Locking compression plate as an external fixator in the treatment of closed distal tibial fractures

Zhou, Yu Jie; Wang, Yanbiao; Liu, Lifeng; Zhou, Zhenyu; Cao, Xia

doi:10.1007/s00264-015-2903-7

Cited by 29 publications

(36 citation statements)

References 24 publications

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“…However, the application of supercutaneous plating technique is still not generally acknowledged. Recently, many authors [ 3 , 14 – 21 ] reported the good clinical results of using external locked plating for treating tibial fractures. Thus, we systematically reviewed the published literature on the biomechanics, outcomes, and complications of the locking plate used as an external fixator to treat fractures of the tibia.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

confidence: 99%

Locked plating as an external fixator in treating tibial fractures

Luo

Ding

et al. 2017

Medicine

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“…The advantages of applying open reduction and internal xation were that the fracture site could be exposed su ciently and the reduction could be ful lled anatomically under direct vision. Researchers [3,[15][16][17] reported that the deformed union rate of fractures after plate xation was less than 10%, but the risk of postoperative complications with soft tissues was higher, including super cial infections, deep infections, delayed wound healing, and necrosis of soft tissues. In the early 1940s, the intramedullary nail system was introduced to treat tibial shaft fractures, which can reduce the deformity union for tibial fracture and decrease the formation of pseudo-articular joints after the surgery, meanwhile promote the ossi cation of fractured callus.…”

Section: Discussionmentioning

confidence: 99%

An approach to determine the coronal plane deformity of the distal tibia intraoperatively in the treatment of tibial fracture with intramedullary nail fixation

Lu¹,

Yang²,

Xu³

et al. 2020

Preprint

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Background To develop a new approach to determine the existence of coronal plane deformity (valgus and varus) intraoperatively in the treatment of tibial fracture with closed reduction and intramedullary nail fixation. Methods A retrospective analysis was conducted by enrolling 33 consecutive patients with tibial fracture who underwent closed reduction and intramedullary nail fixation from January 2018 to January 2019 in our trauma center. There were 23 males and 10 females aged from 22 to 69 years old with an average of 41.3. The standard anteroposterior and lateral preoperative radiographs were performed routinely. After insertion of the tibial intramedullary nail through the standard entry point intraoperatively, the parallel relationship between the distal horizontal interlocking screw and the tibiotalar joint surface on the anteroposterior fluoroscopy was used to determine the occurrence of valgus or varus deformity of the distal tibial fragment. Results 33 patients were postoperatively followed up for 13 to 25 months (mean 18.7 months). The fractures achieved bone union in 4.3 months by average (ranging from 3 to 6 months). The lateral distal tibial angle (LDTA) of the unaffected side which is measured postoperatively was 87.3°-89.6 ° (average 88.7 °± 0.8°), and the LDTA of the affected side was 87.5°-90.4°(average 88.9°± 1.1°). There was no statistically significant difference between the unaffected side and the affected side (t=-1.865, p=0.068). The intraoperative measurement indicated 6 cases of valgus angulation and 3 cases of varus angulation deformities, and all the deformities were corrected accordingly during the surgery. According to the Olerud-Molander Ankle Score, the clinical outcomes demonstrated 22 excellent cases, 8 good cases, 2 fair cases, and 1 poor case of all the fractures at 12 months after surgery. Conclusion During closed reduction and intramedullary nail fixation for tibial fractures, the parallel relationship between the distal horizontal interlocking screw and the tibiotalar joint surface on the intraoperative anteroposterior films showed the better discriminative ability to determine the onset of valgus or varus deformity of the distal tibial fragment after the tibial intramedullary nail inserted through the standard entry point.Level of Evidence: Level IV, case series study.

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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%

“…In the present study, pin tract infection was only seen in one screw of one patient. We attribute this extraordinarily low rate of pin tract infection to fully-threaded titanium screws that had better biological compatibility and adhered more easily to the skin compared with the partially-threaded stainless steel Schanz screws used in traditional external fixation [ 9 , 11 ].…”

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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Locking compression plate as an external fixator in the treatment of closed distal tibial fractures

Cited by 29 publications

References 24 publications

Locked plating as an external fixator in treating tibial fractures

Locked plating as an external fixator in treating tibial fractures

An approach to determine the coronal plane deformity of the distal tibia intraoperatively in the treatment of tibial fracture with intramedullary nail fixation

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

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