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Introduction: Nonunion of humeral fractures afterconservative or surgical treatment represents a disablingcondition for the patient and a challenge for the surgeon. Studyaimed to evaluate the outcome of treatment of humeral shaftnonunions with dynamic compression plate and cancellousbone graft.Material and Methods: This study was conducted atDepartment of Orthopaedics, GMC Srinagar from June 2016to December 2019. Twenty patients were operated over thisperiod. Trauma was the cause of injury in majority of thepatients. Nonunion was atrophic in 80% and hypertrophic in20% of the individuals. All the patients had closed fractureat presentation, and 70% had received previous treatmentfrom traditional bone setters and 30% had failure of theconservative cast management.Results: The average time to union was 18 weeks. Treatmentpreviously from traditional bone setters significantly affectedthe time to fracture union (p<0.05). All fractures unitedsuccessfully.Conclusion: we concluded that treatment with dynamiccompression plating and cancellous bone grafting remains aneffective treatment option for nonunion of humeral shaft.
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Objective To investigate biomechanical characteristics of the modified memory alloy internal fixator for separation of pubic symphysis. Methods The model of pubic symphysis separation injury was established based on 10 pelvic specimens. The control group was fixed with the dynamic compression plate after reduction, and the experimental group was fixed with the modified memory alloy internal fixator for separation of pubic symphysis after reduction. The biomechanical stability for two kinds of internal fixation was compared. Results There were no loosening and fracture of internal fixation in both groups. The displacement of pubic symphysis in horizontal, anterio-posterior and vertical direction in the experimental group was obviously reduced compared with the control group (P＜0.05). Conclusions Compared with the dynamic compression plate, the modified memory alloy internal fixator for separation of pubic symphysis shows better resistance to the tensile force against horizontal and anterio-posterior direction, as well as better resistance to the vertical shear force.
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A prospective observational study was conducted in Government Victoria Hospital, Visakhapatnam from 2013 to 2018 to evaluate Arogyasri scheme. Arogyasri scheme provides end to end cashless services for identified diseases in Andhra Pradesh. During this period, 891 gynecological surgeries were conducted under this scheme. Out of them, 44 were not approved for claim. A total of 10,880,238 rupees were claimed.
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Background: The achievement and maintenance of reduction of diaphyseal fractures of forearm are hindered by deforming muscular forces. The aim of this study to compare the results of close diaphyseal fracture of both bones forearm in adult treated by well-fitting intramedullary (square) nail & dynamic compression plate. Material & Methods: The present study comprised of 60 patients with close fracture both bones forearm belonging to either sex of adult age group, treated in the department of orthopedics, Dr. B. R. Ambedkar Medical College, Bengaluru, Karnataka, India. All 60 cases included in this study underwent clinical and radiological examination at the time of admission; and type, site, displacement, rotation and angulation of fractures were determined. At follow up examination interval between injury & this examination was recorded & than clinical & radiological examination were carried out. Results: The present study showed that the mean age of patients was 35 yrs, male to female ratio was 3.6:1 and right side were more common as compared to left side, mostly patients had indirect injuries (55%). comparison of functional end result between Hadden et al4 different modalities of treatment and of our present study. Results of plating is comparable with Hadden et al4 sereis but Nailing is inferior. Conclusion: We concluded that functional end results to be excellent to good, plating is the best mode of treatment for fracture forearm bones as 83% excellent to good results had achieved but nailing also have comparable results as achievement of 76% excellent to good results.
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Femoral nailing is the overall “gold standard” in treating femoral shaft fractures. However, plate osteosynthesis at the femoral shaft is still being done in selected patients. We report a case of right femoral implant failure after a broad limited contact dynamic compression plate (LC-DCP) insertion and its subsequent management using our minimally invasive technique. Our technique is biologically compliant as well as cosmetically friendly. We converted a loadbearing implant into a load-sharing implant in view that obesity is a significant predictive factor of non-union in a femoral fracture treated with locking plate. The patient subsequently recovered well with no complication.
