Non-locking Plate Research Articles

Prospective Randomized Comparison of Locked Plates Versus Nonlocked Plates for the Treatment of High-Energy Pilon Fractures.

To compare the radiographic and functional outcome of patients with high-energy pilon fractures treated with locked versus nonlocked plates. Randomized prospective trial. Academic level 1 trauma center. Between December 2006 and December 2008, 60 consecutive patients with 62 AO/OTA type A, B, and C tibial pilon fractures were enrolled in the study. Thirty-two of the fractures were treated using locked plates and 29 were treated with nonlocked plates. Follow-up data were available for 33 of the 60 patients. Treatment with locked versus nonlocked plates. Short Musculoskeletal Function Assessment (SMFA) questionnaire and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (AHS). Radiographic measurements on anteroposterior and lateral views for the quality of reduction and maintenance of alignment immediately postoperatively compared with the latest follow-up. There were no significant differences in the mechanism or injury pattern, average age of the patients, ratio of males to females, tourniquet time, operative time, interval to surgery, AHS, or SMFA scores. One of 15 fractures in the locked plate group lost reduction at the latest follow-up compared with 3 of 19 fractures in the nonlocked group. In this study, there seems to be no difference between the 2 constructs. Thus, one must question the routine use of locked plates in the treatment of high-energy pilon fractures. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Interventions for treating fractures of the distal femur in adults.

Interventions for treating fractures of the distal femur in adults.

1st metatarsophalangeal joint fusion: A comparison of non-union and gender differences between locking and non-locking plating systems

BackgroundFusion of the first metatarsophalangeal joint (1st MTPJ) is a common surgical procedure used to treat a variety of diseases and deformities of the forefoot. Fixation methods vary and typically fusion rates are good. ObjectivesThe objectives of the study are to demonstrate whether there is any advantage to using locking as opposed to non-locking plates for 1st MTPJ fusion. Additionally the study aims to determine whether there is any difference in non-union rates according to gender. MethodsOne hundred and seventy two consecutive 1st MTPJ fusions were performed for 153 patients. 40 patients (23%) were male and 132 (77%) female. Twenty patients received Hallu-fix™ plates, 76 CharlotteTM plates and 76 AnchorageTM plates. Postoperative radiographs were reviewed for non-union. Failure rates were compared using Fisher's exact tests (p=0.05). ResultsTwelve (6.9%) non-unions were identified. The difference in failure rates between all systems was not statistically significant. However, the difference in fusion rates between males (17.5%) and females (3.8%) was significant. ConclusionThis study finds that 1st MTPJ fusion is an effective method to treat diseases of the 1st MTPJ. Locking plates may offer better fusion rates than their non-locking counterparts. This is especially evident in male patients.

Screw Loosening and Pelvic Canal Narrowing After Lateral Plating of Feline Ilial Fractures With Locking and Nonlocking Plates.

To compare the frequency of complications, including screw loosening and pelvic canal narrowing, associated with dynamic compression plating, locking plating, and double locking plating of ilial fractures in cats. Historical cohort study. The radiographs and medical records of cats with pelvic fractures that were presented between 2004 and 2013 were reviewed. The cases were categorized based on the plate type and number as dynamic compression plate (DCP), single locking plate (LPS) and double locking plates (dLPS). The frequency of screw loosening was compared across categories using a Fisher's exact test. The change in pelvic alignment, described by the change in sacral index (postoperative sacral index-followup sacral index), was compared across plate categories using ANOVA. The frequency of screw loosening for DCP (5/10) was significantly higher than LPS (1/13) and dLPS (0/11) (P = .05, P = .012, respectively). There was no significant difference in the SI change across plate categories. The mean change in sacral index for DCP was -0.11 (95%CI -0.25 to 0.03), for LPS was 0.0007 (95%CI -0.07 to 0.08), and for dLPS was -0.01 (95%CI -0.04 to 0.02). None of the cats showed constipation postoperatively. Screw loosening occurred less often but the change in pelvic canal alignment was not significantly different in ilial fractures repaired with LPS or dLPS compared to ilial fractures repaired with DCP. Locking plating of ilial fractures in cats may offer advantages compared to nonlocking plating.

