Locking Plate Research Articles

Surgical management and weight-bearing recommendations for geriatric distal femur fractures.

To investigate current practices among orthopaedic trauma surgeons in treating geriatric distal femur fractures and evaluate current postoperative weight-bearing recommendations. A 26-question survey was emailed to Major Extremity Trauma Research Consortium surgeon members to characterize current practice with different fixation methods for distal femur fractures and the surgeon-directed postoperative weight-bearing recommendations for each approach. Surveys were completed by 123 orthopaedic trauma surgeons with a response rate of 37% (123/332). Retrograde intramedullary nailing (IMN) was commonly performed by 88% of surgeons, and lateral locked plate was commonly performed by 74% of surgeons. Retrograde IMN with a lateral plate was commonly performed by 51% of surgeons. Dual femoral plating was commonly performed by 18% of surgeons and sometimes performed by 39% of surgeons. Surgeons were significantly more likely to allow immediate postoperative weight-bearing for retrograde IMN (P < 0.001), retrograde IMN with lateral plate (P < 0.001), and dual plate (P < 0.001) as compared with locked lateral plate. Most surgeons (79%) would be interested in participating in a randomized controlled trial (RCT) investigating single implant versus dual implant for distal femur fractures and believe that a trial incorporating immediate weight-bearing is important. A variety of implants are commonly used to treat geriatric distal femur fractures. Patients with distal femur fracture commonly have weight-bearing restrictions in the immediate postoperative period. A large proportion of orthopaedic trauma surgeons have clinical equipoise for an RCT to investigate the impact of surgical construct and weight-bearing on geriatric distal femur fracture patient recovery.

Outcome of dynamic locked plate in treatment of intracapsular femur neck fracture

Background: The ideal surgical treatment of femoral neck fractures is still debatable. When internal fixation is used, many implants are available. This study aimed to evaluate the outcome following fixation of intracapsular femur neck fractures using the Targon-FN system (B. Braun, AG. Melsungen, Germany) comparing the results with a similar study done by the manufacturer and to assess risk factors associated with complications. Methods: A prospective interventional case series involved 30 consecutive patients aged from 23 to 82 (Mean 49 years) treated at Al-Jalaa trauma hospital in Benghazi- Libya in period from January 2016 to July 2017, for an intracapsular femur neck fracture with Targon-FN system. According to Garden classification 9 fractures (30%) undisplaced and 21 (70%) were displaced fractures, with 2 patients (6.7%) had type I, 7 patients (23.3%) had type II, 7 patients (23.3%) had type III and 14 patients (46.7%) had type IV fracture. Epidemiological data were collected. Patients were followed-up for 2 years (average 16 months). Joint function was assessed clinically by using Harris hip score (HHS) and fracture healing by radiological assessment at sex weeks, 3 months, 6 months, 1 year and finally at 2 years. Complications were recorded. Statistical analysis done to predict risk factors associated with reoperation and complications. Results: Sixteen patients (53.3%) developed one or more complications. Complications were higher than those of manufacturer’s study and included avascular necrosis (53.3%, n=16), nonunion (30%, n=9), blown out implant (16.66%, n=5), loosening screw (3.3%, n=1), and deep infection (3.3%, n=1). In total, 5 patients required total hip replacements. At end of 2 years 19 patients (63%) had poor result, one patient (3.3%) had fair result, 1 patient (3.3%) had good result and 9 patients (30%) had excellent result according to HHS. Delayed surgery, fracture displacement, surgeon’s experience, age ≥40 years and time to postop weight bearing recognized as risk factors for complications. Conclusions: A minimally-invasive surgery of Targon FN justifies use of this system for the preservation of the patient’s hip joint, early rehabilitation and mobilization. Complications and re-operation could be minimized by performing surgery within 24-48 hours, provision of skillful surgeons, and proper timing of postoperative weight bearing. The main limitation is the small number of cases and short follow-up averaged at 16 months.

