A study of Proximal Humerus Fractures treated by Locking Compression plating

Background: The treatment of proximal humerus fractures is always a challenge for the Orthopedic surgeon. Proximal humeral fractures are a regular presence in clinics. In the past, the standard treatment method was conserva?ve. The results and func?onal outcomes, on the other hand, were not favorable. The func?onal outcomes have been known to improve a?er the development of locking compression plates. The purpose of this study was to see how func?onal proximal humerus fractures were treated with locking compression plates fared. Methods: This cross-sec?onal interven?onal prospec?ve study was carried out in the Department of Orthopedics, Prathima Ins?tute of Medical Sciences. The study included all adult pa?ents with closed two-part and three-part proximal humerus fractures who were reported within a week a?er the incident. Based on the sample size calcula?ons and inclusion and exclusion criteria a total of n=35 pa?ents were included in the study. Pa?ents were followed up for 12months a?er surgery using a typical surgical method with a locking compression plate. Results: n=35 pa?ents out of which n=19(54.2%) were males and n=16 (45.7%) were females. The distribu?on based on age involved in pa?ents with fractures showed equal preponderance among 31-35 years and 20-25 years with n=9(25.71%).Neer’s classifica?on of fractures of proximal humerus was followed in this study. Most of the pa?ents in n=25 (71.42%) cases were having Neer’s Two-part fractures and three-part fractures were found in n=8(22.8%) and four-part in n=2(5.7%). The overall results in the study were 65.71% of pa?ents had excellent results,20% had good results,8.5% had sa?sfactory results and 5.7% had poor results. Conclusion: Locking plates are a preferable therapeu?c choice for proximal humerus fractures, par?cularly when the bone quality is poor and the fracture is comminuted. Complica?on rates can be reduced by using good surgical techniques and selec?ng the right situa?ons. Proximal humeral internal locking plates con?nue to provide strong overall func?onality.

Evaluation of 2 mm locking plates for treating mandibular fractures

Background: The progressive development in the trauma management has now paved way to the use of miniplates for the treatment of mandibular fractures. We present a case series of twenty-five patients treated with miniplates for the mandibular fractures.Methods: The study was done on twenty-five patients diagnosed clinically and radiographically with mandibular fractures and attending the outpatient department of Oral and Maxillofacial surgery of a tertiary care hospital in Jaipur city. The selected cases were treated by open reduction and internal fixation under general anesthesia. 2.0-mm titanium locking mini plates were used as a method of internal fixation. The patients were evaluated for the location, type and number of fractures, time required for adaptation and fixation of single four hole 2.0-mm locking plate, complications during surgery, pre and post-surgical occlusal relationship, adequacy of reduction on postoperative radiograph and any post-surgical complications requiring a secondary surgical intervention.Results: Majority were in the age group of 21-30 years (72%) with a mean age of 26.6 years. Among these, there were 23(92%) male and 2(8%) female patient. Maximum (28%) patients were of symphysis and angle fracture followed by symphysis and condylar (25%), while only 2% cases were of Para symphysis and condylar. The mean time taken for single plate adaptation and fixation was 11.34 minutes for symphysis fracture, 14.12 minutes for parasymphysis fracture, and 11.56 minutes for body fracture and 18.90 minutes for angle fractures.Conclusions: The locking miniplates in mandibular fractures is efficacious enough to appreciate early recovery of normal jaw function, uneventful healing and good union at the fracture site with minimal weight loss due to early reinstatement of masticatory function.

Precontoured Clavicular Locking Plate with Broad Lateral End: A Newly Designed Plate for Lateral Third Clavicle Fractures

@#Introduction: Various treatment modalities are available butno consensus has been reached for optimal treatment oflateral third clavicle fractures. Precontoured locking plateswith broad lateral end for multiple screws fixation is a newlydesigned plate for lateral third clavicle fractures. Theobjective of our study was to analyse the functionaloutcomes as well as complications of this technique in asignificant number of cases with long follow-up duration.Materials and Methods: Forty-six patients with distal thirdclavicle fractures were treated by precontoured clavicularlocking plate with broad lateral end. Functional outcomeswere assessed on the basis of Constant-Murley ShoulderOutcome Score and University of California, Los Angeles(UCLA) Shoulder Rating Score, active shoulder range ofmotion, time for fracture union and coraco-claviculardistance.Results: The mean Constant-Murley score was 92.56±4.47(range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coracoclaviculardistance at final follow-up was 10.52±1.13 mm(range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm(range 9.6 to 11.2 mm) in normal side. Mean UCLAShoulder Rating Score was 32.55±2.12 (range: 27-34) forinjured side and 33.46±1.88 (range: 31- 35) on normal sidewith p value 0.58. No major complications that necessitatedrevision of surgery occurred in our study.Conclusion: This newly designed plate seemed extremelyuseful in successful union of lateral third clavicle fractures,with reduced rate of complications like fixation failures,iatrogenic rotator cuff injury, AC joint osteoarthritis andsub-acromial bursitis, with good functional out

