Locking Miniplates Research Articles

Synergistic effect of umbilical cord extracellular vesicles and rhBMP-2 to enhance the regeneration of a metaphyseal femoral defect in osteoporotic rats

BackgroundThe aim of this study was to evaluate potential synergistic effects of a single, local application of human umbilical cord MSC-derived sEVs in combination with a low dose of recombinant human rhBMP-2 to promote the regeneration of a metaphyseal femoral defect in an osteoporotic rat model.Methods6 weeks after induction of osteoporosis by bilateral ventral ovariectomy and administration of a special diet, a total of 64 rats underwent a distal femoral metaphyseal osteotomy using a manual Gigli wire saw. Defects were stabilized with an adapted Y-shaped mini-locking plate and were subsequently treated with alginate only, or alginate loaded with hUC-MSC-sEVs (2 × 109), rhBMP-2 (1.5 µg), or a combination of sEVs and rhBMP-2 (n = 16 for each group). 6 weeks post-surgery, femora were evaluated by µCT, descriptive histology, and biomechanical testing.ResultsNative radiographs and µCT analysis confirmed superior bony union with callus formation after treatment with hUC-MSC-sEVs in combination with a low dose of rhBMP-2. This finding was further substantiated by histology, showing robust defect consolidation 6 weeks after treatment. Torsion testing of the explanted femora revealed increased stiffness after application of both, rhBMP-2 alone, or in combination with sEVs, whereas torque was only significantly increased after treatment with rhBMP-2 together with sEVs.ConclusionThe present study demonstrates that the co-application of hUC-MSC-sEVs can improve the efficacy of rhBMP-2 to promote the regeneration of osteoporotic bone defects.

Comparative Evaluation of Masticatory Bite Force in Mandible Fractures Treated with Three-Dimensional Curved Locking Strut Plate Versus Straight Locking Miniplate.

To compare the efficacy of titanium 2.0-mm curved locking strut plate and 2.0-mm straight locking miniplate with regard to their intraoperative use and the stability of fixation achieved both, clinically and radiographically. Forty patients with 62 sites of mandibular fractures requiring open reduction and internal fixation were included in the study. The sample was divided into two groups of twenty patients each depending upon whether patient received three-dimensional 2.0-mm locking curved strut plate (group A) or 2.0-mm straight locking miniplates (group B). Mouth opening, teeth in the fracture line, degree of displacement, time taken, neurosensory and bite force evaluation were done preoperatively, 1st, 7th day, 2nd week, 4th week, 6th week and 12th week postoperatively. Positive correlation was found between preoperative and postoperative bite force values at subsequent follow-up weeks. At 3rd month evaluation, the change in bite force from the previous follow-up visit was significantly greater in group A (locking strut plate) than group B (locking miniplate) in the incisor, left molar and right molar region. Statistically significant difference was observed between the two groups regarding time taken (P < 0.016) depicting less time taken for placement of three-dimensional 2.0-mm locking curved strut plate(group A) 20.30 ± 4.85min as compared to 27.30 ± 6.82min for fixation with 2.0mm straight locking miniplates in group B. The findings were suggestive that the both systems had better adaptation during fixation, comparable radiographic reduction and increased stability in postoperative period. However, 3D locking strut plate took relatively lesser operative time, offered good rigidity and better stabilization of fractured segments in three dimensions along with significant improvement in the masticatory bite force postoperatively.

Development of a Metaphyseal Non-Union Model in the Osteoporotic Rat Femur.

The aim of this current study was to establish a metaphyseal femoral non-union model in osteoporotic rats by comparing a power tool versus a manual tool for fracture creation. Twelve adult female Sprague Dawley rats were ovariectomized (OVX) and received a special diet for 6 weeks. Biweekly pQCT measurements confirmed a significant reduction in the cancellous and total bone mineral density in OVX rats compared to control (CTRL) animals. After 6 weeks, OVX rats underwent surgery creating a distal metaphyseal osteotomy, either using a piezoelectric- (n = 6) or a manual Gigli wire (n = 6) saw. Fractures were stabilized with a Y-shaped mini-locking plate. Within each group, three rats received Alginate directly into the fracture gap. OVX animals gained more weight over 8 weeks compared to CTRL animals. pQCT analysis showed a significant difference in the volumetric cancellous bone mineral density between OVX and CTRL rats. A histological examination of the osteoporotic phenotype was completed. Radiographic evaluation and Masson-Goldner trichrome staining with the piezoelectric saw failed to demonstrate bony bridging or a callus formation. New bone formation and complete healing were seen after 6 weeks in the Gigli group. For the creation of a metaphyseal atrophic non-union in the osteoporotic bone, a piezoelectric saw should be used.

