Locking Plate
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Junhao Deng ◽  
Ming Li ◽  
Jiantao Li ◽  
Zhirui Li ◽  
Fanqi Meng ◽  

Abstract Purpose The increasing worldwide prevalence of anterior column-posterior hemi-transverse fracture (ACPHTF) brings formidable challenges to orthopaedic surgeons. Our newly-designed locking plate had previously demonstrated promising effects in ACPHTF, but evidence of their direct comparison with conventional internal fixations remains lacking. In this study, we aimed to compare our novel plate with the traditional devices via finite element analysis. Methods The ACPHTF model was created based on a 48-year-old volunteer’s CT data, and then fixed in three different internal fixations: an anterior column locking plate with posterior column screws, double column locking plates, and our novel anatomical locking plate. These models were next loaded with a downward vertical force of 200 N, 400 N and 600 N, and the stress peaks and displacements of three different sites were recorded and analyzed. Results We first tested the rigidity and found that our newly-designed locking plate as well as its matched screws had a greater stiffness especially when they were under a higher loading force of 600 N. Then we evaluated the displacements of fracture ends after applying these fixations. Both our novel plate and DLP showed significantly smaller displacement than LPPCS at the anterior column fracture line and the pubic branch fracture line, while our novel plate was not obviously inferior to DLP in terms of the displacement. Conclusion This novel plate demonstrates a distinct superiority in the stiffness over LPPCS and DLP and comparable displacements to DLP in ACPHTF, which suggests this novel anatomical locking guide plate should be taken into consideration in ACPHTF.

2021 ◽  
Vol 8 ◽  
Seth Bleakley ◽  
Ross Palmer ◽  
Nate Miller ◽  
Kirk McGilvray ◽  
Slobodan Tepic

A novel canine tibial plateau leveling osteotomy (TPLO) fixation device was recently developed with design features such as titanium alloy (TA) material, distal monocortical screw fixation, and a point contact undersurface specifically targeted to reduce surgical site infection rates by ensuring tissue perfusion under the plate. The strength of the novel TPLO construct was compared with that of a predicate stainless steel (SS) locking plate construct with bicortical screws in 16 paired cadaveric canine limbs. The mean loads to failure were 716.71 ± 109.50 N (range 455.69–839.69 N) and 629.50 ± 176.83 N (range 272.58–856.18 N) in the TA and SS groups, respectively. The average ratio of the loads to failure of the paired specimens was 1.18 (p = 0.031). No failure of the TA constructs involved the distal fixation with monocortical screws. Substantial mechanical equivalence of this novel TA monocortical/bicortical fixation construct to an established SS bicortical screw fixation construct is demonstrated. Clinical investigation of potential merits of this novel TA, monocortical/bicortical locking screw/plate system is now warranted.

2021 ◽  
Yanzhen Qu ◽  
Xudong Xie ◽  
Wu Zhou ◽  
Tian Xia ◽  
Faqi Cao ◽  

Abstract Background: We aimed to compare the efficacy and functional outcomes of using an acromioclavicular joint hook plate (AJHP) versus a locking plate (LP) in the treatment of anterior sternoclavicular joint dislocation.Methods: Seventeen patients with anterior sternoclavicular joint dislocation were retrospectively analyzed from May 2014 to September 2019. Six patients were surgically treated with an AJHP, and 11 were surgically treated with an LP. Five male and one female patients composed the AJHP group, and nine male and two female patients composed the LP group. The mean age of all patients was 49.5 years.Results: Reduction and fixation were performed with AJHP or LP in all 17 patients. All patients were followed up for a mean duration of 14.4 months. There were no reported complications, wound infections, or instances of plate or screw breakage. The mean operative blood loss, operative time, and length of incision in the AJHP group were significantly better than those in the LP group. Shoulder girdle movement of the AJHP group was significantly better than that of the LP group.Conclusions: This study revealed that AJHP facilitated glenohumeral joint motion, reduced the risk of rupture of mediastinal structures, required a shorter incision, and had lesser blood loss and a shorter duration of operation compared with LP. However, some deficiencies require further improvement.

2021 ◽  
Vol 73 (9) ◽  
pp. 603-608
Kongkhet Riansuwan ◽  
Somkiat Jivasomboonkul ◽  
Rapin Phimolsarnti ◽  
Chandhanarat Chandhanayingyong ◽  
Apichat Asavamongkolkul

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.