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ObesityABSTRACT
PURPOSE: The purpose of this study is to evaluate the clinical and radiologic results of plate fixation in the Vancouver B1 and C periprosthetic femoral fracture (PFF). MATERIALS AND METHODS: Twenty patients who had sustained a Vancouver type B1 and C periprosthetic fracture after hip arthroplasty (years 2002-2012) were identified. The mean age was 66.0 years (range, 43-85 years) and the mean follow-up duration of the group was 38 months (range, 12-102 months). The dynamic compression plate (DCP) group included 12 patients and the locking compression plate (LCP) group included eight patients. Harris hip score (HHS) and walking ability, knee joint range of motion (ROM) were compared before injury and last follow-up. Fracture union rate and period were compared. RESULTS: The mean HHS score was 90.7 (64-96). There was no statistical difference between the two groups. At the last follow-up, knee joint ROM was 103.3degrees (105degrees-140degrees) in the DCP group and 118.4degrees (110degrees-140degrees) in the LCP group, showing good results in the LCP group (p=0.043). No significant difference in the fracture union rate and union periods was observed between the two groups. CONCLUSION: A better result for the postoperative knee flexion exercise capacity was observed in the LCP group. Use of LCP plate fixation is a good option in management of Vancouver classification B1 and C PFF.
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Humans , Arthroplasty , Arthroplasty, Replacement, Hip , Classification , Femoral Fractures , Follow-Up Studies , Hip , Knee , Knee Joint , Periprosthetic Fractures , Range of Motion, Articular , WalkingABSTRACT
Background: Study was designed to analyze the effects of surgical management of fractures of both bones of forearm with dynamic compression plate with screw fixation. Material and methods: From August 2008 to October 2010, data from 56 patients with fractures of both the radius and ulna were collected and evaluated retrospectively. Patients were managed with early surgical debridement, open reduction and internal fixation with a DCP. All patients had complete functional and radiographic assessments. Results: Patient regained full range of movements within 6-8 weeks. At 12-14weeks check X-ray showed good radiological union. In this series out of 56 cases 42 (75%) cases are graded excellent, 7 (12.5%) cases are graded good, fair 5 (9%) cases and poor 2 (3.5%) cases. Conclusion: Our study has proven that open reduction and internal fixation of diaphyseal fractures of radius and ulna can be best done with dynamic compression plating technique which has given a good result. The technique of DCP fixation is a simple procedure which can be done by the junior orthopedic surgeon with an excellent result.
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PURPOSE: To compare the clinical and radiologic outcomes of internal fixation using locking compression plate (LCP) or limited contact-dynamic compression plate (DCP) for patients with diaphyseal forearm fractures. METHODS: Forty-four patients with diaphyseal forearm fractures treated with either LCP (22 patients) or DCP (22 patients) were compared in regards to clinical outcomes, range of motion and Grace and Eversmann criteria at the last follow-up. Union rate and mean time to radiological union were also compared depending on comminution. RESULTS: Mean range of motion and Grace and Eversmann criteria between two groups did not show significant differences. Bony union was achieved in all patients. Although mean time to union was not different in simple fractures (15.5 weeks in LCP group vs. 13.8 weeks in DCP group), it was different between two groups in mutifragmentary fractures (14.8 weeks in LCP groups vs. 24 weeks in DCP group). CONCLUSION: Internal fixation using both LCP and DCP for diaphyseal forearm fractures yield satisfactory clinical and radiologic outcomes. In multifragmentary fractures, LCP can shorten radiologic union time than using DCP.
