Non-locking Reconstruction Plate Research Articles

AO/OTA type C3 distal humeral fractures in patients aged 75 years and older: Is ORIF with double precontoured anatomical locking plates a reliable treatment?

IntroductionThe incidence of osteoporotic distal humeral fractures (DHF) is on the rise. Their operative management is demanding. Fixation with non-locking reconstruction plates was associate with a high number of complications. Elbow arthroplasty (total or hemi) has been proposed as an alternative treatment, in spite of lifetime activity restrictions, and risk of complications, unknown implant survival and problematic revision surgery. Precontoured anatomical locking plates have increased the strength of the fixation in complex fractures. Hypothesis: double plating ORIF with precontoured anatomical locking plates is a safe and reliable treatment option for the management of AO/OTA type C3 DHF in patients aged 75 and older. Patients and methodsA retrospective case series study of patients aged 75 years old and older with an AO/OTA type C3 DHF treated with ORIF with double precontoured anatomical locking plates between 2007 and 2021. Pathologic fractures were excluded. Patients’ demographic, surgical, clinical, and radiological data were reviewed. ResultsA total of 27 women and 3 men, mean age of 80.1 years (range 75–93 years), were included. Mean Charlson index was 5 (range 3–8). Out of 30 patients, 19 had already died. Mean survival time after the surgical treatment was 72.3 months. Mean Mayo elbow performance score was 88.9 (range 60–100); 23 patients scored excellent or good. All fractures healed with no cases of delay union or non-union, hardware failure or loss of reduction. No patient needed a revision surgery to arthroplasty. The total number of complications was 12 (40%), mainly ulnar neuropathy (5) and cerclage removal (4). ConclusionORIF with double pre-contoured locking plates may be a safe and reliable treatment for type C3 DHF in patients aged 75 years and older, with a good functional outcome. Complications are expected but not related to loss of reduction, fixation failure or revision to elbow arthroplasty.

Comparison of locking and non-locking reconstruction plate-screw system in lateral mandibular defects by finite element analysis

PurposeThe purpose of this study is to analyze and compare stress distribution on bone screws and plate systems in locking and non-locking screw-plates design in lateral mandibular defects. Material and methodsSolid mathematical model of mandible was created by three-dimensional finite elements analysis and 25 mm length of lateral resection (L defect) was performed on the model. Models were reconstructed with 2.4 locking and non-locking reconstruction plate system. Each masticator muscles attached to mandible were simulated as direction, attachment area and magnitude on 3D model to compare with reality. The stress formation on bone and hardware system were evaluated. ResultThe stress values on the cortical bone, plate and screw system were higher in conventional plate model than the locking system model. The highest stress values were measured in the proximal segment especially in conjunction with conventional screw system. Furthermore, the distribution of stress on the bone surface was more homogenous in the locking system. ConclusionIt is evident that the use of the locking system in 25 mm length lateral mandibular defects provides an additional advantage over conventional systems in reconstruction models.

Cost-effectiveness of a locking versus non-locking reconstruction plate in medial opening wedge high tibial osteotomy: the importance of costing perspective

