Outcome of Pertrochanteric Femur Fractures with Proximal Femur Locking Compression Plate

Background: Fractures of the proximal femur, including fractures affecting the pertrochanteric region, have become a public health problem. Owing to aging of the population, we have to operate on even more elderly patients who sometimes present with significant co-morbidities. Although conventional implants have given good results in stable peritrochanteric fractures, proximal femur locking compression plate (PFLCP) which has been recently introduced is better suited for comminuted, unstable pertrochanteric fractures and osteoporotic bones. In PF-LCP, bone-implantconstruct so formed is mechanically stable and fixation failure due to screw loosening in osteoporotic bone can be reduced. Materials &Methods: This prospective study was conducted in our institute and was approved by local ethical committee. Twenty-five consecutive patients of either sex with age more than 60 years (range, 60-84) having pertrochanteric fractures were operated upon with PFLCP. A.O classification was followed in the study and Singh’s index for osteoporosis was calculated. Operating time, blood loss and any technical difficulty with the implant were recorded. Patients were followed clinically and radiologically for union at fracture site and implant-related complications for a period of 24 months. The Harris Hip Score was used to document hip functions at final follow-up. Observations: Amongst the 25 patients, the average operation time in our study was 66.60±10.57 minutes. The average radiological union was 3.40±0.63 months (13.6 weeks). Average time for full weight bearing was 13.12±1.90 weeks. There were two cases of wound infection, one case of coxa vara and one case of a proximal screw back-out. There was no case of plate lift or screw breakage. There was no case of non-union. Conclusion: The PFLCP can be a feasible alternative to the treatment of peritrochanteric fractures. Treatment with PFLCP can provide good-to-excellent healing in osteoporotic bones having comminuted and unstable peritrochanteric fractures, with a limited occurrence of complications.

Functional and radiological outcomes of distal humerus fractures treated with pre-contoured locking compression plate

<p><strong>Background: </strong>Distal humerus intra-articular fractures are one of the complicated fractures managed by orthopaedic surgeons. We did a prospective and a retrospective study on 21 patients with these fractures treated with pre-contoured locking compression plate.</p><p><strong>Methods: </strong>The<strong> </strong>21 patients in this series were followed for a minimum of 1 year. The prospective study cases were followed at 3 months, 6 months and annually. The rating system of the Mayo elbow functional scoring system was used. The radiological evaluation was done using standard AP and lateral views.<strong></strong></p><p><strong>Results: </strong>We had 14 patients with range of motion of 50-100 degrees. There was only one patient with range of motion of &lt;50 degrees. 6 patients had the maximum range motion of &gt;100 degrees. We had 6 (23.57%) excellent, 9 (42.85%) good, 5 (23.80%) fair and 1 (4.7%) poor in the Mayo elbow scoring at the end of 1 year. We were able to compare our outcomes with a study done by Kumar et al done in 2017. They had 27 (89.66%) of excellent and good results as opposed to 27 (79.4%) in our study. Out of 21 patients in our study 17(80.95%) patients had good 11 (52.5%) / excellent 6 (28.5%) results. This was comparable with Jupiter et al. His study of 34 patients 26 (79.40/0) patients showed good 14 (41%) / excellent 13 (38.4%) result.<strong></strong></p><p><strong>Conclusions: </strong>Pre-contoured locking compression plate appears to be technically an ideal implant for comminuted osteoporotic bone providing an angle stable construct.</p>

Effectiveness of laddered embossed structure in a locking compression plate for biodegradable orthopaedic implants

Locking compression plate (LCP) has conventionally been the most extensively employed plate in internal fixation bone implants used in orthopaedic applications. LCP is usually made up of non-biodegradable materials that have a higher mechanical capability. Biodegradable materials, by and large, have less mechanical strength at the point of implantation and lose strength even more after a few months of continuous degradation in the physiological environment. To attain the adequate mechanical capability of a biodegradable bone implant plate, LCP has been modified by adding laddered – type semicircular filleted embossed structure. This improved design may be named as laddered embossed locking compression plate (LELCP). It is likely to provide additional mechanical strength with the most eligible biodegradable material, namely, Mg-alloy, even after continuous degradation that results in diminished thickness. For mechanical validation and comparison of LELCP made up of Mg-alloy, four-point bending test (4PBT) and axial compressive test (ACT) have been performed on LELCP, LCP and continuously degraded LELCP (CD-LELCP) with the aid of finite element method (FEM) for the assembly of bone segments, plate and screw segments. LELCP, when subjected to the above mentioned two tests, has been observed to provide 26% and 10.4% lower equivalent stress, respectively, than LCP without degradation. It is also observed mechanically safe and capable of up to 2 and 6 months of continuous degradation (uniform reduction in thickness) for 4PBT and ACT, respectively. These results have also been found reasonably accurate through real-time surgical simulations by approaching the most optimal mesh. According to these improved mechanical performance parameters, LELCP may be used or considered as a viable biodegradable implant plate option in the future after real life or in vivo validation.