A scoping review of biomechanical testing for proximal humerus fracture implants.

BackgroundFixation failure is a relatively common sequela of surgical management of proximal humerus fractures (PHF). The purpose of this study is to understand the current state of the literature with regard to the biomechanical testing of proximal humerus fracture implants.MethodsA scoping review of the proximal humerus fracture literature was performed, and studies testing the mechanical properties of a PHF treatment were included in this review. Descriptive statistics were used to summarize the characteristics and methods of the included studies.Results1,051 proximal humerus fracture studies were reviewed; 67 studies met our inclusion criteria. The most common specimen used was cadaver bone (87 %), followed by sawbones (7 %) and animal bones (4 %). A two-part fracture pattern was tested most frequently (68 %), followed by three-part (23 %), and four-part (8 %). Implants tested included locking plates (52 %), intramedullary devices (25 %), and non-locking plates (25 %). Hemi-arthroplasty was tested in 5 studies (7 %), with no studies using reverse total shoulder arthroplasty (RTSA) implants. Torque was the most common mode of force applied (51 %), followed by axial loading (45 %), and cantilever bending (34 %). Substantial testing diversity was observed across all studies.ConclusionsThe biomechanical literature was found to be both diverse and heterogeneous. More complex fracture patterns and RTSA implants have not been adequately tested. These gaps in the current literature will need to be addressed to ensure that future biomechanical research is clinically relevant and capable of improving the outcomes of challenging proximal humerus fracture patterns.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0627-x) contains supplementary material, which is available to authorized users.

Biomechanical loading test on reconstructed mandibles with fibular, iliac crest or scapula graft: a comparative study

Advantages and disadavantages of the three most commonly-used bone grafts for mandibular reconstruction are widely known, but biomechanical experimental studies are rare. We have done loading tests on cadaveric mandibles reconstructed with fibular, iliac crest, and scapular grafts using 3 different osteosynthesis systems to detect and compare their primary stability. Loading tests were done on mandibles with grafts from the fibula and iliac crest and published previously. A 4.5cm paramedian L-type defect was reconstructed with scapula using 2 monocortical non-locking plates, 2 monocortical locking plates, or a single bicortical locking plate/fracture gap in 18 human cadaveric mandibles. These were loaded on to the “Mandibulator” test bench and the movement of fragments in 3 dimensions was assessed and quantified by a PONTOS® optical measurement system. Comparison of the osteosynthesis groups showed that the miniplate was significantly superior to the 6-hole TriLock® plate for both fibular and iliac crest grafts. The fibular graft gave greater stability than the iliac crest and scapular grafts for all 3 osteosynthesis systems. All bony specimens offered sufficient resistance to mechanical stress within the recognised range of biting forces after mandibular reconstruction, independently of the choice of bone graft and osteosynthesis system used. Anatomical and surgical advantages need to be taken into account when choosing a graft. Stability can be maximised with a fibular graft, and further optimised by enlarging the binding area by using the “double barrel” method. Computer simulated experiments could segregate factors that biased results, such as morphological differences among cadavers.

Periprosthetic supracondylar femoral fractures following knee arthroplasty: a biomechanical comparison of four methods of fixation.

The aim of this study was to determine the biomechanical properties of four fixation options for periprosthetic supracondylar femoral fractures. Fourth-generation composite femurs were implanted with a posterior-stabilizing femoral component of total knee arthroplasty. All femurs were osteotomized to produce a AO/OTA 33-A3 fracture pattern and four different constructs were tested: (1) non-locking plate; (2) polyaxial locking plate; (3) intramedullary fibular strut allograft with polyaxial locking plate; (4) retrograde intramedullary nail. The composite femurs underwent non-destructive tests to determine construct stiffness in axial and torsional cyclic loading. The final testing consisted of quasi-static axial loading until failure. Under cyclic torsional loading, the retrograde intramedullary nail was less stiff than non-locking plate, polyaxial locking plate and intramedullary fibular strut allograft with polyaxial locking plate (p = 0.046). No differences were detected in cyclic axial loading between the different constructs. During quasi-static axial loading to failure, the intramedullary nail achieved the highest axial stiffness while the non-locking plate showed the lowest (p = 0.036). The intramedullary fibular strut allograft with polyaxial locking plate did not prove to be significantly better to the polyaxial locking plate only in a periprosthetic distal femur fracture model.