Purpose: Medial opening wedge high tibial osteotomy (HTO) is a surgical procedure for patients with medial compartment knee osteoarthritis (OA) and varus alignment. The osteotomy is stabilized using an internal plate, vital for bone healing and recovery during rehabilitation. Locking plates provide better stability and resistance to higher load bearing, resulting in an earlier return to full weight bearing and allow patients to return to work and other activities sooner. Locking plates may also decrease the number of postoperative complications related to bone healing (e.g., non-union). However, locking plates are more expensive than non-locking plates because of their material properties and their bulkiness can cause irritation, which may require surgical removal of the plate and introduce additional costs. The purpose of the study was to estimate the cost-effectiveness of a locking versus a non-locking plate in medial opening wedge high tibial osteotomy (HTO) for patients with medial compartment knee osteoarthritis. Methods: We conducted a retrospective study of patients who had undergone medial opening wedge HTO for varus malalignment and medial compartment knee OA between July 2005 and June 2015 at our institution. Patients prospectively completed the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and 12 months postoperatively. We calculated KOOS change scores to assess effectiveness. We reviewed medical charts for additional healthcare resource use from the time of HTO to 12 months following surgery, and obtained direct and indirect costs from hospital and provincial administrative databases. We calculated incremental cost-effectiveness ratios (ICER) and used the net benefit regression framework considering a range of willingness-to-pay (WTP) values to estimate cost-effectiveness from both the healthcare payer and societal perspectives. We used cost-effectiveness acceptability curves and (CEAC) and sensitivity analyses to account for uncertainty in our estimates. Results: 143 patients received a locking plate (49±8 years, 75% male) and 105 (47±9 years, 75% male) received a non-locking plate. Improvements in KOOS scores, surgical costs and healthcare resource use were similar between groups. Direct costs of the locking plate were greater (+$664.20). Indirect costs of the locking plate were lower (−$6228.21), attributed to faster return to full weight bearing and to work. The ICER values were $399.41 from the healthcare payer perspective and −$3745.26 from the societal perspective. From the payer perspective, the locking plate was not cost-effective for willingness-to-pay (WTP) values <$1,000 and uncertainty estimates suggest that even at a WTP ≥ $1,000, the probability that the locking plate is cost-effective is 55% (Fig. 1A). However, when we considered the societal perspective, the locking plate was cost-effective with 99% certainty regardless of WTP (Fig. 1B). As WTP increases, this certainty slowly declines as a result of cost savings with minimal improvement in effect. These findings were replicated through sensitivity analyses. Conclusions: Our results suggest that the HTO locking plate is highly likely to be cost-effective from the societal perspective, but not from the payer perspective. This is due to lower indirect costs associated with earlier return to full weight bearing and thus less time away from work, which offset the greater direct costs of the procedure. These findings highlight the importance in considering a societal perspective for economic evaluations of surgical procedures, particularly in publicly funded health-care systems.

Evaluation of locking and non-locking reconstruction plate–screw system with lateral mandibular defects by FEA

Objectives: The purpose of this study is to analyse and compare stess distrubiton on bone screws and plate systems in locking and non-locking screw–plates design with two different size of lateral mandibular defects.

Reconstruction of residual mandibular defects by iliac crest bone graft in war-wounded Iraqi civilians, 2006–2011

Our aim was to assess the long-term results, complications, and factors associated with failure of mandibular reconstructions among wounded Iraqi civilians with mandibular defects. Success was measured by the quality of bony union, and assessed radiographically and by physical examination. Failures were defined as loss of most or all of the bone graft, or inability to control infection. During the 6-year period (2006–2011), 35 Iraqi patients (30 men and 5 women, mean age 33 years, range 15–57) had residual mandibular defects reconstructed by iliac crest bone grafts. The causes were bullets (n=29), blasts (n=3), and shrapnel (n=3). The size of the defect was more than 5cm in 19 cases. Along the mandible the defect was lateral (n=14), central/lateral (n=5), lateral/central/lateral in continuity (n=6), and central in continuity (n=10). The mean time from injury to operation was 548 days (range 45–3814). All but 2 patients had infected lesions on admission. Bony fixation was ensured by locking reconstruction plates (n=27), non-locking reconstruction plates (n=6), and miniplates (n=2). Complications were associated with the reconstruction plate in 2 cases, and donor-site morbidity in 5. After a mean follow-up of 17 months (range 6–54), bony union was achieved in 28 (80%). The quality of the bone was adequate for dental implants in 23 cases (66%). Our results suggest that war-related mandibular defects can be reconstructed with non-vascularised bone grafts by multistage procedures with good results, provided that the soft tissues are in good condition, infection is controlled, and the method of fixation is appropriate. Further studies are needed to assess the role of vascularised free flaps in similar conditions.

