Current concepts to reduce mechanical stiffness in locked plating systems: a review article

Nanavati, Nikhil; Walker, M. Martin

doi:10.2147/orr.s66014

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…With increasing reports of asymmetric/insufficient callus formation and delayed/non-union with locking plates, systems have been developed to make the locking constructs more dynamic by overdrilling the near cortex, use of far cortical locking (FCL) screws, or use of www.traumainternational.co.in Agrawal A dynamic locking screws [25]. Biomechanical studies comparing the stiffness and strength of these constructs in distal femur fractures are awaited.…”

Section: Dynamic Locked Platesmentioning

confidence: 99%

Distal femur AO type A fractures – Surgical options, techniques, results and complications

Agrawal¹

2016

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Background: Distal femur fractures are challenging injuries, frequently resulting in complications like non-unions, malunions, knee stiffness and infections. This article reviews the current concepts in the surgical management of extra-articular (AO/OTA type A) fractures of the distal femur, with an evidence-based approach. The role of newer and emerging techniques is also briefly discussed. Keywords: Supracondylar fractures of femur, AO type A fractures of distal femur, extra-articular fractures of distal femur, current concepts in distal femur fractures, recent advances in distal femur fractures.

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Section: Dynamic Locked Platesmentioning

confidence: 99%

Distal femur AO type A fractures – Surgical options, techniques, results and complications

Agrawal¹

2016

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Cyclic Damage Accumulation in the Femoral Constructs Made With Cephalomedullary Nails

Hamandi

Whitney

Stouffer

et al. 2021

Front. Bioeng. Biotechnol.

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Background: The purpose of this study was to evaluate the risk of peri-prosthetic fracture of constructs made with cephalomedullary (CM) long and short nails. The nails were made with titanium alloy (Ti-6Al-4V) and stainless steel (SS 316L).Methods: Biomechanical evaluation of CM nail constructs was carried out with regard to post-primary healing to determine the risk of peri-implant/peri-prosthetic fractures. Therefore, this research comprised of, non-fractured, twenty-eight pairs of cadaveric femora that were randomized and implanted with four types of fixation CM nails resulting in four groups. These constructs were cyclically tested in bi-axial mode for up to 30,000 cycles. All the samples were then loaded to failure to measure failure loads. Three frameworks were carried out through this investigation, Michaelis–Menten, phenomenological, and probabilistic Monte Carlo simulation to model and predict damage accumulation.Findings: Damage accumulation resulting from bi-axial cyclic loading in terms of construct stiffness was represented by Michaelis–Menten equation, and the statistical analysis demonstrated that one model can explain the damage accumulation during cyclic load for all four groups of constructs (P > 0.05). A two-stage stiffness drop was observed. The short stainless steel had a significantly higher average damage (0.94) than the short titanium nails (0.90, P < 0.05). Long titanium nail group did not differ substantially from the short stainless steel nails (P > 0.05). Results showed gender had a significant effect on load to failure in both torsional and bending tests (P < 0.05 and P < 0.001, respectively).Interpretation: Kaplan–Meier survival analysis supports the use of short titanium CM nail. We recommend that clinical decisions should take age and gender into consideration in the selection of implants.

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Treatment of Fractures of the Distal Third of Tibia Diaphysis by MIPO Technique

Schwarz¹,

Majerníček²,

Chomiak³

2020

ACHOT

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PURPOSE OF THE STUDY MIPO (Minimally Invasive Plate Osteosynthesis) technique is currently a commonly used method to treat fractures of the distal third of tibia diaphysis. At the same time, it is just like other methods accompanied by a relatively high complication rate. The purpose of this study was to determine whether the use of this technique at our department is effective and whether the complication rate does not differ considerably from values reported by literature. MATERIAL AND METHODSIn the period 2014-2016, minimally invasive plate osteosynthesis was performed in a total of 42 patients, who had suffered a fracture of the distal third of tibia diaphysis. They sustained a low-energy trauma. The mean age of patients was 50 years (range 27-86 years) and the mean follow-up period was 11.8 months (range 1.5-38 months). All the patients were treated with a minimally invasive technique with the use of subcutaneous LCP. In 41 patients (98%) it was inserted via anteromedial approach. In one patient only (2%), the LCP was inserted via anterolateral approach due to the unfavourable local finding on the medial side of the distal lower limb. RESULTSOf the total number of operated patients, 35 patients (83%) underwent surgery within 24 hours of injury, including two patients in whom an external fixator was used. The mean operative time was 61 minutes (range of 30-150 minutes). The primary healing occurred in 93% of patients with radiological signs of healing within 5.6 months on average (range of 1.5-16 months). Time to full weight bearing was 4.2 months on average (range of 1.5-16 months). Delayed healing was observed in four patients. In three patients, a non-union developed, necessitating revision surgery. Infectious complications were reported in seven patients, in three of whom deep wound infection developed. In one case, the chronic infection resulted in a lower limb amputation. In five patients mal-union occurred. DISCUSSIONThe outcomes achieved by the authors in treating fractures of the distal third of tibia diaphysis with a minimally invasive technique do not considerably differ from the outcomes reported by other authors in literature. In terms of the outcomes and the complication rate, the MIPO method is comparable to the treatment of these fractures with the use of nails. Limiting for fracture healing is the vascular supply. Therefore, in treating these injuries it is necessary to proceed with minimum invasiveness and carefulness and to seek to limit any additional trauma to soft tissues, thus also to vascular supply. In case of syndesmosis failure, the concurrent treatment of distal fibula fractures is clearly indicated. In case of intact syndesmosis, fibular osteosynthesis and the sequence of procedures are to be decided by the surgeon. At present, rigid osteosynthesis is being abandoned for potential slower healing up to development of non-unions. CONCLUSIONSThe treatment of fractures of the distal third of tibia diaphysis remains an unsolved issue despite the development of stateof-the art materials...

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Current concepts to reduce mechanical stiffness in locked plating systems: a review article

Cited by 4 publications

References 15 publications

Distal femur AO type A fractures – Surgical options, techniques, results and complications

Distal femur AO type A fractures – Surgical options, techniques, results and complications

Cyclic Damage Accumulation in the Femoral Constructs Made With Cephalomedullary Nails

Treatment of Fractures of the Distal Third of Tibia Diaphysis by MIPO Technique

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