Terms and Conditions, Rekha YB, Reddy NB. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Effects of construct stiffness on healing of fractures stabilized with locking plates. Our new stainless steel plate, called the minimum contact locking compression plate (MC-LCP), has protrusions on the plate undersurface, two dynamic compression screw holes and six locking screw holes. Hoffmeier KL, Hofmann GO, Mückley T. Choosing a proper working length can improve the lifespan of locked plates. Acta Orthop Scand. In such cases, shortening the fracture site to approximately 5–10 mm would be acceptable to decrease the distance between the proximal and distal bone fragments. The number of empty holes near the fracture site and the rate of bone healing were not clearly related. Insert a second screw using the same technique. Locking Compression Plate (LCP) The LCP permits use of angled conventional (compression) screws and fixed-angle locked screws through its patented combi-hole design (Figure 3). 2006 Aug;37(8):691–7. Tables 2, 3, and 4 summarize the univariate analysis. In these circumstances, take the opportunity to remove the implants. 2013 May;99(3):353–60. The mechanism locking the screw in the plate also comes in two types: in the first the screw head is locked in its chamber by a threaded locknut. Bottland et al. Reports published by various authors are listed in Table 5 [3, 23, 24, 26,27,28,29,30,31]. 2014 Feb;28(2):83–9. 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. 2003 Nov;34(Suppl 2):B63–76. A prospective study of treatment of distal femur fractures with locking condylar plate. Insert a screw through the most distal plate hole. The implants may need to be removed in cases of soft-tissue irritation.In case of joint stiffness, or tendon adhesions’ restricting finger movement, tenolysis or arthrolysis become necessary. Injury. PubMed Google Scholar. In cases with simple fractures, one non-union case had one empty hole and one non-union case had four empty holes, whereas in cases with comminuted fractures, five non-union cases had two more empty holes. Case 2 was distal femur fracture with Gustilo IIIA in a 73-year-old man; he was run over by a shovel car. Additionally, although we did not consider bone mineral densities and BMI, there is a possibility that they might have influenced bone union. reported no plate length differences between non-union and union groups, which was similar to our results . Sliding screw plate. The present study was approved by Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital (Ethics Committee No. Of the cases with simple fractures, there was one non-union case with one empty hole and one non-union case with four empty holes (Table 3). PubMed Different types of screws Conventional screws Cortex screw (with or without shaft) Cancellous bone screw (with or without shaft) Locking head screws (LHS) Self-tapping LHS Self-drilling, self-tapping LHS 5. By using this website, you agree to our Immediately postoperatively, a temporary plaster splint is applied which immobilizes the first MCP joint as well as the wrist. 2013;33:7–11. In most of our cases, non-union likely resulted from fracture site instability after reduction internal fixation. Surgical techniques and a review of the literature. The guidelines reported by Gautier et al. In these circumstances, take the opportunity to remove the implants. 15 Locking plates 1.. 2. All of the authors critically revised the manuscript. The Synthes Locking Compression Plates—T-Plates are intended to buttress metaphyseal Tomoyuki Noda. The pull of the thenar muscles results in palmar flexion of the distal fragment. In case 3, it showed that plate length was 196 mm, fracture distance was 65 mm, plate span ratio was 196/65 = 3.01, bridge span length was 85 mm, medial fracture distance was 0 mm (because of shortening fracture site), and empty hole number was 1. For distal fixation, at least 3 metaphyseal locking screws were used. 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). c Radiograph and CT showed no callus at 6 months postoperatively. Kiyono, M., Noda, T., Nagano, H. et al. Courses, webinars, and online events, in your region or worldwide, Pediatric distal femur module is now online, Radiopalmar approach to the base of the thumb. 