scholarly journals The Clinical Efficacy of Anterior Pelvic Wall Locking Plate Fixation Through the Lateral Rectus Approach for Treating Quadrilateral Surface Acetabular Fractures

2021 ◽  
Author(s):  
Zhidong Wang ◽  
ZhenHeng Wang ◽  
GuangDong Chen ◽  
MaoFeng Gao ◽  
Mao Li ◽  
...  
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Lateral Rectus ◽  
Fracture Reduction ◽  
Acetabular Fractures ◽  
Clinical Effects ◽  
Reconstruction Plate ◽  
Pelvic Wall ◽  
Transverse Fractures

Abstract Background:Cases of acetabular fractures involving the quadrilateral surface are increasing annually. Quadrilateral surface surgery is complex, involves combined approaches, and the quality of fracture reduction closely depends on the surgical procedure. This study aimed to explore the clinical effects of the anterior pelvic wall locking plate through the lateral rectus approach for treating acetabular fractures involving quadrilateral surface. Methods:A retrospective analysis of 35 patients with acetabular fractures involving the quadrilateral surface treated with anterior pelvic wall-locking plates at the First Affiliated Hospital of Soochow University from June 2016 to December 2020. Patients included 25 males and ten females; age 23-82 years, average 52.4 years. The fracture classification was based on the Letournel-Judet classification: 13 cases of double-column fractures, seven cases of T-shaped fractures, seven cases of anterior wall with posterior semi-transverse fractures, and eight cases of transverse fractures. All patients were exposed through the lateral rectus approach, and fractures were fixed with the anterior pelvic wall-locking plate combined with the reconstruction plate. The Matta imaging standard assessed the quality of fracture reduction, and hip joint function was assessed according to the modified Merled’Aubigné-Postel scoring standard. Results:Patients meeting the inclusion and exclusion criteria were followed up for 12-42 months, with an average of 26.1 months. At the last follow-up, Matta imaging evaluation showed that 24 cases were anatomically reduced (68.6%, 24/35), seven cases were satisfied (20%, 7/35), and four cases were dissatisfied (11.4%, 4/35). The satisfaction rate was 88.6% (31/35), according to the modified Merled'Aubigné-Postel scoring standard. The hip function was excellent in 23 cases, good in six cases, fair in four cases, and poor in two cases. The excellent and good rates were 82.9% (29/35). Conclusion: The acetabular fracture involving the quadrilateral surface is clearly revealed through the lateral rectus approach. The anterior pelvic wall-locking plate combined with the reconstruction plate can fix well, with satisfactory clinical effects.

scholarly journals A Novel Anatomical Self-locking Plate Fixation for Both-column Acetabular Fractures: - Finite Element Analysis

2021 ◽  
Author(s):  
Ming Li ◽  
Ding Xu ◽  
Yong Zhang ◽  
Bo Chen ◽  
Haiyang Li ◽  
...  
Keyword(s):  
Finite Element ◽  
Locking Plate ◽  
Plate Fixation ◽  
Peak Stress ◽  
Element Model ◽  
Implant Failure ◽  
Acetabular Fractures ◽  
Reconstruction Plate ◽  
Element Analysis ◽  
Fixation Methods

Abstract Background: Both-column acetabular fractures often require multiple plates for fixation, and the risk of internal implant failure is high. The author designed a posterior anatomic self-locking plate (PASP) to avoid the shortcomings. The stability of PASP was compared with two popular reconstruction plate fixation methods, and the influence of sitting, turning right and left on implants were explored. Methods: PASP, double reconstruction plate (DRP), and cross reconstruction plate (CRP) were assembled on the finite element model of both-column fractures of the left acetabulum. A load of 600N and a torque of 8N·m were loaded on the S1 vertebral body to detect stress and displacement changes when sitting, turning right and left. Results: The peak stress and displacement of three types of fixation methods on the left both-column fractures under three types of movements were CRP > DRP > PASP. PASP has the minimal value when turning left. The maximum peak of stress and displacement of PASP are 313.5 MPa and 1.15 mm respectively when turning right. Conclusion: PASP can provide higher stability than two reconstruction plates for both-column acetabular fractures. The rational movement after posterior DRP and PASP fixation for acetabular fracture is to turn to the ipsilateral side, which can avoid implant failure.

scholarly journals Age-Independent Clinical Outcome in Proximal Humeral Fractures: 2-Year Results Using the Example of a Precontoured Locking Plate

