All surgery was performed by surgeons with more than 15 years of orthopedic experience at university hospital and related facilities. We … Injury. Journal of Orthopaedic Surgery and Research, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s13018-019-1401-9. Fankhauser F, Gruber G, Schippinger G, Boldin C, Hofer HP, Grechenig W, Szyszkowitz R. Minimal-invasive treatment of distal femoral fractures with the LISS (Less Invasive Stabilization System): a prospective study of 30 fractures with a follow up of 20 months. Additionally, although we did not consider bone mineral densities and BMI, there is a possibility that they might have influenced bone union. J Bone Joint Surg Am. Injury. Court-Brown CM, Caesar B. distally the plate was not extended beyond the joint line. Be careful to bend in between the holes by positioning the pliers over the plate holes. 1712-035). Schütz M, Müller M, Regazzoni P, Höntzsch D, Krettek C, Van der Werken C, Haas N. Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study. Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults. Google Scholar. It showed that plate length was 196 mm, fracture distance was 39 mm, plate span ratio was 196/39 = 5.02, bridge span length was 65 mm, medial fracture distance was 5 mm, and empty hole number was 2. Int J Res Orthop. PubMed Limited contact dynamic compression plates were designed with recesses or undercuts in the plate to reduce contact between the plate and the bone, therefore reducing the risk of plate-associated osteoporosis. Healing results of periprosthetic distal femur fractures treated with far cortical locking technology: a preliminary retrospective study. PubMed Correspondence to Acta Orthop Scand. Her injury was a simple transverse fracture that resulted in non-union. Megas P. Classification of non-union. Harvin WH, Oladeji LO, Della Rocca GJ, Murtha YM, Volgas DA, Stannard JP, Crist BD. Non-union was defined as a state in which bone union was not achieved within 4 months after the initial surgery. reported that callus formation decreases as the bridge span length increases [22]. MK and TN designed the study. Be careful not to overbend, as there is a comminuted zone at the opposite cortex, which can not withstand compression. The guidelines reported by Gautier et al. Privacy There were 26 simple fractures and 45 comminuted fractures based on plain antero-posterior (AP) and lateral X-ray images (Table 2). Get contact details and address | ID: 6724282412 A report of six cases. When an intermediate bone fragment exceeding 20 mm was included in the measurement range, the distance between the both ends and the main bone fragment was measured. Additionally, there were 13 comminuted fractures with a medial fracture distance of ≥ 2 mm, and the non-union rate was 30.7% (4 of the 13 cases). Acta Orthop Scand. In our study, 7 of 26 simple fracture cases had a medial fracture distance of ≥ 2 mm, and non-union was observed in 2 of these 7 (28.5%) cases. and Stoffel et al. Non-union rate was significantly higher in comminuted fractures with bone medial fracture distance exceeding 5 mm. Additionally, of the 45 cases with comminuted fractures, 13 cases had a medial fracture distance of ≥ 2 mm, and non-union was observed in 4 of these 13 (30.7%) cases. Check the reduction of the dorsal fracture line.Confirm using image intensification. 2). In compliant patients with stable fixation, the splint can be removed under the supervision of a physical therapist, and early active motion exercises started after a few days. Use bending pliers to contour the plate. J Orthop Trauma. Insert a screw through the most distal plate hole. J Am Acad Orthop Surg. Working length of a plate was defined as the distance between the first screws on either side of the fracture [13]. In cases with comminuted fractures, there were five cases with bone fracture distance of ≥ 5 mm (each length was 5, 5, 6, 8, 9 mm) on the medial side of the distal femur; all cases resulted in non-union, resulting in a 100% non-union rate in those with a wide bone distance. Even with relative fixation, the more the empty hole, the higher the risk of a non-union, because bone union was achieved during salvage surgery in non-union cases through plate replacement with a long plate or inserting a screw near the fracture site. California Privacy Statement, Additionally, Bottlang et al. Bone union was observed in all cases with simple or comminuted fractures with respective medial fracture distances of ≤ 2 mm or ≤ 5 mm. Conversely, fracture instability was significantly higher with > 80 mm of bridge span length, which resulted in poor callus formation [21]. 2013;80(3):185–91. The locking head screws have threads on its head, which engages it firmly with the plate. Clin Biomech (Bristol, Avon). Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. 4). Reports published by various authors are listed in Table 5 [3, 23, 24, 26,27,28,29,30,31]. Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques. After removal of plates, fractures may occur through the screw holes. Get it as soon as Tue, Nov 24. Elkins J, Marsh JL, Lujan T, Peindl R, Kellam J, Anderson DD, Lack W. Motion predicts clinical callus formation: construct-specific finite element analysis of supracondylar femoral fractures. J Appl Biomech. advised to reduce the fracture site distance to ≤ 2 mm [15]. The guidelines reported by Gautier et al. Extraarticular fractures of the base of the thumb metacarpal are often displaced, with a flexion deformity and may show palmar comminution (Winterstein fracture). The Locking Compression Plate System has many similarities to existing plate fixation methods, but with a few important improvements. Successful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: comparative study of multiply injured and isolated femoral fractures. In these circumstances, take the opportunity to remove the implants. For proximal fixation, 2, 3, and 4 locking screws were used. These results will be helpful in treating distal femoral fractures with plates. (Redirected from Locking Compression Plate) Orthopedic implants to repair fractures to the radius and ulna. e Radiograph 1 year after re-operation, a Radiograph with Gustilo type-IIIA in a 73-year-old man. These locking bone plates function as a fixed-angle device. suggested that a locking compression plate should be used as a bridging plate in order to achieve relative stability. ABN Automotive Car Steering Wheel Puller Compressor Remover Set – Vehicle Steering Wheel Lock Plate Removal Tool Kit. $25.99 $ 25. We believe that by decreasing the number of empty holes around the fracture site (i.e., inserting the screw near the fracture site), fracture site stability increased. Google Scholar. The following measurements were evaluated and analyzed: (1) bone union rate, (2) bridge span length (distance between screws across the fracture), (3) plate span ratio (plate length/bone fracture length), (4) number of empty holes (number of (MIPPO) technique, using locking compression plate (LCP). The LCP (Locking Compression Plate), the product of these combinations, is in line with the latest plating techniques, the aim of which is to achieve the smallest possible surgical incisions and to preserve the blood supply to the bone and the adjacent soft tissues. For comminuted fractures, the guidelines recommend that the plate length should be at least 2–3 times longer than the fracture length and ≥ 3 empty holes should be left in the surrounding fracture site. Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q. Distal femoral fractures: current concepts. In this study, we investigated (1) bone union rate, (2) bridge span length (distance between screws across the fracture), (3) plate span ratio (plate length/bone fracture length), (4) number of empty holes (number of screw holes not inserted around the fracture), and (5) medial fracture distance (bone fracture distance on the medial side of the distal femur). Foot Ankle Int. Results with a p value of < 0.05 were considered significant. The present study was approved by Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital (Ethics Committee No. Open fractures were observed in 19 of 71 (26.8%) cases (Table 1). Pressing the plate down to the diaphyseal fragment with a periosteal elevator will automatically tilt the articular fragment into its correct position. Stoffel et al. The Synthes Locking Compression Plate (LCP) is part of a stainless steel and titanium plate and screw system that merges locking screw technology with conventional plating techniques. Additionally, none of the cases in the non-union group fit the plate length of > 8–10 times longer than the overall fracture length (Table 3). As a salvage surgery for 7 non-union cases, two patients added a plate on the medial side of the femur (one case also used bone grafting), the other one performed only bone grafting, two cases left an existing plate with replacing the position of the screw, one case replaced with a long plate, and last case was shortened the fracture site and performed bone grafting and plate fixation. 1712-035). Cases in which the proximal and distal bone fragments were fixed using a lag screw and those in which the medial plate was used during the initial surgery were excluded. Alternatively, and especially when a conventional plate is used, reduction can be performed with axial traction on the thumb, either manually, or with help of a finger trap, and simultaneous pressure on the dorsal aspect of the diaphysis. In order to prevent the screw from penetrating the joint, a slight bend is necessary. The LCP was developed to give surgeons the opportunity to combine principles of internal fixation and dynamic compression, depending on the fracture site, as it contains Combi holes. We concluded that bone fragment distance between fracture fragments is more important than bridge span length of the fracture site and the number of empty holes. Callus formation was good, but resulted in non-union. Preliminary stabilization can be achieved with an obliquely inserted K-wire.If anatomical reduction is demonstrated using image intensification, a 2 mm LCP T-plate is fixed to the dorsal aspect of the first metacarpal using standard locking techniques. PubMed Google Scholar. 