Fig 7 - uploaded by Je-Hyun Yoo
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(A, B) A 74-year-old female with long spiral fracture of the distal femur with the fracture extension into a lateral femoral condyle (black arrow). (C) The fracture was fixed with LCP using MIPO technique. (D) Two months after surgery, she slipped down and peri-plate fracture occurred at the proximal end screw site. LCP: Locking compression plate, MIPO: Minimal invasive percutaneous plate osteosynthesis.
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Objective
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Citations
... The restriction in the normal movement of the locked plating is advantageous because it exerts no or minimal compression on the periosteal vessels. However, locked plating does not achieve bone traction along the transcortical direction by screw fixation (9)(10)(11)(12)(13). In contrast, the use of bicortical fixation is limited in proximal humerus fractures because the proximal screws for the locked plating are directed to the articular cartilage. ...
... Lee et al. 10.3389/fsurg.2024.1333670 ...
Introduction
Bicortical screw fixation, which penetrates and fixes the near and far cortex of bone, has been conventionally used to achieve compressive fixation for fracture using screws. Open reduction and internal fixation using the locking plate are widely used for treating proximal humerus fractures. However, minimal contact between the bone and the locking plate can lead to an insufficient reduction. Theoretically, a dual-lead locking screw with different leads for the screw head and body could enhance the reduction and fixation stability of fragments in proximal humeral fractures without bicortical fixation, and achieve additional compression at the bone-plate-screw interface. This study assessed the insertion mechanics of the lead ratio of the dual-lead locking screw and its effect on the fixation stability of the proximal humerus fracture.
Methods
A Multi-Fix® locking plating system composed of ∅ 3.5 mm locking screws and a locking plate was used to make a locked plating for Sawbone bone blocks and fourth-generation composite humeri. Two different types of Sawbone bone blocks were used to simulate the osteoporotic (10 PCF) and normal cancellous (20 PCF) bones. The lead of the screw head thread (Lhead) was 0.8 mm, and that of the screw body (Lbody) was 0.8, 1.25, 1.6, 2.0, and 2.4 mm, whose lead ratios (Rlead=Lbody/Lhead) were 1.0, 1.56, 2.0, 2.5, and 3.0, respectively.
Results
The dual-lead locking screw elevated the compression between the locking plate and the bone. The elevation in the compression due to the dual-lead thread became weaker for the cancellous bone when the lead of the screw body was more than twice that of the screw head. The plate/humerus compression with strong bone quality withstood higher dual-lead-driven compression.
Discussion
A dual-lead locking screw of Lbody=1.25mm (Rlead=1.56) is recommended for maximum rotational stability for the locked humerus plating. The screws with over Lbody=1.6mm (Rlead=2) have no advantage in terms of the failure torque and maximum torsional deformation. Any locking dual-lead screw with a body thread lead of <1.6 mm (Rlead=2) can be used without the risk of bone crush when surgeons require additional compression to the locked cancellous bone plating.
Introduction: Studies conducted on forearm bone diaphysis nonunion are limited due to the rarity of this condition. The present study aimed to evaluate the outcome of our technique using autologous iliac corticocancellous bone graft fixed by locking plate system for the forearm bone diaphyseal nonunion without infection.
Patients and methods: We treated eight patients with nonunion of radial or ulnar shaft fracture (four men, four women) aged 38 years (range: 18 – 52 years) on average. The average follow-up period was 18 months (range: 12 – 24 months). In our technique, we applied the locking plate to the diaphyseal bone fragment, before grafting the bone block to the nonunion site. After excision of sclerotic ununited bone, the autologous iliac corticocancellous bone was grafted to the defect and fixed with single locking screw. Pain, grip strength, and disabilities of the arm, shoulder, and hand (DASH) score were measured and compared before and 12 months after the surgery. Radiographs were taken at each follow-up, and the time of bony union was determined.
Results: The mean time to radiological union was 4.2 months (range: 3 – 6 months), and bony union was achieved in all cases within 6 months. All measured values, visual analog scale, DASH score, and grip strength, were significantly improved at 12 months after surgery (p < 0.05). No minor/major complications including infection, nonunion, or malunion were reported.
Conclusions: Locking compression plate fixation and autologous iliac corticocancellous bone grafting with a holding locking screw appears to be a reliable primary procedure for nonunion of the forearm diaphyseal fracture without infection.
Level of evidence: IV; Therapeutic study
Introduction/Objective. Subtrochanteric fractures are unstable, tending to a varus, antecurvatum, and shortening deformity. The aim of this paper was to compare operation time and fluoroscopy time between different internal fixation methods in the treatment of subtrochanteric fractures. Method. The prospective study of the group of 27 patients with a subtrochanteric fracture treated by the SIF (selfdynamisable internal fixator with a trochanteric unit) method had been done. Operation time and fluoroscopy time values from this group were compared to the same parameters data from the literature for intramedullary (IM) nails, proximal femur locking plates (PF-LCP), dynamic condylar screws (DCS), and the 95?-angled blade plate. Results. In the SIF group, operation time was 62.2 (25?140) minutes and fluoroscopy time was 43 (20?95) s. Average operation time from the literature data was: 102.1 (43?181) minutes for IM nail, 94.2 (75?129) minutes for PF-LCP, 105.3 (70?166) minutes for DCS and 221.5 (171?272) minutes for blade plate. Average fluoroscopy time from the literature data was: 109.6 (34?250) seconds for IM nail, 102.3 (47?180) seconds for PF-LCP, 238 seconds for DCS. Operation time and intraoperative fluoroscopy time were higher in IM nail, PF-LCP, DCS and blade plate comparing to SIF method (p
