Dynamic locked plating for fixation of distal femur fractures using near- cortical over-drilling: Preliminary results of a prospective observational study

Galal, Sherif

doi:10.1016/j.jcot.2017.07.004

Cited by 10 publications

(14 citation statements)

References 14 publications

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“…Besides, the overdrilling of the near cortex allows an axial toggling of the screw shaft in the near cortex bone hole, which enhances a more elastic plate fixation with rather parallel axial movements of the bone fragments and reduced shear motions at the fracture site. This was not investigated in the current study, however, previous work reported that overdrilling of the near cortex fostered callus formation and bone healing in a first case series of distal femur fractures . Therefore, those expected benefits of the LagLoc fixation, together with its potentially better overall stability, can justify the use of an additional instrument and one locking screw instead of a cheaper lag screw, compared to the locking plate technique with the use of a compression screw through a plate hole.…”

Section: Discussionmentioning

confidence: 85%

LagLoc—a new surgical technique for locking plate systems

Triana

Gueorguiev

Sommer

et al. 2018

Journal Orthopaedic Research

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Treatment of oblique and spiral fractures remains challenging. The aim of this study was to introduce and investigate the new LagLoc technique for locked plating with generation of interfragmentary compression, combining the advantages of lag screw and locking-head-screw techniques. Oblique fracture was simulated in artificial diaphyseal bones, assigned to three groups for plating with a seven-hole locking compression plate. Group I was plated with three locking screws in holes one, four, and seven. The central screw crossed the fracture line. In group II the central hole was occupied with a lag screw perpendicular to fracture line, whereas holes one and seven were occupied with locking screws. Group III was instrumented applying the LagLoc technique as follows. Hole four was predrilled perpendicularly to the plate, followed by overdrilling of the near cortex and insertion of a locking screw-crossing the fracture line-whose head was covered by a holding sleeve to prevent temporarily the locking in the plate hole and generate interfragmentary compression. Subsequently, the screw head was released and locked in the plate hole. Holes one and seven were occupied with locking screws. Interfragmentary compression in the fracture gap was measured using pressure sensors. All screws in the three groups were tightened with 4 Nm torque. Interfragmentary compression in group I (167 ± 25 N) was significantly lower in comparison to groups II (431 ± 21 N) and III (379 ± 59 N), p ≤ 0.005. The difference in compression between groups II and III remained not significant (p = 0.999). The new LagLoc technique offers an alternative tool to generate interfragmentary compression with the application of locking plates by combining the biomechanical advantages of lag screw and locking screw fixations. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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Section: Discussionmentioning

confidence: 85%

LagLoc—a new surgical technique for locking plate systems

Triana

Gueorguiev

Sommer

et al. 2018

Journal Orthopaedic Research

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“…No other complications were reported. Galal (2017). In Ziran et al study of thirtyive patients, there was also a male preponderance seen and the meantime to fracture union was 16 weeks.…”

Section: Resultsmentioning

confidence: 94%

Evaluation of functional outcome following ORIF with Distal femoral locking plate in Intraarticular fractures of the distal femur

Subash¹,

Damodharan²,

Vishnu³

2021

ijrps

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Fractures of the distal femur are high-velocity injuries and are associated with factors such as fracture comminution and osteoporosis, especially in elderly individuals which are quite challenging to manage. Various implants and techniques are available for the surgical management of these fractures. This study was performed to evaluate the functional outcome of these fractures following ORIF (Open reduction and internal fixation) with the DFLP (Distal femoral locking plate). Thirty patients with distal femoral intraarticular fractures who presented between February 2013 to February 2016 were managed by ORIF with DFLP and were followed up for three years. Functional evaluation was performed using the Neers scoring system. The average age of the patients was 38.06 years ranging from 22 to 64 years. There were twenty-one males, and nine females seen in our study with the right side being more commonly affected. We achieved a 100% union rate in our series with the meantime to fracture union being 12.86 weeks. We had excellent results in 65% of patients and satisfactory results in 35% of patients with minimal complications. ORIF with the DFLP is a unique biological fixation option in intraarticular fractures of the distal femur, and it provides for reasonable rates of fracture union and an excellent functional outcome with minimal complications.

