Loosening Of Locking Screws Research Articles

A STUDY ON FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURES TREATED WITH PHILOS PLATING

Background: Proximal humerus fractures are common and debilitating injuries. These fractures have a dual age distribution occurring either in young people following high energy trauma Usually high energy trauma associated with dislocation or in those older than 60 years with low-velocity injuries like simple fall, especially in elderly patients is due to osteoporosis and deforming forces of muscle attached. Wide range of treatment modalities ranging from conservative management to reverse shoulder arthroplasty. The non-operative method gives good results in stable and minimally displaced fractures. Displaced humeral neck fractures used to be managed conservatively in the past, but these were complicated by loss of reduction, malunion, non-union, stiffness and ultimately poor functional outcome. We took up this study to assess the efcacy and functional outcome of P.H.I.L.O.S. plating in proximal humerus. Our objectives are to study the fracture pattern with the Neer's criteria, to reconstruct the proximal humerus fracture anatomically with Philos plate, allow early shoulder mobilization and assessing the functional outcome using Constant Murley score. It is an Materials and methods: observational study of 30 patients (18 females and 12 males) with proximal humerus fractures that attended to the Department of Orthopaedics, Government General Hospital, Rangaraya medical college, Kakinada from December 2018 to December 2020. The mean follow-up Results: period was 12 months. Two patients lost follow-up. Of the remaining 28 patients, all fractures were united clinically and radiologically. At the nal follow-up the mean Constant-Murley score was 69.2 (range 50 -100). The results were excellent in 3, good in 12, fair in 10 patients, poor in 3 patients. During the follow-up 4 cases had varus mal-union, 5 had stiffness of the shoulder, 2 had supercial infection and1 had screw penetration. No cases of hardware failure, locking screw loosening or non-union were noted. T Conclusion: he divergent and convergent orientation of the locking screws of PHILOS plate provides stable biological xation with good radiological union. It minimises the soft tissue dissection and gives both axial and angular stability hence, reducing the risk of fracture displacement.

Proximal humerus locking plate fixation for proximal humerus fractures

Objective: To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal Humerus fractures. Methods: We reviewed 20 patients who underwent open reduction and internal fixation with PHILOS plate from June 2012 to June 2013. There were 16 men and 4 women with a mean age of 45.01 years (range 41-50). There were 9 patients in the age group of 40 years. According to Neer classification system, 7, 12 and 1 patients had 2-part, 3-part, and 4-part fractures, respectively. All surgeries were carried out at tertiary care Hospital. Functional evaluation of the shoulder at final follow-up was done using Constant score. Results: The mean follow-up period was 18 months (range 12-36 months). Three patients were lost to follow-up. Of the remaining 20 patients, all fractures were united clinically and radiologically. The mean time for radiological union was 90 days {12 weeks (range 8-20 weeks)}. At the final follow-up the mean Constant score was 67.25 (range 50-100). The results were excellent in 7 patients, good in 7 patients, fair in 5 patients and poor in 1 patient. During the follow-up, one case of varus malunion, four cases of stiffness and five cases of abductor weakness were noted. No cases of avascular necrosis, hardware failure, locking screw loosening or non-union, failure of fixation were noted. Conclusion: PHILOS provides stable fixation in proximal Humerus fractures. To prevent potential complications like avascular necrosis, meticulous surgical dissection to preserve vascularity of humeral head is necessary.

Outcome of locking plate fixation for proximal humerus fractures

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate functional outcome of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong><span lang="EN-US"> We reviewed 30 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2010 to 2015. There were 23 men and7 women with a mean age of 36 years (range 20-64).There were 22 patients in the age group of <60 years and 8 patients in the age group of >60 years. According to Neer classification system, 12, 11 and 4 patients had2-part, 3-part, and 4-part fractures, respectively and 2 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma center. Functional evaluation of the shoulder at final follow-up was done using Neer’s Evaluation Criteria.</span></p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong><span lang="EN-US"> The mean follow-up period was 20 months (range 14-40 months). All fractures united clinically and radio logically. The mean time for radiological union was 13.2 weeks (range 9-26 weeks).At the final follow-up the mean Neer’s Evaluation Criteria was 90 (range 76-100). The results were excellent in 17patients, Satisfactory in 8 patients, Unsatisfactory in 4 patients and Failure in 1 patient. During the follow-up, 3 cases of varus malunion, 1 case of failure of fixation were noted. No cases of AVN, hardware failure, locking screw loosening, infection or nonunion were noted.</span></p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong><span lang="EN-US"> PHILOS provides stable fixation in proximal humerus fractures. In order to prevent the complications like avascular necrosis, knowledge of anatomy and vascular supply of head of humerus and good surgical dissection to preserve vascularity of humeral head is important.</span></p>