Transbuccal vs. Intraoral Approach using an Angulated Screwdriver in Fixation of a Mandibular Angle Fracture

Objectives: This study aimed to evaluate surgical stability and cosmetic outcomes in patients with mandibular angle fractures (MAFs) using an angled screwdriver (ASD) versus transbuccal trocar (TBT) for single locking plate fixation. Methods: A prospective cohort clinical study was done on 44 male patients (88%) and 6 (12% females patients with MAFs, categorized into 2 groups. Group A patients were treated with strictly intraoral vestibular incision using an angulated screwdriver; group B was treated with TBT. Both groups placed a single locking 2.0 mm mini-plates at the inferior border. The main outcome variables were the perioperative complication rate. Results: There were no statistical differences between both groups regarding postoperative wound dehiscence, screw or/and plate looseness, infection rate, and inferior dental nerve injury. The study (ASD) approach took 28.10±3.3minutes, while the TBT approach took 37.40±1.75minutes, indicating a highly significant difference in operating time (P=0.001). Post-operative edema had decreased significantly in the ASD group. Conclusion: According to the present results, a strictly intraoral approach for ASD enabled stable fixation of MAFs using a single mini-locking plate. This can significantly reduce operation time and postoperative edema and prevent extraoral scarring.

Comparison of clinical outcomes of three internal fixation techniques in the treatment of olecranon fracture: a retrospective clinical study

ObjectiveThe application of double plating in olecranon fractures is becoming increasingly widespread. There is no research comparing this technique with traditional tension band wiring (TBW) and the single plate technique. The purpose of this study was to compare the efficacy of three fixation techniques in olecranon fractures.Materials and methodsFrom March 2016 to May 2020, we collected the clinical data of 95 patients with olecranon fractures who underwent surgical treatment. Thirty-five patients received TBW surgery (TBW Group), 32 patients received a 3.5 mm locking compression plate (LCP, 3.5 mm LCP Group), and 28 patients received double mini-locking plate treatment (DP Group). The operation time, fracture union time, time of return to work, range of motion (ROM), soft tissue stimulation to remove internal fixation, and patient-related functional results (the Weseley score, Mayo Elbow Performance Score [MEPS], and Disabilities of Arm, Shoulder and Hand Score [DASH]) were recorded. The clinical results and complications of the three internal fixation techniques were compared.ResultsThe average follow-up time was 15.011.82 months (12–18 months). All patients’ fractures healed by first intention. There were no statistically significant differences in the operation time, fracture union time, ROM, Weseley score, MEPS or DASH scores of the three groups of patients. The postoperative return time for patients in the TBW group was 10.002.15 weeks, the 3.5 mm LCP group was 9.561.93 weeks, and the DP group was 8.432.38 weeks (P = 0.014); 12 patients in the TBW group required removal of plant due to soft tissue stimulation, the 3.5 mm LCP group had 8 cases, and the DP group had 2 cases (P = 0.038).ConclusionThe postoperative clinical results and elbow joint function of patients with olecranon fractures fixed by tension band wiring, 3.5 mm LCP and double mini-locking plate are similar, which indicates that double-plate technology can be used as an alternative to the two groups of traditional techniques. In addition, double-plate technology also helps patients return to work earlier and has a lower incidence of soft tissue stimulation.