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“…Near-cortical over-drilling allows for some motion between the screw and the near-cortex, decreasing construct stiffness, but with no difference in fixation stability. 21 24 Since Group 1 had a hole size in the near-cortex 0.5 mm larger than the screw size, this probably was not adequate to influence the load supported by the constructs. In contrast, the hole size 1 mm larger than the screw size in Group 3 showed increased maximum load and decreased deflection compared with Group 2, thus, suggesting that Group 3 supported the highest load with less displacement.…”

Section: Discussionmentioning

confidence: 99%

“…2,4,[19][20][21][22][23][24] The over-drilling technique promotes an increased motion between the near-cortex and screw shaft, which reduces construct stiffness by the conventional locked plate and allows for a more symmetrical axial movement, but with no increased failure under physiological load. 23,24 The speed of bone healing is even more important if one considers free-ranging animals because of the likelihood of reintegration into the wild after treatment. The maned wolf (Chrysocyon brachyurus), which is the largest South American canid, has been designated as Near Threatened by the International Union for the Conservation of Nature because of habitat loss and other threats, including roadkill, retaliation to predation and possible diseases of domestic animals.…”

Section: Introductionmentioning

confidence: 99%

Influence of the Near-Cortical Over-Drilling Technique on the Mechanical Behaviour of Locking Plate Constructs Applied in Maned Wolf's Femur

Siqueira

Rahal

Mesquita

et al. 2022

Vet Comp Orthop Traumatol

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Objective The aim of this study was to evaluate the influence of near-cortical over-drilling holes on the mechanical behaviour of locking plate constructs applied in maned wolf's femur by using mechanical testing and finite element method (FEM). Study Design Seven pairs of adult maned wolves (Chrysocyon brachyurus) femur bones were randomly distributed into four groups. In all groups, a 3.5 mm locking compression plate, designed with 12 combi-holes and one locked, was applied to the lateral surface of the femur. G1 (n = 4) received bicortical locking screws placed in holes 1, 3, 5, 8, 10 and 12. In G2 (n = 5), the plate was applied as used in G1, but the application of the locked screws involved the near-cortical over-drilling technique. In G3 (n = 4), the plate was applied as used in G2, but the size of the near-cortical over-drilling was larger. The combi-holes 6 and 7 were maintained over a 10 mm fracture gap without screws. All constructs were tested for failure in the axial load. The axial load was applied eccentrically to the femoral head. Results Statistical differences were observed in the maximum load with G3 > G1 and G3 > G2, and in the deflection with G2 > G1 and G2 > G3. The FEM showed the lowest total displacement of the bone-plate constructs as well as of the plate in G1 compared with G2 and G3. Conclusion The near-cortical over-drilling technique used in unstable fractures induced in the maned wolf's femur showed by static axial compression test that maximum load and deflection are dependent on drill hole size induced in the near-cortex. Based on FEM, the lowest total displacement of the bone-plate constructs was observed in Group 1.

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Dynamic locked plating for fixation of distal femur fractures using near- cortical over-drilling: Preliminary results of a prospective observational study

Abstract: Dynamic locked plating using near-cortex over-drilling is a simple technique that uses standard locked plates that promotes callus formation when used for fixing distal femur fractures.

Cited by 10 publications

References 14 publications

LagLoc—a new surgical technique for locking plate systems

LagLoc—a new surgical technique for locking plate systems

Evaluation of functional outcome following ORIF with Distal femoral locking plate in Intraarticular fractures of the distal femur

Influence of the Near-Cortical Over-Drilling Technique on the Mechanical Behaviour of Locking Plate Constructs Applied in Maned Wolf's Femur

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