Variable Angle Locking Compression Plate Research Articles

New Generation Superior Single Plating versus Low-Profile Dual Mini-Fragment Plating of Diaphyseal Clavicle Fractures - A Biomechanical Study

Abstract Background Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and optimized plate-to-bone fit design. On the other hand, mini-fragment plates used in dual plating mode have demonstrated promising clinical results. However, these two bone-implant constructs have not been investigated biomechanically in a human cadaveric model. Aims To compare the biomechanical competence of single superior plating using the new generation plate versus dual plating with low-profile mini-fragment plates. Methods Sixteen paired human cadaveric clavicles were assigned pairwise to two groups for instrumentation with either a 2.7 mm Variable Angle Locking Compression Plate placed superiorly (Group 1), or with one 2.5 mm anterior plate combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture AO/OTA15.2C was simulated by means of a 5 mm osteotomy gap. All specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking. Results Initial stiffness was significantly higher in Group 2 (9.28±4.40 N/mm) compared to Group 1 (3.68±1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of craniocaudal and shear displacement, fracture gap opening, and torsion were significantly bigger over the course of 12500 cycles in Group 1 compared to Group 2; p≤0.038. Cycles to 2 mm shear displacement were significantly lower in Group 1 (22792±4346) compared to Group 2 (27437±1877), p=0.047. Conclusion From a biomechanical perspective, low-profile 2.5/2.0 dual plates demonstrated significantly higher initial stiffness, less interfragmentary movements, and higher resistance to failure compared to 2.7 single superior variable-angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in unstable fracture configurations.

NEW-GENERATION SUPERIOR SINGLE PLATING VERSUS LOW-PROFILE DUAL MINI-FRAGMENT PLATING OF DIAPHYSEAL CLAVICLE FRACTURES: A BIOMECHANICAL STUDY

Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and optimized plate-to-bone fit design. On the other hand, mini-fragment plates used in dual plating mode have demonstrated promising clinical results. However, these two bone-implant constructs have not been investigated biomechanically in a human cadaveric model. Therefore, the aim of the current study was to compare the biomechanical competence of single superior plating using the new generation plate versus dual plating with low-profile mini-fragment plates.Sixteen paired human cadaveric clavicles were assigned pairwise to two groups for instrumentation with either a 2.7 mm Variable Angle Locking Compression Plate placed superiorly (Group 1), or with one 2.5 mm anterior plate combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture AO/OTA15.2C was simulated by means of a 5 mm osteotomy gap. All specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking.Initial stiffness was significantly higher in Group 2 (9.28±4.40 N/mm) compared to Group 1 (3.68±1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of craniocaudal and shear displacement, fracture gap opening and torsion were significantly bigger over the course of 12500 cycles in Group 1 compared to Group 2; p≤0.038. Cycles to 2 mm shear displacement were significantly lower in Group 1 (22792±4346) compared to Group 2 (27437±1877), p=0.047.From a biomechanical perspective, low-profile 2.5/2.0 dual plates demonstrated significantly higher initial stiffness, less interfragmentary movements, and higher resistance to failure compared to 2.7 single superior variable-angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in unstable fracture configurations.

New generation of superior single plating vs. low-profile dual minifragment plating in diaphyseal clavicle fractures: a biomechanical comparative study

Recently, a new generation of superior clavicle plates was developed featuring the variable angle locking technology for enhanced screw positioning and a less prominent and optimized plate-to-bone fit design. On the other hand, mini-fragment plates in dual plating mode have demonstrated promising clinical results. The aim of the current study was to compare the biomechanical competence of single superior plating using the new generation plate versus dual plating using low-profile mini-fragment plates. Sixteen paired human cadaveric clavicles were pairwise assigned to two groups for instrumentation with either a superior 2.7 mm Variable Angle Locking Compression Plate (Group 1), or with one 2.5 mm anterior combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture (AO/OTA 15.2C) was simulated by means of a 5mm osteotomy gap. Specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking. Initial construct stiffness was significantly higher in Group 2 (9.28 ± 4.40 N/mm) compared to Group 1 (3.68 ± 1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of axial and shear displacement, fracture gap opening and torsion, over the course of 12,500 cycles were significantly higher in Group 1 compared to Group 2, p≤0.038. Cycles to 2mm shear displacement were significantly lower in Group 1 (22792 ± 4346) compared to Group 2 (27437 ± 1877), p=0.047. From a biomechanical perspective, low-profile 2.5/2.0 dual plates can be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in less common unstable fracture configurations. 2.7 single superior variable angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in less common unstable fracture configurations.

