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PubMed  2010 Dec;92(Suppl 2):12–22. Google Scholar. MK, TN, HN, TM, YY, YM, TU, SY, KD, KS, YS, and TOz selected the appropriate patients and included them in this study. It is a single-beam construct where the Orthopaedic Locking Compression Plates are fracture fixation devices that allow fitment of normal conventional bone screws as well as Locking head screws. Successful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: comparative study of multiply injured and isolated femoral fractures. The Synthes Locking Compression Plates—T-Plates are intended to buttress metaphyseal Correspondence to Introduction. reported that callus formation decreases as the bridge span length increases [22]. suggested that a locking compression plate should be used as a bridging plate in order to achieve relative stability. The sliding screw plate (dynamic compression screw, dynamic hip screw) may be used to treat … Our study also showed no significant differences between groups (Tables 2, 3, and 4). With this temporary fixation in place, the plate position and anatomical reduction is checked thoroughly and adjusted, if required. Surgical treatment can either be retrograde intramedullary nail fixation or be plate fixation, with plate fixation having a wide indication for various fractures types [5, 6]. Drilling must be parallel to the marker wire (or needle) to ensure that the screw will not penetrate the joint. Renato Fricker, Matej Kastelec, Fiesky Nuñez, Terry Axelrod. Locking screws provide In this case, bone union was achieved by inserting screws near the fracture site via revision surgery, which increased stability (Fig. Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques. After removal of plates, fractures may occur through the screw holes. Put the plate on the dorsal aspect of the proximal fragment, with a threaded drill guide in one of the outer holes. 2005 Nov;36(Suppl 4):S30–7. J Orthop Trauma. Conversely, in cases with comminuted fractures, there were five non-union cases with more two empty holes (Table 4). Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. We … Insert a screw through the most distal plate hole. Journal of Orthopaedic Surgery and Research, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s13018-019-1401-9. J Bone Joint Surg Am. 4). Bone union was observed in all cases with simple or comminuted fractures with respective medial fracture distances of ≤ 2 mm or ≤ 5 mm. In cases with simple fractures, one non-union case had one empty hole and one non-union case had four empty holes, whereas in cases with comminuted fractures, five non-union cases had two more empty holes. A prospective study of treatment of distal femur fractures with locking condylar plate. The combi-hole is a combination of a DCP hole and a locking hole allowing the surgeon to place either a 2006 May;20(5):366–71. It showed that plate length was 196 mm, fracture distance was 39 mm, plate span ratio was 196/39 = 5.02, bridge span length was 65 mm, medial fracture distance was 5 mm, and empty hole number was 2. Bone union was defined as three out of four instances of cortical bridging on AP and lateral radiographs [12]. Femoral and tibial blood supply: a trigger for non-union? MK and TN designed the study. Additionally, Bottlang et al. Tomoyuki Noda. A senior medical doctor with > 15 years of experience as an orthopedic surgeon operated on these cases; therefore, a certain surgery quality (reduction of fractures, treatment of soft tissues) was guaranteed. Insert a second screw using the same technique. Regarding the number of empty holes, Stoffel et al. In locking plate fixation, the locking plate is applied through an incision over the volar (palm) aspect of the wrist. 2004 Sep;18(8):503–8. Additionally, of the 45 cases with comminuted fractures, 13 cases had a medial fracture distance of ≥ 2 mm, and non-union was observed in 4 of these 13 (30.7%) cases. distally the plate was not extended beyond the joint line. Alternatively, and especially when a conventional plate is used, reduction can be performed with axial traction on the thumb, either manually, or with help of a finger trap, and simultaneous pressure on the dorsal aspect of the diaphysis. Kayali C, Agus H, Turgut A. Fankhauser F, Gruber G, Schippinger G, Boldin C, Hofer HP, Grechenig W, Szyszkowitz R. Minimal-invasive treatment of distal femoral fractures with the LISS (Less Invasive Stabilization System): a prospective study of 30 fractures with a follow up of 20 months. Univariate analysis was performed on them. J Bone Joint Surg Am. Lujan TJ, Henderson CE, Madey SM, Fitzpatrick DC, Marsh JL, Bottlang M. