Pre-contoured Locking Compression Plates Research Articles

MINIMALLY INVASIVE OSTEOSYNTHESIS WITH PLATE OR NAIL FOR META-DIAPHYSEAL TIBIAL FRACTURES - WHAT IS BETTER?

The aim of this article is to review the surgical techniques for minimally invasive osteosynthesis and associated complications with application of locking compression plates, which have undeniable biomechanical and biological advantages in the treatment of multifragmentary meta-diaphyseal tibial fractures. Unstable proximal tibial fractures include a vast majority of fracture patterns affecting the lower extremities. Most of the fracture types are as a result of high-energy trauma from car accidents, high-altitude injury or motor vehicle incident. Usually, those fractures present with severe soft tissue injury with varying degrees of intra-articular fracture involvement. Intramedullary nailing of tibial fractures as a proven method of biologic fixation and represents one of the most widely used methods for the treatment of unstable fractures involving the proximal meta-diaphyseal area of the tibia, allowing sufficient fracture stability during the early limb movement and weight bearing on the leg. Nevertheless, the complications and technical difficulties in its application raise the question for the choice of an appropriate implant in the treatment of these fracture models in terms of their morphology. Minimally invasive percutaneous plate osteosynthesis with indirect reduction and biologic fixation has the advantage of spearing the local blood flow, even in severely comminuted tibial fracture patterns. The use of pre-contoured locking compression plates for proximal tibia allows stable fixation with good and excellent final clinical results.

Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series.

Establishing fracture union of low and comminuted intercondylar fractures of the humerus is inherently challenging. The purposes of the present study were to investigate the biomechanical effectiveness of pin & plate (PP) fixation compared to other dual-plating techniques by finite element analysis, and to present a technical description as well as retrospectively review the outcomes of PP fixation in such difficult fractures. Low-level intercondylar fracture 3D models of the humerus were virtually stabilized with three fixations on lateral side including PP, lateral pre-contoured locking compression plate (L-LCP), and variable angle lateral pre-contoured locking plate (VA-L-LCP) whereas medial pre-contoured locking compression plate (M-LCP) on medial side. Loading conditions under consideration were axial compression, internal rotation, posterior bending, and valgus rotation. Regarding the clinical series, eight patients with intra-articular and comminuted fractures of the distal humerus (6 intercondylar fractures, 1 fracture-subluxation, and 1 isolated lateral condylar fracture) were operated by isolated PP fixation or combinations of PP and the other standard implants. Data were collected on fracture union, perioperative complications, and objective clinical outcomes. Biomechanical results revealed the most instability of the fracture occurring under posterior bending. PP fixation presented comparable fracture stability and fragment displacement compared to other dual-plating fixations, except stress on the Kirschner wire under internal rotation which was higher than other fixations. Regarding the clinical series, fracture union was achieved in all cases with an average union time of 17weeks (range 12-20). All except one patient had good-to-excellent MEPS results with an average Disabilities of the Arm, Shoulder, and Hand (DASH) score of 14.6 (range 0-45) and an average arc of elbow motion of 107.5 degrees (range 60-140). By the biomechanical performance, PP fixation is a reliable technique for fixation of low intercondylar fractures of the humerus. Supported by the clinical outcomes, the present technique could be an alternative for this particular fracture especially when severe comminution prevents the use of the standard dual plating technique.

Functional and radiological outcomes of distal humerus fractures treated with pre-contoured locking compression plate