Functional outcome of volar variable angle locking compression plate in distal end radius fractures: A retrospective case record analysis

Background: Distal end-of-radius fractures are one of the most common fractures seen worldwide, accounting for approximately one-sixth of all fractures. Closed reduction and cast immobilization have been the mainstay of treatment, but recently open reduction and plating with conventional plates have gained importance as they can be of great value in treating distal end radius fractures. This study is based on the latest innovation in this regard, the effectiveness of the volar variable angle locking compression plate in treating distal end radius fractures. Aim and Objectives: To evaluate the functional outcome associated with volar variable angle locking compression plate for distal end radius fractures and also to study the efficacy of the plate in capturing the fracture fragments. Materials and Methods: A retrospective study involving 30 patients with distal end radius fractures who were treated with open reduction and internal fixation using a volar variable angle locking compression plate. Patients admitted between November 2018 and November 2019 were included in this study. Clinical, functional, and radiological outcomes were used to assess the efficacy of the plate. Results were calculated using the Disabilities of the Arm, Shoulder and Hand (DASH) score questionnaire at the end of 1-year postsurgery. Follow-up data for all patients for 1 year were available in our medical records. The extent of the range of motion (ROM) at the wrist joint was noted. Results: 53.3% of patients had excellent results, 36.7% of patients had good results, while 10% of patients had fair results. Almost all the patients had good ROM postoperatively except two patients. One of them developed wrist stiffness and another patient had reduced ROM due to noncompliance to the treating doctor's advice. Conclusion: Our study signifies the importance fragment specific fixation of distal end radius fractures. Patients were mobilized sooner than other accepted modalities of treatment. We conclude that volar variable angle locking compression plates are superior to the other accepted modalities of treatment for distal end radius fractures.

Clinical and radiological evaluation of proximal tibia fracture fixed with variable angle proximal tibial interlocking plate: A prospective observational study

Background: Tibial plateau fractures are complex injuries produced by high- or low-energy trauma and principally affect young adults. In view of the ever-increasing high-velocity road traffic accidents, there is an increase in complex, multifragmentary periarticular fractures of the tibia. The goal of proximal tibial fracture treatment is to obtain the early union of fracture in the most acceptable anatomical position with the early and maximum functional return of activity. The use of more modern implants with locking screws and precontoured locking plates provides better stability and may further improve outcome. In this regard, this study was undertaken to study the functional outcome and radiological outcome of closed proximal tibial fracture Schatzker's type I, II, and III treated with variable angle-locking compression plate (VA-LCP). Methods: A hospital-based prospective study was undertaken among the 54 adult patients with closed proximal tibial fracture Schatzker's type I, II, and III requiring surgical intervention and treated by VA-LCP. A predesigned, self-administered pro forma was designed to keep the objectives of the study at the center point. The patients were categorized based on their relevant age, gender, fracture type, and complications. Qualitative data were represented in the form of frequency and percentage. The final outcome was obtained using modified Rasmussen clinical and radiological score as well as the total healing period of the subjects followed up for a period of 24 weeks. All care and caution were exercised while utilizing the patient data for the current research as outlined in the hospital guidelines pertaining to the usage of patient data for this study, and confidentiality was maintained throughout. Results: The maximum study population belonged to the age group of 50–59 years, which comprised about 44.5%. 26 (48.2%) of the tibial fractures were diagnosed to have Schatzker's type II fractures followed by 15 (27.7%) type III and 13 (24.1%) type I. Group I (30–39 years) showed faster healing with a mean healing period of 18.6 ± 1.9 weeks, followed by Group II (40–49 years) with a mean healing period of 19.6 ± 4.1. Mechanical failure (7, 12.9%) and some secondary complications (12, 22.2%) were also observed during follow-up in the outpatient department. At the end of follow-up, 35 patients (64.8%) had excellent clinical result, 19 (35.2%) had good clinical result, and no patient had a poor functional outcome. For the radiological assessment, there were 29 patients (53.8%) with excellent, 18 (33.3%) with good, 7 (12.9%) with fair, while none with poor results. Conclusion: Treatment of proximal tibial fractures is challenging because of limited soft tissue cover and less vascularity. There are various treatment options for these fractures starting from closed reduction with casting to open reduction and internal fixation with a plate. The excellent functional results and lack of soft tissue complications suggest that a VA-LCP should be considered as an option in tibial plateau fractures. A balance between anatomical reduction and soft tissue stripping is required to avoid any complications.