Clinical observation of double mini locking plate in the treatment of olecranon fracture

To investigate the clinical effect of double mini-locking plates in the treatment of ulna olecranon fractures. From March 2017 to May 2020, 19 patients with olecranon fractures were treated with double mini locking plates, including 12 males and 7 females, aged from 20 to 75 years old with an average of (40.50±7.62) years old;10 patients had the injuries on the left side and 9 patients on the right side. All the 19 patients were fresh closed fractures without ulnar coronoid process fracture, elbow dislocation and other injuries. The fracture healing time and complications were recorded, and the clinical efficacy was evaluated by Mayo elbow performance score (MEPS) before operation and 12 months after operation. All the 19 patientswas followed up, and the duration ranged from 12 to 17 months with an average of (13.51±3.17) months. Postoperative follow-up showed all fractures healed. Fracture healing time ranged from 2 to 6 months, with an average of(3.77±1.24) months. There was no internal fixation fracture, screw loosening, infection, internal fixation irritation, heterotopic ossification, elbow stiffness and other complications occurred. The MEPS score of affected elbow at 12 months after operation was 91.26±3.87, which was significantly different from that before operation 56.18±9.56 (P<0.05);according to Mayo Elbow function score standard, 11 cases were excellent, 7 cases were good, and 1 case was fair. It is a reliable fixation method to treat olecranon fracture with double mini locking plate. The incision lengh is small and the fracture fixation is reliable. Elbow joint function exercise can be performed early after operation. Postoperative internal fixation has less skin irritation and satisfactory elbow joint function recovery.

A Prospective Study of Closed Comminuted Osteoporotic Metacarpal Shaft Fractures Treated with Locking Mini Plates in a Tertiary Care Hospital

A Prospective Study of Closed Comminuted Osteoporotic Metacarpal Shaft Fractures Treated with Locking Mini Plates in a Tertiary Care Hospital

Stabilization of anterior mandibular fracture using different osteosynthesis devices: perioperative clinical notes

There is still no definitive consensus about the ideal technique in the treatment of anterior mandibular fractures. Therefore, this study aimed to determine clinical and radiographic outcomes of four different internal fixation devices used for this type of fractures. This was a cohort study that included 64 fracture cases. Fractures were fixed using four types of open reduction internal fixation devices: single 2.0-mm mini-locking plates, double 2.0-mm miniplates, double lag screw and double microplates. Investigated variables were surgical duration, wound dehiscence, infection, occlusion, mouth opening, patient compliance, nerve damage and postoperative oedema. Male patients constituted 90.6% of the study sample. A proportion of 33% of the fractures were single symphysis and 67% were parasymphysis fractures. The most time-saving technique was the lag screw followed by microplate with mean/SD of 50.65 ± 4.152min. Wound dehiscence occurred in 4.7% and 3.1% of the miniplate and the mini-locking groups respectively. Miniplate and microplate groups had small interfragmentary space at 1-month postoperative radiographs, while mini-locking and lag screw groups had no extra-callus formation. The double lag screw and the single mini-locking plate are the most effective devices for primary bone healing of displaced mandibular symphysis/parasymphysis fractures which is attributed to their enhanced stability. Miniplates and microplates gave functionally well-balanced fixation and were also associated with higher patient convenience due to improved adaptability and relatively lower cost than locking plates. Cost-effectiveness of lag screws in comparison to bone plates is particularly beneficial in low-income countries.

Comparative Evaluation Between 2mm Locking and 2mm Non-Locking Miniplate System for Open Reduction and Internal Fixation of Mandibular Parasymphysis Fracture

Aims: To compare the stability, rigidity, bone healing and functional outcome of 2mm locking and 2mm non-locking miniplate system in mandibular parasymphysis fracture. Material and method: The was conducted at dept. of oral and maxillofacial surgery, GNIDSR, Kolkata, India, from May 2016, to December, 2019, 34 patients (male 30 and female 4) were randomly divided into 2 groups. The patients underwent osteosynthesis—Group A (n=17, 15 males and 2 females) with orthomax 2-mm locking titanium miniplates(LMP) and Group B (n=17, 15 males and 2 females) with orthomax 2-mm nonlocking titanium miniplates(NLMP). The age, gender, operating time, pain and swelling, mobility, occlusion, chewing efficacy, bony healing with radiological evaluation were all reviewed. The assessment of the patients was done preoperatively and postoperative days at 1 day, 3 day, 7th day, 14th day, 1st month, 2nd month, and 3rd month using the clinical parameters, observation and radiology. Results: A total of 34 parasymphysis fractures met the inclusion criteria. In our study, a statistically significant difference was not found in the clinical parameters such as operating time, pain, swelling, occlusion, chewing efficacy, mobility between the fracture segments and infection, hardware failure in postoperative period. A statistically significant difference was found in the CT scan evaluation with pre-op and post op fracture width and hounsfield unit in between two groups at preop and 3rd month postop days and it was also supported by OPG findings. Conclusion: We concluded that Locking miniplates are technically not cumbersome than non-locking one – No significant increase in operating time. Use of two locking miniplates in the parasymphysis region placed on the Champy’s line of oesteosynthesis provides a better stability and oesteosynthesis at the 3rd month postoperative period than non-locking.