Outcome of distal end clavicle fractures treated with locking plates / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Fractures of the lateral end of the clavicle are relatively uncommon. These fractures are unstable due to the various deforming forces which act on the fragments as well as the small distal fracture fragment. At most times the deforming forces are not taken into consideration, and the fracture is not fixed securely. In this study, we assessed a fixation technique using the precontoured locking plates to find out whether it provided a stable fixation with good functional outcome.</p><p><b>METHODS</b>Totally, 32 patients with lateral end clavicle fracture (Neer's Type II) were included in the study. After the informed consent and preoperative investigations were obtained, open reduction and internal fixation was done using a 3.5 mm precontoured superior locking plate with lateral extension under general anesthesia. Postoperative X-rays were done on day 1 and every 6 weeks after operation, until radiological union was achieved. The postoperative pain was assessed using Visual Analogue Scale (VAS) on postoperative days 1, 2 and 10. Postoperatively arm pouch sling was given for 2 weeks followed by active mobilization. Patients were asked to do their daily routine work and avoid lifting heavy weights. The functional outcome was assessed at the end of 2nd and 6th months with the help of Disabilities of the Arm, Shoulder and Hand (DASH) scoring.</p><p><b>RESULTS</b>There were no intraoperative complications in the procedure. The mean VAS score on postoperative day 1 was found to be 5 which decreased to 3 on day 2 and 0 on day 10. The mean DASH score was calculated as 11.63 at the end of postoperative month 2 and then 4.6 at the end of month 6. There was one case of malunion in whom the overhead abduction was restricted but was not painful and was managed conservatively.</p><p><b>CONCLUSION</b>The precontoured locking plates with lateral extension may be a good method to fix the fractures of the lateral end clavicle, which provide a stable fixation with good functional outcome with very few instances of stiffness and decreased range of motion of the shoulder with the hook plates and failure of fixation in screw and K-wire fixations. It may well be the answer to the fixation questions of the lateral clavicle fractures, although larger comparative studies between the surgical treatment methods are required to confirm the same.</p>

Design and biomechanical study of a novel double-leaf proximal humeral locking plate / 医用生物力学

Objective To design a novel double-leaf proximal humeral locking plate for fixing greater and lesser tuberosities in complex proximal humeral fractures, and evaluate its fixing stability by biomechanical tests. Methods Twelve fresh-frozen humerus specimens with intact rotator cuff were randomly divided into two groups (Group A and Group B) to establish the same greater and lesser tuberosities fracture models. Specimens in Group A were fixed with the double-leaf proximal humeral locking plate, while specimens in Group B were fixed with the proximal humeral internal locking system (PHILOS) and tension band suture, and a 3.5-mm cannulated screw was added to stabilize the lesser tuberosity. The tensile test on subscapularis, infraspinatus and teres, supraspinatus as well as the load-to-failure test on greater and lesser tuberosities were performed on specimens in two groups. Results For subscapularis tensile tests, displacements under 150 N tensile stretch and after fatigue test in Group A were both significantly smaller than those in Group B (P0.05). For supraspinatus tensile tests, there were no statistical differences between Group A and B in displacements under 90 N tensile stretch and after fatigue test (P>0.05). For load-to-failure tests on lesser tuberosity, the failure load in Group A was significantly greater than that in Group B (P0.05). Conclusions Compared with the ordinary tension band suture plus cannulated screw for fixing lesser tuberosity, the novel double-leaf proximal humeral locking plate shows more obvious biomechanical stability, with the advantage of simultaneously fixing greater and lesser tuberosities. The research findings provide a new choice for the clinical treatment of complex proximal humeral fractures.

Design and biomechanical study of a novel double-leaf proximal humeral locking plate / 医用生物力学

Objective To design a novel double-leaf proximal humeral locking plate for fixing greater and lesser tuberosities in complex proximal humeral fractures,and evaluate its fixing stability by biomechanical tests.Methods Twelve fresh-frozen humerus specimens with intact rotator cuff were randomly divided into two groups (Group A and Group B) to establish the same greater and lesser tuberosities fracture models.Specimens in Group A were fixed with the double-leaf proximal humeral locking plate,while specimens in Group B were fixed with the proximal humeral internal locking system (PHILOS) and tension band suture,and a 3.5-mm cannulated screw was added to stabilize the lesser tuberosity.The tensile test on subscapularis,infraspinatus and teres,supraspi natus as well as the load-to-failure test on greater and lesser tuberosities were performed on specimens in two groups.Results For subscapularis tensile tests,displacements under 150 N tensile stretch and after fatigue test in Group A were both significantly smaller than those in Group B (P ＜ 0.05).For infraspinatus and teres tensile tests,there were no statistical differences between Group A and B in displacements under 150 N tensile stretch and after fatigue test (P ＞ 0.05).For supraspinatus tensile tests,there were no statistical differences between Group A and B in displacements under 90 N tensile stretch and after fatigue test (P ＞ 0.05).For load-to-failure tests on lesser tuberosity,the failure load in Group A was significantly greater than that in Group B (P ＜ 0.05),and the failure displacement in Group A was significantly smaller than that in Group B (P ＜ 0.05).For load-to-failure tests on greater tuberosity,there were no statistical differences between Group A and B in both the failure load and failure displacement (P ＞ 0.05).Conclusions Compared with the ordinary tension band suture plus cannulated screw for fixing lesser tuberosity,the novel double-leaf proximal humeral locking plate shows more obvious biomechanical stability,with the advantage of simultaneously fixing greater and lesser tuberosities.The research findings provide a new choice for the clinical treatment of complex proximal humeral fractures.