Outcome after polyaxial locking plate osteosynthesis in proximal tibia fractures: a prospective clinical trial

BackgroundThe aim of this study was to evaluate the clinical and/or radiologic outcome using different polyaxial locking plates for the treatment of proximal tibia fractures, the Non-Contact-Briding plate (NCB-PT®) by Zimmer or the Variable Angle Locking Compression Plate (VA-LCP®) by Synthes.MethodsThis study enrolled 28 patients with proximal tibia fractures (AO/ OTA 41 B-C) and indication for locking plate osteosynthesis. All patients were treated with a polyaxial locking plate system. Depending on the fracture morphology, patients were either treated with a NCB-PT® or VA-LCP®. The implant was chosen according to the surgeon’s experience and preference, in case of a higher degree of comminution the tendency was observed to use the NCB-PT® plate. After a time interval of 12 months postoperative we conducted clinical (e.g.e.g.exempli gratia range of motion, the Rasmussen score) and radiological (e.g. primary/secondary loss of reduction) follow-ups.ResultsPatients provided with the NCB-PT® (9 patients) showed longer operation time, use of longer implants, longer interval from injury to surgery and lower clinical scores after the 12 months follow-up compared with the VA-LCP® group (19 patients). Interestingly, the results showed no significant differences regarding the clinical and radiologic outcome.ConclusionsThe small number of patients as well as the heterogeneity of fractures constitute a limitation of this study. Nevertheless, the differentiated use of implants is associated with comparable clinical and radiological outcomes. This trial emphasizes the need for further prospective randomised trials with higher patient numbers.Trial registrationRetrospectively registered 21.12.2020. Registration number NCT04680247.

A prospective study in surgical management of distal end radius fracture with variable angle locking compression plate

Background and Objective: The distal end of the radius is subject to many different types of fracture, depending on factor such as age, transfer of energy, mechanism of injury and bone quality i.e. Colle’s, Smith’s volar and dorsal Barton’s fracture [1]. Fractures of distal end radius are the most common fractures of the upper extremity, encountered in all of the skeletal fractures and constitute 17% and 75% of forearm fractures and having incidence from 5.7 to 124.6 per 10,000 persons per year [2]. In Intra articular distal radius fracture’s degree of anatomical reduction is directly related to the posttraumatic arthritis. Conservative treatment is usually unsuccessful, and it is fraught with complications, such as early osteoarthrosis, deformity, subluxation, and instability [3-5] The aim of treatment here is good reduc-tion and immediate stability to achieve anatomic fracture union, which will allow the early mobilization of wrist and also to avoid the complications of fracture [6-8] Fracture healing decided by factors such as gap, stability and blood supply [9]. With locking compression plate the locking screw supports subchondral bone and resists axial forces. Compression of locking compression plate to bone is unnecessary and preserves periosteal blood supply [10]. The locking plate minimizes the compression exerted on the bone to achieve stability, impairment of blood supply, periosteal compression and along with that it allows screws to be angled around central axis of plate hole to match with the anatomy [11]. The motive of this study is variable angle locking compression plates in the treatment of distal end radius fractures and it’s beneficial effects.Materials and Methods: 20 patients with Distal End Radius fracture were selected admitted at Chigateri general hospital and Bapuji hospital attached to J.J.M. Medical College, Davangere during October 2018 to October 2020.The study will include patients with distal end radius fractures seen as both out-patient and in-patient fulfilling the inclusion criteria. The patients are assessed both clinically and radiologically. Other associated injuries are noted. The patients undergoing open reduction and internal fixation and application of variable angle locking compression plates for distal end radius fracture are reviewed post operatively, one month, three month, six month and after one year clinically and with x-rays.Result: The study comprised of 15 male and 5 female patients aged from 18 to 72 years with the mean age of 42.2 years with most patient had injury to right side i.e. 11 out of 20 (55%) patients. The average duration from the date of injury to date of surgery was 3 days. The follow up ranged from 6 to 14 months. Using the Modified Cooney, Green and O’Brien functional score for wrist we had 50% excellent, 30% good, 15% fair and 5% poor results with only 3 out of 20 (15%) patients having complications like (arthritis, extensor pollicis longus tendon irritation, superficial skin infection)Interpretation and Conclusion: Fixation of Distal End Radius Fracture with a Variable angle locking compression plate has acceptable outcome for both the patients and surgeon. Variable angle locking plates give acceptable results in the treatment of this type of fracture with better and faster recovery of functions and range of movements.