Comparison of Bite Force in Patients After Treatment of Mandibular Fractures With 3-Dimensional Locking Miniplate and Standard Miniplates

Background: Fractures of the mandible can be studied and described in anatomic terms, functional considerations, treatment strategies, and outcome measures. The performance of any fixation system depends on multiple factors including plate adaptation, screw placement, bone quality, drilling conditions, and postoperative patient compliance. Bite force assesses masticatory muscle function under clinical and experimental conditions.Method: 30 patients with isolated, noncomminuted mandibular fractures were randomly divided into two equal groups. Group 1 patients were treated using 3-dimensional locking miniplates and group 2 patients were treated with standard miniplates. The bite forces were recorded at definite time intervals: preoperatively, and second week, sixth week, third month, and sixth month postoperatively.Result: At 6 weeks postoperative, 3 month postoperative, and 6 month postoperative, the mean bite force was found to be significantly higher among group 1 patients as compared to those in group 2 in all the sites. While at 2 week postoperative, the mean bite force was found to be significantly higher in Group 2 as compared to Group 1 at incisor region.Conclusion: The overall results of the present study show better performance in bite force for the 3-dimensional locking miniplate when compared with standard miniplates.

Evaluation of mini-locking plate system in management of body mandibular fracture (Clinical study)

Aim: To evaluate the mini-locking plate system in management of body mandibular fracture. Patient and methods: Twenty patients were randomly classified into two equal groups. Group (1): (The study group): Ten patients were treated by open reduction and internal fixation using single 2.0mm locking plate and arch bar as a tension band maintained for 5 weeks. Group (2): (The control group) Ten patients received the same treatment as in group (1) but with single 2.0mm conventional plate. Follow- up was performed for 6 months and post-operative complications such as infection, wound dehiscence, neurosensory disturbances and malocclusion were recorded. Arch bar was removed after 5 weeks of surgery. Data regarding age, sex, and bone density at the fracture side during healing, bite force measurements at anterior, premolar and molar regions were collected, tabulated and statistically analyzed using IBM SPSS software package version 20.0. Results: Uneventful healing of all fractures treated with mini-locking plates and conventional plate system, with no cases of malunion, nonunion, infection, or malocclusion being observed through the follow up periods. There was statistically difference between both groups regarding the mean bone density one week, 1, 3 and 6 months post-operatively. Bite force recording showed increasing values at subsequent follow ups corresponding to the healing of the fracture in both groups. Conclusion: Bone density in group (1) was in an accelerated pattern and of higher value than that of group (2). Patients treated with locking plate screw system regain more bite force compared to those treated with conventional miniplate screw system.

Comparison of Conventional 2.0 mm Non-Locking and Locking Miniplates in Management of Fracture Mandible

Comparison of Conventional 2.0 mm Non-Locking and Locking Miniplates in Management of Fracture Mandible

Clinical effects of mini-locking plate with vertical or parallel technology for treatment of Dubberley type B capitellar fractures