Locking v/s non-locking reconstruction plates in mandibular reconstruction

Purpose:To compare the efficacy of locking plates to non-locking plates in the osteosynthesis of mandibular fractures on the basis of clinical parameters.Materials and Methods:A prospective randomized clinical trial was conducted at the Faculty of Dental Science, CSMMU (formerly King Georges Medical College), Lucknow, to treat consecutive mandible fractures. The patients were randomly divided into two groups. The patients underwent osteosynthesis—group 1 with 2.4-mm locking titanium plates and group 2 with 2.7 mm non-locking titanium plates. The cause of trauma, the number of days from injury to surgery, average age, gender, and site distribution were all reviewed. The assessment of the patients was done at 1, 3, and 6 weeks and 3 months using the clinical parameters.Results:A total of 12 patients with mandibular fractures met the inclusion criteria. In our study, a statistically significant difference was not found in the clinical parameters such as infection, paraesthesia, hardware failure, and mobility between the fracture segments. A statistically significant difference was found between pain and swelling from the previous follow-up visit in groups 1 and 2. In locking group, pain decreases significantly at 3rd week, 6th week, 12th week from 1st week and pain was absent after 3 week. In non-locking group, pain decreases significantly at 3rd week, 6th week and 12th week from 1st week but pain was present till 12th week. Pre-operative swelling was present only in case of non-locking group. Swelling was present in 66.7% of non-locking group and 0% in locking group. After one week swelling was absent in 100% patients at 3rd, 6th and 12th week. Swelling was considerably decreased in locking group as compared to the non-locking group.Conclusion:These findings show that the use of locking plates in mandibular fracture was efficacious enough to bear the masticatory loads during osteosynthesis of the fracture. The locking plates provide the advantage of a greater stability, with clinical results almost similar to those seen with non-locking plate osteosynthesis.

Does plate adaptation affect stability? A biomechanical comparison of locking and nonlocking plates

Purpose: The purpose of this investigation was to determine whether the degree of plate adaptation and effects of locking influenced the mechanical behavior of the plate/screw/substrate system for 2.0-mm monocortical superior border plates and 2.4-mm reconstruction plates secured at the inferior border intended to stabilize simulated mandibular angle fractures. Materials and Methods: A total of 130 polyurethane synthetic mandible replicas (Synbone, Landquart, Switzerland) were used in this investigation. Five controls each, for incisal edge and molar loading, as well as 5 samples each for 2.4-mm locking and nonlocking reconstruction plates and 2.0-mm locking and nonlocking monocortical superior border plates, intimately adapted (0.0-mm offset), 1.0-mm offset and 2.0-mm offset were subjected to loading at the incisal edge and molar region with an Instron 1331 (Instron Corp, Canton, MA) servohydraulic mechanical testing unit. Load/displacement data were recorded, and yield load, yield displacement, and stiffness were determined. Mean and standard deviation values were calculated. Statistically significant differences were determined for the effects of locking and degree of plate adaptation using a 1-way analysis of variance (P <.05). For differences within categories and among groups, a Sheffé multiple-comparison test was performed. First-order polynomial best-fit curves were created for each group to further evaluate and compare the mechanical behavior. Results: There were no statistically significant differences (P <.05) for yield load, yield displacement, and stiffness within the 2.4 and the 2.0 locking categories for both molar and incisal edge loading. For the 2.4 nonlocking category, there were statistically significant differences for yield load, yield displacement, and stiffness between the 0.0-mm offset group and both the 1.0-mm and 2.0-mm offset groups for both molar and incisal edge loading but not between the 1.0-mm and 2.0-mm groups. For the 2.0 nonlocking category, there were statistically significant differences for yield load, yield displacement, and stiffness between both the 0.0-mm and 1.0-mm offset groups and the 2.0-mm offset group for both molar and incisal edge loading but not between the 0.0-mm and 1.0-mm groups. Conclusions: The degree of adaptation (amount of offset) affected the mechanical behavior of the nonlocking systems evaluated. It did not affect the locking systems. Failure occurred as an “all-or-nothing” pattern. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1319-1326, 2002