Dynamic Locking Plate versus Multiple Cancellous Screws for the Fixation of Intracapsular Femoral Neck Fractures: Long-Term Results and Quality-Of-Life Assessment Based on Patient-Reported Outcome Measures.

The purpose of this study was to compare the long-term clinical outcomes and quality-of-life measures for two fixation methods in the setting of displaced femoral neck fractures. The two groups included fixation with multiple cancellous screws (group 1) and telescopic femoral neck screws and a small locking plate device (Targon FN) (group 2). Patients underwent reduction and internal fixation with either multiple cancellous screws or the Targon FN device from March 2000 to January 2012. Failure endpoints included nonunion, osteonecrosis of the femoral head, and revision surgery. Patient-reported outcome measures included chronic pain, ability to ambulate, and the use of ambulation assistive devices. Statistical analysis demonstrated a statistically significant lower rate of non-union and overall complication in the Targon FN group (p value < 0.001 and p value = 0.005, respectively). Logistic regression analysis showed that operative fixation with the Targon FN device decreased the odds ratio for overall complication by a factor of 0.34 (p = 0.02). There were no statistically significant differences between groups 1 and 2 in patient-reported outcomes (chronic pain (p = 0.21), ability to ambulate (p = 0.07), and the use of an ambulation assistive device (p = 0.07)). When compared to traditional cancellous screw fixation of femoral neck fractures, the Targon FN device has significantly lower complication rates and equivalent patient-reported outcomes.

Comparing Intramedullary Nails and Locking Plates in Displaced Proximal Humerus Fracture Management: A Systematic Review and Meta-Analysis.

This study aims to provide an updated review comparing the complication rates and clinical outcomes of intramedullary nails and locking plates (LPs) in displaced proximal humerus fracture (PHF) management. We performed a systematic review of the Cochrane Central Register of Controlled Trials, Clinical Trials Registry, EMBASE, and PubMed. Studies with level III evidence or higher comparing intramedullary nails and LPs used for internal fixation of displaced PHFs were included. The Methodological Index for Nonrandomized Studies (MINORS) criteria and Cochrane Handbook for Systematic Reviews of Interventions 5.2.0 were used to assess the risk of bias. Our meta-analysis included a comparison of method-related complications, pain scores, range of motion (ROM), and functional scores. A total of 13 comparative studies were included: five randomized controlled trials, three prospective cohort studies, and five retrospective cohort studies. The total number of patients included was 1,253 (677 in the LP group and 576 in the intramedullary nail group). Superior Constant-Murley scores and external rotation ROM were found in the LP group during the early postoperative period. However, long-term functional scores and complication rates were comparable between the two groups. We conclude that intramedullary nailing and LP fixation are both equally effective for the treatment of displaced PHFs. Neither treatment appears superior at this time, and more large-scale randomized controlled trials should be conducted to further evaluate the potential benefit of LPs in the early postoperative period.

Evaluation of the Stability of Internal Fixation Constructs in a Low Distal Tibia Extra-articular Cadaveric Fracture Model: A Comparative Biomechanical Study.

