Treatment of Distal Femoral Fractures Using Polyaxial Locking Plate

PURPOSE: To report the clinical outcome of polyaxial locking plate (Noncontact bridging (NCB) plate (Zimmer, Warsaw, Indiana)) for the treatment of distal femur fracture with minimal invasive percutaneous periosteal osteosynthsis (MIPPO) technique. MATERIALS AND METHODS: Between February 2008 to April 2010, twenty six patients (11 men, 15 women), twenty eight cases diagnosed as distal femoral fractures are enrolled in this retrospective study. The mean age of the patients was 63 years (34 to 85) and the mean follow-up was 20.3 months (12 to 32). According to the AO/ASIF classification, 15 fractures were type A, 1 type B and 9 type C. And there were 3 periprsthetic fractures around knee. The analysis of the clinical and radiologic outcome were performed by Sanders functional evaluation scale and radiologic follow up after operation, respectively. RESULTS: Among 28 cases, 25 cases united without additional operation. According to Sanders functional evaluation scale, there were 11 excellent, 9 good, 4 fair, 2 poor. As complications, there were 1 knee stiffness, 1 delayed union, 1 implant failure with refracture, 1 implant loosening. Three patients except one knee stiffness, underwent a second LISS plating using NCB plate and and bone grafting, resulting in a satisfactory final outcome. CONCLUSION: Internal fixation using polyaxial locking plate with MIPO technique may be one of the most effective methods for the treatment of distal femoral fractures.

Minimally invasive fixation of complex proximal tibial fractures by uniaxial and polyaxial locking plates / 上海交通大学学报（医学版）

Objective To investigate the clinical application of minimally invagive fixation of complex proximal tibia fractures by uniaxial and polyaxial locking plates. Methods The clinical data of 38 patients with minimally invagive fixation of complex proximal tibia fractures by uniaxial(n=21)and polyaxial(n=17)locking plates from January 2008 to June 2009 were retrospectively analysed,and the union rates and function recovery were compared between groups.Results All patients were followed up for 3 to 20 months,with an average of 12 months.All patients had bone union.The time of fracture union for fixation by uniaxial locking plates was 10 to 20 weeks,with an average of 14 weeks;and that for fixation by polyaxial locking plates was 11 to 18 weeks,with au average of 13 weeks.Evaluated by Johner-Wruhs method, there were 14 "excellent" cases,5 "better" eases,2 "good" cases and 0 "poor" case for fixation by uniaxial locking plates (rate of "excellent and better",90.4%),and there were 11 "excellent" cases,5 "better" cases,1 "good" cage and 0 "poor" case for fixation by polyaxial locking plates (rate of "excellent and better",94.1%). Conclusion Minimally invagive fixation of complex proximal tibia fractures by uniaxial and polyaxial locking plates is stable,has less effects on bone blood supply,high bone union rate and favourable function recovery,and is an effective way in the treatment of complex proximal tibia fractures.Fixation by uniaxial locking plate has a better mechanical intensity,while fixation by polyaxial locking plate can adjust the screw angle according to fracture situation,which can be clinically applied accordingly.

Preliminary application polyaxial locking plate in the treatment of tibial plateau fractures / 中国矫形外科杂志

[Objective]To report the polyaxial locking plate and its primary clinical results in the treatment of the tibial plateau fractures.[Method]From July 2006 to August 2007,38 patients with tibial plateau fractures,including 26 males and 12 females,were treated with surgical reduction and internal fixation with polyaxial locking plate.The mean age of the patients was 30.6 years(18-65 years).According to Schatzker classification,there were 3 of type Ⅰ,5 of type Ⅱ,5 of type Ⅲ,6 of type Ⅳ,16 of type Ⅴ,3 of type Ⅵ,of which 34 were closed fractures and 4 open fractures.The follow-up period ranged from 7 to 18 months with a mean of 13.7 months.Function of the knees were assessed according to HSS system and radiological examination.[Result]Solid arthrodesis were obtained in all patients at 3-6 months after operation.Skin flap necrosis and incision infection happened respectively in 2 cases of type Ⅴ and type Ⅵ fractures.The score of HSS system was 92.8(range 78-98) averagely half year after operation and no reduction loss was observed.[Conclusion]The polyaxial locking plate is an effective fixation technique for the surgical treatment of the tibial plateau fractures because of its convenience and stability.The locking screws can be implanted in various directions and reduction loss is avoided post-operation.