Comparison of 4 Methods for Dynamization of Locking Plates: Differences in the Amount and Type of Fracture Motion

Henschel, Julia; Tsai, Stanley; Fitzpatrick, Daniel; Marsh, J. Lawrence; Madey, Steven M.; Bottlang, Michael

doi:10.1097/bot.0000000000000879

Cited by 51 publications

(37 citation statements)

References 37 publications

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“…(14,15) The FCL system differs from the conventional locked screws; at the near cortex, the core diameter of the MotionLoc screw (Zimmer, Warsaw, IN) is smaller and does not engage the plate closest to the cortex, thereby providing the necessary motion at the near cortex. (7,9,22,23) The clinical impact of the FCL technique on long fractures was confirmed by several biomechanical studies that showed multiple benefits of reducing axial stiffness by providing approximately parallel interfragmentary micro motion. (7,9,22,23) Clinical studies have provided strong evidence to support the advantages of the FCL technique in fracture management, indicating multiple benefits such as safety and effectiveness.…”

Section: Discussionmentioning

confidence: 93%

“…(7,9,22,23) The clinical impact of the FCL technique on long fractures was confirmed by several biomechanical studies that showed multiple benefits of reducing axial stiffness by providing approximately parallel interfragmentary micro motion. (7,9,22,23) Clinical studies have provided strong evidence to support the advantages of the FCL technique in fracture management, indicating multiple benefits such as safety and effectiveness. (11,12,(24)(25)(26) In 2014, Bottlang et al (24) demonstrated that FCL was both safe and effective in treating a series of 31 distal femoral fractures.…”

Section: Discussionmentioning

confidence: 93%

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Assessment of the Efficacy of the Far Cortical Locking Technique for Proximal Humeral Fractures: A Comparison with the Conventional Bicortical Locking Technique

Seo

Yoon

et al. 2020

Preprint

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Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL allows axial motion and promotes uniform callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique. Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA). Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion) were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p = 0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups. Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 93%

Assessment of the Efficacy of the Far Cortical Locking Technique for Proximal Humeral Fractures: A Comparison with the Conventional Bicortical Locking Technique

Seo

Yoon

et al. 2020

Preprint

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“…Screw type and placement, bridge length, and plate type can be varied to alter stiffness; however, for these, surgeons must rely on their experience, which can lead to inconsistent outcomes. Constructs with controlled motion including the dynamic locking screw (DLS) (Röderer et al, 2014 ), far cortical locking screw (FLS) (Doornink et al, 2011 ), and active LP (Bottlang et al, 2016 ; Henschel et al, 2017 ; Madey et al, 2017 offer a more reliable solution. The DLS allows micromotion at the near cortex up to 0.45 mm via a pin-sleeve design; the FLS provides a motion envelope at the near cortex up to 0.75 mm (half of the 4.5-mm cortical tread at the far cortex minus a 3-mm bypass at the near cortex); and the active LP enables a maximum axial micromotion of 1.5 mm.…”

Section: Discussionmentioning

confidence: 99%

Axial Micromotion Locking Plate Construct Can Promote Faster and Stronger Bone Healing in an Ovine Osteotomy Model

Han

Deng

et al. 2021

Front. Bioeng. Biotechnol.

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Fixing bone fractures with controlled axial interfragmentary micromotion improves bone healing; however, the optimal type of implant construct for this purpose is still lacking. The present study describes a novel axial micromotion locking plate (AMLP) construct that allows axial interfragmentary micromotion of 0.3 or 0.6 mm. We investigated whether the AMLP constructs enhance bone healing compared to an ordinary locking plate (LP) using an ovine osteotomy model. The stiffness of the constructs was tested under axial loading. We created a 3-mm osteotomy in the left hind leg tibia of sheep that was then stabilized with a 0.3- or 0.6-mm AMLP or LP construct (n = 6/group). Bone healing was monitored weekly by X-ray radiography starting from week 3 after surgery. At week 9, the specimens were collected and evaluated by computed tomography and torsional testing. We found that the AMLPs had a lower stiffness than the LP; in particular, the stiffness of the 0.6-mm AMLP construct was 86 and 41% lower than that of the LP construct for axial loads <200 and >200 N, respectively. In the in vivo experiments, tibial osteotomies treated with the 0.6-mm AMLP construct showed the earliest maximum callus formation (week 5) and the highest volume of bone callus (9.395 ± 1.561 cm3 at week 9). Specimens from this group also withstood a 27% greater torque until failure than those from the LP group (P = 0.0386), with 53% more energy required to induce failure (P = 0.0474). These results demonstrate that AMLP constructs promote faster and stronger bone healing than an overly rigid LP construct. Moreover, better bone healing was achieved with an axial micromotion of 0.6 mm as compared to 0.3 mm.

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“…The key draw-back of this design is the lack of design capacity to achieve micromotion. However, it should be noted, that any of these three stiffness modulated designs in Figure 4, could also incorporate dynamisation through micromotion between the screw and plate, as incorporated in the locking plate (Henschel et al, 2017). Finally the Material Heterogeneity design, generated issues similar to the telescopic and lattice structures in terms of post-processing.…”

Section: Discussionmentioning

confidence: 99%

“…Thus the design of bone plates requires fixation yet also the capacity for micromotion. Recent developments in bone plate design have aimed to achieve these opposing yet simultaneous requirements (Henschel et al, 2017), albeit through generic design. HTO is a widely recognised treatment for patients who have unicompartmental arthritis with malalignment of the mechanical axis (Röderer et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Design Principles to Increase the Patient Specificity of High Tibial Osteotomy Fixation Devices

Kanagalingam

Shepherd

Fernández-Vicente

et al. 2019

Proc. Int. Conf. Eng. Des.

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High stiffness fracture fixation devices inducing absolute stability, activate inefficient primary healing and stress shielding. Taking High Tibial Osteotomy as a representative example, review of the clinical literature and mapping the fracture healing process revealed two physically contradicting requirements, which are only partially met by current techniques. Stiffness of the fixation is required immediately after fracture, however in the remodelling phase this can cause stress shielding. Stability is required immediately after fracture, however in the ossification phase less stability is required to stimulate secondary (and more efficient) healing. This study evaluates the use of the TRIZ Inventive Design Principles to overcome these physical contradictions. Six designs concepts were evaluated, of which the Macro-Geometry stiffness modulated design was ranked the highest. This was achieved through spatial decomposition of the problem utilising the Inventive Principles of Asymmetry, Extraction and Local Quality. This study offer perspectives on how to increase the patient specificity of fixation utilising the increased topology freedom of design for additive manufacture (AM).

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Comparison of 4 Methods for Dynamization of Locking Plates: Differences in the Amount and Type of Fracture Motion

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 51 publications

References 37 publications

Assessment of the Efficacy of the Far Cortical Locking Technique for Proximal Humeral Fractures: A Comparison with the Conventional Bicortical Locking Technique

Assessment of the Efficacy of the Far Cortical Locking Technique for Proximal Humeral Fractures: A Comparison with the Conventional Bicortical Locking Technique

Axial Micromotion Locking Plate Construct Can Promote Faster and Stronger Bone Healing in an Ovine Osteotomy Model

Design Principles to Increase the Patient Specificity of High Tibial Osteotomy Fixation Devices

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