Objective To investigate the clinical effects of mini-locking plate with vertical or parallel technology in the treatment of Dubberley type B capitellar fractures. Methods A case series study was done on clinical data of 17 cases of Dubberley type B capitellar fractures treated through operation with vertical or parallel mini-locking plate. There were 12 males and 5 females, with age range of 23-77 years (mean 56.4 years). The fractures were classified according to the Dubberley system, including type ⅠB in 2 cases, ⅡB in 6 and type ⅢB in 9. The operations were conducted through the Kocher approach at posterior-lateral rear elbow joint and the fractured bone was fixed firstly with Kirschner wire and mini screws after resetting and then with vertical or parallel mini locking plate. The surgery time and bleeding volume during the surgery were recorded. The position of fracture, healing, avascular necrosis of capitellum, heterotopic ossification, and traumatic arthritis were evaluated. At the final follow-up, the Mayo elbow performance score (MEPS) was used to evaluate the function of elbow, and flexion and extension of the elbow, swing of the forearm and inner stability of the elbow joint were evaluated. Results The surgery time was 50-90 minutes (mean 60 minutes). The bleeding volume during surgery was 40-120 ml (mean 60 ml). All patients were followed up for 12-24 months (mean 12.1 months). Anatomical reduction was seen in 12 cases and almost anatomical reduction in 5. None had vessel or nerve wound, and the wound was healed at phase Ⅰ within 10-12 days after operation. The clinical fracture healing time was 8-12 weeks (mean 11.4 weeks). At the final follow-up, the fractures were well healed without complications like fracture reduction loss, ischemic necrosis of the humerus, traumatic arthritis or heterotopic ossification of the elbow joint. MEPS in all cases was 60-100 points (mean 87.6 points). MEPS assessment result was excellent in 13 cases, good in 3 and fair in 1, with the excellent rate of 94%. At the final follow-up, the average activity of the elbow was 6 ° (0°-10°) for extension and 118° (90°-130°) for flexion, the average forearm pronation was 70° (60°-90°), the average forearm supination was 82°(70°-90°), and the inner stress test showed no instability. Conclusion Vertical or parallel mini-locking plate in the treatment of Dubberley type B capitellar fractures is associated with few complications, early functional exercise after operation, and satisfactory short-term outcome. Key words: Humeral fractures; Fracture fixation, internal; Mini-locking plate

Treatment of Mandibular Angle Fractures with Single Three-Dimensional Locking Miniplates without Maxillomandibular Fixation: How Much Fixation Is Required?

The aim of this simple nonrandomized and observational study was to evaluate the efficacy of single three-dimensional (3D) plate for the treatment of mandibular angle fractures without maxillomandibular fixation. A total of 30 patients with noncomminuted fractures of mandibular angle requiring open reduction and internal fixation were included in the study. All the patients were treated by open reduction and internal fixation using single 3D titanium locking miniplate placed with the help of transbuccal trocar or Synthes 90-degree hand piece and screw driver. 3D locking titanium miniplates used in our study was four-holed, box-shaped plate, and screws with 2 mm diameter and 8 mm length. The following clinical parameters were assessed for each patient at each follow-up visit: pain (visual analog scale: 0-5), swelling (visual analog scale: 0-5), mouth opening, infection, paresthesia, hardware failure (plate fracture), occlusal discrepancies, and mobility between fracture fragments. A significant decrease in pain level was seen during the follow-up visits. No statistically significant changes were seen in swelling, but mouth opening increased in the subsequent visits. Also better results were seen in terms of fracture stability and occlusion in the postoperative period. Two cases of infection and two cases of hardware failure were noted in sixth postoperative week. 3D plating system is an easy to use alternative to conventional miniplates to treat mandibular angle fractures that uses lesser foreign material, thus reducing the operative time and overall cost of the treatment. Better fracture stability and occlusion was also achieved using the 3D plating system.

Mini-locking plates for the treatment of Regan-Morrey type III fracture of ulnar coronoid process through anterior approach of elbow joint

To explore clinical effects of mini-locking plates for the treatment of Regan-Morrey type III fractures of ulnar coronoid process through an anterior approach of elbow joint. A retrospective analysis on 12 patients with Regan-Morrey type III fractures of the ulnar coronoid process was performed from January 2011 to June 2014, who were treated with unini-locking plates through the anterior approach of elbow joint. There were 7 males and 5 females, ranging in age from 23 to 65 years old, averaged 43 years old. Four patients had fractures on the left and 8 patients had fractures on the right. The X-ray films were taken to evaluate the location and healing of the fracture before and after operation. Clinical evaluation included analysis on surgical complications, range of motion and Mayo elbow function score. All the patients were treated with mini-locking plates, and the elbow joint was stable after operation. All the patients were followed up, and the duration ranged from 14 to 36 months. All the fractures were healed, and the healing time ranged from 12 to 20 weeks. The average healing time was 15.6 weeks. There were no complications occurred such as heterotopic ossification, traumatic arthritis and others. At the latest follow-up, the average angle of elbow flexion was (127.0±5.6)°(120° to 135°); the average extension angle was(4.2±4.5)° (0° to 10°); the average pronation angle of forearm was (86.0±6.1)°(75° to 90°); the average supination angle of forearm was (87.0±6.9)°(80° to 100°). Mayo elbow function score was 80 to 96 points, with an average of 88 points, of which 2 cases got an excellent result, 10 good. Elbow anterior approach can clearly expose the Regan-Morrey type III coronoid fractures, and mini-locking plate fixation has a satisfactory effect.

