Evidence for Success with Locking Plates for Fragility Fractures

Abstract

Fixation of fragility fractures with plates and screws often results in loss of fixation and need for revision surgery. Locking plates and screw were introduced to improve fixation of fragility fractures and have been in use for a decade. This review was conducted to compile evidence that locking plates and screws improve fixation of fragility fractures. A search of PubMed was performed to identify biomechanical studies as well as clinical series of fragility fractures treated with locking plates. Biomechanics papers had to use models of osteoporotic bone and had to directly compare locking plates with traditional plates. Clinical studies included case series in which locking plates were applied to elderly patients with fractures of the proximal humerus and periprosthetic distal femur fractures. Most studies are retrospective case series. Locking plates lead to greater stability and higher loads to failure than traditional plates. When applied to proximal humerus fractures, uncomplicated healing occurs in 85% of patients. Constant and Dash scores approach normal values. For distal femoral periprosthetic fractures, union rates of 75% are reported with a malunion rate of 10%. Early evidence suggests that locking plates improve results of treatment of proximal humerus fractures and distal femoral periprosthetic fractures in the elderly. Loss of fixation is associated with failure to achieve stability at the fracture site. Principles of fracture fixation in osteoporotic bone defined prior to the introduction of locking plates should still be applied.

Distal Humeral AO type C Fracture - Analysis of LCP Fixation

“…Fragmented and frequently osteoporotic bone is fixated with anatomical LCP (limited-contact) plates [2,9]. The plates can be configured a) at 90-90 (perpendicularly to each other), b) parallel to each other [2][3][4][5][6][7][8][10][11][12][13][14][15][16]. Existing studies point to good outcomes with both configurations, with no significant advantage of one implantation system [1][2][3][4][5]13].…”

“…Me cha nizm uszko dze nia, ja kość tkan ki kost nej po wo du je, że w więk szo ści przy pad ków do cho dzi do roz ka wał ko wa nia, znisz cze nia struk tu ry i ubyt ku ko ści w ob rę bie po wierzch ni sta wo wej ko ści ra miennej, sta no wiąc pro blem lecz ni czy oraz wy zwa nie dla chi rur ga [5][6][7][8]. W trak cie ba da nia i le cze nia trze ba pa mię tać o tkan kach mięk kich, któ re wy ma ga ją oceny, za opa trze nia, wpły wa ją na spo sób i wy nik koń -co wy te ra pii [1,3,9,10].…”

“…W ze spo le niu roz ka wał ko wa nej, czę sto zmie nio nej oste opo ro tycz nie ko ści za sto so wa nie znaj du ją ana tomicz ne płyt ki LCP o ogra ni czo nym kon tak cie z kością [2,9]. Ist nie ją dwie mo żli wo ści kon fi gu ra cji pły -tek: a) 90-90 (pro sto pa dle do sie bie), b) rów no le gle do sie bie [2][3][4][5][6][7][8][10][11][12][13][14][15][16]. Pro wa dzo ne ba da nia uka zu ją do bre wy ni ki w jed nym i dru gim przy pad ku, bez zna czą cej prze wa gi jed ne go sys te mu im plan ta cji [1][2][3][4][5]13].…”

“…Ist nie ją dwie mo żli wo ści kon fi gu ra cji pły -tek: a) 90-90 (pro sto pa dle do sie bie), b) rów no le gle do sie bie [2][3][4][5][6][7][8][10][11][12][13][14][15][16]. Pro wa dzo ne ba da nia uka zu ją do bre wy ni ki w jed nym i dru gim przy pad ku, bez zna czą cej prze wa gi jed ne go sys te mu im plan ta cji [1][2][3][4][5]13]. Uwa ża my, że ce lem osią gnię cia opty mal nej sta bil no ści ze spo le nia na le ży kie ro wać się za sa da mi po da ny mi przez O'Dri scol la i szcze gó ło wym przygo to wa niem przed i śród o pe ra cyj nym, któ re wpły nie na wy bór tech ni ki ze spo le nia [8].…”

“…The mechanism of the injury and the quality of the bone tissue result in most cases in bone fragmentation, structural damage and loss of bone tissue in the articular surface of the humerus, posing a therapeutic problem and a challenge for the surgeon [5][6][7][8]. Soft tissues must not be ignored during diagnostic work-up and treatment: they require eva lu ation and appropriate management and influence the course and result of the treatment [1,3,9,10].…”