Dynamization at the Near Cortex in Locking Plate Osteosynthesis by Means of Dynamic Locking Screws

Richter, Henning; Plecko, Michael; Andermatt, Daniel; Frigg, R.; Kronen, Peter W; Klein, Karina; Nuss, Katja; Ferguson, Stephen J.; Stöckle, Ulrich; Rechenberg, Brigitte von

doi:10.2106/jbjs.m.00529

Cited by 31 publications

(35 citation statements)

References 38 publications

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“…Results of the present study can be directly correlated with those of two studies that employed the ovine osteotomy model to investigate locking plate dynamization with far cortical locking screws 1 and Dynamic Locking Screws (DLS) (DePuy Synthes) 7 . Standard locked constructs in all three studies caused deficient, asymmetric callus formation, whereby healed tibiae of the locked control groups failed at torsional loads of 28 ± 12 Nm 1 , 27 ± 15 Nm 7 , and 28 ± 25 Nm in the present study.…”

Section: Discussionmentioning

confidence: 76%

“…The resulting osteotomy gap had a controlled width of 3 mm, formed by the distance between the central screw holes in plates, which was 2.4 mm greater than that in the drill template, and by the osteotomy cut of 0.6 mm. For medication, the standard protocol of the ovine fracture model was followed 7,27 . Antibiotic prophylaxis with benzylpenicillin and gentamicin and analgesia with carprofen (4 mg/kg of body weight) and buprenorphine were initiated preoperatively and were continued for four days postoperatively.…”

Section: Animal Modelmentioning

confidence: 99%

“…In the ovine osteotomy model, this routine prophylactic measure is essential to prevent tibial fracture caused by bending loads while allowing axial load-bearing and walking immediately postoperatively 1,7 . Each sheep was housed in a single 2.5-m 2 pen and walked on the first postoperative day.…”

Section: Animal Modelmentioning

confidence: 99%

“…R esearch over the past fifty years has consistently shown that controlled axial dynamization promotes callus formation and improves the speed and strength of fracturehealing [1][2][3][4][5][6][7][8] . For example, Goodship and Kenwright demonstrated that 1-mm axial dynamization delivered more than three times stronger healing and two times faster healing compared with rigid fixation 4 .…”

mentioning

confidence: 99%

“…Clinically, distal femoral fractures stabilized with far cortical locking constructs healed at a mean time of sixteen weeks with a 3% nonunion rate 18 . Far cortical locking has been implemented in commercial implants 7,[19][20][21][22] and has been simulated using standard locking screws by means of overdrilling 14 or slotting 23 of the near cortex.…”

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confidence: 99%

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Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing

Bottlang

Tsai

Bliven

et al. 2016

The Journal of Bone and Joint Surgery

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Background: Axial dynamization of fractures can promote healing, and overly stiff fixation can suppress healing. A novel technology, termed active plating, provides controlled axial dynamization by the elastic suspension of locking holes within the plate. This prospective, controlled animal study evaluated the effect of active plates on fracture-healing in an established ovine osteotomy model. We hypothesized that symmetric axial dynamization with active plates stimulates circumferential callus and delivers faster and stronger healing relative to standard locking plates. Methods: Twelve sheep were randomly assigned to receive a standard locking plate or an active locking plate for stabilization of a 3-mm tibial osteotomy gap. The only difference between plates was that locking holes of active plates were elastically suspended, allowing up to 1.5 mm of axial motion at the fracture. Fracture-healing was analyzed weekly on radiographs. After sacrifice at nine weeks postoperatively, callus volume and distribution were assessed by computed tomography. Finally, to determine their strength, healed tibiae and contralateral tibiae were tested in torsion until failure. Results: At each follow-up, the active locking plate group had more callus (p < 0.001) than the standard locking plate group. At postoperative week 6, all active locking plate group specimens had bridging callus at the three visible cortices. In standard locking plate group specimens, only 50% of these cortices had bridged. Computed tomography demonstrated that all active locking plate group specimens and one of the six standard locking plate group specimens had developed circumferential callus. Torsion tests after plate removal demonstrated that active locking plate group specimens recovered 81% of their native strength and were 399% stronger than standard locking plate group specimens (p < 0.001), which had recovered only 17% of their native strength. All active locking plate group specimens failed by spiral fracture outside the callus zone, but standard locking plate group specimens fractured through the osteotomy gap. Conclusions: Symmetric axial dynamization with active locking plates stimulates circumferential callus and yields faster and stronger healing than standard locking plates. Clinical Relevance: The stimulatory effect of controlled motion on fracture-healing by active locking plates has the potential to reduce healing complications and to shorten the time to return to function.

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Section: Discussionmentioning

confidence: 76%

Section: Animal Modelmentioning

confidence: 99%

Section: Animal Modelmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing

Bottlang

Tsai

Bliven

et al. 2016

The Journal of Bone and Joint Surgery

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Virtual mechanical tests out‐perform morphometric measures for assessment of mechanical stability of fracture healing in vivo

Schwarzenberg

Klein

Ferguson

et al. 2020

Journal Orthopaedic Research

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Finite element analysis with models derived from computed tomography (CT) scans is potentially powerful as a translational research tool because it can achieve what animal studies and cadaver biomechanics cannot-low-risk, noninvasive, objective assessment of outcomes in living humans who have actually experienced the injury, or treatment being studied. The purpose of this study was to assess the validity of CT-based virtual mechanical testing with respect to physical biomechanical tests in a large animal model. Three different tibial osteotomy models were performed on 44 sheep. Data from 33 operated limbs and 20 intact limbs was retrospectively analyzed. Radiographic union scoring was performed on the operated limbs and physical torsional tests were performed on all limbs. Morphometric measures and finite element models were developed from CT scans and virtual torsional tests were performed to assess healing with four material assignment techniques. In correlation analysis, morphometric measures and radiographic scores were unreliable predictors of biomechanical rigidity, while the virtual torsion test results were strongly and significantly correlated with measured biomechanical test data, with high absolute agreement. Overall, the results validated the use of virtual mechanical testing as a reliable in vivo assessment of structural bone healing. This method is readily translatable to clinical evaluation for noninvasive assessment of the healing progress of fractures with minimal risk. Clinical significance: virtual mechanical testing can be used to reliably and noninvasively assess the rigidity of a healing fracture using clinical-resolution CT scans and that this measure is superior to morphometric and radiographic measures.

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Locked Plating

Lowe¹

2020

Essential Biomechanics for Orthopedic Trauma

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Dynamization at the Near Cortex in Locking Plate Osteosynthesis by Means of Dynamic Locking Screws

Cited by 31 publications

References 38 publications

Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing

Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing

Virtual mechanical tests out‐perform morphometric measures for assessment of mechanical stability of fracture healing in vivo

Locked Plating

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