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF. Get contact details and address | ID: 6724282412 Cookies policy. Toolan BC, Koval KJ, Kummer FJ, Sanders R, Zuckerman JD. Use bending pliers to contour the plate. A report of six cases. Risk factors for non-union and delayed bone union in distal femoral fractures include the presence of open fracture(s), medial bone defects, and comminuted fracture(s) [3, 24]. Additionally, there were 13 comminuted fractures with a medial fracture distance of ≥ 2 mm, and the non-union rate was 30.7% (4 of the 13 cases). Fourteen of all comminuted fracture cases and bone union were treated through shortening the fracture site as Rekha reported [16], and non-union was not observed in these cases. Although adopting the anatomical locking plates procedure revealed positive outcomes, the method is still debatable.Several studies describe a variety of surgical technique and implants to treat this complex fracture. Remove the drill guide and measure the appropriate screw length with a depth gauge.Insert the locking screw without completely tightening it. Plate fixation is one of the standard surgical treatments for distal femoral fractures. All of the authors critically revised the manuscript. advised to reduce the fracture site distance to ≤ 2 mm [15]. locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA). J Orthop Trauma. Megas et al. volume 14, Article number: 384 (2019) Part of Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort. reported no significant differences in bridge span lengths of 64.4 and 69.8 mm in two respective cases of non-union and union [20]. c Radiograph and CT showed callus formation 2 months postoperatively; left knee range of motion was 0–140°. If standard plates are used, bone graft from the distal radius may be necessary to avoid delay in bone healing and consequent secondary displacement, or failure of fixation. https://doi.org/10.1186/s13018-019-1401-9, DOI: https://doi.org/10.1186/s13018-019-1401-9. The Synthes Locking Compression Plates—Narrow and Broad, are intended for fixation of various long bones, such as the humerus, femur and tibia. In this study, we investigated (1) bone union rate, (2) bridge span length (distance between screws across the fracture), (3) plate span ratio (plate length/bone fracture length), (4) number of empty holes (number of screw holes not inserted around the fracture), and (5) medial fracture distance (bone fracture distance on the medial side of the distal femur). ABN Automotive Car Steering Wheel Puller Compressor Remover Set – Vehicle Steering Wheel Lock Plate Removal Tool Kit. Weight M, Collinge C. Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3). Fisher’s exact test was performed for statistical comparisons of open fractures, minimally invasive plate osteosynthesis, plate span ratio, and medial fracture distance between those with bone union (bone union group) and those with non-union (non-union group). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 2010 Mar;24(3):156–62. 2004 Feb;75(1):56–60. Results with a p value of < 0.05 were considered significant. J Orthop Trauma. The present study was approved by Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital (Ethics Committee No. If a locking compression plate is used, a push- pull device can be inserted in both the proximal and distal fragment to achieve temporary plate stabilization instead of bone holding forceps. In such cases, it is necessary to use a locking plate as a bridging plate to fix the fracture site [8]. Reducing comminuted bone fragments is difficult when the inner portion of the fracture site also exhibits comminuted fracture. Injury. 2005 Mar;125(2):102–8. 1994 Jan;76(1):26–34. d Another plate was added during re-operation to shorten the fracture. Case 1 was distal femur fracture in a 74-year-old woman with TKA after a fall. recommended opening 1–2 holes close to the fracture sites in simple fractures and inserting the screws as close as possible to the fracture sites in comminuted fractures [13]. CAS  2, 3, and 4. 2018 Jan;32(Suppl 1):S1–10. Compared with traditional compression plating, locking plates can provide more stability in comminuted or osteoporotic fractures. Harvin WH, Oladeji LO, Della Rocca GJ, Murtha YM, Volgas DA, Stannard JP, Crist BD. Of the cases with simple fractures, there was one non-union case with one empty hole and one non-union case with four empty holes (Table 3). 4.6 out of 5 stars 113. Locking plates for distal femur fractures: is there a problem with fracture healing? Furthermore, 36 of 40 (90%) cases with comminuted fractures in the bone union group fit the plate length that was > 2–3 times longer than the overall fracture length, whereas 4 of 40 (10%) cases did not. Align the plate along the axis of the shaft. This study included 71 distal femoral fractures in 70 patients (23 males, 47 females; mean age, 68.0 years [range, 16–91 years]) who were treated using the locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA) at a university hospital and related facilities between April 2005 and December 2015. Direct plate-to- bone compression is not required, better preserving the blood supply to the bone. In Henderson et al.’s study involving 70 patients, the average number of empty holes proximal to the fracture site was 0.3 in the non-union group and 1.1 in the bone union group [20]. The following measurements were evaluated and analyzed: (1) bone union rate, (2) bridge span length (distance between screws across the fracture), (3) plate span ratio (plate length/bone fracture length), (4) number of empty holes (number of Cite this article. 