Objective To introduce a method for fixation in periprosthetic fracture with locking compression plate (LCP). Methods Duringthe surgery, a long 12-hole LCP was placed to the lateral side of the femur. Six holes of the plate were placed proximal to the main fracture line to make sure that there could be enough cortex units for rigid fixation of proximal fragments. Locking screws used except for the most proximal hole where a 4.5 mm screw was used instead. Results The patient was pain free at the fracture site one week after the surgery,and was able to walk with a cane 3 months after the surgery. Bone union was evident radiographically 3 months after the surgery. There was no loose signs around the stem. Six months after the surgery, the patient recovered full function without pain. Conclusion In our experience from this case, LCP in treating periprosthetic fracture was easy and less time consuming, more over, extensive periosteal stripping could be avoided. LCP is a good choice in treating some periprosthetic fractures.
ObjectiveTo compare the effectiveness of external fixation and volar locking compression plate in the treatment of distal radius fractures of type C. MethodsBetween March 2012 and March 2013, 122 patients with distal radius fractures of type C were enrolled in the prospective randomized study. Fractures were treated by external fixation in 61 patients (external fixation group) and by open reduction and internal fixation using a volar locking compression plate in 61 patients (plate group). There was no significant difference in age, gender, fracture side, weight, height, body mass index, fracture type, and interval of injury and operation between 2 groups (P>0.05). The blood loss, operation time, hospitalization days, fracture union time, wrist function, and complications were compared between 2 groups. And the quality of reduction was observed, including volar tilting angle, ulnar deviation, radial height, and articular reduction. ResultsThe blood loss, operation time, and hospitalization days in plate group were significantly higher than those in external fixation group (P<0.05). All of the patients in both groups were followed up 12-28 months. Postoperative complications occurred in 4 patients (6.6%) of external fixation group (pin tract infection in 2 cases and radial nerve neuritis in 2 cases) and in 5 patients (8.2%) of plate group (wound infection in 1 case, carpal tunnel syndrome in 2 cases, and tendon rupture in 2 cases), showing no significant difference between 2 groups (P=0.500). The X-ray films showed fracture healing in all patients of 2 groups; the union time of plate group was significantly longer than that of external fixation group (P<0.05). At last follow-up, there was no significant difference in ulnar deviation and radial height between 2 groups (P>0.05), but the volar tilting angle of plate group was significantly larger than that of external fixation group (P<0.05). There was no significant difference in wrist function and articular reduction between 2 groups (P>0.05). ConclusionFor distal radius fractures of type C, the use of external fixation or volar locking compression plate can obtain satisfactory clinical outcomes, but the external fixation has the advantages of less invasion, shorter hospitalization days, minor complications, and faster fracture union.
ObjectiveTo explore the therapeutic effect of using locking compression plate (LCP) as an external fixator and using an external fixator on open fractures of the tibia. MethodsBetween September 2010 and December 2012, 56 patients with the open tibia fractures underwent external fixation using LCP as an external fixator (LCP group, n=22) or external fixator (external fixator group, n=34). We compared the healing time, the rate of postoperative complication and the postoperative function between two groups. ResultsThe mean healing time was 11 weeks (8-28 weeks) and there was 1 case of delayed healing in the LCP group. The mean healing time was 14 weeks and there was 4 cases of delayed healing in the external fixator group. We found significant difference in the healing time (t=2.740, P=0.008) and the infection rate of pin track (13.6% vs 32.4%; χ2=2.496, P=0.114) between the LCP and external fixator group. ConclusionFor open fractures of the tibia, using LCP as an external fixator may increase the healing time and decrease the rate of postoperative complications.
Objective To evaluate the cl inical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with locking compression plate (LCP) in the treatment of proximal humeral shaft fracture. Methods From July 2004 to April 2008, 26 patients with displaced fractures of the proximal humeral shaft were recruited, including 8 males and 18 females. Age of patients averaged 66 years old (range, 34-82 years old). According to AO classification, there were 4 cases of type A1, 2 cases of type A2, 8 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1 and 2 cases of type C2. The time from injury to surgery averaged 2 days (range, 1-5 days). There were 8 osteoporotic fractures. Results All surgical wound healed primarily, and there was no wound infection. Three patients had postoperative radial nerve neurapraxia, which recovered at 4, 6, 8 months respectively. All patients were followed up for 6-24 months with an average of 14.1 months. Radiological examination revealed bony union within 6 months in 25 cases. There was 1 delayed union which remained asymptomatic and eventually healed at 8 months with acceptable Constant-Murley score. There were 3 cases of shoulder impingement syndrome diagnosed at 3 months post-operatively. After implant removal, they all achieved an acceptable Constant-Murley score. According to Constant-Murley scoring system, there were 11 excellent, 10 good and 5 acceptable results. The excellent or good rate was 80.8%. Conclusion MIPO technique using LCP is an effective method to treat proximal humeral shaft fractures, which facil itates functional recovery of the shoulder joint. During the surgery, it is important to achieve a good fracture reduction and to avoid compl ications.