Angular stable lateral plating is a valid alternative to conventional plate fixation in the proximal phalanx. A biomechanical study

BackgroundDorsal plating is commonly used in proximal phalanx fractures but it bears the risk of interfering with the extensor apparatus. In this study, dorsal and lateral plating fixation methods are compared to assess biomechanical differences using conventional 1.5mm non-locking plates and novel 1.3mm lateral locking plates. MethodsTwenty-four fresh frozen human cadaveric proximal phalanges were equally divided into four groups. An osteotomy was set at the proximal metaphyseal–diaphyseal junction and fixed with either dorsal (group A) or lateral (group B) plating using a 1.5mm non-locking plate, or lateral plating with a novel 1.3mm locking plate with bicortical (group C) or unicortical (group D) screws. The specimens were loaded in axial, dorsovolar and mediolateral direction to assess fixation stiffness followed by a cyclic destructive test in dorsovolar loading direction. FindingsAxial stiffness was highest in group D (mean 321.02, SEM 21.47N/mm) with a significant difference between groups D and B (P=0.033). Locking plates (groups C and D) were stiffer than non-locking plates under mediolateral loading (P=0.007), no significant differences were noted under dorsovolar loading. Furthermore, no significant differences were observed under cyclic loading to failure between any of the study groups. InterpretationNo considerable biomechanical advantage of using a conventional 1.5mm dorsal non-locking plate was identified over the novel 1.3mm lateral locking plate in the treatment of proximal phalanx fractures. Since the novel low-profile plate is less disruptive to the extensor mechanism, it should be considered as a valid alternative.

Treatment of type B periprosthetic femur fractures with curved non-locking plate with eccentric holes: Retrospective study of 43 patients with minimum 1-year follow-up

IntroductionPeriprosthetic femur fracture (PFF) is a serious complication after total hip arthroplasty that can be treated using different internal fixation devices. However, the outcomes with curved non-locking plates with eccentric holes in this indication have not been reported previously. The objectives of this study were to determine: (1) the union rate; (2) the complication rate; (3) autonomy in a group of patients with a Vancouver type B PFF who were treated with this plate. HypothesisUse of this plate results in a high union rate with minimal mechanical complications. Materials and methodsForty-three patients with a mean age of 79 years±13 (41–98) who had undergone fixation of Vancouver type B PFF with this plate between 2002 and 2007 were included in the study. The time to union and Parker Mobility Score were evaluated. The revision-free survival (all causes) was calculated using Kaplan-Meier analysis. The average follow-up was 42 months±20 (16–90). ResultsUnion was obtained in all patients in a mean of 2.4 months±0.6 (2–4). One patient had varus malunion of the femur. The Parker Mobility Score decreased from 5.93±1.94 (2–9) to 4.93±1.8 (1–9) (P=0.01). Two patients required a surgical revision: one for an infection after 4.5 years and one for stem loosening. The survival of the femoral stem 5 years after fracture fixation was 83.3%±12.6%. ConclusionUse of a curved plate with eccentric holes for treating type B PFF led to a high union rate and a low number of fixation-related complications. However, PFF remains a serious complication of hip arthroplasty that is accompanied by high morbidity and mortality rates. Level of evidenceRetrospective study, level IV.

Minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft fractures

Background The most notable change in the treatment of fractures has been the shift from the mechanical aspects of internal fixation with absolute stability and primary bone union as the goal to the biological aspects of internal fixation with relative stability and healing with callus as the preferred method, with a huge focus on preservation of the blood supply of bone and soft tissue to ensure the continued vitality of the individual fragments to improve fracture healing. Percutaneous plate fixation minimizes soft tissue compromise with decreased incidence of wound breakdown and deep infection. It also preserves the vascularity of the bone fragments, and thus reduces the time for union, decreases the need for bone grafting even in comminuted fractures, and also decreases the incidence of nonunion, which requires a second major open intervention. Aim The aim of this study was to evaluate the outcome of minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft (upper and middle thirds) fractures in adults using conventional nonlocked plates through the medial approach. Patients and methods This prospective study included 16 adult male patients who had high-energy closed tibial shaft fractures (upper and middle thirds) with varying degrees of displacement and comminution. All patients were evaluated clinically and radiologically before and after surgery, followed up for a mean time of 14 months postoperatively, and evaluated radiologically and functionally according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system. All patients were treated using conventional nonlocked plates inserted percutaneously on the medial surface of the tibia. Results All the fractures united with a mean union time of 16.2 weeks, ranging from 13 to 36 weeks. Clinical and radiological outcomes according to the ASAMI scoring system in this study showed excellent results in 14 patients, representing 87.5% of the studied group, and good results in two patients, representing 12.5% of the studied group. No neurovascular complications, no persistent limitation of the knee or ankle motions, no deep wound infection, and no implant failure occurred in any of the patients until the last follow-up, and none of the patients required a second major open intervention. Conclusion The minimally invasive percutaneous plate fixation technique is an effective method of stabilization for closed tibial shaft fractures, yielding good bone alignment and protecting soft tissues, leading to higher union rates with good functional outcome. The use of conventional nonlocked plates applied through the medial approach decreases the surgical time and the risk of postoperative compartmental syndrome.

Comparisons in finite element analysis of minimally invasive, locking, and non-locking plates systems used in treating calcaneal fractures of Sanders type II and type III

Background Calcaneal fractures are relatively common but complex, while the treatment of these fractures is still controversial. The objective of this study was to compare the biomechanical stability of minimally invasive, locking, and non-locking plating systems used for fixing Sanders type II and type III calcaneal fractures. Finite element analysis was used for comparing the three types of plating systems. This study helped in guiding the clinical management of calcaneal fractures. Methods The CT data acquired from a volunteer was used to construct a finite element model of calcaneus. The fracture lines were made according to Sanders type II (A, B, C) and type III (AB, AC, BC) and six calcaneal fractures models were constructed accordingly. Three fixation methods used in clinical treatment were simulated by design tools (minimally invasive plating with percutaneous screws, Y-size non-locking plating, and locking plating) and then fixed to these fracture models with the help of clinical principles. The single minimally invasive plating fixation was also tested to compare the function of percutaneous screws. Then, the neutral force was applied on established methods. The displacement and presses distribution condition in various plating models were analyzed and compared. Results The levels of displacement and compressive press on the bone around fixation or strains on plating were within the physiological limit, indicating that the three methods were suitable for application. Compared with the locked and unlocked plates, the minimally invasive plating caused a relatively lower displacement without the high stress in bone or fixation. The minimum stress in fixation was observed in locking plate as the distribution of stress was concentrated in the anterior part of locking plate. Conclusions The minimally invasive plating method could be a better alternative method in treating Sanders type II and type III calcaneal fractures. The observed stiffness of locking plate was not obviously stronger than unlocked plate.

Radiostereometric analysis of early anatomical changes following medial opening wedge high tibial osteotomy.