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Humans , Follow-Up Studies , Forearm , Range of Motion, ArticularABSTRACT
Objective To investigate the difference of efficacy of interlocking nails and dynamic compression plate in tibial shaft fractures.Methods The clinical data of 137 cases with tibial shaft fractures were reviewed retrospectively.They were divided into two groups according to the various treatments which included interlocking nails group(72 cases with 79 fractures) and dynamic compression plate group(65 cases with 70 fractures).The efficacy,healing fineness rate,function score after operation and complications were compared.Results After operation,the patients were followed up 21.4 months on average.The postoperative callus time,weight-bearing limb time,healing time and postoperative fixation time taken in interlocking nails group was shorter than that in dynamic compression plate group [(2.36 ± 0.46) months vs.(3.12 ± 0.57) months,(2.42 ± 0.51) months vs.(3.14 ± 0.63) months,(7.65 ± 1.29) months vs.(9.33 ±1.54) months,(12.64 ± 3.76) months vs.(16.38 ± 3.15) months],and there was significant difference (P＜ 0.05).The healing fineness rate was 97.5％(77/79) in interlocking nails group,and 92.9％(65/70) in dynamic compression plate group,and there was nosignificant difference (x2 =1.76,P ＞0.05).The incidence of comphcations in interlocking nails group was higher than that in dynamic compression plate group[25％(2H9) vs.12.9％(9H0)],and there was significant difference(P ＜ 0.05).Condmions Interlocking nails have better biomechanical features with high union rate,low infective rate and good recovery of joint function.The clinical result of interlocking nails for the tibial shaft fractures is also better than that of dynamic compression plate.
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Objective To compare the clinical effect of dynamic compression plate (DCP) and limited contact dynamic compression plate (LC-DCP) fixation in the treatment of limbs long bone fracture,provide certain basis for the choice of clinical internal fixation.Methods The clinical data of 172 patients with limbs long bone fracture treated with DCP and LC-DCP fixation were retrospectively analyzed.One hundred and one cases in LC-DCP group,and 71 cases in DCP group,the operation time,intraoperative blood loss,hospitalization time,fracture healing time,incidence of nonunion,daily activity ability and joint function score and clinical curative effect in two groups were compared.Results The operation time,fracture healing time,incidence of nonunion in LC-DCP group were better than those in DCP group[(62 ± 13) min vs.(88 ±20) min,(60.0 ± 20.5) d vs.(85.0 ± 25.5) d,1.0％ (1/101) vs.7.0％ (5/71)],there were significant differences (P ＜ 0.05),but the intraoperative blood loss and hospitalization time between two groups had no significant difference (P ＞ 0.05).Barthel and Harris score in LC-DCP group were better than those in DCP group [(72.61 ± 8.63) scores vs.(52.58 ± 5.53) scores,(69.28 ± 7.63) scores vs.(55.07 ± 6.26) scores],there were significant differences (P ＜ 0.05).The excellent rate in LC-DCP group was better than that in DCP group [99.0％ (100/101) vs.90.1％ (64/71)],there was significant difference (x2 =15.71,P ＜ 0.01).Conclusion Limbs long bone fracture treat with LC-DCP,can improve clinical curative effect and reduce complications,improve the daily ability of joint function in patients and is worth using in clinic.
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Objective To compare the clinical effects in patients treated with anterograde reamed intramedullary nail (IMN) and dynamic compression plate (DCP) for diaphyseal fractures of the humerus.Methods Forty-seven patients with diaphyseal fractures of the humerus,were divided into two groups by random digits table:IMN group (23 cases) and DCP group (24 cases),IMN and DCP were performed fixation,respectively.After the surgery,perioperative,functional outcomes of shoulder and elbow,postoperative complications between two groups were compared.Results The average follow-up time was (22.3 ± 5.7)months,3 cases were lost in 12-month-follow-up,1 case in IMN group and 2 cases in DCP group.The operation time,intraoperative blood loss in IMN group were significantly shorter than those in DCP group [(67.7 ± 15.3) min vs.(87.0 ± 12.5) min,(106.3 ±57.6) ml vs.(226.7 ±60.2) ml,P＜0.05].The incidence rate of subacromial impingement in IMN group was significantly higher than that in DCP group [18.2％ (4/22) vs.0,P ＜ 0.05].The incidence rate of wound infection in IMN group was significantly better than that in DCP group [4.5％(1/22) vs.22.7％(5/22),P ＜ 0.05].There were no statistically significant differences between two groups in other indexes (P ＞ 0.05).Conclusions DCP has some advantage in perioperative period,but they are comparable in the functional outcomes of shoulder and elbow and complications.