Introduction Despite the recent advances in implant design, the choice of an internal fixation modality for extra-articular distal tibia fractures remains controversial, and there is sparse literature comparing the stability of intramedullary nails and locked plates for such fractures. Hence, we conducted a biomechanical study on an AO type 43A3 tibia fracturecadaveric model stabilized by four different constructs, viz., intramedullary (IM) interlocking nail, anteromedial plate, anterolateral plate, and posterior plate.An AO type 43A3 fracture is defined as an extra-articular fracture of the distal tibia with metaphyseal comminution. Methods A biomechanical comparative study on formalin-preserved human cadaveric tibiae was undertaken; a total of four groups were tested, with eight bones in each group. Out of the 32 cadaveric tibiae, 19 bones belonged to male cadavers, and 13 bones belonged to female cadavers. All bones were dissected from age-appropriate cadavers and fixed with an implant, followed by the creation of a 1 cm osteotomy to simulate an AO type 43A3 fracture. All fixation constructs were subjected to three-point bending tests in the anteroposterior (AP) and mediolateral (ML) planes. Three parameters, viz., bending stiffness, peak fracture gap angle, and neutral zone, were evaluated on the load-displacement curves. Afixation construct was deemed biomechanically stable if it had a highbending stiffness, a low neutral zone (inherent toggle in the construct by its weight), and a low peak fracture gap angle. Results Out of the four implants tested, locked IM nails exhibited the maximum biomechanical stability in terms of higher bending stiffness, smaller peak fracture gap angle, and smaller neutral zones. The IM nail exhibited the highest bending stiffness in the AP plane, and the anterolateral plate had the lowest bending stiffness, and the difference was statistically significant (p= 0.032).In the AP plane, the anterolateral plate exhibited a bending stiffness of 1.51 ± 0.69 Nm/degree, whereas the intramedullary nail exhibited a bending stiffness of 2.34 ± 0.81 Nm/degree, and the posterior locked plate had a bending stiffness of 1.57 ± 0.44 Nm/degree. In the ML plane, the anterolateral plate exhibited the highest neutral zone as compared to the intramedullary nail, which had the lowest neutral zone, and the difference was statistically significant (p = 0.019). The intramedullary nail exhibited the lowest neutral zone of 0.46 ± 0.31 degrees, whereas the posterior locked plate exhibited a neutral zone of 0.78 ± 0.43 degrees in the ML plane. The anterolateral plate exhibited a neutral zone of 1.43 ± 1.00 (expressed as mean ± SD) degrees in the mediolateral plane. Conclusion Our biomechanical study supports the recommendations of using a locked intramedullary nail for AO type 43A3 fractures. We concluded that the anterolateral plate construct exhibited the least biomechanical stability, in terms of lower AP bending stiffness and higher neutral zone. If the surgeon must choose a locked plating technique for any reason, the anterolateral locking plate should be avoided. If plating is at all required, we can recommend both anteromedial and posterior locked plating as biomechanically sound options.

Locking plate versus K-wires and cast fixation in lateral closing-wedge osteotomy for cubitus varus deformity.

The aim of this study was to assess the clinical and radiographic outcomes of cubitus varus treatments based on different fixation methods: Locking plate vs. Kirschner-wires (K-wires) and cast fixation. This retrospective study of 28 patients was performed in lateral-wedge osteotomy for cubitus varus deformity in our hospital from July 2018 to July 2020. 14 patients in group A were treated by locking plate after lateral closing-wedge osteotomy, whereas other 14 patients were treated by K-wires in group B. We measured the bony union and carrying angle. The clinical and radiographic outcomes were assessed according to the Bellemore criteria. No nonunion, neurovascular injury or myositis ossificans was noted at follow-up. In group A, 1 patient with lateral condylar prominence was found. In group B, 2 patients with pinning site infection were treated successfully with oral antibiotics and 2 patients needed revision surgery for residual varus. According to the Bellemore criteria, statistically significant difference was noted between the two groups (P = 0.0458). In the present study, no statistically significant difference was noted in the length of incision and operation time between the 2 groups (P > 0.05). However, the postoperative carrying angle was significantly different at final follow-up between the 2 groups (P < 0.01). Compared with K-wires and cast fixation, we recommend the wedge osteotomy with lateral locking plate to treat the cubitus varus deformity because locking plate could achieve better functional and cosmetic results and stabilize the distal humerus rigidly.

Effect of an Orthogonal Locking Plate and Primary Plate Working Length on Construct Stiffness and Plate Strain in an In vitro Fracture-Gap Model.

