scholarly journals Effect of semi-rigid locking screws on the stiffness of a fracture-fixation construct: A conceptual finite-element study

2019 ◽  
Vol 11 (6) ◽  
pp. 168781401985457
Author(s):  
Xiao-Hua Pan ◽  
Wen-Chuan Chen ◽  
Kun-Jhih Lin ◽  
Kang-Ping Lin ◽  
Cheng-Lung Tsai ◽  
...  
Keyword(s):  
Compressive Load ◽  
Skin Incision ◽  
Delayed Union ◽  
Bone Plate ◽  
Long Bone ◽  
Structural Stiffness ◽  
Locking Screws ◽  
Plate Length ◽  
Working Length ◽  
Locking Screw

Strong stiffness provided by locking-plate system has resulted in nonunion and delayed union for long bone fracture. Longer bone plate can lengthen the working length to reduce the structural stiffness of the fixation device but will enlarge skin incision. Using the semi-rigid locking screw may be helpful but the efficacy was unclear. In simulated fracture model, four rigid locking screws were continually inserted beneath the fracture gap. The other four rigid/semi-rigid locking screws were equally distributed or concentrated at screw holes superior to the fracture gap. Axial compressive load was exerted to compare the biomechanical performance under various screw configurations and plate working length. Results revealed that using the semi-rigid locking screws, the structural stiffness of the fixation structure were lowered by 29.5%–45.1% comparing to the model with the same screw configuration using rigid locking screws. Semi-rigid screw models with shorter working length represented comparable flexibility of the fixation structure to the rigid locking screw model with longer working length. Compared to rigid locking screw, semi-rigid locking screw may provide similar flexibility with shorter bone plate, which may be beneficial to reduce the required plate length so that the skin incision may be minimized for fracture reduction.

scholarly journals The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Michael J. Weaver ◽  
George W. Chaus ◽  
Aidin Masoudi ◽  
Kaveh Momenzadeh ◽  
Amin Mohamadi ◽  
...  
Keyword(s):  
Stainless Steel ◽  
Fracture Fixation ◽  
List Type ◽  
Plate Material ◽  
Locking Screws ◽  
Femur Fractures ◽  
Plate Length ◽  
Working Length ◽  
Material Fracture ◽  
Supracondylar Femur Fractures

Abstract Background Nonunion following treatment of supracondylar femur fractures with lateral locked plates (LLP) has been reported to be as high as 21 %. Implant related and surgeon-controlled variables have been postulated to contribute to nonunion by modulating fracture-fixation construct stiffness. The purpose of this study is to evaluate the effect of surgeon-controlled factors on stiffness when treating supracondylar femur fractures with LLPs: Does plate length affect construct stiffness given the same plate material, fracture working length and type of screws? Does screw type (bicortical locking versus bicortical nonlocking or unicortical locking) and number of screws affect construct stiffness given the same material, fracture working length, and plate length? Does fracture working length affect construct stiffness given the same plate material, length and type of screws? Does plate material (titanium versus stainless steel) affect construct stiffness given the same fracture working length, plate length, type and number of screws? Methods Mechanical study of simulated supracondylar femur fractures treated with LLPs of varying lengths, screw types, fractureworking lenghts, and plate/screw material. Overall construct stiffness was evaluated using an Instron hydraulic testing apparatus. Results Stiffness was 15 % higher comparing 13-hole to the 5-hole plates (995 N/mm849N vs. /mm, p = 0.003). The use of bicortical nonlocking screws decreased overall construct stiffness by 18 % compared to bicortical locking screws (808 N/mm vs. 995 N/mm, p = 0.0001). The type of screw (unicortical locking vs. bicortical locking) and the number of screws in the diaphysis (3 vs. 10) did not appear to significantly influence construct stiffness (p = 0.76, p = 0.24). Similarly, fracture working length (5.4 cm vs. 9.4 cm, p = 0.24), and implant type (titanium vs. stainless steel, p = 0.12) did also not appear to effect stiffness. Discussion Using shorter plates and using bicortical nonlocking screws (vs. bicortical locking screws) reduced overall construct stiffness. Using more screws, using unicortical locking screws, increasing fracture working length and varying plate material (titanium vs. stainless steel) does not appear to significantly alter construct stiffness. Surgeons can adjust plate length and screw types to affect overall fracture-fixation construct stiffness; however, the optimal stiffness to promote healing remains unknown.