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BACKGROUND: Studies comparing the relative strength of polymethylmethacrylate (PMMA) augmented fixation, standard plating and locked compression plate (LCP) system are few. The use of either the bone cement-augmented dynamic compression plate or the Hybrid LCP constructs may provide an additional tool for the treatment of fractures in patients with osteoporosis. METHODS: Eighteen (18) osteoporotic cadaveric humeral bones were assigned randomly to each of three groups (Dynamic Compression Plate [DCP], DCP augmented with bone cement, and the Hybrid LCP system) and tested in anterior-posterior bending and torsion/external rotation. The load to failure values were obtained and the results for each specimen compared. RESULTS: Significant differences were observed between the standard DCP and Hybrid LCP group (p-value=0.012), and in the cement-augmented and Hybrid LCP group (p-value=0.099) in torsion/external rotation loading. No significant difference was observed between the standard DCP and bone-cement augmented group (p-value=0.248). No significant difference was observed among the three groups in terms of stiffness (p-value=0.3868) in the four-point anterior-posterior bending modality. Screw pull-out of the implant was observed only in the regular DCP group in torsion/external rotation loading stress. CONCLUSION: Significant differences were seen between the three constructs in torsion/external rotation but not in anterior-posterior four-point bending. Bone failure, but not screw pull-out, was seen in the Hybrid LCP and bone cement-augmented DCP groups in torsion. This study showed that the LCP system and the bone cement-augmented constructs may provide greater screw purchase to the osteoporotic humerus.
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Humans , Humans , Bone Cements , Bone Screws , Polymethyl Methacrylate , Rotation , Bone Plates , Fracture Fixation, Internal , Fractures, Bone , Osteoporosis , HumerusABSTRACT
Las fracturas de huesos largos encontradas más frecuentemente en animales pequeños son las del fémur. Por su posición anatómica, son difíciles de inmobilizar, entonces, la utilización de fijaciones internas es de gran utilidad. Las placas de compresión dinámica (PCD) proveen gran estabilidad, son durables y al producir compresión interfragmentaria, minimizan el movimiento fragmentario y promueven la cicatrización primaria del hueso. Sus ventajas están asociadas a la reconstrucción anatómica, movilidad temprana y capacidad de carga del miembro. El polimetilmetacrilato (PMMA) es una resina acrílica utilizada en prótesis dentales. Pero, estudios muestran otros usos, tratamientos de tumores óseos, prótesis en deformaciones craneales, vertebroplastias percutáneas y prótesis testiculares en animales, entre otros. El objetivo de este estudio fue fabricar PCD-PMMA y comprobar su resistencia a las distintas fuerzas que están presentes en una fractura. Se fabricaron 48 PCD de 3,5 milímetros de cuatro orificios a partir de un molde de alginato. Se obtuvieron seis fémures de cadáveres caninos de 10 a 20 kg de peso, a los cuales se les realizó una osteotomía que simulaba una fractura oblicua. Posteriormente, se posicionaron las placas en los huesos osteotomizados para someterlas a las distintas fuerzas que participan en una fractura. Las PCD-PMMA resistieron 2,83 newton/metro a la fuerza de torsión y 0,21 kilonewton a las fuerzas de compresión y flexión. La resistencia de la PCD-PMMA obtenida fue en promedio de 20 kg, a cada una de las fuerzas. Se pudo concluir que es posible fabricar una PCD-PMMA de 3,5 mm de cuatro orificios, cuya resistencia es de 20 kg de peso a las tres fuerzas aplicadas. Entonces, pueden ser utilizadas para la estabilización de fracturas de huesos largos que sean sometidos a una presión inferior a 20 kg de fuerza.