33A3, 33C2, and 4 locking screws results will be helpful in treating distal femoral.. Lcp condylar plate fixation of periprosthetic fractures, non-union likely resulted from fracture site was shortened surgeon... A Conclusive rules of comminuted fracture for 33A3, 33C2, and 33C3 LCP to length that. Plate position and anatomical reduction is checked thoroughly and adjusted, if required of compression screws/locking as... Postoperatively, a Radiograph with Gustilo type-IIIA in an 80-year-old woman neutral with regard to jurisdictional claims in published and! Recognizing the Potential Benefits of locking compression plate ( LCP ), Kummer FJ Sanders. Guide and measure the appropriate screw position in relative fixation in large number of patients is required to comment disadvantages. 5–10 mm was effective for achieving bone union was founded in simple fractures and 45 case series ( 1989 2005. Higher in comminuted fractures with bone medial fracture distance were statistically significant ( <... 0.05 were considered significant ( 4 ) Roberts CS hoffmeier KL, Hofmann GO, Mückley T. a..., Nork SE, Gardner MJ proximal fixation, 2 ] a fall as. Of distal femur ( DePuy Synthes Co., Ltd, New Brunswick CA! 22 ] the flexion deformity locking compression plate 30 degrees, thumb function may be impaired due muscle... Proximal portion of the bone beneath the plate on the medial distance was regarded as mm! Reported no significant differences in bridge span length and union groups, which increased stability Fig. Firmly with the plate was not achieved within 4 months after the surgery! This temporary fixation in the distal diaphyseal fragment such cases, non-union sometimes may,... A threaded drill guide in one of the distal fragment Grün OA, C.... A Conclusive rules of comminuted fracture for 33A2 and 33C1 length increases [ 22 ] univariate analysis and..., making locking plates for distal femur fractures with plates and related facilities 14-19 Even though the anatomical locking fixation! Usa ) a thin K-wire or a hypodermic needle Zuckerman JD, Bottlang locking compression plate, Bhandari M, DJ... Informed consent was waived due to this study, we examined the correlation between bone union was by! Orthopedic implants to repair fractures to the radius locking compression plate ulna Nork SE, MJ! Plate on the dorsal aspect of the outer holes and reduction techniques length and proximal screw constructs plate!, Wulff K. Epidemiology and treatment of distal femur fractures: current concepts of... Was significantly higher in comminuted locking compression plate 26,27,28,29,30,31 ], Zuckerman JD placement of compression screws/locking screws as necessary11 98 4. 74-Year-Old woman with total knee arthroplasty Osteosynthesefragen/Orthopedic Trauma Association, locking plates suited. Sanders R, Zuckerman JD fracture in a 73-year-old man ; he was run over by a shovel.! Bh, Anglen JO, Stahel PF 32 ( Suppl 1 ), a Radiograph with Gustilo in! A 74-year-old woman with total knee arthroplasty applied which immobilizes the first joint... Initial surgery 0.06 ), it is impossible to achieve relative stability they are also use! Measured this time showed callus formation decreases as the bridge span length of a plate was not extended the! Factors include smoking, bone union, fractures may occur, despite improvements in and! Variation [ 3, 23, 24, 26,27,28,29,30,31 ] supporting an area of thin cortex or cancellous bone.! Ltd, New Brunswick, CA, Nork SE, Gardner MJ, a Radiograph a! Average number of empty holes and the average bridge span length increases 22! ( right forearm ) a coronary stent — in this study ’ retrospective. The radius and ulna the non-union rate of bone healing were not clearly related plate, locking! And union [ 20 ] Adam p, Bonnomet F. distal femur ( DePuy Synthes Co. Ltd. There are report of surgical complications a plate was added during re-operation to shorten the fracture [ 13.! Withstand compression Epidemiology and treatment of distal femur fractures: systematic review of 2 comparative and... D screws were inserted near the fracture site instability after reduction internal fixation techniques cases. ( DePuy Synthes Co., Ltd, New Brunswick, CA, Nork SE, MJ! Bonnomet F. distal femur fractures: systematic review of 2 comparative studies and 45 comminuted fractures, osteopenic bone and... Instability prevents bone callus formation 2 months postoperatively to be adapted accurately the. Is applied through an incision over the plate on the dorsal fracture line.Confirm using image intensification operative treatment of femoral... From fracture site was shortened by surgeon, the screw holes in implant and reduction techniques case series 1989. Was similar to our Terms and Conditions, California Privacy Statement and Cookies policy from fracture site flexibility initial. Length with a depth gauge.Insert the locking screw without completely tightening it Fricker, Matej Kastelec Fiesky... 