Application of Active Platelet Concentrate in Combination with Allograft in Cases of Long Bone Nonunion and Delayed Union

2011 ◽  
Vol 31 (3) ◽  
pp. 621-628
Author(s):  
Serdar Hakan BAŞARAN ◽  
Halil Nadir ÖNEŞ ◽  
M. Gökhan BİLGİLİ ◽  
Gökhan PEKER ◽  
M. Cevdet AVKAN
Keyword(s):  
Delayed Union ◽  
Platelet Concentrate ◽  
Long Bone ◽  
Bone Nonunion

scholarly journals Delayed healing of lower limb fractures with bisphosphonate therapy

2015 ◽  
Vol 97 (5) ◽  
pp. 333-338 ◽  
Author(s):  
B Yue ◽  
A Ng ◽  
H Tang ◽  
S Joseph ◽  
M Richardson
Keyword(s):  
Lower Limb ◽  
Bone Fractures ◽  
Operative Management ◽  
Delayed Union ◽  
Bisphosphonate Therapy ◽  
Long Bone ◽  
Non Union ◽  
Lower Limb Fractures ◽  
The Mean ◽  
Limb Fractures

Introduction Bisphosphonate therapy (BT) is used commonly in the management of osteoporosis. A systematic review was conducted investigating delayed union of lower limb, long bone fractures in patients on BT. We specifically assessed whether BT increases the risk of delayed union or non-union in lower limb, long bone fractures. Methods A literature search was conducted in the PubMed and Embase™ on 4 November 2014. Articles that investigated lower limb fractures, history of BT and fracture union were included in the review. Results A total of 9,809 papers were retrieved and 14 were deemed suitable for this review. The mean time to union in patients on BT was 8.5 months. A longer time to union was reported in a study investigating BT users versus controls (6.5 vs 4.8 months respectively). The mean rate of delayed or non-union for BT associated atypical fractures was 20% per fracture. Specifically in one study, delayed union was more common in the cohort with more than three years of BT (67%) than in the group with less than three years of BT (26%). Surgical fixation was associated with improved outcomes compared with non-operative management. Conclusions BT has been described to be associated with multiple adverse outcomes related to atypical fractures. Current evidence recommends operative management for this patient group. Further investigation is required to evaluate the exact effects of BT on lower limb fractures, in particular typical femoral fractures.

Retrospective comparison between minimally invasive plate osteosynthesis and open plating for tibial fractures in dogs

2012 ◽  
Vol 25 (05) ◽  
pp. 410-417 ◽  
Author(s):  
A. Boero Baroncelli ◽  
B. Peirone ◽  
M. D. Winter ◽  
D. J. Reese ◽  
A. Pozzi
Keyword(s):  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Major Complication ◽  
Complete Healing ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Fracture Length ◽  
Plate Length ◽  
Working Length ◽  
Significant Difference

SummaryObjectives: To compare fracture healing in diaphyseal tibial fractures stabilized using either minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF).Methods: Dogs in each group were matched for type of fracture, age and body weight. Stage of healing was measured blindly every four weeks postoperatively until complete healing. Outcome variables including fracture length, plate length, plate bridging ratio, plate working length, healing grading, and fracture reduction were compared between groups using the Mann-Whitney test. Significant difference was set at p <0.05.Results: Based on the definition of clinical union, at 30 days five out of eight dogs managed with MIPO had healed, while two of the eight of dogs managed with ORIF had healed. We did not find any significant differences in the other outcome measures. No complications were reported in the MIPO group whereas one major complication was reported in the ORIF group.Clinical significance: All dogs treated by MIPO healed rapidly without any complications, nevertheless the difference in radiographic healing between the two groups was not significant.

scholarly journals Platelet-Rich Plasma Combined With Autologous Grafting in the Treatment of Long Bone Delayed Union or Non-union: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Weijun An ◽  
Peng Ye ◽  
Tao Zhu ◽  
Zhizhong Li ◽  
Jianbin Sun
Keyword(s):  
Subgroup Analysis ◽  
Bone Grafting ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Delayed Union ◽  
Long Bone ◽  
Non Union ◽  
Autologous Bone Grafting ◽  
Autologous Bone

Background: Platelet-rich plasma (PRP) has been suggested as an emerging treatment for bone defects. However, whether PRP could enhance the therapeutic efficacy of autologous bone grafting for long bone delayed union or non-union remains unknown. A meta-analysis of randomized and non-randomized controlled trials (RCT and NRCT) was performed to summarize current evidence.Methods: Relevant RCTs and NRCTs comparing the influences of autologous bone grafting on healing of long bone delayed union or non-union with and without PRP were obtained by searching PubMed, Embase, Cochrane's Library, China National Knowledge Infrastructure, and WanFang databases from inception to September 10, 2020. A random-effect model was applied to pool the results with the incorporation of the potential heterogeneity. Subgroup analysis according to study design was also performed.Results: Six RCTs and two NRCTs with 420 patients were included. Compared to patients allocated to autologous bone grafting alone, those allocated to combined treatment with PRP and autologous bone grafting were not associated with higher rates of radiographic bone healing [risk ratio (RR): 1.06, 95% confidence interval (CI): 0.99–1.13, P = 0.09; I2 = 24%] or excellent/good posttreatment limb function (RR: 1.14, 95% CI: 0.95–1.37, P = 0.37; I2 = 0%) but was associated with a shorter healing time (mean difference: −1.35 months, 95% CI: −1.86 to −0.84, P &lt; 0.001; I2 = 58%). Subgroup analysis according to study design showed similar results for the above outcomes (P-values for subgroup difference all &gt;0.10).Conclusions: Combined treatment with PRP and autologous bone grafting may be effective to accelerate the healing of long bone delayed union or non-union compared to autologous bone grafting alone.

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