The aim of this study was to compare stiffness and strain of an in vitro fracture-gap model secured with a primary 3.5-mm locking compression plate (LCP) at three primary plate working lengths without and with an orthogonal 2.7-mm LCP. Primary plate screw configurations modeled short working length (SWL), medium working length (MWL), and long working length (LWL) constructs. Construct stiffness with and without an orthogonal plate during nondestructive four-point bending and torsion, and plate surface strain measured during bending, was analyzed. Single plate construct stiffness was significantly, incrementally, lower in four-point bending and torsion as working length was extended. Addition of an orthogonal plate resulted in significantly higher bending stiffness for SWL, MWL, and LWL (p < 0.05) and torsional stiffness for MWL and LWL (p < 0.05). Single plate construct strain was significantly, incrementally, higher as working length was extended. Addition of an orthogonal plate significantly lowered strain for SWL, MWL, and LWL constructs (p < 0.01). Orthogonal plate application resulted in higher bending and torsional construct stiffness and lower strain over the primary plate in bending in this in vitro model. Working length had an inverse relationship with construct stiffness in bending and torsion and a direct relationship with strain. The inverse effect of working length on construct stiffness was completely mitigated by the application of an orthogonal plate in bending and modified in torsion.

Comparison of Locked Plates and Blade Plates for Varus Osteotomy of the Proximal Femur by the Finite Element Method.

Objective: The present study compared the difference in load and pressure distribution behavior of the blade plate and locked plate for varus osteotomy of the proximal femur per the finite element method. Methods: Modeling was performed by scanning a medium-sized left femur with medial valgus deformity made of polyurethane. Results: The stiffness of the locked plate is higher compared with that of the blade plate. However, this difference was not significant. In addition, the locked plate has proximal locking screws to ensure that the bending moments on the screws are smaller during loading. Conclusion: In summary, both plates are well-established and effective. However, the study using the finite element method plays a fundamental role in understanding the load and pressure distribution of the implant. Moreover, it opens up new possibilities for further studies, including surgical proposals and customized implant materials.

The Treatment of Periprosthetic Fracture Revision of the Humerus with “Bamboo Support” Structural Allograft Technique—Atrophic Non-Union of a Post-Operative Periprosthetic Fracture after Reverse Total Shoulder Arthroplasty: A Case Report

Periprosthetic fractures are a serious complication of joint replacement surgery. With the growing prevalence of reverse total shoulder arthroplasty (RTSA), the incidence of relatively uncommon periprosthetic humeral fractures has increased. Here, we present the unique case of a 74-year-old woman who developed atrophic non-union after plate osteosynthesis for a periprosthetic fracture associated with RTSA. Fixation failure was evident 3 months after the surgical intervention; the patient underwent a 3-month course of arm sling immobilization. However, bone resorption continued, and varus angulation of the fracture developed. In this case, surgical strategy involved the use of long proximal humerus internal locked system plate (DePuy Synthes, Paoli, PA, USA), augmented with autologous iliac bone graft and allogenic humerus structural bone graft with the “bamboo support technique”, fixed with Cable System (DePuy Synthes, Paoli, PA, USA). No reports have addressed the management of failed periprosthetic fractures using allogeneic humeral strut bone grafts. This report aims to fill the gap by presenting a novel surgical technique for the management of periprosthetic fractures associated with RTSA in case of treatment failure.

Management of periprosthetic femoral fractures following total knee arthroplasties using locking plates or intramedullary nailing. Comparative study of 567 cases

