Assessment of Functional Outcome of Bicolumnar Dual Plating for Bicondylar Fractures of Tibial Plateau

Introduction: Operative treatment of bicondylar fractures of tibial plateau is challenging and controversial. Aims: The aim of this study is to reveal the functional outcome of it by using bicolumnar dual plates and screws. Methods: This is a prospective hospital based interventional study carried out in the department of Orthopaedics of Nepalgunj Medical College Teaching Hospital. Thirty two Schatzker type V or AO (Association of Osteosynthesis) type 41 C1 & C2 fractures were treated between January 2016 and December 2019 with bicolumnar dual plating. The functional clinical outcomes were analyzed and evaluated using modified Rasmussen score. Results: Thirty two patients were included in the study. Out of which twenty four were male and eight were female. Average age was 32.21 years, eighteen were right sided and fourteen were left sided. Duration of surgery was 106 mins (range 90-120 mins) and the average duration of hospitalization was 7.81 days (range 4-14 days). Five patients of impending compartment syndrome and three patients with common peroneal nerve palsy were managed conservatively and also were included in the study. Two patients with superficial wound infection needed minimal debridement. One patient had varus angulation of 100 at third follow up after he fell from bed but surgical intervention were not needed. All fractures united. The average time for fracture healing was 21.5 weeks (range 16-32 weeks). At the Eighteen months follow up, the average knee range of motion was 1310(range 1100-1400). The functional outcome were evaluated using modified Rasmussen scoring system, which was 27.34 (range 22-30). Conclusion: Bicolumnar dual plating for bicondylar fractures of tibial plateau can provide excellent and stable fixation allowing early range of motion and gives excellent to good functional outcome.

Failure of dual plating in a complex open distal femur fracture as the result of major trauma

A 61-year-old polytrauma patient was admitted with a right distal comminuted metaphyseal femoral fracture with intra-articular extension (Orthopaedic Trauma Association 33C2.3 classification) among other injuries. Due to the high degree of comminution and massive bone loss, this was initially managed with a dual plating open reduction internal fixation. Dual plating has shown to be a superior fixation method than single variable angle locking compression plate (VA-LCP) plating providing greater fixation in metaphyseal bone. Our case reports the failure of dual plating which required removal of metalwork and subsequent fixation using intramedullary nail and plate technique. Failure of dual plating is not well documented in the literature. The most recent radiographs taken 15 months postrevision surgery show that the bone has started to heal with evidence of callus formation.

Bone Morphogenetic Protein-2 Rapidly Heals Two Distinct Critical Sized Segmental Diaphyseal Bone Defects in a Porcine Model

ABSTRACT Introduction Segmental bone defects (SBDs) are devastating injuries sustained by warfighters and are difficult to heal. Preclinical models that accurately simulate human conditions are necessary to investigate therapies to treat SBDs. We have developed two novel porcine SBD models that take advantage of similarities in bone healing and immunologic response to injury between pigs and humans. The purpose of this study was to investigate the efficacy of Bone Morphogenetic Protein-2 (BMP-2) to heal a critical sized defect (CSD) in two novel porcine SBD models. Materials and Methods Two CSDs were performed in Yucatan Minipigs including a 25.0-mm SBD treated with intramedullary nailing (IMN) and a 40.0-mm SBD treated with dual plating (ORIF). In control animals, the defect was filled with a custom spacer and a bovine collagen sponge impregnated with saline (IMN25 Cont, n = 8; ORIF40 Cont, n = 4). In experimental animals, the SBD was filled with a custom spacer and a bovine collage sponge impregnated with human recombinant BMP-2 (IMN25 BMP, n = 8; ORIF40 BMP, n = 4). Healing was quantified using monthly modified Radiographic Union Score for Tibia Fractures (mRUST) scores, postmortem CT scanning, and torsion testing. Results BMP-2 restored bone healing in all eight IMN25 BMP specimens and three of four ORIF40 BMP specimens. None of the IMN25 Cont or ORIF40 Cont specimens healed. mRUST scores at the time of sacrifice increased from 9.2 (±2.4) in IMN25 Cont to 15.1 (±1.0) in IMN25 BMP specimens (P < .0001). mRUST scores increased from 8.2 (±1.1) in ORIF40 Cont to 14.3 (±1.0) in ORIF40 BMP specimens (P < .01). CT scans confirmed all BMP-2 specimens had healed and none of the control specimens had healed in both IMN and ORIF groups. BMP-2 restored 114% and 93% of intact torsional stiffness in IMN25 BMP and ORIF40 BMP specimens. Conclusions We have developed two porcine CSD models, including fixation with IMN and with dual-plate fixation. Porcine models are particularly relevant for SBD research as the porcine immunologic response to injury closely mimics the human response. BMP-2 restored healing in both CSD models, and the effects were evident within the first month after injury. These findings support the use of both porcine CSD models to investigate new therapies to heal SBDs.