The objective of this study was to use radiostereometric analysis (RSA) to evaluate the anatomical changes that occur in the tibia immediately after surgical correction with medial opening wedge high tibial osteotomy (HTO), and the changes that occur over the course of the first twelveweeks of osseous union. Patients included nine males and one female, with a mean age of 49.0 ± 5.5 years and mean BMI of 28.4 ± 3.8 kg/m(2). The patients underwent HTO using a non-locking plate. RSA marker beads were inserted in the tibia, femur, and patella. RSA exams were first obtained intra-operatively prior to the osteotomy, and subsequently at one, two, four, six, and twelveweeks postoperatively. Patients were corrected from a mean alignment preoperatively of 8.6 ± 2.5° to 0.3 ± 1.9° postoperatively, with a mean osteotomy of 12.5 ± 3.6mm. Immediate tibia changes surrounding the osteotomy site included 9.2 ± 2.4° of valgus rotation and 6.2 ± 2.0mm of distal translation. Secondary motions included 2.5 ± 2.4° of internal rotation of the distal tibia, 1.8 ± 1.4mm of posterior movement of the femur, and 8.5 ± 3.4mm of patella baja. Micromotion between the proximal and distal tibial segments decreased over time. The results suggest that subtle changes to the anatomy occur, beyond what is intended with the procedure, but partial corrections of these phenomena occurred over the twelveweeks. Micromotion surrounding the osteotomy site decreased with osseous union.

A Comparison of Locking Versus Non-Locking Plates in Distal Femur Fractures

Background: Comminuted distal femur fractures are associated with a high complication rate and their treatment is difficult. This type of fracture is more common in young people with major trauma and following motor vehicle accidents. In old patients with osteoporosis the fractures are often closed and occur following a minor trauma. The aim of our study was to compare the outcomes and complications of treatment of intra-articular distal femur fractures using locking and nonlocking condylar buttress plates. Methods: In this retrospective study, 79 patients undergoing surgery due to type C distal femur fractures (T or Y condylar fracture) from 2008-2010 were included. Patients with comorbidities such as diabetes or end stage diseases and patients with other lower extremity fractures on the same side were excluded. For each patient demographic data including age, sex, mechanism of injury, and type of injury was collected. All patients were followed for at least one year postoperatively for complications such as infection, non-union, and malunion. Results: In this study 58 patients (73%) were male and 21 (23%) female. The mean age of the locking group was 37.4 ± 17.3 years and the nonlocking group 40.6 ± 17.3 years. There were no significant differences between the two groups in age and sex. In the locking group 36 patients (80%) had closed fractures and 9 (20%) open fractures and in the nonlocking group 25 patients (73.4%) had closed fractures and 9 (26.6%) open fractures. In both groups 5 patients had infections (11.1% in the locking group and 14.7% in the nonlocking group) and two patients each had nonunion (4.4% and 5.9% respectively). In the locking group 4 patients (8.9%) and in the nonlocking group 6 patients (17.6%) had plate failure. Conclusions: In our study the effects of treatment with both locking and nonlocking condylar buttress plates regarding infection and nonunion were similar but malunion and plate failure were higher in the nonlocking group. Nonetheless, this difference was not statistically significant.

Open Reduction and Internal Fixation Versus Total Elbow Arthroplasty for the Treatment of Geriatric Distal Humerus Fractures

The purpose of this systematic review and meta-analysis was to pool and analyze outcomes and complication rates in elderly patients with intraarticular distal humerus fractures being treated with either total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF) with locking plates. PubMed, Embase, and the Cochrane databases were used. The search included publications up to June 2013. Article selection was independently performed by 2 authors and disagreements were resolved by consensus. Studies meeting criteria for inclusion were observational cohort studies or randomized controlled trials evaluating functional and radiographic outcomes and complications in elderly patients treated for distal humerus fractures with either primary TEA or ORIF with locking plates. Studies with mean age <60 years, indications for TEA other than acute fracture, and those including nonlocked plates were excluded. Standardized data extraction was performed. A quality assessment tool was used to evaluate individual study methodology. Descriptive statistics for functional outcomes were reported. Meta-analysis and regression analysis were performed for complication rates. A systematic review and meta-analysis revealed that TEA and ORIF for the treatment of geriatric distal humerus fractures produced similar functional outcome scores and range of motion. Although there was a trend toward a higher rate of major complications and reoperation after ORIF, this was not statistically significant. The quality of study methodology was generally weak. Ongoing research including prospective trials and cost analysis is indicated to better define the roles of ORIF versus TEA in the management of these injuries.

