Clinical outcomes of unstable metacarpal and phalangeal fractures treated with a locking plate system: a prospective study

2020 ◽  
Vol 45 (6) ◽  
pp. 582-587
Author(s):  
Takeshi Katayama ◽  
Kazuhiko Furuta ◽  
Hiroshi Ono ◽  
Shohei Omokawa
Keyword(s):  
Clinical Outcomes ◽  
Locking Plate ◽  
Plate Fixation ◽  
Bony Union ◽  
Complication Rates ◽  
Locking Plate Fixation ◽  
Level Of Evidence ◽  
Finger Motion ◽  
Phalangeal Fractures

We prospectively assessed clinical and radiological outcomes of locking plate fixation in treating unstable fractures in 11 metacarpals, 15 proximal phalanges, and eight middle phalanges in 34 consecutive patients from October 2011 to December 2016. Median length of follow-up was 14 months (range 12–24). The motion of finger joints, bony union, and complication rates were recorded. The median postoperative range of motion of the two interphalangeal joints and the metacarpophalangeal joint was 82% of the contralateral hands. Fractures in the three locations had significantly different recovery of the finger motion, with the best recovery for the metacarpal fractures. Closer distance between the plate edge and joint line was associated with a more limited range of the finger motion. The clinical outcomes approached an acceptable level at final follow-up. Finger stiffness is unavoidable after locking plate fixation of metacarpal and phalangeal fractures even with early hand therapy, with stiffness occurring in 10 out of 34 cases at the time of final follow-up 1 year after surgery. Level of evidence: II

Comparison of Five Years Clinical and Radiological Outcomes between Progressive and Non-Progressive Wrist Osteoarthritis after Volar Locking Plate Fixation of Distal Radius Fractures

2019 ◽  
Vol 24 (01) ◽  
pp. 30-35 ◽  
Author(s):  
Takeshi Katayama ◽  
Hiroshi Ono ◽  
Shohei Omokawa
Keyword(s):  
Clinical Outcomes ◽  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Locking Plate ◽  
Wrist Flexion ◽  
Radius Fractures ◽  
Locking Plate Fixation

Background: This study aimed to identify the effect of the progression of postoperative wrist osteoarthritis on 5 years clinical and radiological outcomes after volar locking plate fixation of distal radius fractures. Methods: Altogether, 56 patients with distal radius fractures were followed up 5 years after surgery. Clinical assessment was performed using the Mayo modified wrist score, a visual analogue scale of pain, the Japanese version of the Disabilities of the Arm, Shoulder, and Hand score, and Patient-related wrist evaluation. Standardized wrist radiographs were used to assess wrist morphology and the Knirk and Jupiter’s degree of osteoarthritis. Multivariate logistic regression was used to analyze postoperative morphological changes in the wrist and carpal alignment regarding their correlation with progression of wrist osteoarthritis. Results: Progression of postoperative wrist osteoarthritis was recognized in 37 of the 56 cases (66.1%). Compared with the clinical outcomes at the time of the fracture union completion, almost clinical outcomes improved up to 5 years follow-up time as well as at 1 year after surgery. The range of wrist flexion at 5 years follow-up was significantly less in the progressive osteoarthritis group than in those with non-progressive osteoarthritis. The persistent step-off immediately after surgery significantly affected the postoperative progression of wrist osteoarthritis. Changes in the radial inclination, volar tilt, and radioscaphoid angle correlated with progression of wrist osteoarthritis. The highest correlation was with the change of radioscaphoid angle. Conclusions: Good clinical results were maintained at 5 years after surgery, but progression of postoperative wrist osteoarthritis interfered with improvement of wrist flexion. Change in the radioscaphoid angle was the factor that was most highly correlated with progression of postoperative wrist osteoarthritis.

scholarly journals Sliding bone graft combined with double locking plate fixation for the treatment of femoral shaft nonunion

2019 ◽  
Vol 47 (5) ◽  
pp. 2034-2044 ◽  
Author(s):  
Wenzhao Xing ◽  
Zhenhua Pan ◽  
Lei Sun ◽  
Liang Sun ◽  
Chunpu Zhang ◽  
...  
Keyword(s):  
Bone Graft ◽  
Locking Plate ◽  
Plate Fixation ◽  
Femoral Shaft ◽  
Bony Union ◽  
Locking Plate Fixation ◽  
Duration Of Surgery ◽  
Novel Method ◽  
Mean Time

Objectives The aim of this study was to describe and evaluate a novel method of sliding bone graft combined with double locking plate fixation in treating femoral shaft nonunion. Methods Clinical data from patients with femoral shaft nonunion that was treated with sliding bone grafts combined with double locking plate fixation were retrospectively collected. Data included duration of surgery, blood loss, union rate, time to union and possible complications. Results Twenty-five patients included in the study were followed for a mean duration of 16.6 ± 2.6 months (range, 12–22 months). All of the fractures (100%) achieved bony union. Mean time to union was 6.0 ± 1.0 months (range, 4–8 months). No infections or medullary cavity occlusions were observed. Conclusions Sliding bone graft combined with double locking plate fixation was shown to be a safe, effective, and convenient surgical option for the treatment of nonunion, due to its high union rates with no complications. Further studies with larger sample sizes and longer-term follow-up are warranted.