2022 ◽  
Vol 11 (2) ◽  
pp. 408
Author(s):  
Rony-Orijit Dey Hazra ◽  
Johanna Illner ◽  
Karol Szewczyk ◽  
Mara Warnhoff ◽  
Alexander Ellwein ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Fracture Reduction ◽  
Complication Rates ◽  
Locking Plate Osteosynthesis ◽  
Group 2 ◽  
Group 1

Introduction: The optimal treatment strategy for the proximal humeral fracture (PHF) remains controversial. The debate is centered around the correct treatment strategy in the elderly patient population. The present study investigated whether age predicts the functional outcome of locking plate osteosynthesis for this fracture entity. Methods: A consecutive series of patients with surgically treated displaced PHF between 01/2017 and 01/2018 was retrospectively analyzed. Patients were treated by locking plate osteosynthesis. The cohort was divided into two groups: Group 1 (≥65 years) and Group 2 (<65 years). At the follow-up examination, the SSV, CMS, ASES, and Oxford Shoulder Score (OS), as well as a radiological follow-up, was obtained. The quality of fracture reduction is evaluated according to Schnetzke et al. Results: Of the 95 patients, 79 were followed up (83.1%). Group 1 consists of 42 patients (age range: 65–89 years, FU: 25 months) and Group 2 of 37 patients (28–64 years, FU: 24 months). The clinical results showed no significant differences between both groups: SSV 73.4 ± 23.4% (Group 1) vs. 80.5 ± 189% (Group 2). CMS: 79.4 ± 21 vs. 81.9 ± 16, ASES: 77.2 ± 20.4 vs. 77.5 ± 23.1, OS: 39.5 ± 9.1 vs. 40.8 ± 8.2; OS: 39.5 ± 9.1 vs. 40.8 ± 8.2. In the radiological follow-up, fractures healed in all cases. Furthermore, the quality of fracture reduction in both groups is comparable without significant differences. The revision rate was 9.5% in Group 1 vs. 16.2% in Group 2. Discussion: Both age groups show comparable functional outcomes and complication rates. Thus, the locking plate osteosynthesis can be used irrespective of patient age; the treatment decision should instead be based on fracture morphology and individual patient factors.

scholarly journals Single column locking plate fixation is inadequate in two column acetabular fractures. A biomechanical analysis

2010 ◽  
Vol 5 (1) ◽  
pp. 30 ◽  
Author(s):  
Kiarash Khajavi ◽  
Arthur T Lee ◽  
Derek P Lindsey ◽  
Philipp Leucht ◽  
Michael J Bellino ◽  
...  
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Biomechanical Analysis ◽  
Acetabular Fractures ◽  
Locking Plate Fixation ◽  
Single Column

scholarly journals The Femoral Prosthesis Fracture Analysis around Femur after Hip Replacement

2015 ◽  
Vol 4 (4) ◽  
pp. 45
Author(s):  
Yuehao Xu
Keyword(s):  
Treatment Group ◽  
Hip Replacement ◽  
Locking Plate ◽  
Plate Fixation ◽  
Healing Process ◽  
Treated Group ◽  
Control Group ◽  
Clinical Effects ◽  
Femoral Prosthesis ◽  
Locking Plate Fixation

<p><strong>Objective: </strong>To<strong> </strong>investigate the clinical effects of patients with femoral prosthesis fracture phenomena after the application of locking plate fixation for hip replacement surgery. <strong>Method: </strong>78 cases of postoperative patients with periprosthetic femoral fracture phenomenon after hip replacement were selected and divided randomly into a control and treatment group, respectively, with an average of 39 cases per group. The control group was treated with the shape memory alloy inner ring fixing technology whereas the locking plate fixation was applied for the treatment group. <strong>Result:</strong> Fracture treatment around the femoral prosthesis in patients of treated group was better in comparison to the control group. Significantly, the treatment group revealed shorter duration of hospitalization, the recovery of limb weight-bearing capacity and the healing process as compared to  the control group. Harris scores were significantly higher in the treated group in contrast to the control group. Additionally, lower adverse reaction rate was found in the treatment group as compared to the control group. <strong>Conclusion:</strong> Obviously, patient who have femoral periprosthetic fracture phenomena after receiving hip replacement were likelihood to be treated with the locking plate fixation technique.</p>

scholarly journals Intramedullary nail fixation versus locking plate fixation for adults with a fracture of the distal tibia: the UK FixDT RCT