Evaluation of fracture healing and subimplant bone response following fixation with a locking miniplate and screw system for mandibular angle fractures in a sheep model

This study aims to establish a mandible fracture model, and to review fracture healing following fixation with a locking miniplate system. Eighteen 2-year-old sheep were divided into three groups of six. Each animal had a single fracture that was anatomically reduced and internally fixed by a single 4-hole plate with two monocortical screws each side of the fracture. The fractures were internally fixed with poorly contoured conventional miniplates or poorly contoured mini-locking plate or well contoured conventional miniplates. Two sheep in each of the three groups were killed at 2, 4 and 8 weeks after surgery. The mandibles were radiographed then decalcified specimens were reviewed microscopically. No clinical difference was observed between the groups. All fractures were at an advanced stage of bony union by 4 weeks. Fracture union appeared radiographically more advanced with the locking plate system. This study established a protocol for simulating a fracture model for the study of fracture healing. A more advanced stage of union was seen for fractures internally fixed with locking plates/screws than with a conventional system. The observations suggest the purported biological benefits of locking miniplate system do exist.

Effectiveness of 2.0 mm Standard and 2.0 mm Locking Miniplates in Management of Mandibular Fractures: A Clinical Comparative Study

To compare and evaluate the effectiveness of 2.0mm locking miniplates versus 2.0mm standard miniplates in treatment of mandible fractures. Sixty randomly selected patients who sustained mandibular fractures were selected for this study. The fractured fragments were stabilized using 2.0mm locking miniplates in 30 cases and in the remaining 30 cases the fractured fragments were fixed with conventional 2.0mm miniplates. Post-operative stability was assessed with radiographs at 7thday, 1st, and 3rdmonths. The stability of the reduced fracture was assessed clinically and both the types of plates were assessed with an OPG or conventional radiographs. This study shows favorable results on use of locking miniplates in mandibular fractures. The results show that there were no significant differences in the post-operative complications between the conventional and the locking plate/screw mandibular systems. The locking plate/screw system was more rigid than conventional plate/screw system, thereby reducing the need and duration of intermaxillary fixation (IMF).

The Search for the Ideal Fixation of Palatal Fractures: Innovative Experience with a Mini-Locking Plate

Fractures of the palate have defied conventional management, such that malrotation and disinclination of the palatal shelves occur in a significant number of patients after repair. The fractured palatal shelves of eight patients were first prealigned. To do so, one or more 205-mm ratchet clamps and two intermaxillary fixation (IMF) posts were used. Rigid fixation was then achieved by applying a 2.0-mm mini-locking titanium plate (across the palatal vault) and by applying an adaptation miniplate across the fracture line as it exited the anterior surface of the maxilla. Screws were passed directly through the mucoperiosteum, to engage the palatal shelves and to lock the locking plate into position. Lacerations in the mucoperiosteum were neither used to aid fixation nor used as portals for dissection; incisions and mucoperiosteal flaps in the palatal vault were avoided. Adjuncts, such as intraoral splints, have not been used in cases to date, and early mobilization was allowed. Reconstitution of the craniomaxillofacial buttresses was added in patients with more extensive maxillary injury. The palatal appliance and screws remained rigidly in position in the roof of the mouth, much like an external fixator, until their removal 8 to 12 weeks after the repair. No patient suffered erosion of the mucoperiosteum or other major morbidity, other than a transient fistula of the soft palate. The palatoalveolar segments remained in proper realignment and inclination, and pretraumatic occlusal patterns and the width and depth of the lower face appear to have been restored with one exception. The latter suffered a subtle posterolateral open bite that was corrected orthodontically. Prealignment of fractured palatal shelves with one or more large ratchet clamps and two IMF posts provides several points of forced reduction of the palatal shelves, along the dental arch. In addition, stabilization with mini-locking plate(s) in the palatal vault and an adaptation plate across the fracture line, as it exits the maxilla, appear to have merit, based on this preliminary report (n = 8). Outcomes seen on computed tomography and clinical examination during this 3-year experience have been favorable.