RADIOLOGICAL AND FUNCTIONAL OUTCOME OF DUAL PLATING IN DISTAL FEMUR MULTIFRAGMENTARY ARTICULAR FRACTURES: A SHORT TERM STUDY

Introduction: In this prospective cases series, we are reporting a mean 12-month follow up of the utilisation of dual plating technique for multi fragmentary articular distal femur fractures. Our technique consists of a lateral distal femoral locked plate and a low prole locked medial plate through a modied anterior (Swashbuckler) approach for the xation of C2, C3 fractures. Patients and Methods: 15 patients (9 males and 6 females) presented with supra condylar femoral fractures type C2/C3, according to Müller long bone classication and its revision, OA/OTA classication. These fractures were treated using dual plating through swashbuckler approach. They were followed up for clinical and radiological outcomes. Secondary outcomes included post-operative complications. Results: Mean time of radiological union in studied population was 18 weeks with a range of 14-24 weeks. We did not observe any post-operative varus angulation.12 out of 14 patients had good to excellent functional outcome. Fair outcome was reported in only two patients Conclusion: The technique of Dual plating xation using modied anterior approach (swashbuckler) for type C2,C3 distal femoral fractures is an efcient method of management. It has several advantages such as precise exposure, easy manipulation, anatomical reduction and stable xation. However, operative indications and principles should be strictly followed. The surgical technique must be perfect and the biomechanical qualities of the implants must be understood to prevent the development of major complications

Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty

Introduction Adequate treatment for periprosthetic distal femur fractures is challenging because of various reasons, including severe osteoporosis and distal fragments that are too small or too distal. We have introduced a new surgical technique for dual plating of periprosthetic distal femur fractures following total knee arthroplasty (TKA) and determined the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with a dual locking compression plate (LCP). Materials and methods Between January 2010 and July 2019, 18 patients [mean age, 74.8 (68–89) years; average follow-up period, 14.8 (12–43) months] underwent MIPO with distal femoral LCP laterally and proximal humeral internal locking system (PHILOS) medially for periprosthetic distal femoral fractures following TKA. The minimum follow-up was 1 year. The clinical and radiological outcomes were assessed using the modified WOMAC scores, knee range of motion, time to callus formation, time to union, and complications of malunion, nonunion, and shortening. Results The average time to union was 18.4 weeks (range, 10–51 weeks) and to callus formation was 7.8 weeks (range, 2–14 weeks). At the 1-year follow-up, the average JLETS was 37.6 (range, 24–53), average knee ROM was 110.3° (range, 80–135°), and average varus-valgus angles of the distal femur were 3.2° (range, −2.9–10.5°). No nonunion, broken plates, or implant failure occurred. Malunion occurred in three patients. Conclusion MIPO with dual LCP is a reliable method for stabilizing periprosthetic distal femoral fractures following TKA, with satisfactory bone union rates and low complication rates.

Dual plate osteosynthesis in bicondylar tibial plateau fractures-case series

<p>Tibial plateau fractures accounts for about 1% of injuries. Various mechanisms have been described, resulting in milder form to serious injuries depending upon force of impact. High velocity injuries resulted from valgus or varus impacted forces combined with axial loading such as in Schatzker type 6. The ideal method of treatment for these fractures is always a matter of debate. As all intra-articular fractures necessitate anatomic reduction of the articular surface, restoration of axial alignment, and stable fixation, which can be achieved very well by open reduction and internal fixation (ORIF) with dual plating. To study the functional and radiological outcome of Tibial plateau fractures treated surgically with dual plate osteosynthesis. 15 patients in the age group 18-60 were included. Rasmussens criteria was used to assess the functional and radiological outcomes with follow up period of 1 year prospectively. The outcome assessment using Rasmussens score concluded good results. The average duration for union was ­6 months. ROM achieved in these patients were to be at least 124 degrees. The infection rate in this study was accounted as 13.3%. Open reduction and internal fixation of tibial plateau fractures, by dual plating has good functional and radiological outcome. This is an effective method of treatment even with moderate soft tissue injury if meticulous surgical technique, appropriate soft tissue handling and adequate healing period given. All these have shown to decrease the postoperative complications such as infection.</p>