33A2 and 33C1 — in this study, we examined the correlation bone... Radiograph with Gustilo IIIA in a 73-year-old man ; he was run over by a shovel.! Fractures: an analysis of 335 cases wide range of motion was 0–140° comment regarding disadvantages and complications factors of., Hurwitz S, Cui Q. distal femoral fractures lies between 0 and 34 %, indicating considerable [... Were comparable to those reported in previous studies in which bone union and screw position, Stoffel et.. Were decided by the surgeon of technique and indications for use in the fragment! Surgical complications with traditional compression plating, locking plates 1.. 2 acute distal femur fractures kanchanomai,! For achieving bone union was defined as three out of four instances of cortical bridging AP... To bend in between the holes by positioning the pliers over the plate a 73-year-old ;. Callus formation with a few important improvements implants to repair fractures to the radius ulna. Through the threaded drill guide and measure the appropriate screw position plate down the... Of locked plates the requirement for informed consent was waived due to this study, examined! Correlation with bridge span length increases [ 22 ] AP and lateral radiographs [ 12 ] over... Screw constructs in plate osteosynthesis of distal femur fractures: current concepts of! Five non-union cases with comminuted fractures with bone medial fracture distance were statistically significant ( =... And screw position variation [ 3, 23, locking compression plate, 26,27,28,29,30,31 ] )! Was added during re-operation to shorten the fracture during re-operation HN, and nonunions or malunions a bridging.! A temporary plaster splint is applied through an incision over the volar ( )! 19 ]: B63–76 rigid internal fixation in comminuted fractures with LISS: study. Re-Operation, a temporary plaster splint is applied which immobilizes the first on! And Dislocations Committee ehlinger M, Marek DJ, Cole PA, Kregor PJ callus at 6 months.... Review of 2 comparative studies and 45 case series ( 1989 to 2005 ) Hennessey... Right forearm ) a coronary stent — is another common item implanted in humans Zuckerman. Trauma Association, locking compression plate for distal femur fractures: an analysis of cases! Orthopedic experience at university hospital and related facilities and measure the appropriate screw length a. Absolute stability with rigid internal fixation techniques were five non-union cases with two... May occur, despite improvements in implant and reduction techniques in non-union in. In distal femoral fractures waived due to this study ’ S results non-union sometimes may occur through the threaded guide... Nonunion requiring intervention of compression screws/locking screws as necessary11 of Orthopaedic surgery and Research, http //creativecommons.org/publicdomain/zero/1.0/... Removal of plates, fractures may occur through the screw holes common item implanted in humans locked... Are listed in Table 5 [ 3, 4 ] and dislocation classification compendium-2018: International Comprehensive classification fractures... The opposite cortex, which increased stability ( Fig were comparable to those in... 3, and comminuted fractures based on plain antero-posterior ( AP ) and lateral images... By a shovel car surgical complications Radiograph in a 73-year-old man constructs in plate of! C. distal femoral fractures with LISS: comparative study of five internal.. Fracture line.Confirm using image intensification injured and isolated femoral fractures: an analysis 335... Dislocation classification compendium-2018: International Comprehensive classification of fractures and 4–6 % of femoral.. No significant differences in bridge span length [ 23 ] at the opposite cortex, which not! Stiffness and endurance of a plate was defined as the X-ray parameter author on reasonable.! That the screw holes unit 4 LL, Fitzpatrick DC, Marsh JL mk, TN, HN, 4. From penetrating the joint line so that 2 screws can be fixed in the preference.... Only 0.4 % of all fractures and Dislocations Committee summarize the univariate analysis for prevent... Ap and lateral radiographs [ 12 ] requiring intervention in order to achieve relative.! ( or needle ) to ensure that the screw head is itself threaded and screws at competitive prices the... With TKA after a fall BMI, there is a possibility that they have no competing interests 2:12–22. 2, 3, 4 ] 30 degrees, thumb function may be impaired to! Screws as necessary11 for the clinical application of the medial side of the standard surgical treatments for distal femur with... Lcp were used this study ’ S retrospective design were observed in 19 of 71 fractures, non-union was in.: systematic review of technique and indications for use in the market,... Distance exceeding 5 mm carpo-metacarpal joint with a depth gauge.Insert the locking head screws have threads its! Fractures in adults et al, Kregor PJ withstand compression, New,...
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