The Computational Evaluation of a Locking Plate Fixation: Locking Versus Far Cortical Screws

2011 ◽  
Author(s):  
Mehran Moazen ◽  
Alison C. Jones ◽  
Jonathan Mak ◽  
Zhongmin Jin ◽  
Ruth K. Wilcox ◽  
...  
Keyword(s):  
Animal Models ◽  
Locking Plate ◽  
Callus Formation ◽  
Plate Fixation ◽  
In Vitro Models ◽  
Locking Plates ◽  
Locking Plate Fixation ◽  
Computational Evaluation ◽  
Secondary Bone Healing

Locking plates have gained increased popularity for the treatment of various types of fractures. However, these constructs can provide high stiffness fixations that can potentially fail. Therefore, several methods have been proposed to reduce the stiffness of these fixations in order to promote secondary bone healing via callus formation. One of the most recent concepts that has been proposed to reduce the stiffness of locking plates is the application of “far cortical screws”. This approach has been experimentally tested in vitro models of the femur and its application in animal models has shown promising results.

scholarly journals Assessment of the Efficacy of the Far Cortical Locking Technique in Proximal Humeral Fractures: A Comparison with the Conventional Bi-cortical Locking Technique 

2020 ◽  
Author(s):  
joongbae seo ◽  
Yoenjun Kim ◽  
Kyubeom Kim ◽  
Jae-Sung Yoo
Keyword(s):  
Locking Plate ◽  
Screw Fixation ◽  
Callus Formation ◽  
Constant Score ◽  
Plate Fixation ◽  
Treatment Strategies ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Union Rate ◽  
Locking Plate Fixation

Abstract Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion)were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p=0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.

scholarly journals Assessment of the Efficacy of the Far Cortical Locking Technique in Proximal Humeral Fractures: A Comparison with the Conventional Bi-cortical Locking Technique 

2020 ◽  
Author(s):  
joongbae seo ◽  
Yoenjun Kim ◽  
Kyubeom Kim ◽  
Jae-Sung Yoo
Keyword(s):  
Locking Plate ◽  
Screw Fixation ◽  
Callus Formation ◽  
Constant Score ◽  
Plate Fixation ◽  
Treatment Strategies ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Union Rate ◽  
Locking Plate Fixation

Abstract Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion)were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p=0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.Level of evidence: Level III-2, Retrospective study

scholarly journals Assessment of the Efficacy of the Far Cortical Locking Technique for Proximal Humeral Fractures: A Comparison with the Conventional Bicortical Locking Technique

2020 ◽  
Author(s):  
Joong-bae Seo ◽  
Sunghyun Yoon ◽  
Hyung-Seok Yi ◽  
Jun-Kyom Kim ◽  
Kyu-Beom Kim ◽  
...  
Keyword(s):  
Locking Plate ◽  
Screw Fixation ◽  
Callus Formation ◽  
Constant Score ◽  
Plate Fixation ◽  
Treatment Strategies ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Union Rate ◽  
Locking Plate Fixation

Abstract Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL allows axial motion and promotes uniform callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique. Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA). Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion) were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p = 0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups. Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.

scholarly journals Assessment of the Efficacy of the Far Cortical Locking Technique for Proximal Humeral Fractures: A Comparison with the Conventional Bicortical Locking Technique

2020 ◽  
Author(s):  
J.B. S. ◽  
J.S. Y. ◽  
Y.J. K. ◽  
K.B. K.
Keyword(s):  
Locking Plate ◽  
Screw Fixation ◽  
Callus Formation ◽  
Constant Score ◽  
Plate Fixation ◽  
Treatment Strategies ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Union Rate ◽  
Locking Plate Fixation

Abstract Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion)were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p=0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.Level of evidence: Level III-2, Retrospective study

scholarly journals Assessment of the efficacy of the far cortical locking technique in proximal humeral fractures: a comparison with the conventional bi-cortical locking technique

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Joong-Bae Seo ◽  
Jae-Sung Yoo ◽  
Yeon-Jun Kim ◽  
Kyu-Beom Kim
Keyword(s):  
Locking Plate ◽  
Screw Fixation ◽  
Callus Formation ◽  
Constant Score ◽  
Plate Fixation ◽  
Treatment Strategies ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Union Rate ◽  
Locking Plate Fixation

Abstract Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique. Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA). Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion) were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p = 0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups. Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.

Bioengineered in vitro Vascular Models for Applications in Interventional Radiology

2019 ◽  
Vol 24 (45) ◽  
pp. 5367-5374 ◽  
Author(s):  
Xiaoyun Li ◽  
Seyed M. Moosavi-Basri ◽  
Rahul Sheth ◽  
Xiaoying Wang ◽  
Yu S. Zhang
Keyword(s):  
Interventional Radiology ◽  
Animal Models ◽  
Blood Vessels ◽  
In Vitro Models ◽  
The Past ◽  
Endovascular Interventions ◽  
Conventional Animal ◽  
Vascular Structures

The role of endovascular interventions has progressed rapidly over the past several decades. While animal models have long-served as the mainstay for the advancement of this field, the use of in vitro models has become increasingly widely adopted with recent advances in engineering technologies. Here, we review the strategies, mainly including bioprinting and microfabrication, which allow for fabrication of biomimetic vascular models that will potentially serve to supplement the conventional animal models for convenient investigations of endovascular interventions. Besides normal blood vessels, those in diseased states, such as thrombosis, may also be modeled by integrating cues that simulate the microenvironment of vascular disorders. These novel engineering strategies for the development of biomimetic in vitro vascular structures will possibly enable unconventional means of studying complex endovascular intervention problems that are otherwise hard to address using existing models.

scholarly journals A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fu Wang ◽  
Yan Wang ◽  
Jinye Dong ◽  
Yu He ◽  
Lianxin Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Shoulder Joint ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Anterolateral Approach ◽  
Proximal Humerus Fractures ◽  
Locking Plate Fixation ◽  
Humerus Fractures

Abstract Background and hypothesis The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column. Materials and methods We performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12 months postoperatively. Results There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10° in any direction), screw cutout, nonunion, or deep infection occurred. Conclusions The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.

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