2018 ◽  
Vol 22 (25) ◽  
pp. 1-148 ◽  
Author(s):  
Matthew L Costa ◽  
Juul Achten ◽  
Susie Hennings ◽  
Nafisa Boota ◽  
James Griffin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Locking Plate ◽  
Plate Fixation ◽  
Distal Tibia ◽  
Locking Plate Fixation ◽  
Fixation Group ◽  
Plate Group ◽  
Significant Difference

BackgroundThe best treatment for fractures of the distal tibia remains controversial. Most of these fractures require surgical fixation, but the outcomes are unpredictable and complications are common.ObjectivesTo assess disability, quality of life, complications and resource use in patients treated with intramedullary (IM) nail fixation versus locking plate fixation in the 12 months following a fracture of the distal tibia.DesignThis was a multicentre randomised trial.SettingThe trial was conducted in 28 UK acute trauma centres from April 2013 to final follow-up in February 2017.ParticipantsIn total, 321 adult patients were recruited. Participants were excluded if they had open fractures, fractures involving the ankle joint, contraindication to nailing or inability to complete questionnaires.InterventionsIM nail fixation (n = 161), in which a metal rod is inserted into the hollow centre of the tibia, versus locking plate fixation (n = 160), in which a plate is attached to the surface of the tibia with fixed-angle screws.Main outcome measuresThe primary outcome measure was the Disability Rating Index (DRI) score, which ranges from 0 points (no disability) to 100 points (complete disability), at 6 months with a minimum clinically important difference of 8 points. The DRI score was also collected at 3 and 12 months. The secondary outcomes were the Olerud–Molander Ankle Score (OMAS), quality of life as measured using EuroQol-5 Dimensions (EQ-5D), complications such as infection, and further surgery. Resource use was collected to inform the health economic evaluation.ResultsParticipants had a mean age of 45 years (standard deviation 16.2 years), were predominantly male (61%, 197/321) and had experienced traumatic injury after a fall (69%, 223/321). There was no statistically significant difference in DRI score at 6 months [IM nail fixation group, mean 29.8 points, 95% confidence interval (CI) 26.1 to 33.7 points; locking plate group, mean 33.8 points, 95% CI 29.7 to 37.9 points; adjusted difference, 4.0 points, 95% CI –1.0 to 9.0 points;p = 0.11]. There was a statistically significant difference in DRI score at 3 months in favour of IM nail fixation (IM nail fixation group, mean 44.2 points, 95% CI 40.8 to 47.6 points; locking plate group, mean 52.6 points, 95% CI 49.3 to 55.9 points; adjusted difference 8.8 points, 95% CI 4.3 to 13.2 points;p < 0.001), but not at 12 months (IM nail fixation group, mean 23.1 points, 95% CI 18.9 to 27.2 points; locking plate group, 24.0 points, 95% CI 19.7 to 28.3 points; adjusted difference 1.9 points, 95% CI –3.2 to 6.9 points;p = 0.47). Secondary outcomes showed the same pattern, including a statistically significant difference in mean OMAS and EQ-5D scores at 3 and 6 months in favour of IM nail fixation. There were no statistically significant differences in complications, including the number of postoperative infections (13% in the locking plate group and 9% in the IM nail fixation group). Further surgery was more common in the locking plate group (12% in locking plate group and 8% in IM nail fixation group at 12 months). The economic evaluation showed that IM nail fixation provided a slightly higher quality of life in the 12 months after injury and at lower cost and, therefore, it was cost-effective compared with locking plate fixation. The probability of cost-effectiveness for IM nail fixation exceeded 90%, regardless of the value of the cost-effectiveness threshold.LimitationsAs wound dressings after surgery are clearly visible, it was not possible to blind the patients to their treatment allocation. This evidence does not apply to intra-articular (pilon) fractures of the distal tibia.ConclusionsAmong adults with an acute fracture of the distal tibia who were randomised to IM nail fixation or locking plate fixation, there were similar disability ratings at 6 months. However, recovery across all outcomes was faster in the IM nail fixation group and costs were lower.Future workThe potential benefit of IM nail fixation in several other fractures requires investigation. Research is also required into the role of adjuvant treatment and different rehabilitation strategies to accelerate recovery following a fracture of the tibia and other long-bone fractures in the lower limb. The patients in this trial will remain in longer-term follow-up.Trial registrationCurrent Controlled Trials ISRCTN99771224 and UKCRN 13761.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 22, No. 25. See the NIHR Journals Library website for further project information.