<p><strong>Background: </strong>Distal humerus intra-articular fractures are one of the complicated fractures managed by orthopaedic surgeons. We did a prospective and a retrospective study on 21 patients with these fractures treated with pre-contoured locking compression plate.</p><p><strong>Methods: </strong>The<strong> </strong>21 patients in this series were followed for a minimum of 1 year. The prospective study cases were followed at 3 months, 6 months and annually. The rating system of the Mayo elbow functional scoring system was used. The radiological evaluation was done using standard AP and lateral views.<strong></strong></p><p><strong>Results: </strong>We had 14 patients with range of motion of 50-100 degrees. There was only one patient with range of motion of <50 degrees. 6 patients had the maximum range motion of >100 degrees. We had 6 (23.57%) excellent, 9 (42.85%) good, 5 (23.80%) fair and 1 (4.7%) poor in the Mayo elbow scoring at the end of 1 year. We were able to compare our outcomes with a study done by Kumar et al done in 2017. They had 27 (89.66%) of excellent and good results as opposed to 27 (79.4%) in our study. Out of 21 patients in our study 17(80.95%) patients had good 11 (52.5%) / excellent 6 (28.5%) results. This was comparable with Jupiter et al. His study of 34 patients 26 (79.40/0) patients showed good 14 (41%) / excellent 13 (38.4%) result.<strong></strong></p><p><strong>Conclusions: </strong>Pre-contoured locking compression plate appears to be technically an ideal implant for comminuted osteoporotic bone providing an angle stable construct.</p>

Nonunion of clavicle treated with precontoured locking compression plate fixation and bone grafting: A long-term outcome

Background: Plate fixation with bone grafting is the treatment of choice for nonunion of the clavicle and the use of precontoured locking compression plate (LCP) has been proposed to have an advantage of minimal hardware prominence and low rate of implant removal surgery. Materials and Methods: The retrospective analysis was performed to assess the long-term efficacy of precontoured LCP and bone grafting in nonunion of the clavicle. Fifteen patients who had undergone the surgery were assessed retrospectively in terms of clinical and radiological outcome for 4.1 years (range 2–7 years). The outcome was assessed using clinical and functional assessment by QuickDASH scoring and visual analog scale (VAS) system, radiological assessment in terms of union, time of return to previous activities, and any adverse results during the surgery or in the postoperative follow-up. Results: The radiological consolidation was achieved in all patients in a mean period of 18 weeks (range14–20 weeks). All patients returned to their previous activity level in a mean period of 5.9 months (range 2.5–9 months). There was a statistically significant improvement in QuickDASH and VAS scores (P < 0.05); however, one patient had symptomatic hardware prominence. Conclusion: The use of precontoured LCP in nonunion clavicle is a well-tolerated surgery giving promising results with most patients returning to previous activity level with the advantage of minimal hardware prominence and low rate of implant removal surgery.

Excellent clinical and radiological outcome following locking compression plate fixation of displaced medial clavicle fractures

BackgroundTreatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons. An increasing number of symptomatic non-unions following conservative treatment of displaced fractures led to the development of various surgical approaches. Aim of this study was to evaluate the clinical and radiological outcome following operative treatment of displaced medial end clavicle fractures.MethodsPatients who presented with a displaced fracture of the medial clavicle between September 2012 and December 2019 were retrospectively enrolled in this study. All patients were operatively treated with open reduction and internal fixation (ORIF) using an anatomically precontoured locking compression plate (LCP) originally designed for the lateral clavicle (Synthes®, Umkirch, Germany). Functional outcome was recorded using the American Shoulder and Elbow Surgeons (ASES) Score, the Munich Shoulder Questionnaire (MSQ), Shoulder Pain and Disability Index (SPADI) and Constant Score.ResultsOverall 18 patients with a mean age of 54.5 ± 23.5 years suffering from a displaced fracture of the medial clavicle were identified. The mean follow-up was 40.9 ± 26.2 months. The mean ASES accounted for 88.3 ± 20.8 points, the mean MSQ was 83.1 ± 21.7 points, the mean SPADI was 85.6 ± 22.5 and a mean normative age- and sex-specific Constant Score of 77.5 ± 19.1 points resulted. No minor or major complications were observed. Radiologic fracture consolidation was achieved in all patients after a mean of 6.4 months.ConclusionSurgical treatment of displaced medial clavicle fractures using an anatomically precontoured locking plate originally designed for the lateral clavicle led to very good to excellent clinical and functional results.Trial registrationNo: DRKS00024813, retrospectively registered 19.03.2021 (www.drks.de).