Complications following volar locking plate fixation for distal radial fractures: a systematic review

2013 ◽  
Vol 39 (7) ◽  
pp. 745-754 ◽  
Author(s):  
A. Bentohami ◽  
K. de Burlet ◽  
N. de Korte ◽  
M. P. J. van den Bekerom ◽  
J. C. Goslings ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Locking Plate ◽  
Assessment Tool ◽  
Plate Fixation ◽  
Assessment Tools ◽  
Volar Locking Plate ◽  
Locking Plate Fixation ◽  
Distal Radial Fractures ◽  
Level Of Evidence

The purpose of this systematic review is to assess the prevalence of complications following volar locking plate fixation of distal radial fractures. A computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Only prospective comparative and prospective cohort studies that presented data concerning complications after treatment of distal radial fractures with a volar locking plate in human adults with a minimal follow-up of 6 months were included. Two quality assessment tools were used to assess the methodological quality of the studies (level of evidence rating according to the Oxford Centre of Evidence Based Medicine and the modified version of the Cochrane Bone, Joint and Muscle Trauma Group’s former quality assessment tool). Thirty three studies were eligible for final assessment. Most complications were problems with nerve and tendon function as well as complex regional pain syndrome. With an overall complication rate of 16.5%, most of which were ‘minor’ complications and low rates of nonunion and malunion, volar locking plate fixation can be considered a reasonably safe treatment option for patients with distal radial fractures.

scholarly journals Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095914
Author(s):  
Justin C. Kennon ◽  
Erick M. Marigi ◽  
Chad E. Songy ◽  
Chris Bernard ◽  
Shawn W. O’Driscoll ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Ulnar Neuropathy ◽  
Complication Rates ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Functional Scores ◽  
The Mean

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

Incidence of tendon ruptures after locking plate fixation of distal radial fractures: are the cited rates still accurate?

2020 ◽  
pp. 175319342094846
Author(s):  
Daniel J. Brown ◽  
Neal Ormsby ◽  
Olivia C. Brown ◽  
Graham Cheung
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Large Change ◽  
Contributing Factors ◽  
Locking Plate Fixation ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Plate Design ◽  
Tendon Ruptures

With the introduction of the anterior locking plate in the early part of this century, there was a large change in how distal radial fractures were treated. Early articles about the techniques reported tendon ruptures occurring in as many as 10%, although studies from our unit reported rates closer to 2%. Subsequent refinements in surgical technique and improvements in plate design have been made with the aim of reducing the number of ruptures. Despite this, the original articles and their rates continue to be quoted. In this retrospective study of 798 cases treated with anterior locking plates, tendon ruptures have been significantly reduced and are now as low as 0.5%. Contributing factors leading to this improvement are identified and discussed. Level of evidence: III

scholarly journals The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: a retrospective study

2020 ◽  
Author(s):  
Shengkun Hong ◽  
Wei Wang ◽  
Jinku Guo ◽  
Feixiong He ◽  
Cong Wang
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Clavicle Fracture ◽  
Operation Time ◽  
Locking Plate Fixation ◽  
Traditional Methods ◽  
Traditional Group ◽  
Lag Screw ◽  
Clavicle Fractures

Abstract Background: Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are two main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots versus traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.Methods: We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing and complications were assessed at a follow-up of 12 to 40 months.Results: The mean age of all the patients was 50.8 years. There were 52 and 49 patients in Nice knot group and traditional group respectively, and no differences between two groups was found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (p < 0.01) than the traditional group (mean and standard deviation [SD], 78.6±19.0 compared with 94.4±29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there was no significant differences between groups, despite the Nice knot group had slightly better results.Conclusions: Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.

scholarly journals Comparison of the efficacy of the tension band wiring with eyelet wire versus anatomical locking plate fixation for the treatment of displaced olecranon fractures

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110592
Author(s):  
Haruhiko Shimura ◽  
Akimoto Nimura ◽  
Koji Fujita ◽  
Hidetoshi Kaburagi
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Locking Plate ◽  
Plate Fixation ◽  
Elbow Flexion ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Locking Plate Fixation ◽  
The Mean ◽  
Olecranon Fractures