IntroductionProximal femur fractures in elderly patients pose a common problem that requires surgical management. The main objective of this study was to compare the results of treatment by locked plate (LP) and by anterograde (AIN) or retrograde (RIN) intramedullary nailing. The secondary objective was to analyze the complications related to each group. The hypothesis of this study was that the radiological and clinical results of each group were comparable. Materials and methodsThe data of 438 patients from 8 centers were studied retrospectively with 365 LP and 69 cases of intramedullary nailing (49 AIN and 20 RIN). The groups were comparable in terms of mean age (75±2years), mean preoperative Parker score (5.3±0.5) and mean KOOS score (74±2). Most patients lived at home before their fracture [n=375 (86%)]. At follow-up, the joint range of motion, the KOOS and Parker scores, living premises, the time required to regain full weight-bearing, the time required for consolidation as well as the reduction alignment: frontal, sagittal, horizontal. ResultsThe average follow-up was: 79±2weeks (65 to 82). The functional and radiological results were comparable, although nailing allowed a faster return to weight-bearing (1±2weeks for nailing versus 7±2weeks for LP, p=0.048) and a better postoperative Parker score (5.5±0.5 for nailing versus 4.7±0.2 for LP, p=0.045). Rotational malalignment in femoral nailing was often in the direction of internal rotation, compared to the LP (p=0.045). Complications were comparable with the exception of mortality, which was more frequent for LP [22.5% in the LP group versus 13% in the nailing group (p=0.045)]. Complications were categorized as: mechanical complications 6.8% of LP, 5.7% of nailing (p>0.05), infections [11% of LP, 5.8% of nailing (p>0.05)], surgical revisions [2% of LP, 10% of nailing (p>0.05)]. Discussion and conclusionThe hypothesis was refuted. These results show that nailing conferred a faster recovery of weight-bearing, a better Parker score, and is associated with a lower mortality rate. The morbidity rate is comparable between the two techniques. Indeed, when the indication for osteosynthesis by LP or by nailing is made, and both choices are technically justifiable, it would be prudent to favor the technique, which carries the least risk, which in this case is nailing. This conclusion must, however, be taken in to consideration with regard to the reduced number of nailing. A larger series of nailing, particularly retrograde, would be necessary to be able to confirm this last difference between the 2 groups. Level of evidenceIV; comparative retrospective study.

Functional Outcome of Distal Humerus Intra-articular Fractures Treated with Pre-contoured Anatomical Locking Plates

Introduction: The most difficult therapeutic challenge is treating humerus fractures, which might result in a subpar functional outcome. It is anticipated that early mobilization, anatomic reduction, and internal fixation will enhance the functional results. The purpose of this study is to assess the functional result, intercondylar fixation rate, and anatomically pre-contoured locking plate treatment of a distal humerus fracture. Material and Method: This prospective research included patients with type 13-C2 distal humerus fractures, regardless of sex, who were hospitalized. Using the modified triceps tongue flap method, all patients received open reduction and internal fixation with anatomic pre-contoured locking plates and screws. Patients underwent 6 months of follow-up after surgery. They had follow-up evaluations using the Mayo Elbow Performance Score (MEPS) for clinical, radiological, and functional assessments. The Chi-square test was used to analyze the outcomes. Observations: Males accounted for the majority of injuries (66.7% vs. 33.3%). The age distribution was 36.93 ± 14.67. Traffic accidents were the most common cause of injuries (66.7%). The most frequently affected side was the right upper limb (76.7%). Eighty percent of the patients had MEPS scores that were excellent or good overall. At the fracture site, the radiological union took an average of 10.2 ± 2.11 weeks. In the 6th week, the mean extension-flexion arc was 32.06°–104.06°, and in the 6th month, it was 11.55°–124.16°. Early superficial infection (3.3%), malunion (3.3%), ulnar neuropraxia (3.3%), and chronic osteomyelitis (3.3%) were the consequences. In conclusion, the functional result of the elbow was effectively preserved in distal humerus fractures treated with anatomic pre-contoured locking plates. Keywords: Elbow joint, distal humerus intra articular fractures, bone plates, articular range of motion, osteomyelitis, MEPS, pre-contoured anatomical locking plate.

Outcomes of Minimally Invasive Locking Plate Osteosynthesis for Periprosthetic Distal Femur Fractures following Primary Total Knee Arthroplasty

Abstract Introduction: Periprosthetic distal femur fractures have been on the rise with an increasing number of total knee arthroplasties being performed. In addition to regular fixation principles in distal femur fractures, periprosthetic fractures pose additional challenges due to osteoporotic bone and preexisting medical comorbidities. Materials and Methods: We retrospectively analyzed 31 patients who underwent surgical fixation with a locking plate using a minimally invasive technique for periprosthetic distal femur fractures at a single level 1 orthopedic hospital for 4 years. Results: Out of the 31 patients included in the study, 21 were female. The mean age of the study population was 65.63 years, ranging from 51 to 82 years. The mean time to union was 14.32 weeks, with a range from 12 to 22 weeks. The average Knee Society Score was 78.2, which is considered a good outcome. There was one case of implant failure in our case series, which could be attributed to immediate weight bearing. Conclusion: In conclusion, we found that fixation of supracondylar femur fractures associated with stable nonstemmed total knee arthroplasty with a locking plate using a minimally invasive technique yielded good results.