Comminuted olecranon fractures: locking compression plate fixation verses conventional plate fixation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A variable consensus exists on the optimal management strategies for olecranon fractures. Though the mechanical properties of the conventional plates and the locking plates used show no difference, pre-contoured locking plates provide a significant advantage over non-locking plates in unstable fractures. The aim of the study was to compare clinical and radiological outcomes in the management of the comminute olecranon fractures by anatomically pre-contoured locking compression plates and the conventional plates.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study was a prospective study of 50 patients with comminuted olecranon fracture, with 25 patients each randomized into two groups, those that underwent fixation of the fracture using a pre-contoured locking compression plate (group LCP) and those fixed using a conventional plate (3.5 mm reconstruction plate) (group CP). Patients were followed up to 1 year with functional outcome assessed at each follow-up with Mayo elbow performance score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean MEPS (LCP vs CP) at 1.5 (47 vs. 43.4) and 3 (67.4 vs 61.6) months follow up showed a statistically significant difference between the two groups, but the difference was not significant at 6 (86.4 vs 85.6) and 12 (88.4 vs 87) months. The time to union (4.3 months vs 5.0 months) was not significantly different between the groups. There were 11 complications in group LCP and 12 complications in group CP.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In the present study, we suggest that the use of a pre-contoured locking compression plate provides better outcomes at earlier periods as compared to the conventional plate; thus, returning the patient to normal function at the earliest.&lt;/p&gt;

Plate Osteosynthesis of Lower End of Femur Fractures Using Locking Compression Plating - A Prospective Study

Background:Distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques and treatment. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Pre-contoured Locking compression plates (LCPs) have shown to give best results in terms of recovery, fracture union, return to work and functional outcome. Objective: To study the functional result of fracture distal femur treated by closed reduction with LCP by minimally invasive plate osteosynthesis (MIPO). Methods:In our study, 20 patients with closed distal femur fractures were evaluated. All cases were treated atOrthopaedic Surgery dept., Kushtia Medical College Hospital, Kushtia, Bangladesh from January 2020 to December 2020. Inclusion criteria: Patients with lower third femoral fracture aged 18 years and above.The patients were evaluated clinically and radiologically for functional outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’s score. Results:It was a prospective study. The study population comprised of 20 patients with mean age of 51.8 years ranging from 21 yrs to 68 yrs. All of them were closed injuries and fresh cases. The mean age was 51.8 years (21-68 yrs). 8 of my patients were male and 12 were female. 13 patients sustained RTA and 7 patients had accidental fall. 8 patients had right sided distal femur fracture and 12 had left sided injury. According to NEER’s score 50% had excellent results, 35% had good results and 15% had fair results. Gait and weight bearing after union was satisfactory. Range of motion of knee joint in majority of patients was within acceptable limits. Conclusions: Closed reduction and internal fixation of fracture lower end of femur by MIPO using LCP is one of the best modalities of treatment for good results.

Technique of minimally invasive plating in mid clavicular fractures and its results

Aim: In this study we wanted to study the technique and pitfalls in minimally invasive plate osteosynthesis technique for displaced midshaft clavicular fractures (DMCFs) and assess its outcome.Materials and Methods: The proposed study is a prospective non randomized control study on the management and treatment of clavicle fractures centered in K.R Hospital attached to the Government Medical College and research institute, Mysore during the term between January 2019 to December 2019.A Total of 31 Cases of Patients underwent internal fixation by MIPO using Pre-contoured locking compression plate. Patients were functionally assessed at the end of follow up period as per the CONSTANT MURLEY Shoulder outcome scoring system.Results: Out of 31 patients, 87.1% of patients were below the age of 40years in our study with Males (87.1%) and Females (12.9%). Most of the patients were operated within 3 days and Right sided fractures were more common than left sided (54.8% vs 45.2%).Average time of union was 13 weeks. Most of the cases did not have any complications except for hypertrophic scar in 2 patients, implant prominence in 3 patients, superficial infection in 1 patient.Conclusion: Closed biological fixation using MIPO technique with locking Pre-contoured plate can preserve the blood supply of the fracture site and minimize soft-tissue related complications. Although it needs surgical expertise and proper technique for better results. MIPO technique with locking reconstruction plate is a feasible and worthwhile alternative for DMCFs.