Comparison of treatment of unstable intra articular fractures of distal radius with locking plate versus non-locking plate fixation.

Unstable intra articular fractures of distal radius are frequently being managed with open reduction and internal fixation. Of late in some biomechanical studies locking plates have been shown to be better in terms of maintenance of radiological parameters in comparison to non-locking plates. We conducted this study to know whether this biomechanical superiority of locking plates is converted in to better clinical outcomes. A study was conducted in 60 patients (30 in each group) with unstable intra articular fractures of distal radius who were treated by open reduction and internal fixation with locking plates and non-locking plates. Patients were evaluated for radiological parameters (intra articular step off, radial height, radial tilt, volar tilt) and functional parameters (flexion, extension, radial deviation, ulnar deviation, pronation, supination grip strength) at two year follow up. Overall outcome was evaluated by scoring systems of Gartland and Werley and modified Green O' Brien. The change in radiological parameters from immediate post op to latest at two year in locking plate group was not significant for radial height, radial tilt, volar tilt, but ulnar variance whereas in non-locking plate there was significant change in radial height, volar tilt, ulnar variance but no significant change in radial inclination. In clinical and functional outcome no significant difference was found at two year follow up. Locking plates maintain the radiological parameters better than non-locking plates but functional outcome are same for both plates at two year after surgery.

Distal tibia fractures: locked or non-locked plating?

Background and purpose — Although plating is considered to be the treatment of choice in distal tibia fractures, controversies abound regarding the type of plating for optimal fixation. We conducted a systematic review to evaluate and compare the outcomes of locked plating and non-locked plating in treatment of distal tibia fractures.Patients and methods — A systematic review was conducted using PubMed to identify articles on the outcomes of plating in distal tibia fractures that were published up to June 2012. We included English language articles involving a minimum of 10 adult cases with acute fractures treated using single-plate, minimally invasive techniques. Study-level binomial regression on the pooled data was conducted to determine the effect of locking status on different outcomes, adjusted for age, sex, and other independent variables.Results — 27 studies met the inclusion criteria and were included in the final analysis of 764 cases (499 locking, 265 non-locking). Based on descriptive analysis only, delayed union was reported in 6% of cases with locked plating and in 4% of cases with non-locked plating. Non-union was reported in 2% of cases with locked plating and 3% of cases with non-locked plating. Comparing locked and non-locked plating, the odds ratio (OR) for reoperation was 0.13 (95% CI: 0.03–0.57) and for malalignment it was 0.10 (95% CI: 0.02–0.42). Both values were statistically significant.Interpretation — This study showed that locked plating reduces the odds of reoperation and malalignment after treatment for acute distal tibia fracture. Future studies should accurately assess causality and the clinical and economic impact of these findings.

Internal Fixation of the Distal Humerus

The purpose of this study was to evaluate current fixation techniques in the operative fixation of distal humerus fractures, both with conventional and locked plating in both parallel and orthogonal orientation. Twenty-eight upper extremities from 14 cadavers were prepared to create 4 implant testing constructs: Synthes locking plates (IMP1) (medial and posterolateral with lateral flange), Acumed parallel locking plates (IMP2), Smith & Nephew orthogonal locking plates (IMP3), and Synthes orthogonal 3.5-reconstruction plating (IMP4) (1 posterolateral and 1 medial). A 5-mm supracondylar osteotomy was made to simulate the fracture. Stiffness in axial and sagittal plane loading, fatigue properties (over 5000 cycles), and ultimate strength were determined for each construct by biomechanical testing. The parallel locking plates (IMP2) exhibited the highest stiffness in axial load and the highest ultimate strength (P < 0.05). No significant differences in sagittal plane stiffness and in the fatigue properties were seen across the locking plate groups, regardless of orientation. Locked plating constructs performed significantly better in all categories when compared with conventional nonlocked plating. Plastic deformation and implant loosening were the main modes of failure after ultimate strength test. Parallel locking plate configuration showed significantly higher stiffness to axial load and ultimate failure strength when compared with orthogonal locked and nonlocked plating. Locked plating configurations performed significantly better than nonlocked plating configurations, regardless of orientation. Although parallel orientation seems biomechanically superior, translation to the clinical setting may prove difficult when taking surrounding soft tissue and exposure into consideration.

