scholarly journals Helical plating – a novel technique to increase stiffness in defect fractures

2021 ◽  
Vol 42 ◽  
pp. 110-121
Author(s):  
M Lenz ◽  
◽  
P Varga ◽  
D Mischler ◽  
B Gueorguiev ◽  
...  
Keyword(s):  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Load Sharing ◽  
Surface Strain ◽  
Torsional Stiffness ◽  
Plate Surface ◽  
Lateral Plate ◽  
Single Plate ◽  
Helical Plate

Single-plate fixation bridging bone defects provokes nonunion and risks plate-fatigue failure due to under- dimensioned implants. Adding a helical plate to bridge the fracture increases stiffness and balances load sharing. This study compares the stiffness and plate surface strain of different constructs in a transverse contact and gap femoral shaft fracture model. Eight groups of six synthetic femora each were formed: intact femora; intact femora with lateral locking plate; contact and gap transverse shaft osteotomies each with lateral locking plate, lateral locking plate and helical locking plate, and long proximal femoral nail. Constructs underwent non-destructive quasi-static axial and torsional loading. Plate surface strain evaluation was performed under 200 N axial loading. Constructs with both lateral and helical plates demonstrated similar axial and torsional stiffness– independent of the contact or gap situations – being significantly higher compared to lateral plating (p < 0.01). Torsional stiffness of the constructs, with both lateral and helical plates in the gap situation, was significantly higher compared to this situation stabilised by a nail (p < 0.01). Plate surface strain dropped from 0.3 % in the gap situation with a lateral plate to < 0.1 % in this situation with both a lateral and a helical plate. Additional helical plating increases axial and torsional construct stiffness in synthetic bone and seems to provide well-balanced load sharing. Its use should be considered in very demanding situations for gap or defect fractures, where single-plate osteosynthesis provides inadequate stiffness for fracture healing and induces nonunion.

scholarly journals Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yung-Cheng Chiu ◽  
Cheng-En Hsu ◽  
Tsung-Yu Ho ◽  
Yen-Nien Ting ◽  
Ming-Tzu Tsai ◽  
...  
Keyword(s):  
Mechanical Strength ◽  
Locking Plate ◽  
Plate Fixation ◽  
Shaft Fracture ◽  
Bone Plate ◽  
Lateral Side ◽  
Lateral Plate ◽  
Fracture Force ◽  
Shaft Fractures ◽  
Metacarpal Shaft

Abstract Background Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side. Objective The purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture. Materials and methods Thirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test. Results The maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm). Conclusion According to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

Low-Profile Dual Small Plate Fixation Is Biomechanically Similar to Larger Superior or Anteroinferior Single Plate Fixation of Midshaft Clavicle Fractures

2019 ◽  
Vol 47 (11) ◽  
pp. 2678-2685 ◽  
Author(s):  
Connor G. Ziegler ◽  
Zachary S. Aman ◽  
Hunter W. Storaci ◽  
Hannah Finch ◽  
Grant J. Dornan ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Bending Stiffness ◽  
Torsional Stiffness ◽  
Single Plate ◽  
Low Profile ◽  
Significant Difference ◽  
Dual Plating ◽  
Load To Failure ◽  
Clavicle Fractures ◽  
Cadaveric Model

Background: Limited biomechanical data exist for dual small plate fixation of midshaft clavicle fractures, and no prior study has concurrently compared dual small plating to larger superior or anteroinferior single plate and screw constructs. Purpose: To biomechanically compare dual small orthogonal plating, superior plating, and anteroinferior plating of midshaft clavicle fractures by use of a cadaveric model. Study Design: Descriptive laboratory study. Methods: The study used 18 cadaveric clavicle specimens (9 pairs total), and 3 plating techniques were studied: anteroinferior, superior, and dual. The dual plating technique used smaller diameter plates and screws (1.6-mm thickness) than the other, single plate techniques (3.3-mm thickness). Each of the 9 clavicle pairs was randomly assigned a combination of 2 plating techniques, and randomization was used to determine which techniques were used for the right and left specimens. Clavicles were plated and then osteotomized to create an inferior butterfly fracture model, which was then fixed with a single interfragmentary screw. Clavicle specimens were then potted for mechanical testing. Initial bending, axial, and torsional stiffness of each construct was determined through use of a randomized nondestructive cyclic testing protocol followed by load to failure. Results: No significant differences were found in cyclical axial ( P = .667) or torsional ( P = .526) stiffness between plating groups. Anteroinferior plating demonstrated significantly higher cyclical bending stiffness than superior plating ( P = .005). No significant difference was found in bending stiffness between dual plating and either anteroinferior ( P = .129) or superior plating ( P = .067). No significant difference was noted in load to failure among plating methods ( P = .353). Conclusion: Dual plating with a smaller plate-screw construct is biomechanically similar to superior and anteroinferior single plate fixation that uses larger plate-screw constructs. No significant differences were found between dual plating and either superior or anteroinferior single plating in axial, bending, or torsional stiffness or in bending load to failure. Dual small plating is a viable option for fixing midshaft clavicle fractures and may be a useful low-profile technique that avoids a larger and more prominent plate-screw construct. Clinical Relevance: Plate prominence and hardware irritation are commonly reported complaints and reasons for revision surgery after plate fixation of midshaft clavicle fractures. Dual small plate fixation has been used to improve cosmetic acceptability, minimize hardware irritation, and decrease reoperation rate. Biomechanically, dual small plate fixation performed similarly to larger single plate fixation in this cadaveric model of butterfly fracture.