Distal fibula locked plate versus nonlocked plate for treatment of Danis Weber type B fracture comparative prospective study

Abstract Background Ankle fractures are one of the most common fractures affecting both the young and old. they are the third most common fracture in elderly patients. The appropriate method of fixation of those fractures is debatable especially for osteoporotic patients, osteoprosis renders commonly used internal fixation methods technically demanding and prone to failure. Aim To compare distal fibula locked plate to nonlocked plate for treatment of Danis Weber type B fracture regarding union rate, union time, operation time, failure rate, and other complications. Patients and methods This study was conducted on 100 patients classified as a Weber B traumatic fracture. Fifty patients were undergoing open reduction internal fixation (ORIF) using locking plates (group A) and patients underwent ORIF using nonlocking plates (group B). The following parameters were assessed in both groups range of motion, union rate, union time, complications, operation time, American orthopedic foot and ankle society and failure rate. Results There was no statistically significant difference between both groups in operation time and blood loss. Length of hospital stays (days) and Time to full weight bearing, union time was lower in group A than group B. American orthopedic foot and ankle society was higher in group A than in group B. There was no statistically significant difference in range of motion (extension, flexion) between both groups. The rate of loosening of the distal screw and implant removal was higher in group B than in group A. Conclusion No statistically significant difference was found between both groups regarding functional, radiological outcomes, and complications in patients less than or equal to 60 years old. Therefore, one-third plate is preferred in a young age in terms of cost-effectiveness. In patients over 60 years old, using the locking plates yields better stability, and functional and radiological outcome than non-locking plates.

Functional Outcome of Distal Femoral Fractures using NEER Scoring Managed by Distal Femoral Locking Plate versus Retrograde Intramedullary Nail: A Cross-sectional Study

Introduction: Distal femur fractures are a group of fractures that have been a topic of debate for the past decade, were traditionally treated mainly using conservative methods. However, with advancements in surgical techniques and implants, operative intervention has now become the preferred treatment approach. There are various methods for treating distal femur fractures and the present study compares the treatment of distal femoral fracture using distal femur nailing versus the use of locking plate. Aim: To compare the functional outcomes of stabilising distal femur fractures using locking compression plating versus retrograde nailing and to evaluate the merits and drawbacks of each procedure. Materials and Methods: A cross-sectional comparative study was conducted in the Department of Orthopaedics at Calcutta National Medical College and Hospital, Kolkata, West Bengal, India, over a one-year period from (January 2021 to January 2022. Total 46 patients with distal femur fractures were included, with six lost to follow-up. Two groups were divided in which total 20 patients underwent distal femoral nailing, while 20 were treated with distal femoral locking plates. Functional outcomes were assessed using the NEER Score, aiming for perfect restoration of the articular surface, stable fixation, full knee range of motion, and good functional results. Data were entered into a Microsoft Excel spreadsheet for statistical analysis using Statistical Packages for Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA). Numerical variables were summarised as mean and standard deviation, while categorical variables were presented as counts and percentages. A p-value of ≤0.05 was considered statistically significant. Results: The study population consisted of 70% males with a mean age of approximately 55 years. Road traffic accidents were the most common mode of injury. The mean time for radiological union in the nailing group was 14.05 weeks, significantly shorter than the 16 weeks in the plating group. The mean range of knee flexion was 111° in the nailing group and 114.5° in the plating group. The average NEER score was 84.10 for the plating group and 83.30 for the nailing group. There was no statistically significant difference in functional outcomes between the two groups. Conclusion: Both retrograde intramedullary nailing and the use of locking compression plates can be considered as suitable treatment options. Early weight-bearing can be initiated with retrograde nailing. No significant difference was observed in terms of outcome, fracture healing, or NEER score. The time taken for radiological union of fractures using both techniques was comparable. Proper operative planning, execution, and adherence to a strict rehabilitation protocol play crucial roles in the overall patient outcome.