Intra-articular distal radius fractures treated with variable angle locking compression plates: An outcome analysis

Background: Methods for surgical fixation of intra-articular distal end radius fractures has been on an evolving course. One among the novel developments is the use of variable angle locking plate. Its multidirectional locking option facilitates fixation of even the most complex of the fractures, especially in osteoporotic bone. Aim: To study the functional and radiological outcome of operative management of intra-articular fractures of distal end of radius with variable angle locking compression plates. Material & Methods: 56 adult patients (36 males and 20 females) who had intra-articular distal radius fractures satisfying the study criteria & treated at Sunshine hospitals, Secunderabad, Telangana, India between October 2015 and September 2017 using variable angle locking compression plates were taken up for the study. The cases were followed up at 6 weeks, 3 months, 6months and 12 months postoperatively. During each visit, functional outcome was assessed using Demerit score system of Gartland and Werley. Radial height, radial angulation and palmar angulation were measured from the xray to assess the radiological outcomes. Results: There were 2 type B1, 8 type B2, 16 type B3, 13 type C1, 12 type C2 and 5 type C3 as per the AO classification. Functional assessment showed 29(51.78%) excellent results, 21(37.5%) good results, 6(10.71%) fair results and no poor results There was no significant difference in the radiological parameters between different follow-ups as signified by p value >0.05 implying that there was no loss of fixation. One patient had flexor pollicis longus tendon rupture at 13 months postop & was managed by Plate removal + transfer of Flexor Digitorum Superficialis tendon. Two patients developed superficial wound infection which susbsided with oral antibiotics. One patient developed Reflex Sympathetic Dystrophy which was managed medically. One patient had Screw malpositioning but remained asymptomatic through out the follow up period. Conclusion: Variable angle locking plate offers predictable and good outcome in intra-articular fractures of the distal end of the radius.

Displaced Clavicle Fractures in Cyclists: Return to Athletic Activity After Anteroinferior Plate Fixation.

One of the most commonly observed injuries in cycling is fracture of the clavicle. Nevertheless, there is limited literature available on clinical outcomes after plate fixation of clavicle fractures in cyclists, rehabilitation protocols, and the time to return to sports. The aim of this study was to evaluate the functional outcome, complications, and return to athletic activity at short-term follow-up after surgical repair. Case series. Between January 2008 and October 2014, all professional and recreational cyclists presenting with a new clavicle fracture at the emergency department were prospectively recorded. All patients had an anteroinferior plate fixation, variable angle locking compression plate (DePuySynthes). Patients were seen at 2, 6, and 24 weeks at the outpatient clinic to gather Disability of the Arm, Shoulder, and Hand (DASH) and Constant shoulder questionnaires and radiographs were made. Cyclists were allowed to resume outside training 1 week after surgery. Ten professional cyclists and 15 recreational cyclists were included. All (25/25) patients returned to cycling after plate fixation. Mean Constant scores and mean DASH scores of 96.8 ± 4.1 and 5.1 ± 5.5 at 6 weeks and 99.1 ± 1.5 and 2.9 ± 4.6 at 24 weeks were measured. There were 3 complications: 1 patient developed a nonunion, there was 1 wound infection requiring antibiotics, and in 1 patient, a refracture occurred. Plate fixation for cyclists with displaced clavicle fractures was successful in terms of fast return to previous level of athletic activity. It is a valuable and safe option for athletes in cycling.