scholarly journals Treatment of midshaft clavicle fracture with anatomical contoured clavicular locking plate

2018 ◽  
Vol 10 (1) ◽  
pp. 92-96
Author(s):  
Pratyenta Raj Onta ◽  
Krishna Sapkota ◽  
Krishna Wahegaonkar ◽  
Niraj Ranjeet ◽  
Pabin Thapa ◽  
...  
Keyword(s):  
Shoulder Joint ◽  
Open Reduction ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Clavicle Fracture ◽  
Shaft Fracture ◽  
Free Movement ◽  
Early Return ◽  
The Mean

Background: Fracture clavicle is a common fracture around the shoulder joint accounting about 2.6% of all fracture and 44% in shoulder region. Mid shaft clavicle fracture accounts about 81% of total clavicle fracture. Open reduction and plate fixation is a good treatment method for displaced mid shaft clavicle fracture with benefit of early pain free movement of shoulder joint and early return to work. The anatomical contoured clavicular plate maintains mechanical strength and has less soft tissue complications. Aims and Objective: The aim of the study was to evaluate the clinical and radiological outcome, time for fracture union and complications in midshaft clavicle fracture managed with anatomical contoured clavicularlocking plate. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal.There were a total of 30 patients (19 male and 11 female) who had displaced mid shaft fracture. All patients underwent plate osteosynthesis with anatomical contoured locking plate. The patients were followed up at 3 weeks, 6 weeks, 3 month and 6 months’ time. Results: There were 30 patients among whom; one patient had bilateral clavicle fracture. The mean age of the patient was 37.19 (11.96) years. The mean time for clinical and radiological union was 8.77 (1.17) weeks and 17.03 (3.06) weeks. All patients in our study had union of fracture with only one patient having superficial surgical site infection. Conclusion: Open reduction and plate fixation is a good option for displaced mid shaft clavicle fracture which help the patient for early pain-free movement of shoulder. Use of anatomical contoured clavicle plate provides fixation of clavicle to its normal contour and provides better fixation and stability.  

Lateral Plate Fixation of Distal Tibial Metaphyseal Fracture Using Minimally Invasive Plate Osteosynthesis Technique

2006 ◽  
Vol 19 (1) ◽  
pp. 24 ◽  
Author(s):  
Ki Do Hong ◽  
Sung Sik Ha ◽  
Nam Sik Chung ◽  
Jae Cheon Sim ◽  
Sang Cheon Ahn
Keyword(s):  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Lateral Plate ◽  
Metaphyseal Fracture ◽  
Osteosynthesis Technique

scholarly journals Finite Element Analysis of Different Double-Plate Angles in the Treatment of the Femoral Shaft Nonunion with No Cortical Support opposite the Primary Lateral Plate

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Hao Zhang ◽  
Jiantao Li ◽  
Jianfeng Zhou ◽  
Lianting Li ◽  
Ming Hao ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Plate Fixation ◽  
Femoral Shaft ◽  
Von Mises Stress ◽  
Lateral Plate ◽  
Element Analysis ◽  
Single Plate ◽  
Von Mises ◽  
Primary Lateral

Objectives. We evaluated the biomechanical outcome of different plate fixation strategies (the single plate construct, 45° double-plate construct, 90° double-plate construct, 135° double-plate construct, and 180° double-plate construct) used for the fixation of the femoral shaft nonunion with no cortical support opposite the primary lateral plate. This may help surgeons choose the optimal therapy to the femoral shaft nonunion. Methods. The femoral shaft nonunion with no medial support and the models of lateral plate and medial plate was constructed in 3-matic software and UG-NX software, respectively. We then assembled the single plate and different double plates to the fracture model separately to form the fixation models. After meshing the models’ elements, we used the ABAQUS software to perform the finite element analysis. Values of the von Mises Stress (VMS) distribution of the implant, peak VMS, and model displacement and deformation were used to capture the mechanical factors in this study. Results. Our results indicated that the peak von Mises Stress (VMS) of the lateral plate was concentrated in middle surface of the lateral plate near the fragment of each group. The peak VMS was 5201.0 MPa (the single-plate construct), 3490.0 MPa (45° double-plate construct), 1754.0 MPa (90° double-plate construct), 1123.0 MPa (135° double-plate construct), and 816.5 MPa (180° double-plate construct). The additional short plate dispersed some stress leading to the decrease in the peak VMS of the lateral plate. As angle formed by the double plates increased, the dispersed function of the additional plate was becoming obvious. The bending angles of the lateral plate were 18° versus 12° versus 3° versus 2° versus 1° (the single-plate construct versus 45° double-plate construct versus 90° double-plate construct versus 135° double-plate construct versus 180° double-plate construct). Conclusions. Our study indicated that increasing the angle between the plates in a double-plate construct improves the stability of the construct over a single lateral plate when there is no cortical support opposite to the lateral plate. The strongest fixation occurred when the angle between the two plates was greater than ninety degrees.