Objective To summarize the cl inical appl ication of minimally invasive percutaneous locking compression plate (LCP) internal fixation in the treatment of tibial fractures and to evaluate its cl inical effects. Methods From September 2005 to September 2007, 13 patients with tibial fractures were treated with indirect reduction and minimally invasive percutaneous LCP internal fixation, 8 males and 5 females, aged 18-35 years old (27 on average). Among them, the fractures were caused by traffic accidents in 3 cases, by fall ing in 5 cases, by fall ing from height in 4 cases and by bruise in 1 case. The fractures were located at 1/3 upper tibia in 2 cases, at 1/3 medium tibia in 6 cases and at 1/3 lower tibia in 5 cases. All fracture were closed ones. According to the AO classification, 4 cases were type A, 7 type B and 2 type C. The time between fractures and operation was from 3 hours to 5 days (2.5 days on average). Results All incisions obtained heal ing by first intention. All patients were followed up for 10-18 months (13 months on average). All fractures reached cl inical heal ing, and the heal ing time was 12-20 weeks (16 weeks on average). There was no delayed fracture heal ing, nonunion, infection and internal fixation failure. No compl ications such as rotation, crispatura deformity and internal fixation loosening were found. According to the HSS scoring, the function of the knee joint was graded 85-95 (90 on average), and the range of motion was 100-130° (120° on average). According to the AOFAS Ankie Hindfoot Scoring, the function of the ankle joint was graded 80-95 (92.4 on average). Nine cases were excellent, 4 good, and the choiceness rate was 100%. Conclusion Minimally invasive percutaneous LCP internal fixation is in accord with biological set principles and beneficial for tibial fracture heal ing and reconstruction of soft tissues.
Objective To compare the effectiveness of the proximal femoral nail anti-rotation (PFNA) and locking compression plate (LCP) in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in elderly patients. Methods Between May 2009 and August 2012, 69 elderly patients with intertrochanteric fractures with the lateral unsubstantial femoral wall were treated. Fractures were fixed with PFNA in 36 patients (PFNA group), and with LCP in 33 patients (LCP group). There was no significant difference in gender, age, injury cause, side of fracture, and fracture AO type between 2 groups (P > 0.05). The incision length, operation time, intraoperative blood loss, total blood loss, fluoroscopy frequency, time for ambulation, and early (within 3 months) and late (more than 12 months) complications were compared. Fracture healing was assessed according to X-ray reexamination, the function of the hip joint was assessed according to the Harris hip scoring system. Results The incision length, operation time, intraoperative blood loss, and time for ambulation of PFNA group were significantly less than those of LCP group (P < 0.05), but the fluoroscopy frequency of PFNA group was significantly more than that of LCP group (P < 0.05). There was no significant difference in total blood loss between 2 groups (t=-1.686, P=0.096). The patients were followed up 12-24 months in PFNA group and 15-30 months in LCP group. The X-ray reexamination revealed fracture healing at (12.667±2.527) weeks in patients of PFNA group, and at (13.364±1.194) weeks in the others of LCP group except 1 case of nonunion, showing no significant difference (t=-1.443, P=0.154). There was no significant difference in Harris hip score between PFNA group (84.611±7.076) and LCP group (81.785±7.500) at 12 months after operation (t=1.626, P=0.109). The early complication rate and late complication rate were 16.7% (6/36) and 5.6% (2/36) in PFNA group and were 9.1% (3/33) and 9.1% (3/33) in LCP group, all showing no significant difference between 2 groups (χ2=0.871, P=0.481; χ2=0.320, P=0.665). Conclusion Both PFNA and LCP have good effectiveness in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in the elderly patients. Each has its own advantages and disadvantages.
ObjectiveTo compare the therapeutic effect between intramedullary fixation and external fixation on intertrochanteric fracture. MethodsBetween June 2005 and June 2011, 32 patients with Evans-Jensen type Ⅲ intertrochanteric fracture were treated with proximal femoral nail anti-rotation (PFNA), Gamma nail, dynamic hip screw plate (DHS) or locking compression plate (LCP), separately. The operation duration, peri-operative bleeding, load time, Harris hip score and postoperative complications were observed in the patients, and were used to analyze the therapeutic effect among the four methods. ResultsShorter operation duration, less bleeding in the surgery, smaller quantity of drainage after the operation (P<0.05) were found in group Gamma and group PFNA compared with those in group DHS and LCP. The duration of hospitalization didn't differ much between the two fixation systems (P>0.05). The difference in operation duration, operative bleeding and post-operative drainage between group Gamma and PFNA, and between group DHS and LCP was not significant (P>0.05). ConclusionThe intramedullary fixation was better than external fixation for Evans-Jensen type Ⅲ intertrochanteric fracture.
