External fixation using locking plate in distal tibial fracture: a finite element analysis

Zhang, Jingwei; Ebraheim, Nabil A.; Li, Ming; He, Xianfeng; Schwind, Joshua; Liu, Jiayong; Zhu, Limei

doi:10.1007/s00590-015-1604-7

Cited by 20 publications

(36 citation statements)

References 18 publications

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“…The differences of samples in LCP group and EF-tibia group were the distance between the bone and the plate, with other factors keeping consistent. The results of the comparison are consistent with previous report that the stiffness decreases with the increase of the bone-plate distance [12], and the distance used in this study, i.e., 30 mm, is the upper bound to keep external platefixation stable in a distal tibia fracture [13]. The bone-plate distances in EF-tibia and EF-femur groups were the same; while the medial distal femur plate had different diameters of the screws and dimensions of the plate from the medial distal tibial plate.…”

Section: Discussionsupporting

confidence: 91%

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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: Discussionsupporting

confidence: 91%

“…Ma et al and Zhang et al investigated the finite element analysis model, but didn’t make a comparison of stiffness between external plating and conventional LCP [9, 13]. Kanchanomai et al and Ahmad et al reported a tibial shaft fracture model, instead of a distal tibial fracture model [12, 14].…”

Section: Discussionmentioning

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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“…Finally, 12 studies [ 3 , 14 – 21 , 23 – 25 ] were included in this systematic review. These consist of 3 pure biomechanical studies, [ 23 – 25 ] 8 case series, [ 3 , 14 , 16 – 21 ] and 1 study including both of biomechanics and case series. [ 15 ] The overall population included 254 patients (112 cases of closed fractures), with 167 males and 87 females.…”

Section: Resultsmentioning

confidence: 99%

Locked plating as an external fixator in treating tibial fractures

Luo

Ding

et al. 2017

Medicine

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Objectives:This article is a systematic review of the published literature about the biomechanics, functional outcomes, and complications of a locked plate as an external fixator in treating tibial fractures.Methods:We searched the PubMed, Ovid Medline, Embase, ScienceDirect, and Cochrane Library databases to retrieve the relevant studies. Studies published in English and Chinese which assessed adult patients and more than 4 cases who had sustained any type of fresh tibial fracture treated with the external locking plate, provided that they reported functional outcomes, range of motion (ROM), union or complication rates, and the biomechanical studies of external locked plating are also included.Results:The electronic search strategy revealed 248 studies, and 2 studies were identified as relevant through manual search of references. Finally, 12 studies were included in this systematic review. These consist of 3 pure biomechanical studies, 8 case series, and 1 study including both of biomechanics and case series. Due to the heterogeneity of biomechanical studies, we can only conclude that external locked plate shows inferior structural stiffness than internal locked plate. The clinical studies reported that external locked plating gave a satisfactory ROM of the knee and ankle, functional outcomes, union rate, and low complication rate.Conclusions:We can only conclude that external locked plate shows inferior structural stiffness than internal locked plate because of the heterogeneity of biomechanical studies. The clinical studies showed locked plating as an external fixator in treating tibial fractures can be considered as a safe and successful procedure. However, as yet, there is unconvincing evidence that it is superior to standard techniques with regards to clinical and functional outcomes. More and well-designed studies about this technique should be carried out.

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“…Ahmad M et al in their study found that strength and construct stability significantly reduces when plate bone distance is more than 2 mm [19]. Zhang J, Ebrahim N in their study concluded that for stable external fixation with LCP, the plate bone distance should be less than 30mm [20]. Wei Lu, Li Hui in their study of comparison of axial and torsional stiffness of LCP found femoral LCP to be significantly better than tibial LCP [21].…”

Section: Original Research Articlementioning

confidence: 95%

Supracutaneous plating in tibial metadiaphyseal fractures with compromised soft tissue using LCP as an external fixator

et al. 2019

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Introduction: Tibial meta-diaphysealfractures are challenging injuries because of subcutaneous anteromedial surface of bone and frequent soft tissue complications. Ideal management requires stable fixation with minimal soft tissue handling. Locking compression plate (LCP) applied as an external fixator fulfills these criteria and can be an important tool in the armamentarium of an orthopaedic surgeon. Objective of the study is to evaluate the result of this technique. Methods: 23 patients with meta-diaphyseal fractures of tibia with compromised soft tissue treated by this technique were evaluated retrospectively interms of union, maintenance of reduction, complications and final outcome using KSS (Knee society scoring) for proximal fractures and AOFAS (AO Ankle and Foot scoring) for distal fractures. Average follow up duration was 9.4 months (6-14 months). Results: There were fifteen males, eight females with fourteen open fractures and nine cases of closed fractures with tscherne grade 2 or 3 soft tissue injury. Five fractures were in proximal tibia and eighteen were in distal tibia, all fractures united with an average of 21.7 weeks period maintaining acceptable reduction. There were 3 cases of infection, one deep and two superficial treated successfully by debridement and antibiotics. Average knee society scores were 74 and 78.6 for open and close proximal metadiaphyseal fractures respectively. Average AOFAS scores were 81.9 and 84 for open and close distal tibial metadiaphyseal fractures respectively. Conclusion: we found this technique to be more biological, simple to do surgery, effective in maintaining reduction till union, more patient friendly in comparison to traditional large, bulkyfixators and with minimal complications.

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External fixation using locking plate in distal tibial fracture: a finite element analysis

Abstract: To guarantee a stable external plate fixation in distal tibial fracture, the plate-bone distance should be less than 30 mm.

Cited by 20 publications

References 18 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

Locked plating as an external fixator in treating tibial fractures

Supracutaneous plating in tibial metadiaphyseal fractures with compromised soft tissue using LCP as an external fixator

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