Outcome Analysis of Fixed angle Locking Plate in Comminuted Patella Fractures : A Single Centre Prospective study from South India with Early Results.

Comminuted patella fractures pose a challenge to orthopaedic surgeons , since tension band wiring and cerclage is not effective and often lead to loosening of wires, hardware problem, dislocation of fracture and failure of osteosynthesis resulting in post-traumatic osteoarthritis and knee stiffness. The aim of this study is to evaluate the clinical outcome in patients with AO 34C2 and 34C3 highly comminuted patella fractures treated with unidirectional fixed angle titanium patella locking plate. Twelve patients who presented with AO 34C2 and 34C3 comminuted patella fractures, aged between 18-79 years were included in the study. All fractures were reduced and fixed with unidirectional angle fixed stable titanium patella locking plate. Knee range of motion and knee outcome survey activities of daily living scale (KOS-ADL) was used to evaluate the outcome. Union of fracture was achieved in all twelve patients. Mean flexion at final follow-up was 123° (110°-130°). None of the patients had extensor lag. One patient had hardware irritation which resolved at final followup. This technique serves as an effective option in highly comminuted patella fractures by providing excellent mechanical stability resulting in anatomical reduction , excellent functional outcome , lower incidence of hardware irritation or failure of osteosynthesis.

Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated with Lateral Locked Plating: A Risk-Stratified Analysis.

To identify technical factors associated with nonunion after operative treatment with lateral locked plating. Retrospective cohort study. Ten Level 1 trauma centers. Six hundred fifteen adult patients with supracondylar distal femur fractures (OTA/AO Type 33A or C). Lateral locked plating. Surgery for nonunion. We observed nonunion rates of 2% in a low-risk of nonunion group (n = 129), 4% in a medium-risk group (n = 333), and 14% in a high-risk group (n = 153). Varus malreduction with an anatomic lateral distal femoral angle (aLDFA) greater than 84 degrees, was associated with double the odds of nonunion (OR, 2.1; 95% CI, 1.1 to 4.2; P = 0.03). Malreduction by medial translation of the articular block increased the odds of nonunion, with 30% increased odds per 4 mm of medial translation (95% CI, 1.0 to 1.6; P = 0.03). Working length increased the odds of nonunion primarily in the medium risk group, with an 18% increase in nonunion per 10 mm increase in working length (95% CI, 1.0 to 1.4; P = 0.01). Proximal screw density was protective against nonunion (OR, 0.71; 95% CI, 0.53 to 0.92; P = 0.02). Lateral plate length and type of plate material were not associated with nonunion. Malreduction is a surgeon-controlled variable associated with nonunion after lateral locked plating of supracondylar distal femur fractures. Longer working lengths were associated with nonunion, suggesting that simple bridge plating may be less likely to succeed for longer fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of Conventional Incision and 10 mm Approach for Volar Locking Plates in Dorsal Displaced Distal Radius Fractures.

The aim of this study was to investigate whether surgery with a 10 mm approach for volar locking plate fixation provides equivalent early post-operative outcomes to conventional incision surgery for distal radius fractures. The subjects were divided into a conventional incision group (mean age: 59.1 years, 8 males and 23 females) and a 10 mm approach group (mean age: 59.9 years of age, 6 males and 20 females). The wrist range of motion; grip strength; visual analog scale (VAS); quick disabilities of the arm, shoulder, and hand (Q-DASH) score; and modified Mayo score were assessed at 3 months after surgery. In addition, radial inclination, ulnar variance, and volar tilt were evaluated on post-operative radiography. There was no significant difference between the groups in the wrist range of motion, grip strength, VAS, Q-DASH score, modified Mayo wrist score, and three parameters of post-operative radiography. All patients in both groups had no complications during the perioperative period. We found that a 10 mm approach obtained early post-operative outcomes and alignment comparable to conventional incision surgery for patients with dorsal displaced distal radius fractures.

