No abstract

A locking compression plate (LCP) can serve as an external fixation for fractured tibia. However, there is concern about the stability and endurance during partial weight bearing. This study was experimentally evaluated the effects of fracture gap sizes (1, 5, and 10 mm) on the stability and endurance of fractured tibia externally fixed with a 316L-stainless LCP. For stable fractured tibia (1-mm fracture gap), the large contact area of fracture surfaces resulted in nearly similar stiffness to that of intact tibia. The partial weight bearing is therefore possible. Whereas smaller contact area and no contact of fracture surfaces were observed for tibias with 5-mm and 10-mm fracture gaps, respectively. Their stiffnesses were significantly lower than those of intact tibia and tibia with 1-mm fracture gap. Thus, the partial weight bearing should be considered carefully in early phase of treatment. All LCP-tibial models were cyclically loaded beyond 500,000 cycles, that is, approximately 6 months of healing, without any failure of LCP. Thus, the failure of LCP is unlikely a critical issue for the present cases.

The effects of locking screw position (long column fixation—long distance between the nearest screws to the fracture—and short column fixation—short distance between the nearest screws to the fracture) and fracture gap size (1-mm and 8-mm transverse fracture gap) on stiffness and fatigue of fractured femur fixed with a locking compression plate (LCP) were biomechanically evaluated. The stiffness of 1-mm fracture gap models and that of intact femoral model were in the range of 270–284 N/mm, while those of 8-mm fracture gap models were significantly lower (155–170 N/mm). After 1,000,000 cycles of loading, no fracture of LCP of 1-mm fracture gap models fixed in either long column or short column fashions occurred. On the other hand, the complete fractures of LCPs of 8-mm fracture gap models fixed in long column and short column fashions occurred after 51,500 and 42,000 cycles of loading, respectively. These results suggest that the full weight loading may be allowed for the patient with 1-mm transverse femoral fracture fixed with an LCP. On the other hand, the full load of walking should be avoided for the patient with 8-mm transverse femoral fracture fixed with an LCP before adequate healing.

Open clavicle fracture is an uncommon injury mostly caused by severe direct trauma. It is often associated with multiple organ injuries. Generally, surgical intervention with debridement and fracture repair is always indicated in order to prevent infection, non-union, and malalignment. In situations of bony exposure and significant contamination concomitant with severe soft tissue damage, the external fixation is the treatment of choice because of the possibility it offers of providing stable fixation with minimal local tissue damage resulting in excellent union rates and better soft tissue outcome. Nevertheless, traditional external fixation encountered some potential problems as its bulkiness and sharp edges caused discomfort to the patient. In this study, we present an interesting case of a polytraumatized patient with a gunshot injury with complex open clavicle fracture that was successfully treated with external fixation using reconstruction with a locking compression plate as definitive treatment.

Vascular injuries following intertrochanteric fracture have been sporadically reported. Despite its rare occurrence, this complication can be potentially life and limb threatening. The authors report an unusual presentation of false aneurysm of profunda femoris artery following an intertrochanteric fracture with marked displacement of lesser trochanter fragment. The patient presented with thigh swelling and unexplainable dropped hematocrit. Surgical exploration and vascular repair were done. It is essential for the surgeon to be aware of possible associated vascular injuries in intertrochanteric fracture, particularly in fracture with lesser trochanter fragment.