Comparative study of tension band wiring and pre contoured locking compression plate fixation in olecranon fractures in adults

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Olecranon fractures are about 10% of all proximal forearm fractures.Mostly intra articular fractures, require anatomical reduction and internal fixation for satisfactory clinical outcomes. The most commonly used techniques are still tension band wiring (TBW) and plate fixation (PF). The aim of the current study is to discuss whether TBW or PF technique of internal fixation is better in the treatment of olecranon fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a comparative study including 30 adult patients of olecranon fracture classified by Mayo classification and operated upon by tension band plating (group A) and tension band wiring (group B) at Department of Orthopaedics, Sri Aurobindo Medical College and PG Institute, Indore. All operated cases between the period of January 2018 to August 2019 with follow up of 1 year were assessed on the basis of functional outcome using Mayo elbow performance score&lt;strong&gt; &lt;/strong&gt;(MEPS).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The MEPS, 73% of the patients in group A achieved a good to excellent results in comparison to 60% in group B. no significant differences between the two groups could be detected regarding the clinical and radiographic outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both TBW and PF interventions had treatment benefit in OFs. The current study reveals that there are no significant differences in MEPS, improvement rate and ROM between TBW and PF for OFs. More high-quality studies are required to further confirm our results as most of the cases included in study belonged to Mayo type IIA category.&lt;/p&gt;

Prospective study of clavicle fractures treated with pre-contoured locking compression plate

Introduction: We surgically treated acute displaced mid-third diaphyseal clavicle fractures with plate osteosynthesis using a precontoured locking compression plate, to evaluate the functional and radiological outcome and enumerate the complications associated with this modality of treatment. Materials and Methods: This prospective observational clinical study involving 50 adult patients was conducted in hospital over a period of 2 years. Fractures were classified based on Allman and Robinson classification system. Patients underwent ORIF with 3.5mm precontoured locking compression plate. Regular follow up for a minimum period of 6 months was done clinically and radiologically. Duration required for fracture union was studied, functional outcome was measured using Constant Murley score and complications if any were noted. Results: The functional outcome is assessed at the end of 6 months by the Constant and Murley scoring system. The mean constant score was 93.32% with a standard deviation of 6.67% and a range of 71% to 100%. In our study, 36 cases had excellent functional outcome, 10 cases had good functional outcome and 4 cases had fair functional outcome. None of the patients had a poor outcome. Conclusion: Bony union could be achieved with pre-contoured locking compression plate by reducing the complication rates in midshaft comminuted displaced clavicle fractures and functional outcome were satisfactory. Overall operative treatment using precontoured LCP is effective in the treatment of displaced mid-third clavicle fractures. All the fractures achieved union and there were no cases of non-union. Keywords: Clavicle, Fracture, Midshaft, Precontoured locking compression plate.

A prospective comparative study of functional outcome in patients treated non-operatively and surgically (by plate osteosynthesis) for mid-shaft clavicle fractures in adults

