Double locking plate fixation for femoral shaft nonunion

Ye, Peng; Ji, Xiaotong; Zhang, Lihai; Tang, Peifu

doi:10.1007/s00590-016-1765-z

Cited by 17 publications

(16 citation statements)

References 33 publications

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“…13 Research advocating plate replacement indicates that although the plate has the disadvantage of secondary trauma during surgery, it can achieve the aim of radical debridement, correction of deformities and full bone grafting. 17 Our experience supports the use of a locking plate combined with structural autogenous ilium grafting to treat nonunion after plate installation because it maximizes osteoconductive, osteogenic and osteoinductive properties of autologous bone, resulting in bone healing rates reaching 97.1%. 3 However, some treatments fail due to the span of the graft being large and the exterior plate being unable to provide sufficient stability for anterior bone grafting.…”

Section: Discussionsupporting

confidence: 61%

Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients

Sun

Zhong

et al. 2019

J Int Med Res

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Objective To investigate the efficacy of the treatment of atrophic nonunion using structural autogenous ilium bone grafting in combination with vertical fixation of double plates. Methods This retrospective study analysed the clinical data from consecutive patients with atrophic nonunion who underwent autogenous ilium grafting in combination with double-plate vertical fixation. The injury type and the bone affected by nonunion, the duration of nonunion and the outcomes following surgery were recorded for all patients. Results The study enrolled 43 patients with atrophic nonunion of the upper and lower limbs: 17 patients with tibial nonunion, 21 with femoral nonunion, four with humeral nonunion and one with radial shaft nonunion. The mean duration of postoperative follow-up was 14.5 months (range, 8–28 months). A total of 43 of 43 patients (100%) achieved a healed nonunion fracture without the occurrence of complications such as infection, fracture of internal fixation or pain in the harvesting site. Comprehensive postoperative assessments of bone healing and function were observed to be good and/or excellent in all 43 patients. Conclusion Structural autogenous ilium grafting used in combination with double-plate vertical fixation can provide a stable structural environment for near optimal bone healing in patients with atrophic nonunion.

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Section: Discussionsupporting

confidence: 61%

Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients

Sun

Zhong

et al. 2019

J Int Med Res

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“…On the other hand, augmented fixation with additional medial plate is a standard procedure associated with high union rates and no significant postoperative complications . Double plating technique is recommended by many authors for cases where single plate use is not adequate .…”

Section: Discussionmentioning

confidence: 99%

Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?

Todorov

Zderic

Richards

et al. 2018

Journal Orthopaedic Research

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Treatment of complex osteoporotic distal femur fractures with the Less Invasive Stabilization System (LISS) has been associated with high complication rates. The aim of this study was to investigate the biomechanical competence of two different techniques of augmented versus conventional LISS plating. Unstable distal femoral fracture AO/OTA 33-A3 was created via osteotomies in artificial femora simulating osteoporotic bone. Three study groups, consisting of 10 specimens each, were created for fixation with either LISS plate, LISS plate with additional polylactide intramedullary graft, or LISS plate plus medial locking plate (double plating). All specimens were non-destructively tested under axial (20-150 N) and torsional (0-4 Nm) quasi-static loading. Each bone-implant construct was tested with two different working length (WL) configurations (long and short) of the LISS plate. Relative movements between the most medial superior and inferior osteotomy aspects were investigated via three-dimensional motion tracking analysis. Double plating revealed significantly smaller longitudinal and shear displacement than the other two techniques (p ≤ 0.001). In addition, LISS plus graft fixation was with significantly less longitudinal displacement in comparison to conventional LISS plating (p < 0.001). Long WL resulted in significantly higher longitudinal and shear displacement compared to short WL for LISS and LISS plus graft (p ≤ 0.032), but not for double plating (p > 0.999). In conclusion, intramedullary grafting resulted in significantly increased fracture stability under axial loading in comparison to conventional LISS plating. Although it was not efficient enough to provide comparable stability to double plating, intramedullary grafting may be considered as a useful biological alternative to the latter in a surgeon's armamentarium. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2604-2611, 2018.