Fragment specific fixation technique using 2.7mm VA LCP for comminuted posterior wall acetabular fractures: a novel surgical technique.

The purposes of the study were to introduce surgical technique of fragment-specific fixation technique using multiple 2.7-mm variable-angle locking compression plates (VA LCPs) in comminuted posterior wall acetabular fractures and reported its clinical results. Among the 68 patients, 23 with comminuted posterior wall factures with ≥ 3 fragments in the CT scan and no column involvement with a minimum follow-up duration of 12months were enrolled in this study. We evaluated the clinical results after the treatment of comminuted posterior wall acetabular fractures via the fragment-specific fixation technique using 2.7-mm variable-angle locking compression plates (VA LCPs) retrospectively. The average duration of follow-up was 26.8months. Anatomical reduction was achieved in eighteen patients. Imperfect reduction was achieved in five patients. 22 patients achieved fracture union and one patient underwent revision surgery owing to acute postoperative infection. There were no complications, including loss of reduction, fixative failures, sciatic nerve palsy, heterotopic ossification, and early posttraumatic arthritis among 22 patients. The average functional outcome was measured as 'very good'. Fragment-specific fixation technique using 2.7-mm VA LCPs for comminuted posterior wall acetabular fractures could be an acceptable alternative means of surgical fixation.

A prospective study of surgical management of distal end radius fractures using variable angle locking compression plate

Aim: To assess the clinical and functional outcome of surgically treated distal radius fractures with variable angle locking compression plate at SSIMS-RC, Davanagere during August 2016 TO June 2018. Objectives: 1.To evaluate the radiological union in fractures of distal radius fixed with variable angle LCP, 2. To evaluate clinical and functional outcome associated with this treatment modality, 3. to study the complications associated with this study. Materials and methods: 28 cases of distal radius fractures surgically treated with variable angle LCP according to inclusion and exclusion criteria, all patients followed up for a period of 1 year and results assessed with Gartland and Werely classification. Results: In our study mean duration of complete radiological union was 11weeks which is comparable with other studies. We have achieved excellent results in 66.6% of cases, good results in 23.3%, fair results10%, and no poor results. Complications like stitch abscess, reduced range of motion, complex regional pain syndrome seen in 6(20%) cases. Conclusion: The results are evidence that Variable angle locking plates allows effective anatomic realignment and early wrist mobilization. It is biomechanically superior due to closer joint interface placement and better screw placement in different directions. Variable angle locking compression plates in distal radius fractures provide good to excellent results and are effective in the correction and maintenance of distal radius anatomy.

Distal Radius Volar Plate Design and Volar Prominence to the Watershed Line in Clinical Practice: Comparison of Soong Grading of 2 Common Plates in 400 Patients

To compare plate positioning in clinical practice of 2 commonly used volar locking plate designs with respect to the watershed line as classified by the Soong grading system. For this retrospective study, we included a total of 400 patients who underwent open reduction and internal fixation between May 2013 and February 2018. Cohort 1 was defined as patients treated with distal volar radius (DVR) plates during this period. Cohort 2 comprised 200 patients who had volar plate fixation with variable angle locking compression plates (LCP) during the same period. Standardized lateral wrist radiographs were categorized into Soong grade 0, 1, or2. In cohort 1, 87 plates (43.5%) were not prominent volar to the watershed line, grade 0; 95 plates (47.5%) demonstrated grade 1 prominence; and 18 plates (9.0%) demonstrated grade 2 prominence. In cohort 2, 63 plates (31.5%) were grade 0; 103 plates (51.5%) were grade 1; and 34 plates (17%) had grade 2 prominence on, and volar to, the watershed line. These radiographic results show a greater incidence of volar plate prominence with respect to the watershed line, as defined as Soong grading, in cohort2. This study shows that the use of the variable angle LCP plate is associated with more prominent volar positioning with respect to the watershed line compared with the DVR plate. Therapeutic II.