Surgical treatment of proximal humerus fractures using PHILOS plate

ObjectiveTo evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures. MethodsWe reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012. There were 35 men and 16 women with a mean age of 38years (range 24-68). There were 41 patients in the age group of <60years and 10 patients in the age group of >60years. According to Neer classification system, 8, 15 and 23 patients had 2-part, 3-part, and 4-part fractures, respectively and 5 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma centre. Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score. ResultsThe mean follow-up period was 30months (range 12-44 months). Two patients were lost to follow-up. Of the remaining 49 patients, all fractures were united clinically and radiologically. The mean time for radiological union was 12weeks (range 8-20 weeks). At the final follow-up the mean Constant-Murley score was 79 (range 50-100). The results were excellent in 25 patients, good in 13 patients, fair in 6 patients and poor in 5 patients. During the follow-up, four cases of varus malunion, one case of subacromial impingement, one case of deep infection, one case of intraarticular screw penetration and one case of failure of fixation were noted. No cases of avascular necrosis, hardware failure, locking screw loosening or nonunion were noted. ConclusionPHILOS provides stable fixation in proximal humerus fractures. To prevent potential complications like avascular necrosis, meticulous surgical dissection to preserve vascularity of humeral head is necessary.

The effect of polyethylene creep on tibial insert locking screw loosening and back-out in prosthetic knee joints

A prosthetic knee joint typically comprises a cobalt–chromium femoral component that articulates with a polyethylene tibial insert. A locking screw may be used to prevent micromotion and dislodgement of the tibial insert from the tibial tray. Screw loosening and back-out have been reported, but the mechanism that causes screw loosening is currently not well understood. In this paper, we experimentally evaluate the effect of polyethylene creep on the preload of the locking screw. We find that the preload decreases significantly as a result of polyethylene creep, which reduces the torque required to loosen the locking screw. The torque applied to the tibial insert due to internal/external rotation within the knee joint during gait could thus drive locking screw loosening and back-out. The results are very similar for different types of polyethylene.

Prospective Evaluation of Distal Radius Fractures Treated With Variable-Angle Volar Locking Plates

To evaluate the radiographic, objective (range of motion and grip strength), and subjective outcomes of variable-angle volar locking plate (VAVLP) fixation for unstable distal radius fractures. Over a 12-month period, we prospectively evaluated 39 consecutive distal radius fractures treated operatively with VAVLPs. Surgical exposure, fracture reduction, plate application, and postoperative rehabilitation were uniformly performed. Clinical outcome and radiographic measures, with a minimum follow-up of 12 months, were obtained. Final follow-up data were available in 37 patients (26 females and 11 males) with average age of 57 years (range, 16-89 y). The average follow-up time was 14 months (range, 12-22 mo). At final evaluation, average volar tilt was 3°, average radial inclination was 21°, average radial height was 12 mm, and average ulnar variance was -0.2 mm. There was no statistical difference between first postoperative and 1-year follow-up radiographs for any of the measured variables, although there were 4 cases of loss of volar tilt. Average Disabilities of the Arm, Shoulder, and Hand score was 6 and average visual analog scale pain score was 0.3. Mean grip strength at 1 year was 96% of the contralateral side. There was 1 case of variable-angle locking screw loosening and 1 case of extensor tenosynovitis requiring hardware removal. There were no tendon ruptures. The VAVLP fixation restored and maintained acceptable reduction in all patients in this series with a complication rate comparable to standard volar fixed-angle locking plates. Treatment of unstable distal radius fractures with a VAVLP resulted in excellent clinical outcomes at 1-year follow-up. However, use of the VAVLP risks soft tissue irritation, hardware failure, and loss of fracture reduction. Therapeutic IV.