scholarly journals Matta’s criteria may be useful for evaluating and predicting the reduction quality of simultaneous acetabular and ipsilateral pelvic ring fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yi-Hsun Yu ◽  
Chang-Heng Liu ◽  
Yung-Heng Hsu ◽  
Ying-Chao Chou ◽  
I-Jung Chen ◽  
...  
Keyword(s):  
Acetabular Fracture ◽  
Pelvic Ring ◽  
Univariate Analysis ◽  
Poor Quality ◽  
Fracture Reduction ◽  
Acetabular Fractures ◽  
X Rays ◽  
X Ray ◽  
Pelvic Ring Fractures

Abstract Background Although the incidence, types, and radiological outcomes of simultaneous ipsilateral pelvic ring and acetabular fractures have been reported, there have been no reports on factors that may affect the quality of acetabular fracture reduction. Here, we evaluate the radiological outcomes of patients treated for simultaneous ipsilateral pelvic and acetabular fractures and analyze the factors that affect the quality of acetabular fracture reduction. Methods We conducted a retrospective review of patients treated for simultaneous ipsilateral pelvic ring and acetabular fractures between 2016 and 2020. Factors that may predict inadequate reduction of the acetabular fracture were analyzed. Results Data from 27 hips of 26 patients were collected. AO B2.2 and anterior columnar fractures were the most common types of pelvic ring and acetabular fractures, respectively. Univariate analysis revealed that Matta’s criteria for pelvic ring fracture may be useful for predicting fair to poor quality of acetabular fracture reduction on X-rays. Furthermore, associated fractures identified by Letournel’s classification system on computed tomography may be predictive of greater step-offs. Conclusions Associated fractures identified via Letournel’s classification may contribute to inadequate reduction of acetabular fractures. Matta’s criteria for pelvic ring fractures may also be useful for predicting the risk of inadequate reduction of the acetabulum on X-ray scans. These findings may be assessed intraoperatively by fluoroscopy before beginning osteosynthesis for acetabular fractures.

scholarly journals Comparison of a ceiling-mounted 3D flat panel detector vs. conventional intraoperative 2D fluoroscopy in plate osteosynthesis of distal radius fractures with volar locking plate systems

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Raphael Seuthe ◽  
Andreas Seekamp ◽  
Bodo Kurz ◽  
Julian Pfarr ◽  
Jost Philipp Schaefer ◽  
...  
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Distal Radius Fractures ◽  
Fracture Reduction ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
Flat Panel ◽  
Flat Panel Detector

Abstract Objectives To compare intraoperative 3D fluoroscopy with a ceiling-mounted flat panel detector in plate osteosynthesis of distal radius fractures (AO/OTA 2R3C1.2) with volar locking plate systems to conventional 2D fluoroscopy for detection of insufficient fracture reduction, plate misplacement and protruding screws. Methods Using a common volar approach on 12 cadaver forearms, total intraarticular distal radius fractures were induced, manually reduced and internally fixated with a 2.4 distal radius locking compression plate. 2D (anterior-posterior and lateral) and 3D (rotational) fluoroscopic images were taken as well as computed tomographies. Fluoroscopic images, Cone Beam CT (CBCT), 360° rotating sequences (so called “Movies”) and CT scans were co-evaluated by a specialist orthopedic surgeon and a specialist radiologist regarding quality of fracture reduction, position of plate, position of the three distal locking screws and position of the three diaphyseal screws. In reference to gold standard CT, sensitivity and specifity were analyzed. Results “Movie” showed highest sensitivity for detection of insufficient fracture reduction (88%). Sensitivity for detection of incorrect position of plate was 100% for CBCT and 90% for “Movie.” For intraarticular position of screws, 2D fluoroscopy and CBCT showed highest sensitivity and specifity (100 and 91%, respectively). Regarding detection of only marginal intraarticular position of screws, sensitivity and specifity of 2D fluoroscopy reached 100% (CBCT: 100 and 83%). “Movie” showed highest sensitivity for detection of overlapping position of screws (100%). When it comes to specifity, CBCT achieved 100%. Regarding detection of only marginal overlapping position of screws, 2D fluoroscopy and “Movie” showed highest sensitivity (100%). CBCT achieved highest specifity (100%). Conclusion As for assessment of quality of fracture reduction and detection of incorrect position of plate as well as overlapping position of the three diaphyseal screws CBCT and “Movie” are comparable to CT – especially when combined. Particularly sensitivity is high compared to standard 2D fluoroscopy.

