Angular stable lateral plating is a valid alternative to conventional plate fixation in the proximal phalanx. A biomechanical study

Shanmugam, Rukmanikanthan; Ernst, Manuela; Stoffel, Karl; Fischer, Maren; Wahl, D.; Richards, R. Geoff; Gueorguiev, Boyko

doi:10.1016/j.clinbiomech.2015.03.019

Cited by 7 publications

(7 citation statements)

References 34 publications

(53 reference statements)

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“…[16] In another biomechanical cadaver study comparing dorsal and lateral plates, it was shown that 1.5-mm non-locking dorsal plate placement did not have a biomechanical advantage over lateral locking plate placement in proximal phalangeal fractures and that 1.3-mm low-profile lateral locking plates provided more rigid fixation. [17] Robinson et al [9] treated twenty-five extra-articular proximal phalangeal fractures with dorsal plating and 17 fractures with lateral plating, and they found no difference in terms of results between both approaches. Omokawa et al [18] achieved better results with lateral plating than with dorsal plating in proximal phalangeal fractures treated with low-profile locking plates in terms of TAM, and suggested the use of lateral plate placement unless there was comminution and intra-articular fragmentation.…”

Section: Discussionmentioning

confidence: 99%

Comparison between Dorsal and Midlateral Approaches in the Treatment of Extra-articular Fractures of Proximal Phalanges with Locked Miniplates

Kibar¹

2019

South Clin Ist Euras

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We retrospectively examined extra-articular proximal phalangeal fractures excluding the thumb, for which fixation was applied using locked miniplates, with the aim to compare the results of the dorsal and midlateral approaches.Methods: 26 patients were operated via the dorsal approach (Group 1) and 20 patients were operated via the midlateral approach (Group 2). No graft was used in any patient. No splint was applied to any patient after the operation. Active finger movements were resumed on postoperative day 1. Results:The mean ages of patients in Groups 1 and 2 were 35.1 (range: 18-60) years and 33.8 (17-71) years, respectively. Union was achieved in all patients in the study. In Group 1, the mean total active movement (TAM) was 228° (range: 170-270°); according to the digital functional assessment, 18 patients had excellent, 7 patients had good, and 1 patient had fair results. In Group 2, mean TAM was 239° (range: 200-270°); according to the digital functional assessment, 14 patients had excellent and 6 patients had good results. Conclusion:We believe that both dorsal and midlateral approaches in extra-articular proximal phalangeal fractures are effective and reliable methods with similar clinical and functional results, and are thus a suitable alternative for each other.

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Section: Discussionmentioning

confidence: 99%

Comparison between Dorsal and Midlateral Approaches in the Treatment of Extra-articular Fractures of Proximal Phalanges with Locked Miniplates

Kibar¹

2019

South Clin Ist Euras

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“…In the clinical setting, great success has been achieved by fixating fractures by using this method [ 10 ]. Additionally, Shanmugam et al [ 11 ] reported that lateral and dorsal plating did not exhibit mechanical differences in terms of fixating the proximal phalanx. However, comprehensive mechanical experiments that examine the fixation of the metacarpal shaft by using lateral and dorsal plating are currently lacking.…”

Section: Discussionmentioning

confidence: 99%

“…In phalanges, lateral plating and dorsal plating offer similar mechanical strength (axial stiffness and loading to failure) and postoperative functioning [ 11 , 28 ]. However, a retrospective study by Hustedt et al [ 9 ] indicated that although lateral plating offers slightly better results for removing internal fixation and range of motion, the differences were not statistically significant [ 9 ]; the researchers were unable to identify the reason behind the higher failure rate of lateral side plating.…”

Section: Discussionmentioning

confidence: 99%

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Chiu

Hsu

et al. 2021

J Orthop Surg Res

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Background Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side. Objective The purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture. Materials and methods Thirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test. Results The maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm). Conclusion According to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

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“…Low-profile anatomic plates (LPAP) have been designed to require less soft tissue dissection and decrease soft tissue irritation, and have been shown to have similar construct stiffness and strength compared with the more traditional 2.7-mm dynamic compression plate (DCP) plating system in a metacarpal fracture model. 5 A biomechanical study by Shanmugam et al 6 demonstrated that laterally placed low-profile phalanx plates have similar construct stiffness and load to failure as laterally and dorsally placed traditional phalanx plates; however, they did not test dorsally placed LPAP. The LPAP should allow anatomic reduction and stable fixation, allowing early ROM, while decreasing soft tissue dissection and postoperative irritation.…”

Section: Introductionmentioning

confidence: 99%

Complications of Low-Profile Plate Fixation of Phalanx Fractures

Guerrero

Baumgartner

Federer

et al. 2019

Hand (New York, N,Y.)

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Background: Phalanx fractures are common, and plate fixation can be used to treat difficult fractures. Major complications have been reported in up to 64% of phalanx fractures treated with plate fixation, with stiffness being the most common. Low-profile anatomic plates (LPAP) have been designed to decrease soft tissue irritation and postoperative stiffness. The objective of this study was to determine whether the use of LPAP has decreased complications in plate fixation of phalanx fractures. Methods: A retrospective chart review was performed of patients with phalanx fractures treated with open reduction and internal fixation (ORIF) using LPAP at a single institution from January 1, 2010, to January 25, 2018. Twenty-three patients with 23 phalanx fractures treated with LPAP were included. The primary outcome was the presence of a complication. Results: Of the 23 patients, 12 patients (52.2%) had a postoperative complication. Nine patients (39.1%) required return to the operating room, with 7 (30.4%) returning for removal of hardware and tenolysis/capsulotomy. Two patients (8.7%) had superficial infections, one requiring irrigation and debridement. The other infection resolved clinically after 2 courses of oral antibiotics, with the fracture going on to nonunion. One patient had delayed wound healing treated prophylactically with cephalexin; although the wound healed, the patient developed a boutonniere deformity requiring surgery. There were 2 malunions (8.7%), one requiring revision surgery and the other electing for nonoperative management. All but one fracture progressed to union. Conclusions: ORIF with LPAP consistently achieves fracture union for phalanx fractures, but it does not appear that LPAP reduce the high complication rate.

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Angular stable lateral plating is a valid alternative to conventional plate fixation in the proximal phalanx. A biomechanical study

Cited by 7 publications

References 34 publications

Comparison between Dorsal and Midlateral Approaches in the Treatment of Extra-articular Fractures of Proximal Phalanges with Locked Miniplates

Comparison between Dorsal and Midlateral Approaches in the Treatment of Extra-articular Fractures of Proximal Phalanges with Locked Miniplates

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Complications of Low-Profile Plate Fixation of Phalanx Fractures

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