External Fixation Using a Locking Plate

Zhang, Jingwei; Ebraheim, Nabil A.; Li, Ming; He, Xianfeng; Liu, Jiayong; Zhu, Limei; Yu, Yihui; Siddiqui, Saaid

doi:10.1097/bot.0000000000000377

Cited by 14 publications

(8 citation statements)

References 22 publications

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“…LCP has been successfully used in open or closed distal tibial fractures and shown good rates of union and ankle-joint motion [8–11] due to the use of angular stable anchoring of screws in the plate, which enables LCP to stabilize the short distal tibial segment without spanning the ankle joint. However, the stability of LCP as an external fixator was questioned by several studies [12–14] based on the fact that stiffness of compression and torsion of plate would be significantly reduced when the distance between the plate and the bone surface was above 5 mm [12].…”

Section: Introductionmentioning

confidence: 99%

Stiffness of the locking compression plate as an external fixator for treating distal tibial fractures: a biomechanics study

Liu

Yang

Kong

et al. 2017

BMC Musculoskelet Disord

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BackgroundLocking compress plate, as external fixator, is an attractive technique for distal tibial fracture treatment. But it still remains unclear whether the external LCP has sufficient stiffness. Thus, the present study aims to make a comprehensive evaluation of the stiffness of external locking compress plate when it is used as an external fixator in distal tibial fractures treatment.MethodsComposite tibia was used to simulate distal tibia fracture (Orthopedic Trauma Association type 43 A3 fracture). The fractures were stabilized with medial distal tibial locking compress plates (LCP group), medial distal tibial locking compress plates with 30-mm plate-bone distances (EF-tibia group), and medial distal femur locking compress plates with 30-mm plate-bone distances (EF-femur group). Stiffness of each configuration was measured under axial compression loading and in axial torsion loading directions. Compression stiffness and torsional rigidity were compared across different groups.ResultsCompared with LCP group, (1) EF-tibia group showed significantly lower (p < 0.001) compression stiffness and torsional rigidity; (2) EF-femur group showed significantly lower (p < 0.001) compression stiffness, but significantly higher (p < 0.001) torsional rigidity.ConclusionsThe results indicated that locking compress plate as an external fixator was flexible, and the distal femur locking compress plate was preferred over the distal tibial locking compress plate to be an external fixator in distal tibia fracture treatment.

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Section: Introductionmentioning

confidence: 99%

Stiffness of the locking compression plate as an external fixator for treating distal tibial fractures: a biomechanics study

Liu

Yang

Kong

et al. 2017

BMC Musculoskelet Disord

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“…7,29,30 However, the most common region is the tibia. 2,4-6,8,31,32 Our experience with the externalised LCP as an external fixator is also in the tibia. There have been several comparisons made between the externalised LCP and traditional external fixators.…”

Section: Discussionmentioning

confidence: 99%

Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness

Ang

Chen

Yew

et al. 2017

Bone & Joint Research

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ObjectivesExternal fixators are the traditional fixation method of choice for contaminated open fractures. However, patient acceptance is low due to the high profile and therefore physical burden of the constructs. An externalised locking compression plate is a low profile alternative. However, the biomechanical differences have not been assessed. The objective of this study was to evaluate the axial and torsional stiffness of the externalised titanium locking compression plate (ET-LCP), the externalised stainless steel locking compression plate (ESS-LCP) and the unilateral external fixator (UEF).MethodsA fracture gap model was created to simulate comminuted mid-shaft tibia fractures using synthetic composite bones. Fifteen constructs were stabilised with ET-LCP, ESS-LCP or UEF (five constructs each). The constructs were loaded under both axial and torsional directions to determine construct stiffness.ResultsThe mean axial stiffness was very similar for UEF (528 N/mm) and ESS-LCP (525 N/mm), while it was slightly lower for ET-LCP (469 N/mm). One-way analysis of variance (ANOVA) testing in all three groups demonstrated no significant difference (F(2,12) = 2.057, p = 0.171).There was a significant difference in mean torsional stiffness between the UEF (0.512 Nm/degree), the ESS-LCP (0.686 Nm/degree) and the ET-LCP (0.639 Nm/degree), as determined by one-way ANOVA (F(2,12) = 6.204, p = 0.014). A Tukey post hoc test revealed that the torsional stiffness of the ESS-LCP was statistically higher than that of the UEF by 0.174 Nm/degree (p = 0.013). No catastrophic failures were observed.ConclusionUsing the LCP as an external fixator may provide a viable and attractive alternative to the traditional UEF as its lower profile makes it more acceptable to patients, while not compromising on axial and torsional stiffness.Cite this article: B. F. H. Ang, J. Y. Chen, A. K. S. Yew, S. K. Chua, S. M. Chou, S. L. Chia, J. S. B. Koh, T. S. Howe. Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness. Bone Joint Res 2017;6:216–223. DOI: 10.1302/2046-3758.64.2000470.

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“…LCPs have recently been used as a substitute for traditional external fixators, and have proved to be a highly popular alternative in the management of open fracture [ 12 – 16 ], infected nonunion [ 8 – 10 , 17 , 22 ], and even closed fracture of the tibia [ 11 , 23 , 24 ]. Locking screws can lock directly into the plate to obtain a stable connection instead of relying on friction between the plate and the bone, which is similar to the principle of external fixation.…”

Section: Discussionmentioning

confidence: 99%

A locking compression plate as an external fixator for treating infected nonunion of the humeral diaphysis

et al. 2016

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BackgroundInfected nonunion of the humeral diaphysis is a challenging problem for orthopedic surgeons. This study aimed to evaluate the outcome of using a locking compression plate (LCP) as a definitive external fixator in the management of infected nonunion of the humeral diaphysis after failure of internal fixation.MethodsWe retrospectively reviewed a series of seven patients with infected nonunion of the humeral diaphysis treated with an LCP as an external fixator between June 2010 and August 2014. There were five males and two females, with an average age of 40.9 years. Six out of seven patients had been definitively diagnosed with infection due to known bacteria by germiculture. The clinical and radiographic outcomes were retrospectively evaluated.ResultsAll patients were followed-up for a mean period of 26.3 months (range 12–48 months). All fractures obtained complete bone union, and the average time to bone union was 7.9 months (range 3.5–15 months). All infections were eventually resolved without any recurrence of deep infection. Pin tract infection was only seen in one case. Only one patient had transient radial nerve palsy after surgery for traction. The average shortening length of the affected upper limb was 3 cm (range 2–4 cm) compared with the contralateral limb. At the last follow-up, the average Disabilities of the Arm, Shoulder and Hand score of the involved limbs was 3.2 (range 0–13.4). All patients obtained excellent or good functional results, and returned to their original work.ConclusionsThe novel use of an LCP as a definitive external fixator was an effective method for treating infected nonunion of the humeral diaphysis. However, a large-scale prospective clinical study is still needed to verify these findings.

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External Fixation Using a Locking Plate

Cited by 14 publications

References 22 publications

Stiffness of the locking compression plate as an external fixator for treating distal tibial fractures: a biomechanics study

Stiffness of the locking compression plate as an external fixator for treating distal tibial fractures: a biomechanics study

Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness

A locking compression plate as an external fixator for treating infected nonunion of the humeral diaphysis

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