Femur fractures are the most frequent long bone fractures in small animals. Due to the femurs anatomical position, it is difficult to immobilize, and therefore internal fixations are veryuseful. Dynamic compression plates (DCP) provide high stability, are durable, minimize fragment movement and promote primary healing of the bone. Advantages of this treatmentinclude anatomical reconstruction, early mobility and carrying capacity of the affected limb. Polymethylmethacrylate (PMMA) is an acrylic resin that has proved very useful in bone tumor treatment, cranial deformation prosthesis, percutaneous vertebroplasty and testicular prosthesis in animals. The purpose of this study was to manufacture DCP-PMMA and testits resistance to the different forces present in a fracture. Forty-eight (48) 3.5MM x 4-hole DCP were made from an alginate mold. Six (6) femurs were obtained from canine cadavers weighing from 10 to 20 kg, which underwent osteotomy simulating an oblique fracture. The plates were subsequently positioned in the osteotomized bones to submit them to the various forces involved in a fracture. The DCP-PMMA resisted a torque force of 2.83 newton/metres and a compression and flexion force of 0.21 kilonewton. The obtained resistance of the DCP-PMMA was an average of 20 kg per force. The results of this study show that it is possible to make a DCP-PMMA 3.5 mm x 4-hole, the resistance of which is of 20 kg against the three applied forces, and that it can be used to stabilize long bone fractures subjected to a pressure of less than 20 kg.
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Dogs , Femoral Fractures , Growth Plate , Polymethyl Methacrylate , BrachytherapyABSTRACT
Removal of plates is a procedure commonly performed by orthopaedic surgeons and stripped screws are probably the most common problem encountered during this procedure. Stripped screws are caused by slippage between the screwdriver and the screw. Due to the inherent difficulty in removing such screws, surgeons should be knowledgeable in techniques for their removal and should be equipped with the proper instruments to expedite the procedure. There are few published articles about such techniques. This report describes a technique for removal of plates with stripped screws. The tip of a stripped screw is approached from the far cortex and then reamed with a trephine reamer in the direction of the screw until both cortices are cleared. The plate is then removed with stripped screws attached. All the removals utilizing this technique to date have been successful with no complications, and this method is safe, efficient and technically easy to learn.
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During 1993 to 1994, 30 cases of minimally-displaced fracture of the zygomatic complex were treated with open reduction and rigid internal fixation with single 4-hole mini-dynamic compression plates (DCP) and screws at the zygomatico-frontal fracture site. The open reduction was done wth the aid of a bone hook inserted through a tiny stab incision at the zygomatic arch prominence. When good alignment was achieved, the zygomatico-frontal fracture site was fixed with only one 4-hole mini-DCP. The one-point fixation with this type of plate for minimally displaced zygomatic complex fractures reduces morbidity, operative time, and costs.
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Dynamic compression plate, used in the orthopedic surgery as internal fixation system, should have excellent biocompatibility, corrosion resistance, and adequate mechanical properties. The object of this research was test of its biocompatibility as compared with Osteo DCP and fabnfication of a KAIST" DCP with evaluation of its effect by animal experiment. The conclusions were follows: 1. The corrosion resistance of domestic DCP had no significant difference as compared with foreign made DCP. 2. The tissue responses to DCP were thought to be adequate. 3. The new-design DCP had less mobility at fracture site as compared with existing DCP, but there was no significant statistical differences. 4. In summary, it was concluded that KAIST DCP could be applied to the human body and it would be worth while to research the advantages of new-design DCP. DCP: Dynamic Compression Plate KAIST: Korea Advanced Institute of Science & Technology.