Clavicle fracture is a common traumatic injury around shoulder girdle due to their subcutaneous position. It is caused by either low-energy or high-energy impact. Fractures of the clavicle have been traditionally treated non-operatively. Although many methods of closed reduction have been described, it is recognized that reduction is practically impossible to maintain and a certain amount of deformity and disability is expected in adults. 30 patients with mid-shaft clavicle fracture were systematically randomized (alternate patient) into either operative treatment with plate fixation or non-operative treatment with clavicle brace and sling. All fractures were classified using Robinson’s classification for clavicle fractures and only Type 2A2 and 2B1 were considered for the study. Patients were followed up at 3wks, 6wks, 3rd month & 6th month. Functional outcomes were assessed according to the Constant and Murley Scoring and radiologically. Maximum number (90%) of patients had Robinson’s Type 2B1 fracture. The mean duration of hospital stay for patients in Group A(operative) and Group B(non operative) was 3.67 ± 0.90 days and 1.73 ± 0.46 days respectively. In Group A, the mean duration of trauma to surgery was 3.13 ± 2.64 days. While the mean operative time was 104.87 ± 13.52 minutes. The duration of union was significantly lesser in Group A as compared to Group B according to Chi-Square test (p0.05). Primary open reduction and internal fixation with pre-contoured clavicle plate for displaced, middle third clavicle fractures provide a more rigid fixation and allows early mobilization whereas conservative treatment require longer periods of immobilization till fracture union. Functional outcomes are better with surgical management of middle third clavicle fractures with pre-contoured locking compression plate. The successful use of locking compression plate for middle third fractures of clavicle requires careful assessment of fracture pattern, patient selection, meticulous operative technique, appropriate choice of fixation, judicious internal fixation, careful post-operative monitoring and aggressive early institution rehabilitation. So, there is need to individualize the treatment as per the need and functional demand of the patient to give the optimum outcome.

Precontoured Locking Compression Plate with Titanium Alloy Cable System: In Treatment of Neer Type IIb Distal Clavicle Fracture.

ObjectiveTo describe a new method which involves anatomical distal clavicle plate fixation and titanium alloy cable system‐augmented coracoclavicular ligament reconstruction to manage Neer type IIb distal clavicle fracture.MethodsBetween January 2013 and June 2018, 28 patients with acute Neer type IIb lateral clavicle fracture were treated by a new method – precontoured locking compressive distal clavicular plate fixation of the fracture combined with titanium alloy cable system‐augmented reconstruction of the coracoclavicular ligament. There were 11 females and 17 males treated in this way. There were 15 cases of the right side and 13 of the left. The mean age of the patients was 48.5 years (range, 18–78 years). The mean time from injury to surgery was 3.9 days (range, 1–7 days). After completing the preoperative examinations and evaluations, surgeries were performed for all these patients, anatomical distal clavicle plates were used for fractures, and titanium alloy cables were implanted for the augmented reconstruction of coracoclavicular ligaments. Postoperative protocols, including arm sling management and rehabilitative activities, were unified and recommended to all the patients. These patients were followed up for at least 1 year. The mean duration of postoperative follow‐up was 23.3 months (range, 12–52 months). At the last follow‐up, the coracoclavicular distances were recorded and shoulder functional outcomes were assessed by the Constant scores and the Fudan University Shoulder Scores (FUSSs) questionnaires.ResultsRadiographic bony unions were achieved in all patients within 20 weeks. Functional and radiographic outcomes were retrospectively evaluated. The mean coracoclavicular distance was 9.61 ± 0.61 mm on the injured side vs 9.62 ± 0.57 mm on the contralateral uninjured side. The mean Constant score and mean FUSS were 90.1 ± 6.6 (range, 68–98) and 86.1 ± 7.2 (range, 64–95) respectively, which indicating good restoration of function and high level of satisfaction for both the patients and their physical therapists. There were a few major complications, including one delayed healing of the skin, one severe shoulder stiffness, three incidences of moderate shoulder stiffness, and five incidences of symptomatic hardware. There is no deep infections, neurovascular injuried, delayed union or nonunion, peri‐implant fracture, loss of reduction, implant malposition or failure, or other severe complications.ConclusionThis combined method for the treatment of Neer type IIb distal clavicle fracture could yield high bony union rate, good functional outcome, and low complication rate. Further prospective randomized controlled studies are needed to confirm the benefits of this method of treatment.

Radiological Outcome Measures Indicate Advantages of Precontoured Locking Compression Plates in Elderly Patients With Split-Depression Fractures to the Lateral Tibial Plateau (AO41B3).