ObjectiveTo compare the effectiveness of locking compression plate and elastic intramedullary nail for the treatment of benign long bone pathological fractures in children, so as to provide the evidence for clinical treatment. MethodsSeventy-two children with long bone pathological fractures who accorded with the inclusion criteria between January 2005 and July 2013 were randomly divided into 2 groups. Fracture was fixed with elastic intramedullary nail in 33 cases (group A) and with locking compression plate in 39 cases (group B). There was no significant difference in sex, age, body mass index, primary lesion, location of fracture, side of fracture, and interval between injury and operation between 2 groups (P>0.05). ResultsGroup A had shorter operation time, less intraoperative blood loss, and less overall costs than group B, showing significant differences (P<0.05). Primary healing of incision was obtained. All the patients were followed up 1-7 years (mean, 3.4 years). Tumor lesions disappeared and the pathological fracture healed after operation by X-ray film observation, and group A had faster fracture healing time than group B (P<0.05). There was no loosening and displacement of internal fixation, bone resorption, and bone defect nonunion in 2 groups. Recurrence was found in 2 cases (6.1%) of group A and 3 cases (7.7%) of group B, showing no significant difference (χ2=0.074, P=0.580). Re-fracture was found in 1 patient with tibial bone cyst of group B after 3 months of operation, and healed after 1 year of open reduction and internal fixation. According to X-ray film and comprehensive function evaluation of shoulder, elbow, hip, knee, and ankle, the results were all excellent in 2 groups at last follow-up. ConclusionElastic intramedullary nail fixation should be the first choice, and locking compression plate should be the second choice for children with benign long bone pathological fractures.
Objective To analyze the effectiveness of volar locking compression plate (LCP) and radial styloid process plate for the treatment of type C fractures of the distal radius. Methods Between May 2010 and May 2011, 24 cases of type C fractures of the distal radius were treated, including 8 males and 16 females with an average age of 52 years (range, 23-73 years). Injury was caused by falling in 20 cases and by traffic accident in 4 cases. All were fresh closed fractures. The locations were the left side in 15 cases and the right side in 9 cases. According to AO typing, there were 16 cases of type C2 and 8 cases of type C3. The preoperative palmar tilt angle ranged from — 60 to 25° (mean, — 45.3°); the preoperative ulnar inclination angle ranged from — 16 to 13° (mean, 8.2°); and the preoperative radial length shortening was 8-18 mm (mean, 12 mm). The time from injury to operation was 3-10 days (mean, 5.2 days). Results All operation incisions healed primarily. All patients were followed up 9-16 months (mean, 13.5 months). The healing time of fracture was 8-12 weeks (mean, 10.2 weeks). The articular surface was smooth and the radial length was recovered. The postoperative palmar tilt angle ranged from 8 to 15° (mean, 12.3°); the postoperative ulnar inclination angle ranged from 18 to 26° (mean, 22.3°). No loss of reduction, refracture, or carpal tunnel syndrome occurred during follow-up. The average range of motion of the wrist was 45.3° (range, 30-70°) in dorsal extension, was 50.2° (range, 26-78°) in palmar flexion, was 13.5° (range, 8-25°) in radial inclination, was 23.6° (range, 15-32°) in ulnar inclination, was 65.7° (range, 35-90°) in pronation, and was 72.5° (range, 20-90°) in supination at last follow-up. According to the wrist function by Gartland-Werley scoring, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases; and the excellent and good rate was 83.3%. Conclusion Treatment of type C fractures of the distal radius with volar LCP and radial styloid process plate can reconstruct normal anatomic structures and get good functional recovery.
Objective To review the outcomes of geriatric distal humeral fracture fixed with locking compression plate (LCP). Methods From January 2005 to December 2007, 24 patients (20 females and 4 males) with distal humeral fracture underwent open reduction and internal fixation with LCP. Their average age was 75.5 years old, ranged from 60 to 93 years old. Fracture was caused by injury from fall in 22 cases, by traffic accident in 1 case, and by direct hit in 1 case. There were 12 cases of type A2, 2 cases of type A3, 2 cases of type B1, 2 cases of type C1, 2 cases of type C2, 4 cases of type C3 fractures according to AO/ASIF classification. X-ray films in AP and lateral view were taken preoperatively. CT scan with three dimensional reconstructions was done in more comminuted fracture only. Open reduction with triceps sparingtechnique was used in all except type B fracture, and olecranon osteotomy was considered only in more comminuted C3fracture. The average interval between injury and operation was 3 days (range, 1-6 days). Outcome measures includedpain assessment, range of motion, and Mayo elbow performance score and findings at 1 year follow-up. Results Theaverage length of follow-up was 25 months (range, 12-48 months). All 24 fractures were healed within 6 months with anaverage of about 4 months. At 1 year follow-up, 83% (n=20) of patients felt no pain and 17% (n=4) of patients had mildpain; 83% of patient can gain a flexion range of more than 100°; according to Mayo elbow performance score, the meanscores of type A, B and C fracture groups were 97, 85, and 89, respectively, and the post-operative performance of typeA fracture was significantly better than that of type B and C (P=0.034). Four patients had postoperative compl ications.Conclusion Open reduction and internal fixation of geriatric distal humeral fracture can achieve relatively good functionalresult and bony union despite of age.