CORR Insights®: Addition of a Medial Locking Plate to an In Situ Lateral Locking Plate Results in Healing of Distal Femoral Nonunions

Dougherty, Paul J.

doi:10.1007/s11999-016-4745-z

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…A locking plate is the most commonly used implant used to manage distal femoral fractures because it increases overall stiffness by stabilizing the angle of the screw [ 15 ]. Although the clinical efficacy of a locking plate is promising, such attendant complications as delayed healing, implant failure, and non-union are common [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Micromotion-based balanced drilling technology to increase near cortical strain

et al. 2022

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Objective A micromotion-based balanced drilling system was designed based on a locking plate (LP) and far cortical locking (FCL) concept to maintain the balance of micromotions of the cortex on both sides of a fracture region. The system was tested by axial compression test. Methods The fracture gap was set to 2 cm, and locking screws with a diameter of 5 mm and a locking plate were used to fix it. The diameters of the two sections of the stepping drill were 3.5 mm and 5.0 mm, respectively. One of the matching drilling sleeves was a standard sleeve (eccentricity, 0 mm) and the other was an eccentric sleeve (proximal eccentricity, 1 mm). A model of the fixed locking plate (AO/ASIF 33-A3) for distal femoral fractures with a gap of 2 cm was established based on data from 42 artificial femurs (SAWBONE). According to the shape of the screw holes on the cortex, the fixed fracture models were divided into a control group (standard screw hole group X126, six cases) and an experimental group (elliptical screw hole group N, 36 cases). The experimental group was further divided into six subgroups with six cases in each (N126, N136, N1256, N1356, N12356, N123456), based on the number and distribution of the screws on the proximal fracture segment. The control, N126, and N136 groups were subjected to an axial load of 500 N, and the other groups were subjected to an axial load of 1000 N. The displacements of the kinetic head, far cortex, and near cortex were measured. The integral structural stiffness of the model and the near cortical strain were calculated. The data of each group were analyzed by using a paired t-test. Results When the far cortical strains were 2%, 5%, and 10%, the near cortical strains in group N126 were 0.96%, 2.35%, and 4.62%, respectively, significantly higher than those in the control group (X126) (p < 0.05). For a different distribution of the screws, when the far cortical strains were 2%, 5%, and 10%, the near cortical strains in group N126 were significantly higher than those in group N136 (p < 0.05). However, there was no significant difference between the near cortical strains in the two groups with four screws (p > 0.05). For different numbers of screws, the near cortical strains in the three-screw groups were significantly higher than those in the four-screw groups (p < 0.05), and there was no significant difference in near cortical strains among the four-, five-, and six-screw groups (p > 0.05). Conclusion The proposed drill and matching sleeves enabled a conventional locking compression plate to be transformed into an internal fixation system to improve the balanced motion of the near and far cortices. Thus, strain on a fracture site could be controlled by adjusting the diameter of the drill and the eccentricity of the sleeve.

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Section: Introductionmentioning

confidence: 99%

Micromotion-based balanced drilling technology to increase near cortical strain

et al. 2022

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“…A locking plate is the most commonly used implant in the management of distal femoral fractures as it increases overall stiffness by stabilizing the screw angle [8]. Although the clinical e cacy of a locking plate has shown promise, its related complications, such as delayed healing, implant failure, and nonunion, are common [4].…”

Section: Introductionmentioning

confidence: 99%

Novel Micromotion-Balancing Drilling Technology to Increase Proximal Cortical Strain

Wang

Duan

2020

Preprint

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Background: We aimed to design a micromotion-balancing drilling system on the basis of the existing locking plate to maintain the balance of the micromotion of the cortex on both sides of a fracture region. We tested the system by subjecting it to a few biomechanical tests.Methods: According to the shape of screw holes on the cortex, the fixed fracture models were divided into a control group (standard screw hole group X126, 6 cases) and an experimental group (elliptical screw hole group N, 36 cases). The experimental group was further divided into 6 subgroups with 6 cases in each (N126, N136, N1256, N1356, N12356, N123456) on the basis of the number and distribution of the screws on the proximal fracture segment. The control, N126, and N136 groups were subjected to 500-N axial load, and other groups were subjected to 1000-N axial load. The displacements of the kinetic head, distal cortex, and proximal cortex were measured. The integral structural stiffness of the model and the proximal cortical strain were calculated. The data of each group were analyzed by paired t-tests.Results: When the distal cortical strains were 2%, 5%, and 10%, the proximal cortical strains in group N126 were 0.96%, 2.35% and 4.62%, respectively, which were significantly higher than those in the control group (X126) (p<0.05). When the distal cortical strains were 2%, 5% and 10%, the proximal cortical strain in group N126 was significantly higher than that in group N136 (p<0.05). However, there was no significant difference between the proximal cortical strains in the two groups with 4 screws (p>0.05). The proximal cortical strain in the 3-screw groups was significantly higher than that in the 4-screw groups (p<0.05), and there was no significant difference in the proximal cortical strain in the 4-, 5-, and 6-screw groups (p>0.05).Conclusions: The new drill and the matching sleeves enabled a conventional locking compression plate to be transformed into an internal fixation system and improved the balanced motion of the distal and proximal cortices. Thus, the strain on a fracture site can be controlled by adjusting the drill diameter and sleeve eccentricity.

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