Anterior Locking Plate Osteosynthesis of Patellar Factures – Analysis of Complications and Functional Outcome

2021 ◽  
Author(s):  
Maxi Benita Tengler ◽  
Helmut Lill ◽  
Maike Wente ◽  
Alexander Ellwein
Keyword(s):  
Functional Outcome ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Case Series ◽  
Tension Band ◽  
Tension Band Wiring ◽  
High Rate ◽  
Locking Plate Fixation ◽  
Patellar Fractures

Abstract Background Tension band wiring is the standard procedure for patellar fractures, but is associated with a high rate of implant related complications and implant failure. Tension band wiring may fail, especially with multifragmentary and comminuted fractures. Plate fixation of complex patellar fractures seems to be superior to wiring, both clinically and biomechanically. The aim of this study was to evaluate complications after locking plate fixation in patellar fractures two years after surgery and to access the functional outcome. Material and Methods As part of a prospective case series, all patients who had received locking plate fixation of a patellar fracture between April 2013 and May 2018 were clinically examined two years postoperatively and potential complications were evaluated. Results A total of 38 patients aged 19 – 87 years were included. Complications occurred in a total of five patients (13%), including one reactive prepatellar bursitis, one chronic infection and loss of reduction due to a dislocated pole fragment in three cases. The average active range of motion of the affected knee joint two years postoperatively was 133°. The Tegner activity scale score reached 3 points, the Lysholm score 95 points and the Kujala score 95 points. Conclusion With an overall relatively low complication rate and good clinical outcome, dislocated distal pole fragments are a common complication after plate fixation of patellar fractures. If preoperative diagnostic testing shows a pole fragment, a modified hook-plate can be used, with the possibility of fixing the pole fragment.

scholarly journals Plate on Plate Osteosynthesis : A Novel Method For Periplate Fracture Fixation

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0004
Author(s):  
Jagjoth Singh ◽  
Kamarul Arifin Abdul Razak ◽  
Terence Michal Dass ◽  
Tan Weng Liang ◽  
Yogeshwarran Nadeson ◽  
...  
Keyword(s):  
Distal Femur ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
X Rays ◽  
Locking Plate Fixation ◽  
Simple Method ◽  
Invasive Approach ◽  
Novel Method ◽  
A Prospective Study

Periplate fractures may occur after plate fixation, especially in osteoporotic and non-united bones. We present a case of locking plate fixation over an existing plate for such fractures. Case Presentation: 58 years old man slipped and fell in sitting position 8 months post left distal femur LCP. He sustained pain and swelling of the left hip. The left thigh was externally rotated and shorter than the normal side. X-rays revealed a periplate fracture extending to the subtrochanteric region. A reverse right distal femur LCP was planned. A minimally invasive approach was used. Proximal screws were removed from the original plate and new screws were inserted through both plates which were of similar material, Titanium. Discussion: Elderly population makes a large subgroup of the cases due to osteoporosis and rigidity of the LCP construct2. This fixation provides a simple method to reduce surgical time, bleeding, and preserving more blood supply to enhance fracture healing, as opposed to using nails supplemented with cerclage/cable wires. Care should be taken to use the pre-existing screw holes in the overlapping segment of the two plates, as well as similar plate materials to avoid stress risers and reduce corrosion1. Conclusion: Plate on plate osteosynthesis is a novel method that may prove valuable due to the increasing population age and unique types of fractures. Further research is needed to determine any complications related to this type of fixation. References: Georgios Arealis et. al Plate On Plate Osteosynthesis For The Treatment Of Non Healed Periplate Fractures, Hindawi Publishing Corporation, Volume 2014, Article 367490 S. Ruchholtz, et al., “Less invasive polyaxial locking plate fixation in periprosthetic and peri-implant fractures of the femur—a prospective study of 41 patients,” Injury, vol. 44, no. 2, pp. 239–248, 2013

scholarly journals Load Sharing Mechanism Across Graft-Bone Interface in Static Cervical Locking Plate Fixation

2009 ◽  
Vol 45 (4) ◽  
pp. 213 ◽  
Author(s):  
In Ho Han ◽  
Sung Uk Kuh ◽  
Dong Kyu Chin ◽  
Byung Ho Jin ◽  
Yong Eun Cho ◽  
...  
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Load Sharing ◽  
Locking Plate Fixation ◽  
Bone Interface
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