Comparison of Functional Outcomes of Tibial Plateau Fractures Treated with Nonlocking and Locking Plate Fixations: A Nonrandomized Clinical Trial

Fixation of tibial plateau fractures with plate has been widely used. This prospective study was planned to compare locking plate fixation of tibial plateau fracture with nonlocking methods in terms of their functional outcomes. The subjects of the study were selected from consecutive patients suffering from tibial plateau fractures referred to Kashani Hospital in Isfahan, Iran, between 2012 and 2013 and were candidate for surgery. The final included patients were assigned to two groups, those who were treated with locking plate (n = 20) and those who were treated with nonlocking plates (N = 21). The mean duration of follow-up was 13.4 months (ranging between 10 and 17 months). The mean of knee scores was significantly higher in locking plate group than in nonlocking plate group at the follow-up time (80.20 ± 10.21 versus 72.52 ± 14.75, P = 0.039). Also, the mean VAS pain severity score was significantly lower in locking plate group compared with nonlocking plate group (4.45 ± 2.50 versus 6.00 ± 2.59, P = 0.046). This study confirmed superiority of the locking plate method over nonlocking plate method with regard to knee score as well as VAS pain score.

McHale Operation in Patients with Neglected Hip Dislocations: The Importance of Locking Plates

Neglected hip dislocation in patients with cerebral palsy is a challenge for the pediatric orthopedic surgeon. Many patients experience pain, limitation of hip motion, and sitting and hygiene problems. Arthrodesis, proximal femoral head resection, and subtrochanteric valgus osteotomy are effective salvage procedures for patients with painful hip dislocation and restricted hip motion when reconstruction of the hip is not possible. Osteopenia is one of the problems that can complicate the postoperative course in these patients. Postoperative cast immobilization may further worsen the osteopenia and can predispose to fractures of the femur after cast removal. Standard plating of the proximal osteotomy may not always provide adequate stability of the fixation. In order to prevent postoperative osteoporotic fractures we use locking plates, without casting. Since 2003 until 2011, we operated on 9 patients (14 hips) with painful neglected hip dislocations. The first three patients (five hips) were operated on using standard nonlocking plates. All other patients (nine hips) were operated on using locking plates. During the followup, the hardware failed in one of these cases. All patients treated with locking plates had not been casted postoperatively, and none had loss of fixation or fractures during the followup.

Are locking plates better than non-locking plates for treating distal tibial fractures?

Locking and non-locking plates has been used for distal tibia fracture osteosynthesis. Sufficient evidence to favor one implant over the other is lacking in the current literature. Our aim is to compare them in terms of fracture healing, alignment, functional outcome, complications. Sixty-eight patients operated on using a percutaneous plate were retrospectively reviewed. They were divided into two groups: in group 1 (28 patients) a 4.5mm narrow conventional dynamic compression plate (DCP) was used. In group 2 (40 patients) a titanium locked compression plate (LCP) was used. Mean time to union was 16.2 and 15.4 weeks for group 1 and 2, respectively (p=0.618). 11 patients (39.3%) in group 1 and 4 patients (10%) in group 2 showed malalignment (p=0.016). AOFAS scores at follow up were 89 and 88 in groups 1 and 2, respectively. Implant removal was necessary in 9 cases (32.1%) and 4 cases (10%) in group 1 and group 2, respectively (p=0.042). Three patients (10.7%) in group 1 and three patients (7.5%) in group 2 had an infection. Both plating systems have similar results in terms of time to union, infection, and AOFAS scores. The LCP seems superior with respect to alignment and the need for implant removal.