BackgroundSplit-depression fractures to the lateral tibial plateau (AO41B3) often feature severe joint surface destructions. Precontoured locking compression plates (LCPs) are designed for optimum support of the reduced joint surface and have especially been emphasized in reduced bone quality. A lack of evidence still inhibits their broad utilization in elderly patients. Thus, aim of the present study was to investigate the implant-specific radiological outcomes of AO41B3-fractures in young versus elderly patients.MethodsThe hospital’s database was screened for isolated AO41B3-factures, open reduction and internal fixation (ORIF), and radiological follow-up ≥12 months. CT-scans, radiographs, and patients’ records were analyzed. Patients were attributed as young (18–49) or elderly (≥50 years). Additional subgrouping was carried out into precontoured LCP and conventional implants. The Rasmussen Radiological Score (RRS) after 12 months was set as primary outcome parameter. The RRS postoperatively and the medial proximal tibial angle (MPTA) postoperatively and after 12 months were secondary outcome parameters.ResultsFifty nine consecutive patients were included (26 young, 38.2 ± 7.8 years; 33 elderly, 61.3 ± 9.4 years). There were no significant differences regarding mean size and depression depth of the lateral joint surface fragments. Prior to implant-specific subgrouping, the radiological outcome measures revealed no significant differences between young (RRS = 7.7 ± 1.7; MPTA = 90.3 ± 2.3°) and elderly (RRS = 7.2 ± 1.7; MPTA = 90.5 ± 3.3°). After implant-specific subgrouping, the radiological outcome revealed significantly impaired results in young patients with conventional implants (RRS(C) = 6.9 ± 1.6, RRS(LCP) = 8.5 ± 1.5, P = .015; MPTA(C) = 91.5 ± 1.9°, MPTA(LCP) = 89.1 ± 2.1°, P = .01). The effect was even more pronounced in elderly patients, with highly significant deterioration of the radiological outcome measures for conventional implants compared to precontoured LCP (RRS(C) = 5.7 ± 1.6, RRS(LCP) = 8.2 ± .8, P < .001; MPTA(C) = 92.6 ± 4.2°, MPTA(LCP) = 89.2 ± 1.4°, P = .002).ConclusionUtilizing precontoured LCP in the treatment of AO41B3-fractures is associated with improved radiological outcomes. This effect is significant in young but even more pronounced in elderly patients. Consequently, precontoured LCP should closely be considered in any AO41B3-fracture, but especially in elderly patients.

A prospective study of management of middle shaft clavicle fracture in general population by precontoured locking compression plate

AIM: This study has been undertaken to study the role of precontoured locking compression plate in fixation of mid third clavicle fractures. Materials and Methods: We reviewed the results 20 cases of midshaft clavicle fracture treated with precontoured locking compression plate during period from September 2019 and September 2020 in JJM Medical College, Bapuji hospital and Chigateri general Hospital Davanagere. Results: Out of 20 patients operated with precontoured LCP, out of which one patient developed plate prominence, one had implant failure, none of them developed non-union. Union was evaluated clinically and radiographically. Conclusion: This implant has been provided with compression mechanism to achieve maximum compression, fast fracture healing and early mobilization.

Functional outcome of midshaft clavicle fractures treated with a pre-contoured locking plate: A prospective study

Introduction: Traditionally, displaced mid clavicular fractures have been treated with conservative methods. Conservative methods like strapping gives mediocre results. The present study has been undertaken to study the role of pre-contoured locking compression plate in the fixation of mid-third clavicle fractures. Materials and Methods: 40 patients with mid-shaft clavicle fractures (Robinson 2B) with displacement >2 cms were treated with open reduction and internal fixation with a pre-contoured locking plate and functional outcome through 3 months was assessed. Results: Union was seen radiologically in all the fractures by 10-12 weeks. The average Constant-Murley score at 3 months was 93.5. None of our patients had complications like malunion, wound dehiscence, hardware irritation, early mechanical failure, incisional numbness, infections and neurovascular damage. There were 4 patients with hardware prominence, 2 cases of hypertrophic scar formation, 2 patients with delayed union at 18 weeks and 1 case of plate loosening. Conclusions: Pre-contoured locking plate fixation in displaced fractures of clavicle allows earlier return to a pain free functional shoulder. Keywords: Clavicle fracture, Middle third, Pre-contoured locking plate.