Background This retrospective study was conducted to assess the clinical outcome and complications between tension band wiring (TBW) with eyelet wire and locking plate fixation used for the treatment of displaced olecranon fractures. Methods A total of 58 patients (36 males and 22 females; mean age: 63 years) were reviewed between April 2014 and September 2020. TBW with Ring Pin (RP group) was applied in 24 patients, including 15 Mayo type ⅡA and 9 Mayo type ⅡB patients. Anatomical locking plate (ALP group) was used in 34 patients, including 22 Mayo type ⅡA and 12 Mayo type ⅡB patients. Clinical outcome was evaluated using the Mayo Elbow Performance Score (MEPS), and active range of motion of the elbow and forearm and postoperative complications were reviewed. Results General characteristic of the patients and the fracture type were similar in the two groups. The mean MEPS values were 96.5 ± 7.3 in the RP group and 94.9 ± 9.4 in the ALP group. The mean elbow flexion arc was 127°±11 in the RP group. The mean elbow flexion arc was 122°±18 in the ALP group. No significant differences in clinical outcomes were observed between the two groups. Complication rates were significantly higher in the ALP group (19/34: 56%) than in the RP group (6/24: 25%). Conclusion Although there were no statistically significant differences in clinical outcomes between the two groups, the ALP group had a higher proportion of any complication than the RP group.

scholarly journals Outcomes of Proximal Femoral Locking-plate Fixation for Pathological Fractures of the Proximal Femur

2021 ◽  
Vol 73 (9) ◽  
pp. 603-608
Author(s):  
Kongkhet Riansuwan ◽  
Somkiat Jivasomboonkul ◽  
Rapin Phimolsarnti ◽  
Chandhanarat Chandhanayingyong ◽  
Apichat Asavamongkolkul
Keyword(s):  
Proximal Femur ◽  
Locking Plate ◽  
Plate Fixation ◽  
Clinical Results ◽  
Assistive Device ◽  
Locking Plate Fixation ◽  
Pathological Fractures ◽  
Hardware Failure ◽  
Estimated Blood Loss

Objective: To study the treatment outcomes of proximal femoral locking-plate fixation of pathological fractures ofthe proximal femur relative to clinical results, implant failure, and surgical complications.Materials and Methods: From 2007 to 2018, 17 patients (18 femurs) with a diagnosis of impending or existingpathological fracture of the proximal femur were treated with proximal femoral locking-plate fixation. Data collectedincluded operative duration, estimated blood loss, ambulatory status, hardware failure events, and postoperativecomplications.Results: Of the 18 femurs that were included, 13 were existing pathological fractures and 5 were impending fractures.The mean age of patients was 53.7 years (range: 28-89), and 12 of them were female. The mean follow-up was 11.3months (range: 1-67). Ten of 17 patients (62.5%) had progressive lung disease from pulmonary metastasis or fromlung primary. No patient developed oxygen desaturation or cardiac arrest during the intraoperative or postoperativeperiod. Thirteen of 17 patients (76.5%) could walk with or without an assistive device at the time of final follow-up.Two patients required close postoperative monitoring in the intensive care unit due to poor preoperative status,and both of those patients died within one month after surgery from other medical problems. No hardware failureoccurred.Conclusion: For pathological fracture of the proximal femur, proximal femoral locking-plate fixation is a treatmentoption that results in fewer perioperative and postoperative cardiopulmonary events and surgical complications.Most patients can ambulate with or without an assistive device at the final follow-up.

Functional follow-up of locking plate fixation of fractures of the proximal humerus

2007 ◽  
Vol 18 (2) ◽  
pp. 87-92 ◽  
Author(s):  
K. N. Sharafeldin ◽  
J. F. Quinlan ◽  
J. Corrigan ◽  
I. P. Kelly
Keyword(s):  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Locking Plate Fixation

scholarly journals Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

2019 ◽  
Author(s):  
Xueliang Cui ◽  
Hui chen ◽  
Binbin Ma ◽  
Wenbin Fan ◽  
He Li
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Locking Plate ◽  
Plate Fixation ◽  
Humeral Fractures ◽  
Locking Plate Fixation ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Fibular Strut ◽  
Fibular Strut Allograft

Abstract Abstract Background: Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs. Methods: A retrospective review was performed on 60 three- and four-part PHFs . The outcomes were assessed for 35 patients in the LCP group and 25 in the LCP with fibular allograft (FA) group, with a mean age of 72.75 years (60 to 88), at a mean follow-up of 31.95 months (24 to 40). Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). Loss of anatomic fixation was defined if the varus malalignment of the neck-shaft angle (NSA) was more than 5° or if the change in HHH was more than 3 mm. The clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score. Result: The average radiological changes were higher in the LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p<0.001] and NSA of 9.94° versus 3.12° [p﹤0.001 ]). The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p=0.024] and ASES score of 72.80 vs 78.64 [p=0.022]). The FA group showed better forward elevation (p=0.010) and abduction (p=0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p<0.001). Conclusion: For comminuted PHFs in elderly patients, locking plate fixation with a fibular strut allograft showed satisfactory radiological and clinical outcomes. Trial registration: ZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. URL of registry: http://www.njzdyy.com. Date of registration: 2018-05-17 Key words: proximal humeral fracture; fibular allograft; locking plate; elderly patients

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