in age from 12 to 24 years. Three horses had a unilateral horizontal ramus fracture. Two fractures were open and one was closed. Comminution was present in one of these patients while the other two horses had marked displacement of the fragments. Two suffered from comminuted fractures of the horizontal and vertical ramus of the mandible. One of these patients had open and infected fractures. One foal had a bilateral horizontal ramus fracture with marked periosteal 'new bone' formation and malalignement which required corrective osteotomy. Each horse underwent locking compression plate (LCP) osteosynthesis consisting of open fracture reduction and application of one to three 4.5/5.0 mm LCP at the ventral, lateral or caudal aspect of the mandible under fluoroscopic control. Two 3.5 mm LCP were used in the foal. Plate fixation was supported by application of a cerclage wire construct between the incisor and premolar teeth in most patients. Complete fracture healing, with an excellent functional and cosmetic outcome, was achieved in all of the patients. Complications encountered included seroma formation, screw and wire breakage, as well as implant and apical tooth root infections. The LCP was removed after fracture healing had occurred in four patients.

Ist die Behandlung der instabilen distalen Radiusfraktur beim älteren Menschen mittels Fixateur externe nicht mehr indiziert?

In recent years there has been an increasingly marked shift in the operative treatment of unstable fractures of the distal radius. The introduction of locking compression plates has made it possible to extend the indications for palmar stabilisation according to the principles of internal fixation to extension fractures even in osteoporotic bone, and since then the new design has been used more and more widely. First clinical results show very good and good clinical and radiological outcomes in over 80% of cases after locking compression plate osteosynthesis. All this raises the question of whether external fixation is no longer indicated for distal radius fractures in the elderly, or is now no more than a second-line treatment. Within a 5-year period, 67 patients over 65 years of age were identified among 220 who had had unstable fractures of the distal radius in our hospital with external fixation. The average follow-up period (clinical and radiological examinations) was 37 months. We devoted particular attention to the analysis of complications and problems during the treatment. Complete bone healing was observed in all patients treated with external fixation. In most cases, complications were minor pin-track infections (10%). The radiological follow-up examination revealed radial shortening by an average of 2 mm and an average radial shift of 0.2 mm. The joint angle was 2.5 degrees with lateral irradiation and 18 degrees with dorso-palmar irradiation. According to the Gartland and Werley score, the functional, radiological and subjective outcome was excellent or good in 87% of these patients. Overall, internal fixation with angular fixed plates has definite benefits. The medium- and long-term follow-up and functional outcome still show no benefits over external fixation, however. External fixation is a genuine option, even if as second-line treatment.

Clinical application of percutaneous minimally invasive locking compression plate osteosynthesis

目的 探讨经皮微创锁定加压钢板内固定术的临床应用及其疗效.方法应用间接复位技术,通过建立骨折两端皮下隧道,采用锁定加压钢板内固定治疗胫腓骨干骨折15例,锁骨骨折12例,肱骨骨折4例.结果所有患者随访4～18个月,平均10个月.骨折愈合时间:胫骨10～20周(平均12周),1例骨折延迟愈合(20周),无骨不愈合;锁骨6～10周(平均8周),肱骨8～13周(平均11周),均无骨折延迟愈合及不愈合.所有病例无感染及内固定失败等并发症.结论经皮微创锁定加压钢板内固定符合生物学固定(BO)原则,有利于骨折的愈合及软组织的修复。