Distal 3rd Diaphysial Fracture of Humerus Fixed with Dynamic Compression Plate Using Posterior Approach- The Assessment of the Outcome

Objectives: The effectiveness of open reduction and Dynamic Compression Plate (DCP) fixation with or without autogenous bone grafting using the posterior midline approach in the treatment of distal third diaphyseal humeral fractures was assessed. Methods: For humeral nonunion, comminuted fractures, or early failure of conservative therapies, 33 patients (24 men, 9 women; mean age 37 years; range 20 to 60 years) were operated on. The study was carried out at Dhaka Medical College Hospital (DMCH), Dhaka from July 2005 to December 2006. Results: After an average of 17 weeks, all of the patients had union (range 14 to 26 weeks).There was no deep infection, nonunion, malunion, implant failure, or nerve injury in any of the patients. In two cases, transient radial nerve palsy occurred. Minor infections were seen in four of the individuals. All of the patients were pain-free after surgery.The functional outcome was outstanding in all instances and good in 16 patients, yielding 87 % satisfying results. Functional outcomes increased considerably postoperatively compared to preoperatively (p<0.001). In 20 individuals, the range of motion of the shoulders was great. The range of motion at the elbow was considerable in 21 patients and moderate in seven others. More than three-quarters of the patients (75.8%) experienced no problems. Four patients (12.1%) were infected, and two patients (6.1%) developed iatrogenic radial nerve palsy as a result of the surgery. One patient (3%) had a loose screw, while another (3%) needed blood transfusions owing to extensive bleeding at the donor graft site. Conclusion: In distal third humeral fractures, open reduction and posterior DCP fixing, with or without autogenous bone grafting, is a safe and effective treatment option, especially when there is no infection or bony or neurovascular damage. Very few study conducted on distal 3rd diaphysial fracture of humerus fixed with DCP using posterior approach, therefore this study conducted to know the assessment of the outcome.

Reverse Contralateral Distal Femoral Locking Compression Plate for Subtrochanteric Femoral Fractures: A Comparative Retrospective Study with Cephalomedullary Nail and Technical Note

Background: Cephalomedullary nails (CMN) have been proven to be the implant of choice in Subtrochanteric Femoral Fractures. The reverse contralateral distal femoral locking compression plate (DF-LCP) is an alternative fixation in cases that are unsuitable for nailing. The comparative studies made of these two fixation techniques are inadequate. Objective: To retrospectively analyze and compare the outcomes of these two fixation techniques and demonstrate the apparent surgical technique for applying the reverse contralateral DF-LCP. Materials and Methods: The present study included patients over 18 years of age diagnosed of subtrochanteric fractures and treated with either DF-LCP or CMN. Retrospective comparative analyses of union time, operative times, estimated blood loss, and complications were conducted from their medical records and serial radiographs. The surgical technique for reverse contralateral DF-LCP fixation is also described in the present study. Results: The present study enrolled 106 eligible patients, in which 33 patients were treated with reverse contralateral DF-LCP, and 73 patients with CMN. There were no significant differences in age, gender, type of fracture, or history of smoking between the two groups. However, there were significant differences in the requirements of the open reduction technique with 26 fractures (78.8%) in the DF-LCP group and 17 fractures (23.3%) in the CMN group (p<0.001). The comparative outcomes of the DF-LCP and CMN groups demonstrated the statistically significant difference in the number of malreductions or malunions, comprising four events (12.1%) and 22 events (30.1%), respectively (p=0.036). There were no statistically significant differences in terms of union time, operative time, and the amounts of estimated blood loss. Conclusion: The reverse contralateral DF-LCP fixation technique demonstrated comparable outcomes in terms of union time, operative time, and blood loss, and was deemed a safe procedure for subtrochanteric femoral fracture. Lower occurrences of malreduction or malunion complication were shown in DF-LCP group. Keywords: Subtrochanteric fracture; Reverse contralateral distal femoral locking compression plate; Cephalomedullary nail