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“…Thus, the double-plate fixation is emerging as a reasonable alternative to treat the nonunion. A union rate above 90% has been reported in studies [ 18 – 20 ], but double-plate fixation principle has never been proposed. In 2015, Maimaitiyiming et al [ 18 ] reported 14 consecutive patients with femoral shaft aseptic nonunion were treated with double-plate fixation combined with bone grafting and all cases achieved bony union in the average time of 5.2 months.…”

Section: Discussionmentioning

confidence: 99%

“…This study suggests that implants should be placed on the lateral and anterior sides, at a 90° angle with each other. In 2016, Peng et al [ 20 ] demonstrated that double locking plates fixation could serve as an effective therapy strategy for femoral shaft nonunion. Jiang et al [ 19 ] got the union rate of 100% by using the fibular autograft with double locking plates for the treatment of diaphyseal femoral nonunion.…”

Section: Discussionmentioning

confidence: 99%

“…A single plate placed laterally in this fracture types is subjected to a local concentration of bending forces which may induce failure [ 17 ]. Thus, techniques of double-plate fixation have been emerging as a viable fixation scenario for managing the femoral shaft nonunion model that is plating without a competent cortex opposite the plate [ 18 – 20 ]. But, to the best of our knowledge, there are not any mechanical studies of finite element analysis test being published to compare the mechanical stability of the different double-plate angles as fixation methods used in the femoral shaft nonunion with no medial support opposite the primary lateral plate.…”

Section: Introductionmentioning

confidence: 99%

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Finite Element Analysis of Different Double-Plate Angles in the Treatment of the Femoral Shaft Nonunion with No Cortical Support opposite the Primary Lateral Plate

Zhang

Zhou

et al. 2018

BioMed Research International

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Objectives We evaluated the biomechanical outcome of different plate fixation strategies (the single plate construct, 45° double-plate construct, 90° double-plate construct, 135° double-plate construct, and 180° double-plate construct) used for the fixation of the femoral shaft nonunion with no cortical support opposite the primary lateral plate. This may help surgeons choose the optimal therapy to the femoral shaft nonunion. Methods The femoral shaft nonunion with no medial support and the models of lateral plate and medial plate was constructed in 3-matic software and UG-NX software, respectively. We then assembled the single plate and different double plates to the fracture model separately to form the fixation models. After meshing the models' elements, we used the ABAQUS software to perform the finite element analysis. Values of the von Mises Stress (VMS) distribution of the implant, peak VMS, and model displacement and deformation were used to capture the mechanical factors in this study. Results Our results indicated that the peak von Mises Stress (VMS) of the lateral plate was concentrated in middle surface of the lateral plate near the fragment of each group. The peak VMS was 5201.0 MPa (the single-plate construct), 3490.0 MPa (45° double-plate construct), 1754.0 MPa (90° double-plate construct), 1123.0 MPa (135° double-plate construct), and 816.5 MPa (180° double-plate construct). The additional short plate dispersed some stress leading to the decrease in the peak VMS of the lateral plate. As angle formed by the double plates increased, the dispersed function of the additional plate was becoming obvious. The bending angles of the lateral plate were 18° versus 12° versus 3° versus 2° versus 1° (the single-plate construct versus 45° double-plate construct versus 90° double-plate construct versus 135° double-plate construct versus 180° double-plate construct). Conclusions Our study indicated that increasing the angle between the plates in a double-plate construct improves the stability of the construct over a single lateral plate when there is no cortical support opposite to the lateral plate. The strongest fixation occurred when the angle between the two plates was greater than ninety degrees.

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Double locking plate fixation for femoral shaft nonunion

Abstract: Because of the high union rates and lack of significant complications in our series, double locking plate fixation can serve as an effective method of addressing femoral shaft nonunions. No significant complications were found postoperatively.

Cited by 17 publications

References 33 publications

Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients

Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients

Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?

Finite Element Analysis of Different Double-Plate Angles in the Treatment of the Femoral Shaft Nonunion with No Cortical Support opposite the Primary Lateral Plate

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