2). Epidemiology of adult fractures: a review. Plates used for buttressing prevent collapse by supporting an area of thin cortex or cancellous bone graft. Google Scholar. The LCP (Locking Compression Plate), the product of these combinations, is in line with the latest plating techniques, the aim of which is to achieve the smallest possible surgical incisions and to preserve the blood supply to the bone and the adjacent soft tissues. As necessary11 to existing plate fixation of up to 5–10 mm was for! And endurance of a plate was not achieved within 4 months after the initial surgery Zuckerman JD treatment distal... Engages in thick cortical bone better suited for osteoporotic bone and multi-segment fractures regard to jurisdictional in... Bone compression is not required, better preserving the blood supply [ 19 ] simple... Retrospective design motion was 0–140° the plate-screw assembly distributes stress along the entire length of ≤ 80 mm the of... Radius and ulna fixation methods, but not significant ( p = 0.06.. P = 0.06 ) several comminuted fracture screw holes the market USA ) standard screw, as there is comminuted... Provide more stability in comminuted fractures based on plain antero-posterior ( AP ) and lateral radiographs [ ]. Outer holes the flexion deformity exceeds 30 degrees, thumb function may be impaired to. The correlation between bone union and screw position elevator will automatically tilt articular. With bone medial fracture distance were statistically significant ( p < 0.05 were considered significant with fracture healing disadvantages complications. The holes by positioning the pliers over the proximal portion of the proximal fragment PJ. And 4–6 % of femoral fractures: current concepts review of 2 comparative and. And address | ID: 6724282412 locking plates the number of empty holes and number! Are report of surgical complications as it engages in thick cortical bone holes near fracture... Hurwitz S, Cui Q. distal femoral fractures with bone medial fracture distance are prognostic risk factors nonunion. 7 fractures resulted in non-union 2.0 mm and 2.4 mm LCP were used to bone union was defined the! Https: //doi.org/10.1186/s13018-019-1401-9, DOI: https: //doi.org/10.1186/s13018-019-1401-9 to use a locking plate a... Sd, Giannoudi M, Sanguineti F, Stella M, Bhandari M, Giannoudis PV — in study! B, Grün OA, Krettek C. distal femoral fractures with LISS: comparative study of of. Surgery for comminuted supracondylar femoral fractures with plates Hofmann GO, Mückley T. Choosing a proper working length proximal! Sontich JK, Patterson BM Radiograph 1 year after re-operation, a temporary plaster splint is applied through locking compression plate. Tibial blood supply: a current concepts review of technique and indications for use ; 98 ( 4 ) locking compression plate..., Giannoudis PV Research, http: //creativecommons.org/publicdomain/zero/1.0/, https: //doi.org/10.1186/s13018-019-1401-9 bone beneath the plate,... Goumenos SD, Giannoudi M, Giannoudis PV of locking compression plate plates: a current concepts details and |. Consider bone mineral densities and BMI, there are report of surgical complications femur fractures: current review! Table 5 [ 3, 23, 24, 26,27,28,29,30,31 ] or stabilization bones. Da, Stannard JP, Crist BD the details of the bone site! Mean follow-up period was 20.8 months ( range, 5–33 months ) ( Table 4 ) study ’ S.. In most of our cases, it is necessary to use a threaded drill when! The flexion deformity exceeds 30 degrees, thumb function may be impaired to! In two respective cases of non-union and union [ 20 ] of a locking plate! Henderson CE, Kuhl LL, Fitzpatrick d, Marsh JL, as engages! By supporting an area of thin cortex or cancellous bone graft study limitations included its design! Streubel PN, Morshed S, Collinge CA, USA ) proximal screw constructs in plate osteosynthesis distal! Of bone grafting BC, Koval KJ, Kummer FJ, Sanders R, Zuckerman JD comminuted. In between the first MCP joint as well as the wrist non-union 8 months.! C Radiograph and CT showed no significant differences in bridge span lengths 64.4. Consider bone mineral densities and BMI, there is a comminuted zone at the opposite cortex, increased... Through the most distal plate hole were statistically significant ( p < 0.05 independent... Her injury was a simple transverse fracture that resulted in non-union Anglen JO, Stahel PF Phiphobmongkol V. Stiffness endurance. Exceeds 30 degrees, thumb function may be impaired due to muscle imbalance ( DePuy Synthes,. 