Distal Radioulnar Joint Instability in Distal Radius Fractures Managed with Volar Locking Plates

Abstract Introduction: Distal radioulnar joint (DRUJ) injuries are the most common cause of residual wrist disability after fractures of the distal radius. There is a lack of consensus regarding the diagnosis of these injuries along with their management when being accompanied by a fracture of the distal radius. The present prospective study aimed to assess the effect of the involvement of DRUJ on the outcome of distal radius fractures. The study also evaluated the role of clinical and radiographic indices in the diagnosis, management and outcome of these injuries. Materials and Methods: This prospective study involved 51 patients aged &gt;18 years with distal radius fractures treated using volar plating. The intra-operative assessment was done clinically using a piano key or ballotment test after fixation of distal radius fracture using K-wire stabilisation. The mean follow-up was 24 months. The patients were all clinically evaluated using the Modified Gartland and Werley scoring system. Radiographically, we calculated the dorsal/volar tilt, radial inclination, radial height and the ulnar variance. Results: A total of 44 patients with distal radius fractures were managed with the volar plate. The mean age was 45 years (range = 18–77; SD = ±13.6). The majority were men. The maximum cases were found to be of 2R3C type of AO/OTA fractures. Axial instability was observed in 12 cases, with 5 having negative and 7 showing positive axial instability. No statistically significant correlation was identified between the instability of the DRUJ and the overall outcome of distal radius fractures treated with volar plating (P = 0.241). However, a significant association was observed between fractures involving the base of the ulnar styloid (US) and the final clinical outcome (P = 0.023). The mean modified Gartland and Werley score was calculated at 6.09 ± 5.36, and 28.9% of cases suffered from loss of dorsiflexion. Conclusion: The present study revealed that it is important to recognise DRUJ instability in both axial and anteroposterior (AP) planes through clinical and radiological parameters. US base fractures cause DRUJ instability and also create a negative impact on the outcome of distal radius fracture fixed with volar plating. Ulnar variance is a good marker for checking instability in the AP plane by ballotment test. We found that in cases of DRUJ instability, fractures of the ulnar base should be examined and fixed if needed.

Biomechanical Design Optimization of Distal Humerus Fracture Plates: A Review.

The goal of this article was to review studies on distal humerus fracture plates (DHFPs) to understand the biomechanical influence of systematically changing the plate or screw variables. The problem is that DHFPs are commonly used surgically, although complications can still occur, and it is unclear if implant configurations are always optimized using biomechanical criteria. A systematic search of the PubMed database was conducted to identify English-language biomechanical optimization studies of DHFPs that parametrically altered plate and/or screw variables to analyze their influence on engineering performance. Intraarticular and extraarticular fracture (EAF) data were separated and organized under commonly used biomechanical outcome metrics. The results identified 52 eligible DHFP studies, which evaluated various plate and screw variables. The most common plate variables evaluated were geometry, hole type, number, and position. Fewer studies assessed screw variables, with number and angle being the most common. However, no studies examined nonmetallic materials for plates or screws, which may be of interest in future research. Also, articles used various combinations of biomechanical outcome metrics, such as interfragmentary fracture motion, bone, plate, or screw stress, number of loading cycles to failure, and overall stiffness (Os) or failure strength (Fs). However, no study evaluated the bone stress under the plate to examine bone "stress shielding," which may impact bone health clinically. Surgeons treating intraarticular and extraarticular distal humerus fractures should seriously consider two precontoured, long, thick, locked, and parallel plates that are secured by long, thick, and plate-to-plate screws that are located at staggered levels along the proximal parts of the plates, as well as an extra transfracture plate screw. Also, research engineers could improve new studies by perusing recommendations in future work (e.g., studying alternative nonmetallic materials or "stress shielding"), clinical ramifications (e.g., benefits of locked plates), and study quality (e.g., experimental validation of computational studies).

Comparative study between distal fibular locked plate and other conventional plates for fixation of lateral malleolar fracture

Comparative study between distal fibular locked plate and other conventional plates for fixation of lateral malleolar fracture