Chanchal Kumar Singh ◽  
Juhi Deshpande

<p class="abstract"><strong>Background:</strong> Intertrochanteric fracture is a common orthopaedic injury sustained in elderly population because of osteoporosis and trivial fall. Life threatening systemic complications occur mainly due to immobility.</p><p class="abstract"><strong>Methods:</strong> We included 62 patients (40 males and 22 females) of unstable intertrochanteric fracture (AO 31 A2 and A3) attending Department of Orthopaedics. They were all subjected to surgical treatment with proximal femoral locking plate. Patients were followed up at 3rd, 6th and 12th month for outcomes variables i.e.; functional (Harris hip score, Palmer and Parker mobility score) and radiological outcomes (neck shaft angle, loss of reduction, union and implant related complications). Statistical analysis was done using Friedman’s test after calculating the data in terms of mean and median using SPSS 20 software.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean age of our patients was 64 years, 40 were males and 22 females. 50 patients sustained fracture due to trivial fall and 12 due to RTA. 35 out of 62 patients had medical co-morbidites. 26 patients needed open reduction of fracture and 36 were close reduced. 22 of patients had severe comminution (AO A 3 III type). Average blood loss was 254 ml. Mean degree of loss of reduction was 5 degrees in 6th month and 4 degrees in 12th month. Union was achieved in 48 out of 50 patients at 12th month.  Most of the patients achieved fair to good functional outcome scores at 12th month of follow up. We noticed difficulties in fracture reduction as well as complications related to implant.</p><p class="abstract"><strong>Conclusions:</strong> PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimised by following principles of locking plate meticulously.</p>

M. Müller ◽  
F. Greve ◽  
M. Crönlein ◽  
M. Zyskowski ◽  
S. Pesch ◽  

Abstract Introduction Surgical treatment of complex humeral head fractures in the elderly is challenging due to osteoporotic bone, comorbidities and reduced compliance. The treatment strategy (reconstruction versus replacement) should allow for a functional aftercare and result in a high patient satisfaction. Major complications leading to surgical revision are crucial and should be avoided. The purpose of this study was to analyse the major complication rate leading to surgical revision and the patient-based outcome in complex humeral head fractures of the elderly population treated either using locking plate fixation (LCP) or reversed total shoulder arthroplasty (rTSA). Materials and Methods All patients older than 65 years surgically treated due to a four-part fracture of the proximal humerus between 2003 and 2015 were enrolled in our retrospective study. Major complications and revision rates were recorded and functional outcome was assessed using the Munich Shoulder Questionnaire (MSQ) allowing for qualitative self-assessment of the Shoulder Pain and Disability Index (SPADI), of the Disability of the Arm, Shoulder and Hand (DASH) score and of the Constant Score. Results A cohort of 103 patients with a mean age of 73.4 ± 6.2 years suffering from four-part fractures of the humeral head were enrolled. 3 patients were treated using the LCP fixation compared to 40 rTSAs. There were no significant differences in the patient-reported functional outcome. The revision rate was significantly higher in the LCP group (10/63; 15.9%) compared to the rTSA group (1/40; 2.5%). Reasons for revision were avascular head necrosis, cut-out of screws, secondary dislocation of the greater tuberosity and hypersensitivity to metal. Conclusions Reversed total shoulder arthroplasty and locking plate fixation are both established surgical procedures for the management of complex proximal humerus fractures in the elderly leading to similar functional results. However the revision rate in the rTSA group was significantly lower. Primary rTSA should, therefore, be favoured in multimorbid elderly patients with an increased complication risk to avoid repeated anaesthesia.

Paul Borbas ◽  
Rafael Loucas ◽  
Marios Loucas ◽  
Maximilian Vetter ◽  
Simon Hofstede ◽  

Abstract Introduction Coronal plane fractures of the distal humerus are relatively rare and can be challenging to treat due to their complexity and intra-articular nature. There is no gold standard for surgical management of these complex fractures. The purpose of this study was to compare the biomechanical stability and strength of two different internal fixation techniques for complex coronal plane fractures of the capitellum with posterior comminution. Materials and methods Fourteen fresh frozen, age- and gender-matched cadaveric elbows were 3D-navigated osteotomized simulating a Dubberley type IIB fracture. Specimens were randomized into one of two treatment groups and stabilized with an anterior antiglide plate with additional anteroposterior cannulated headless compression screws (group antiGP + HCS) or a posterolateral distal humerus locking plate with lateral extension (group PLP). Cyclic testing was performed with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure. Results There was no significant difference in displacement during 2000 cycles (p = 0.291), stiffness (310 vs. 347 N/mm; p = 0.612) or ultimate load to failure (649 ± 351 vs. 887 ± 187 N; p = 0.140) between the two groups. Conclusions Posterolateral distal humerus locking plate achieves equal biomechanical fixation strength as an anterior antiglide plate with additional anteroposterior cannulated headless compression screws for fracture fixation of complex coronal plane fractures of the capitellum. These results support the use of a posterolateral distal humerus locking plate considering the clinical advantages of less invasive surgery and extraarticular metalware. Level of evidence Biomechanical study.

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