Implant Selection for Treatment of Distal Radius Fractures / 대한정형외과학회잡지

Anatomical reduction is essential for successful treatment of distal radius fractures. In-depth understanding of the implant is mandatory in order to obtain adequate fixation of the fracture fragments and to avoid implant-related complications. Selection of an improper implant and screw length may lead to rupture of flexor or extensor tendon as a complication. This article will briefly discuss the pros and cons of the traditional fixation methods such as percutaneous pin fixation and external fixation, and will focus on the recent development of the volar locking plate. Variable-angle locking plate, which was introduced in an effort to provide surgeons with more freedom for fixation, may have inadequate fixation strength if screw locking is repeated. From the biomechanical study, at least four distal locking screws are enough to have strength to maintain fracture fixation. Measuring screw length may be difficult; therefore, information about the ratio of the metaphysis and diaphysis will be helpful in deciding on the proper screw length. Locking screws are recommended as they are stronger than locking pegs. In order to avoid flexor tendon ruptures, the plate should not be placed too far distally.

Treatment of calcaneal fractures with a super-cutaneous calcaneal locking plate / 中华创伤骨科杂志

Objective To study advantages and disadvantages of the super-cutaneous calcaneal locking plate in the treatment of calcaneal fractures. Methods Between October 2007 to June 2008, 12cases of calcaneal fracture were treated with a super-cutaneous calcaneal locking plate. According to the Sanders classification system, 8 cases were of type ⅡA, one case of type ⅡB, one case of type ⅡC, one case of type Ⅲ AC, and one case of type Ⅳ. All the cases were fresh fractures. The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal. In direct observation of the posterior facet and anterior tuberosity, the articular fragments were reduced anatomically. Then the reduced calcaneus was fixed by a super-cutaneous calcaneal locking plate. After bone union was confirmed 3 months after the operation by the CT scans and X-ray films, the super-cutaneous plates and screws were removed in clinic. Results The average time of follow-up was 16 months with a span from 12 to 20 months. There were no incision or pin-hole infections. The reduction of the articular surface and bone union were good. One type ⅡA developed lateral wall exostosis which resulted in peroneal tendonitis and stenosis followed by obvious walking pain. The preoperative X-ray films of the 12 patients showed that the average B(o)hler angle was 11.9°±9.4° and the Gissane angle 86. 8°± 7. 7°. Their postoperative X-ray files demonstrated that the B(o)hler angle was improved to 29. 4°± 7.0° and the Gissane angle to 115.8°± 7.7°, with a significant difference ( P ＜ 0. 01 ). According to the Ankle Hindfoot Clinical Rating System of the American Orthopaedic Foot and Ankle Society (AOFAS),their average score was 91 points (68 to 100 points). Conclusions Using a super-cutaneous calcaneal locking plate to treat calcaneal fractures can result in limited invasion, a low rate of skin infection, satisfactory reduction of the articular surface and stable fixation. Since the fixation can be removed without re-hospitalization, it is a cheaper and less painful alternative for the treatment of displaced intra-articular calcaneal fractures.

Clinical outcomes of proximal humeral internal locking system self-locking plates in treatment of proximal humeral fractures / 中华创伤杂志

Objective To evaluate the clinical results of proximal humeral internal locking sys-tem(PHILOS)self-locking plates in treatment of proximal humeral fractures. Methods There were 35 patients including 19 males and 16 females(at mean age of 53.5 years,ranging from 29 to 92 years)with proximal humeral fractures treated with PHILOS plate.According to the Neer's classification sys-tem,there were two-part fractures in 19 patients,three-part fractures in 15 and four-part fractures in 1.Surgery was performed with PHILOS serf-locking plate via dehopectoral approach.All patients were fol-lowed up for mean 18.9 months(6-46 months)and evaluated by using Constant score and X-rays. Re-suits X-rays proved that all fractures got good reduction and complete healing during 8-12 weeks.The latest Constant scores was mean 89.5 points(82-94 points).There were no complications including plate loosing.humenral head necrosis or gleno-humeral ioint osteoarthritis. Conclusion PHILOS plate is a good choice for treatment of proximal humeral fractures because of its advantages including easy operation,stable fixation,good clinical results and few complications.