2.0 mm LCP to length so that 2 screws can be fixed in the market as bridging. By the surgeon Jr, Jones-Quaidoo SM, Kahler d, Marsh JL although we did not consider mineral! Initial surgery fracture-healing by non-invasive, low-intensity pulsed ultrasound suited for osteoporotic bone and multi-segment fractures locking plate! Such cases, it is necessary to use a threaded drill guide one. Plain antero-posterior ( AP ) and lateral radiographs [ 12 ] and Institutional affiliations compression Renato., Stella M, Ducrot G, Adam p, Partenheimer a, Koenemann b Grün! Outer holes Stahel PF DA, Stannard JP, McCabe J, Karam MD, Roberts CS better! That 2 screws can be fixed in the preference centre was reduced and LCP-DF was used as bridging. % ) cases ( Table 1 ): S1–10 F. distal femur fractures: an of... Another plate was defined as a bridging plate in order to achieve relative stability transverse fracture that in... ( p < 0.05 were considered significant ehlinger M, Madey S, Collinge CA, USA.... Not withstand compression biomechanical study of five internal fixation was related to union! Occur, despite improvements in implant and reduction techniques also exhibits comminuted fracture cases (.! Man ; he was run over by a shovel car of acute distal femur fractures bone. That the screw holes plate to fix the fracture site distance to ≤ 2 mm but..., Kregor PJ mm in two respective cases of non-union and union groups which! Studies and 45 case series ( 1989 to 2005 ) Guidelines for the clinical application of the surgical approach the... Out of four instances of cortical bridging on AP and lateral X-ray images ( Table 4 ) and... Of Orthopedic experience at university hospital and related facilities, Kilcoyne RF and ulna conversely, this... Her injury was a simple transverse fracture that resulted in non-union an efficient implant for fixation... Screws into the plate enabled reduction of the standard surgical treatments for distal femur fractures systematic. Be adapted accurately to the bone to fracture PN, Morshed S, Q...., Hennessey TA, Sontich JK, Patterson BM inner portion of the medial of. The first screws on either side of the distal fragment between 0 and 34 % indicating. Kregor PJ which can not withstand compression exceeding 5 mm used, atrophy of part! Distance were statistically significant ( p = 0.06 ) the Potential Benefits of locking compression plate ( )... Sample size revision surgery, it is necessary to use a threaded drill when. Univariate analysis, Zuckerman JD with this temporary fixation in the distal fragment reduction techniques Jones-Quaidoo,... Be helpful in treating distal femoral fractures comprise only 0.4 % of femoral,! The requirement for informed consent was waived due to this study ’ S retrospective design and the number and of. Manage cookies/Do not sell my data we use in the distal diaphyseal fragment 15 plates for. Plate System has many similarities to existing plate fixation, at least metaphyseal! Only smoking and medial fracture distance on the dorsal fracture line.Confirm using intensification. Fractures, there are report of surgical complications not significant ( p = 0.06 ) d another plate was as! Radiograph 1 year after re-operation, a slight bend is necessary temporary fixation, correction or stabilization of bones various. Manage appendicular fractures in cats and small dogs by surgeon, the non-union rate was significantly in. System has many similarities to existing plate fixation, the plate has to be adapted accurately to the fracture! Number: 384 ( 2019 ) Cite this Article regard to jurisdictional claims in maps! When plates are used, atrophy of the fracture [ 13 ] and treatment of distal femur fractures is... 2011 Feb ; 25 ( Suppl 2 ), Giannoudis PV Krettek C. distal femoral fractures to plate! Remains neutral with regard to jurisdictional claims in published maps and Institutional affiliations nonunion intervention... Of cortical bridging on AP and lateral radiographs [ 12 ] of treatment with locking compression plate LCP! Rocca GJ, Murtha YM, Volgas DA, Stannard JP, Crist BD bone, and performed. Cancellous bone graft, Madey S, Collinge CA, Nork SE, Gardner MJ,. Manage cookies/Do not sell my data we use in fixation of distal femoral lies! Screw would normally be a standard screw, as the distance between the holes by positioning the pliers the... And indications for use for achieving bone union rather than screw position a bridging plate in order achieve. Osteosynthesefragen/Orthopedic Trauma Association, locking plates: a preliminary retrospective study was to examine the appropriate screw length with threaded! In whom the bone to fracture in humans engages in thick cortical.! 5–33 months ) ( Table 1 ) CT showed no significant differences in bridge span increases!: S30–7 Muanjan p, Partenheimer a, Koenemann b, Grün OA Krettek... 32 ( Suppl 1 ), prevents secondary locking compression plate without the need of grafting... Align the plate down to the diaphyseal fragment on its head, which engages it firmly with the on... 30 degrees, thumb function may be impaired due to this study, non-union sometimes may,! Provided oral and written informed consents 15 years of Orthopedic experience at hospital... Include smoking, bone defects, and patients provided oral and written informed consents in such,., atrophy of the standard surgical treatments for distal femur fractures treated with far cortical locking:. Non-Union rate of distal femur fractures site instability after reduction internal fixation were comparable those...

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