Variable Angle Locking Compression Plate as Alternative Fixation for Jones Fractures:

Jones fractures pose many challenges for the treating surgeon and can cause significant disability for some patients. The aim of this study was to review the results of using a variable angle locking compression plate as an alternative fixation method in the treatment of Jones fractures. A retrospective chart review was conducted of patients who had undergone fixation of Jones fracture with a variable angle locking compression plate from September 2012 through February 2016. Radiographs of the preoperative and six-week postoperative and postoperative follow-up outcomes, including complication and hardware removal, were collected. Twenty-three cases met the inclusion/exclusion criteria. The overall bony union rate was 96% at six-week postoperative and 100% at 20-week postoperative. Mean age was 30 ± 16 years, and mean BMI was 30.7 ± 5.2 kg/m2. Three patients (13%) had plate removal: two (9%) were due to irritation caused by shoe wearing and one patient (4%) had a skin infection (cellulitis) which was treated with intravenous antibiotics. One patient (4%) had developed deep vein thrombosis (DVT) that was resolved with anticoagulant without implant removal. No fixation loss and no associated complications developed from implant removal. Based on our limited experience, this study provided evidence that the variable angle locking compression plate may be an alternative form of fixation for Jones fractures with a low complication rate. This procedure seemed to provide a safe, reliable method that can achieve an anatomic reduction, stable fixation, rapid healing, and good results in the treatment of Jones fractures.

Comparative analysis of clinical outcomes of fixed-angle versus variable-angle locking compression plate for the treatment of Lisfranc injuries

BackgroundFixed-angle locking compression plate (LCP) and variable-angle LCP are utilized for internal fixation of Lisfranc injuries. However, studies regarding the difference of clinical outcomes of these two plates are limited. The purpose of present study was to compare postoperative outcomes between these two plate types in Lisfranc injuries. MethodsA total of 45 consecutive patients (22 patients with fixed-angle LCP and 23 patients with variable-angle LCP) who underwent surgical treatment for Lisfranc injury were reviewed for this retrospective study. The Foot Function Index (FFI), numerical rating scale (NRS) for pain, development of complications, operative time, and patient satisfaction for current activity were compared. ResultsThere were no significant differences in FFI and NRS for pain at three months and 12 months following surgery. Postoperative complication rate was similar between two groups. Patients with variable-angle LCP had an 18 min shorter mean length of operation (p = 0.040). Patient satisfaction for current activity was not differ between two groups. ConclusionsThe use of variable-angle LCP for treatment of Lisfranc injuries did not show superiority in functional outcomes, pain, complication rates, or patient satisfaction to fixed-angle LCP, but operative time was shorter with variable-angle LCP. Level of EvidenceLevel III, retrospective comparative study.

Rim Plate Augmentation of the Posterolateral Bare Area of the Tibial Plateau Using a 3.5-mm Precontoured Locking Compression Plate: A Cadaveric Study.

To evaluate the effectiveness of an additional rim plate [3.5-mm precontoured locking compression plate (LCP)] for stabilizing the posterolateral fragment in lateral tibial plateau fractures. Standard lateral locking plates [either a proximal tibial plate (PTP) or a proximal tibial locking plate (PTLP)] were applied to 40 matched pair knees from 20 fresh-frozen cadavers followed by the application of a secondary rim plate [variable angle LCP (VALCP)] posterior laterally. The mean ratio of supported articular surface in the PTP group was 0.692, whereas that in the PTLP group was 0.569. This difference was statistically significant (P < 0.001). Additional rim plating with a VALCP could only be performed for 27 of 40 knees; 8 of 20 knees in the PTP group and 5 of 20 knees in the PTLP group could not be fitted with a VALCP due to anatomic limitations. For the total standard plating group alone, the mean ratio of supported articular surface was 0.596, whereas the mean ratio of supported articular surface with additional rim plating was 0.798 (P < 0.001). In contrast, additional rim plating was possible for more knees that received a PTLP than a PTP. Ultimately, there was no significant difference in the ratio of supported articular surface after additional rim plating between the 2 different types of standard plates (P = 0.087). Our results identified a bare area in the posterolateral corner of the lateral plateau that was unsupported by rafting screws following conventional, 3.5-mm, precontoured LCP plating. Thus, additional rim plating may be useful for treating plateau fractures with a posterolateral fragment.