scholarly journals Percutaneous fixation with Kirschner wires versus volar locking-plate fixation in adults with dorsally displaced fracture of distal radius: five-year follow-up of a randomized controlled trial

2019 ◽  
Vol 101-B (8) ◽  
pp. 978-983 ◽  
Author(s):  
M. L. Costa ◽  
J. Achten ◽  
A. Rangan ◽  
S. E. Lamb ◽  
N. R. Parsons
Keyword(s):  
Quality Of Life ◽  
Distal Radius ◽  
Locking Plate ◽  
Controlled Trial ◽  
Plate Fixation ◽  
Locking Plate Fixation ◽  
Plate Group ◽  
Displaced Fracture

Aims The aim of this study was to compare the clinical effectiveness of Kirschner wire (K-wire) fixation with locking-plate fixation for patients with a dorsally displaced fracture of the distal radius in the five years after injury. Patients and Methods We report the five-year follow-up of a multicentre, two-arm, parallel-group randomized controlled trial. A total of 461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation were recruited from 18 trauma centres in the United Kingdom. Patients were excluded if the surface of the wrist joint was so badly displaced it required open reduction. In all, 448 patients were randomized to receive either K-wire fixation or locking-plate fixation. In the K-wire group, there were 179 female and 38 male patients with a mean age of 59.1 years (19 to 89). In the locking-plate group, there were 194 female and 37 male patients with a mean age of 58.3 years (20 to 89). The primary outcome measure was the patient-rated wrist evaluation (PRWE). Secondary outcomes were health-related quality of life using the EuroQol five-dimension three-level (EQ-5D-3L) assessment, and further surgery related to the index fracture. Results At 12 months, 402/448 participants (90%) recruited into the main study provided PRWE scores. At year two, 294 participants (66%) provided scores; at year five, 198 participants (44%) provided scores. There was no clinically relevant difference in the PRWE at any point during the five-year follow-up; at five years, the PRWE score was 8.3 (12.5) in the wire group and 11.3 (15.6) in the plate group (95% confidence interval -6.99 to 0.99; p = 0.139). Nor was there a clinically relevant difference in health-related quality of life. Only three participants had further surgery in the five years after their injury (one in the wire group and two in the plate group). Conclusion This follow-up study continues to show no evidence of a difference in wrist pain, wrist function, or quality of life for patients treated with wires versus locking plates in the five years following a dorsally displaced fracture of the distal radius. Cite this article: Bone Joint J 2019;101-B:978–983.

Locking Plate Fixation for Canine Acetabular Fractures

2020 ◽  
Vol 33 (04) ◽  
pp. 294-300
Author(s):  
Francesco Piana ◽  
Miguel Solano ◽  
Stephen Kalff ◽  
Russell Yeadon
Keyword(s):  
Clinical Outcomes ◽  
Locking Plate ◽  
Plate Fixation ◽  
Neurological Deficits ◽  
Acetabular Fractures ◽  
Locking Plates ◽  
Locking Compression Plates ◽  
Long Term Follow Up ◽  
String Of Pearls

Abstract Objective The aim of this study was to document application of locking plates for stabilization of acetabular fractures along with complications and clinical outcomes. We hypothesized that complications and clinical outcomes would be comparable to historical reports using non-locking plate and screw constructs. Study Design Medical records of dogs presented with acetabular fractures at a single referral centre between 2010 and 2018 were reviewed. Cases surgically managed by open reduction and internal fixation, involving placement of at least one locking plate and screws, were included. Signalment, fracture classification, type of implant used, additional methods of stabilization, along with complications and neurological deficits, were collected. Long-term follow-up was based on Liverpool Osteoarthritis in Dogs questionnaire. Results Eighteen acetabula were repaired in 17 dogs. Locking implants were VetLOX (4/18), string-of-pearls (7/18) and locking compression plates (7/18). Locking plates and screws were used as the sole method of fixation in 10/18 acetabula, and as adjunctive fixation with other implants in 8/18 acetabula. Two minor complications and one catastrophic complication were reported. Sixteen of seventeen dogs returned to function with radiographic documentation of fracture healing. Complication rate was comparable to historic reports using non-locking implants. Long-term outcomes assessed by Liverpool Osteoarthritis in Dogs questionnaire were positive in most cases. Conclusion Locking plates are a viable means of stabilizing acetabular fractures in dogs and can provide positive clinical outcomes. Surprisingly, problems including inaccurate fracture reduction and implant loosening were not fully avoided by use of locking implants but incidence was low.

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