2004 Sep;18(8):503–8. Be careful not to overbend, as there is a comminuted zone at the opposite cortex, which can not withstand compression. It is a single-beam construct where the Cite this article. Int J Res Orthop. A biomechanical study. Case 1 was distal femur fracture in a 74-year-old woman with TKA after a fall. Bone union was observed in all cases with simple or comminuted fractures with respective medial fracture distances of ≤ 2 mm or ≤ 5 mm. In this case, bone union was achieved by inserting screws near the fracture site via revision surgery, which increased stability (Fig. e Radiograph 1 year after re-operation, a Radiograph with Gustilo type-IIIA in a 73-year-old man. Get it as soon as Tue, Nov 24. Manage cookies/Do not sell my data we use in the preference centre. Journal of Orthopaedic Surgery and Research The Synthes 4.5 mm Locking Compression Plate (LCP) System is indicated for fixation of various long bones, such as the humerus, femur and tibia and for use in fixation of peri-prosthetic fractures, osteopenic bone and fixation of non-unions or malunions in adult patients. Lee CH, Shih KS, Hsu CC, Cho T. Simulation-based particle swarm optimization and mechanical validation of screw position and number for the fixation stability of a femoral locking compression plate. Springer Nature. If the flexion deformity exceeds 30 degrees, thumb function may be impaired due to muscle imbalance. reported that callus formation decreases as the bridge span length increases . 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. This study included 71 distal femoral fractures in 70 patients (23 males, 47 females; mean age, 68.0 years [range, 16–91 years]) who were treated using the locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA) at a university hospital and related facilities between April 2005 and December 2015. Further study in large number of patients is required to comment regarding disadvantages and complications. Hunt SB, Buckley RE. Google Scholar. Kellam JF, Meinberg EG, Agel J, Karam MD, Roberts CS. d Another plate was added during re-operation to shorten the fracture. The Mann-Whitney U test was performed for statistical comparisons of the average number of empty holes and the average bridge span length. The Locking Compression Plate System has many similarities to existing plate fixation methods, but with a few important improvements. Alternatively, insert the threaded bolt into the plate holes to bend the plate.The bend should never go through a hole as this may damage the locking mechanism. 2011 Feb;25(Suppl 1):S8–14. 2001 Dec;32(Suppl 3):SC55–63. Reducing comminuted bone fragments is difficult when the inner portion of the fracture site also exhibits comminuted fracture. Successful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: comparative study of multiply injured and isolated femoral fractures. 2007 Sep;12(5):458–65. reported no significant differences in bridge span lengths of 64.4 and 69.8 mm in two respective cases of non-union and union . Conclusive rules by Gautier et al. 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. 2007 Oct;89(10):2298–307. Be careful to bend in between the holes by positioning the pliers over the plate holes. Angularly stable plate fixation, using a locking compression plate (LCP), prevents secondary displacement without the need of bone grafting. The present study was approved by Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital (Ethics Committee No. The mean follow-up period was 20.8 months (range, 5–33 months) (Table 1). J Bone Joint Surg Am. 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. Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005). Conversely, in cases with comminuted fractures, there were five non-union cases with more two empty holes (Table 4). Orthopaedic Locking Compression Plates are fracture fixation devices that allow fitment of normal conventional bone screws as well as Locking head screws. Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q. Distal femoral fractures: current concepts. Acta Chir Orthop Traumatol Cech. Non-union was diagnosed 2 of 26 (7.7%) cases with a simple fracture and 5 of 45 (11.1%) cases with a comminuted fracture (Table 2). Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults. b Postoperative radiograph. Although adopting the anatomical locking plates procedure revealed positive outcomes, the method is still debatable.Several studies describe a variety of surgical technique and implants to treat this complex fracture. J Bone Joint Surg Am. Locking plates: tips and tricks. Epidemiology of adult fractures: a review. 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. Part of There are few reports on the relationship between the screw position and bone union when fixing by the bridging plate (relative stability) method. Gautier E, Sommer C. Guidelines for the clinical application of the LCP. locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA). If a locking compression plate is used, a push- pull device can be inserted in both the proximal and distal fragment to achieve temporary plate stabilization instead of bone holding forceps. Drilling must be parallel to the marker wire (or needle) to ensure that the screw will not penetrate the joint. This screw would normally be a standard screw, as it engages in thick cortical bone. 