Evaluation of functional outcome after osteosynthesis of intra articular distal humerus fracture with pre contoured locking compression plates

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Intra articular distal humerus fractures are challenging and cumbersome to treat. Therefore osteosynthesis of such fractures is required. The aim of our study was to evaluate the functional outcome of intra articular distal humerus fractures AO type 13C by osteosynthesis using olecranon osteotomy with pre contoured locking compression plates in orthogonal plate configuration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Thirty patients were included in our study comprising of 18 males and 12 females. Mean age was 39.63 years with mean follow up of 34 weeks. 7 were AO type 13C1, 9 were AO type 13C2 and 14 were AO type 13C3. Osteosynthesis was done for all fractures by olecranon osteotomy approach. Functional outcome was assessed using mayo elbow performance score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean flexion attained at the end of follow up was 127.56 degrees with mean extensor lag of 7.16 degrees. Mean arc of motion was 120.4 degrees. Mean mayo elbow performance score at the end of follow up was 80.36. Mayo elbow performance score in patients aged less than 40 years of age was not statistically significant as compared to patients more than 40 years of age. Functional outcome was also dependent on fracture subtype.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Osteosynthesis of distal humerus fractures AO type 13C using pre contoured locking compression plates in orthogonal plate configuration by olecranon osteotomy provides excellent visualization of fracture and better functional outcome.&lt;/p&gt;

Prospective study of clavicle fractures treated with precontoured locking compression plate

Background and Objectives: Clavicle fracture is one of the most common fracture in human body. From past many years its been treated conservatively with good results. This study is conducted to know role of compression locking plate plate in unstable comminuted clavicle fracture. Materials and Methods: We included 20patients in our study. All were subjected for surgical treatment with LCP and followed up for 1 year. Study is conducted in period between January 2018 and January 2019. Result: 17 patients out of 20 who were treated with Anatomic locking compression plate shows union at average duration of 3 months (12 weeks). Delayed union was seen in 3 patients, plate loosening in one patient and 3 patients had plate prominence. According to Constant and Murley score after fracture union, 15 patients show excellent functional outcome, 4 patients shown good outcome and fair outcome was seen in 1 patient. Conclusion: Our study concluded that precontoured locking compression plates in unstable displaced comminuted fractures in middle third of clavicle give fracture stability, allows early mobility and there by prevents shoulder stiffness. Keywords: Unstable, LCP (locking compression plate), Delayed unionUnstable.

Outcome analysis of extraarticular distal humerus locking plate for fresh fractures of humerus shaft

Background: The complex anatomy of distal humerus with proximity of radial nerve make the exposure and fixation of these fractures difficult. The standard technique of plate osteosynthesis consider at least eight cortices hold in both distal and proximal ends. Obeying these principles becomes difficult in distal humerus fractures. These difficulties have been overcome with the use of anatomical extra-articular distal humerus plate which has more hole density in the distal part with 3.5 mm screws for greater hold in distal part.Methods: A prospective study was carried out at Institute of Medical Sciences BHU Trauma Centre for 19 cases of distal third fracture excluding open fractures of patients between 18-68 years who attended our OPD or Emergency from June 2017 to July 2019. All patients were operated with the triceps-reflecting modified posterior approach. Regular follow-up was done to evaluate elbow functionality, fracture union, secondary displacement, non-union, implant failure and any complications; Mayo Elbow Performance score (MEPS) was used for the final functional assessment.Results: Fourteen 73.6% male and 5 (26.3%) female patients with mean age 41 years constituted the study group, who had an average follow-up of 17.1 months. Preoperatively one patient had radial nerve palsy (neuropraxia) who recovered completely 3 months after surgery. Overall, 18 (94.7%) patients were adjudged to have complete radiological union within 14 weeks; Mean flexion achieved was 134±11.5 (range 90–140). Average MEPS at the latest follow-up was 94.7±7.5.Conclusions: Extra-articular fractures of distal humerus can be satisfactorily treated with the use of single anatomically pre-contoured locking compression plate with excellent elbow functional range of motion and union rates.