T-type comparison of locking compression plate versus variable angle locking compression plate in treatment of distal radial fractures

Objective To compare the clinical effects of the T-type volar locking compression plate and variable angle two-column locking compression plate in treatment of 118 cases with distal radial fractures. Methods Retrospectivly analyzed the clinical data of distal radius fracture cases from Dec. 2011 to Nov. 2015 in Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University who were respectively underwent T-type locking compression plate and variable angle two-column locking compression plate. The T-type locking compression plate group of 60 cases; according to AO/OTA classification, including 3 cases of type A3, type B2 5 cases, type B3 7 cases, type C1 10 cases, type C2 20 cases, type C3 in 15 cases. The variable angle two-column locking compression plate variable angle two-column locking compression plate group 58 cases; according to AO/OTA classification, including 1 cases of type A3, type B2 2 cases, type B3 4 cases, type C1 15 cases, type C2 18 cases, type C3 18 cases. Comparative analysis of two groups of postoperative radiographic parameters and functional recovery. Palm angle, ulnar deviation angle, radius height, wrist joint activity and G-W function score were measured by (±s), and the comparison was performed t test. Results All patients were followed up, mean follow-up time of T-type locking compression plate group was 26.5 months, the mean follow-up time of variable angle two-column locking compression plate group was 25.6 months. The results showed that there were no significant differences between the two groups in ulnar deviation angle, radius height, radial deviation angle and Gartland-Werley function score.There was significant difference between the two groups in the angle of palm angle, wrist dorsal extension, palmar flexion, ulnar deviation, Wrist rotation, and variable angle two-column locking compression plate had advantages. Conclusion Two kinds of treatment of distal radius fractures were satisfactory clinical efficacy, and variable angle two-column locking compression plate had more advantages, doctors can choose corresponding fixation methods according to the specific situation of patients. Key words: Radius fractures; Internal fixators; Fracture fixation, internal

Technical tips: Dualplate fixation technique for comminuted proximal humerus fractures

The authors report dualplate fixation technique for providing stable fixation in comminuted proximal humerus fractures. This technique has been used for proximal humerus fractures with metaphyseal comminution and provides excellent anatomical reduction and neck shaft angle (NSA).The recently locking plate is clinically more widely used due to its small size, low rigidity, high elasticity, and biomechanical properties such as fixed initial angle and rotational stability. However, in severely comminuted complex type proximal metaphyseal humerus fractures, the use of locking plate alone does not provide stable fixation, leading to complications such as varus collapse, anterior–posterior angulation, screw cutout, nonunion, malunion, and metal failure.Therefore, a more robust and enhanced fixation method, the dual plating technique using the locking compression plate (Proximal Humeral Internal Locking System and Variable Angle Locking Compression Plate) was developed.

견봉 골절의 불유합으로 기인한 가관절증의 잠김 금속판을 이용한 치료 - 증례보고 -

A painful pseudoarthrosis will develop due to a delay in diagnosis and treatment, and surgical care is required. Treatment of pseudoarthrosis is really difficult because the acromion is a thin flat bone that is difficult to be fixed firmly. A 52-year-old woman with multiple trauma had an acromial fracture that was not detected until it had caused pain after ambulation. Open reduction and internal fixation with a variable angle locking compression plate for distal radius and autogenous iliac bone graft were performed. At nine months after the operation, there was partial tear in the supraspinatus tendon, and arthroscopic repair of the supraspinatus tendon was performed. At nine months after the operation, radiographs showed a complete union. At three months after tendon repair, the patient had excellent function of the shoulder. We have reported a case of a successful treatment of nonunion and pseudoarthrosis of acromial fracture that is difficult to be fixed.