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. 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. 2011;26(4):405–9. c The definition of the part measured this time. 2013;80(3):185–91. 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. suggested that a locking compression plate should be used as a bridging plate in order to achieve relative stability. Injury. Plates used for buttressing prevent collapse by supporting an area of thin cortex or cancellous bone graft. 2010 Mar;24(3):156–62. MK drafted the manuscript. Bone union was defined as three out of four instances of cortical bridging on AP and lateral radiographs . Additionally, according to Stoffel et al., the number of empty holes, including the fracture site, should be between one and four in simple fractures, and in comminuted fractures, the screws should be inserted as close to the fracture site as possible . When plates are used, atrophy of the bone beneath the plate may predispose the bone to fracture. Google Scholar. Plate screw – can be locking or non-locking head; non-locking produces friction between plate and bone due to compression; locking provides angular stability • Poller/blocking screw – used to redirect an IMN • Lag screw – Inter-fragmentary compression; both fully threaded and partially threaded screws can have a lag effect . 1712-035). Vallier HA, Hennessey TA, Sontich JK, Patterson BM. Introduction: fracture and dislocation classification compendium-2018: International Comprehensive Classification of Fractures and Dislocations Committee. Smith WR, Ziran BH, Anglen JO, Stahel PF. In distal femoral fractures, non-union sometimes may occur, despite improvements in implant and reduction techniques. ABN Automotive Car Steering Wheel Puller Compressor Remover Set – Vehicle Steering Wheel Lock Plate Removal Tool Kit. Thus, Locking Compression Plate is an important armamentarium in treatment of the Distal femur fractures especially when fracture is closed, severely comminuted and in situations of osteoporosis. [14, 15]. Fourteen of all comminuted fracture cases and bone union were treated through shortening the fracture site as Rekha reported , and non-union was not observed in these cases. Align the plate along the axis of the shaft. Patient demographics (age), comorbidities (smoking, diabetes, chronic steroid use, dialysis), and injury characteristics (AO type, open fracture, infection) were obtained for all participants. b Conclusive rules of comminuted fracture for 33A3, 33C2, and 33C3. (MIPPO) technique, using locking compression plate (LCP). Megas P. Classification of non-union. Injury. Toolan BC, Koval KJ, Kummer FJ, Sanders R, Zuckerman JD. a Radiograph in a 74-year-old woman with total knee arthroplasty. Cookies policy. Henderson et al. The locking head screws have threads on its head, which engages it firmly with the plate. 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. Her injury was a simple transverse fracture that resulted in non-union. (Redirected from Locking Compression Plate) Orthopedic implants to repair fractures to the radius and ulna. reported that increasing fracture site flexibility promotes initial bone formation, but had no correlation with bridge span length . 2010 Dec;92(Suppl 2):12–22. Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Performing shortening and fixation of up to 5–10 mm was effective for achieving bone union in several comminuted fracture cases (Fig. 2006 Apr;88(4):846–53. The Synthes Locking Compression Plates—Narrow and Broad, are intended for fixation of various long bones, such as the humerus, femur and tibia. Surgical treatment can either be retrograde intramedullary nail fixation or be plate fixation, with plate fixation having a wide indication for various fractures types [5, 6]. PubMed Central Extraarticular fractures of the base of the thumb metacarpal are often displaced, with a flexion deformity and may show palmar comminution (Winterstein fracture). Foot Ankle Int. J Orthop Surg Res 14, 384 (2019). J Bone Joint Surg Am. The principle of the locking compression plate (LCP) is represented by the combination of two completely different anchorage technologies and two opposed principles of osteosynthesis in one implant it combines the principles of con- ventional plate osteosynthesis for direct anatomical reduction with those of bridging plate osteosynthesis. reported that fracture site instability prevents bone callus formation, even with good blood supply . Working length and proximal screw constructs in plate osteosynthesis of distal femur fractures. Open fractures were observed in 19 of 71 (26.8%) cases (Table 1). Privacy 3). Lujan TJ, Henderson CE, Madey SM, Fitzpatrick DC, Marsh JL, Bottlang M. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Sci. Several example cases are shown in Figs. CAS Injury. 2017;48(11):2597–601. J Appl Biomech. 2005 Nov;36(Suppl 4):S30–7. b Postoperative radiograph. Univariate analysis was performed on them. Plate fixation is one of the standard surgical treatments for distal femoral fractures. 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. If standard plates are used, bone graft from the distal radius may be necessary to avoid delay in bone healing and consequent secondary displacement, or failure of fixation. Simple fractures were defined as 33A2 and 33C1 classifications and comminuted fractures were classified as 33A3, 33C2, and 33C3 according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) fracture classification ; we excluded 33B type AO/OTA fractures. Guidelines for defining the terms “plate span ratio,” “empty hole,” and “medial fracture distance” are provided in Fig. There were 26 simple fractures and 45 comminuted fractures based on plain antero-posterior (AP) and lateral X-ray images (Table 2). Hib Surgicals - Offering Locking Compression Plate, Size: 3.5 Mm at Rs 1589/piece in Mumbai, Maharashtra. distally the plate was not extended beyond the joint line. During surgery, it is sometimes difficult to properly determine screw position. A senior medical doctor with > 15 years of experience as an orthopedic surgeon operated on these cases; therefore, a certain surgery quality (reduction of fractures, treatment of soft tissues) was guaranteed. Google Scholar. Compared with traditional compression plating, locking plates can provide more stability in comminuted or osteoporotic fractures. 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. 2). 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). d Screws were inserted near the fracture during re-operation. Plate span ratio was measured with reference to the length of the plate relative to the length of the fracture line, as proposed by Gautier et al. Working length of a plate was defined as the distance between the first screws on either side of the fracture . Article Iowa Orthop J. Use bending pliers to contour the plate. Acta Orthop Scand. Confirm using image intensification.Drill through the threaded drill guide. Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques. Femoral and tibial blood supply: a trigger for non-union? Healing results of periprosthetic distal femur fractures treated with far cortical locking technology: a preliminary retrospective study. No statistically significant difference in the working lengths of the fracture site was observed between simple fractures and comminuted fractures in both groups (Tables 3 and 4). In this study, non-union was diagnosed in 7 of 71 cases. Conversely, fracture instability was significantly higher with > 80 mm of bridge span length, which resulted in poor callus formation . With respect to plate span ratio, 3 of 24 (12.5%) cases with simple fractures in the bone union group fit the plate length that was > 8–10 times longer than the overall fracture length, whereas 21 of 24 (87.5%) cases did not. Google Scholar. 2.0 mm and 2.4 mm LCP were used to manage appendicular fractures in cats and small dogs. The bone fracture distance on the medial side of the distal femur was related to bone union rather than screw position. Kanchanomai C, Muanjan P, Phiphobmongkol V. Stiffness and endurance of a locking compression plate fixed on fractured femur. c Radiograph and CT showed callus formation 2 months postoperatively; left knee range of motion was 0–140°. Study limitations included its retrospective design and the relatively small sample size. Of 26 simple fractures, there were 7 cases with a medial fracture distance of ≥ 2 mm, and the non-union rate was 28.5% (2 of the 7 cases) (Table 3). Distal femoral fractures comprise only 0.4% of all fractures and 4–6% of femoral fractures [1, 2]. 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. Elkins reported favorable callus formation with a bridge span length of ≤ 80 mm. Internal fixation allows for anatomical reduction. https://doi.org/10.1186/s13018-019-1401-9, DOI: https://doi.org/10.1186/s13018-019-1401-9. Recognizing The Potential Benefits Of Locking Compression Plates 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. 2010 Oct;18(10):597–607.