Schatzker II tibial plateau fractures: Anatomically precontoured locking compression plates seem to improve radiological and clinical outcomes

IntroductionThe design of anatomically precontoured locking compression plates (LCP) allows the placement of angular stable screws right underneath the reduced joint surface fragments. To date, there is a lack of evidence supporting the broad utilization of these implants in split depression fractures to the lateral tibial plateau. Thus, aim of the present matched pair retrospective cohort study was to investigate the radiological and clinical outcomes of anatomically precontoured LCP compared to conventional plate and screw osteosynthesis in Schatzker II fractures. Material and methodsThe institutional databank was searched for Schatzker II fractures from 2010 to 2016. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm LCP or conventional 4.5 mm l-shaped plates and screws were included. CT scans and radiographs were analyzed. Details of the operative procedures and secondary events were collected. A matched pair analyses was conducted in a best fit manner. The primary outcome parameter was the Rasmussen Radiological Score approximately one year postoperatively. Secondary outcome parameters were the medial proximal tibial angle (MPTA), the Rasmussen Clinical Score and the WOMAC Score after a follow up of at least three years. ResultsA total of 50 patients was included. Patient age, gender distribution, size and depression depth of the lateral joint surface fragments, frequency of utilizing bone grafts or substitutes and lateral meniscus repair as well as subsequent implant removal were comparable across the groups. Immediately postoperatively, the Rasmussen Radiological Score revealed no differences. After a mean of 64.2 weeks, the radiological outcome was significantly better in the LCP 3.5 group (RRS 8.2 vs. 6.3 points, p<0.001; MPTA 89.5 vs. 92.0°, p = 0.001). After a mean clinical follow-up of 4.5 years, the Rasmussen Clinical Score (22.9 vs. 27.8 points, p<0.001) and the WOMAC score (24.3 vs. 16.0 points, p = 0.04) revealed significantly impaired results in the conventional group. ConclusionAnatomically precontoured LCP prevent the subsidence of the reduced joint surface fragments more sufficiently and allow for improved patient outcomes compared to conventional plates and screws. The utilization of anatomically precontoured LCP should therefore closely be considered for internal fixation of any split depression fractures to the lateral tibial plateau.

Comparison of radiological and clinical outcomes, complications, and implant removals in anatomically pre-contoured clavicle plates versus reconstruction plates \u2013 a propensity score matched retrospective cohort study of 106 patients

BackgroundPlate fixation is frequently used to treat displaced midshaft clavicular fractures, however the ideal plate choice remains subject to discussion; reconstruction locking compression plates (RLCPs) are cheaper and can be easily contoured, whereas anatomically pre-contoured locking compression plates (ALCPs) are thought to provide better stability and therefore lower rates of mechanical failure.To compare the incidence of mechanical failures, functional and radiological outcomes in patients with midshaft clavicular fractures treated with ALCPs versus RLCPs.MethodsA propensity score matched retrospective cohort study was conducted across two centers. One hundred and six consecutively recruited patients with displaced midshaft clavicular fractures, who were treated with plate fixation and had a minimum follow-up of 6 months, were matched on gender, age, fracture grading, energy of injury, and fracture location. The resulting groups included 53 ALCP-treated fractures and 53 matched controls treated with RLCPs.ResultsDuring a mean follow-up of 20.5 months, there were no implant deformities in the ALCP group whereas the RLCP group had 6 patients (11.3%, p = 0.012) with implant deformities (5 occurrences of plate bending with fracture union, and 1 plate breakage with nonunion). Despite the higher rate of plate deformities in the RLCP group, there were no statistically significant differences in number of patients recovering full shoulder range of motion (ALCP 90.6%, RLCP 88.7%, p = 0.751), incidence of rest pain (ALCP 13.2%, RLCP 9.4%, p = 0.542), or implant removals (ALCP 49.1%, RLCP 56.6%, p = 0.439).ConclusionALCPs may be superior to RLCPs in terms of implant stability but appear to produce similar clinical results.