Less invasive percutaneous wave plating of simple femur shaft fractures: A prospective series

Qual é a área de trabalho ideal na fixação de uma fratura da diáfise do fêmur com placa em ponte? Estudo multinacional transversal

“…When the construction area is increased, stress concentration over the implant, particularly during flexion, is smaller, since the deformation area is bigger; also, there is a limiting factor of the bending moment consequently protecting the plate, represented by the contact to the trans cortical 10 . This observation is corroborated by several authors observations 3,4,7,9,10 . By the use of an experimental model with sheep, it was demonstrated that an axial compression distance of 20% to 30% of the interval length in a 3-millimeter defect is capable to promote bone consolidation in approximately nine weeks 4,11 .…”

“…Consolidation process of fractured bone depends directly of the biological and mechanical environment determined, respectively, by the kinetic energy that generated the lesion and by the type of stability provided by the surgeon [3][4][5][6]8 . In the treatment of the femur diaphysis fracture, bridge plate is indicated when the use of intramedullary tutor is contraindicated 1 .…”

“…However, in the present, there is still doubt about which is the better construction for each pattern of fracture. According to the strain theory described by Perren 5 , when stability principle is based on plate, osteosynthesis construction must present mechanical characteristics that turn it not too rigid or too flexible [2][3][4][5] . The understanding of the modulation of rigidity of the construction allows the surgeon to perform an osteosynthesis that is capable to balance biological and mechanical characteristics of each type of fracture.…”

“…In the authors opinion, different from the participants, distinct fracture patterns, involving such an antagonistic interfragment mobility as observed in fractures type AO 32-A3 e AO 32-C3 should be treated with different working areas . Ideally, in the bridge plate, interfragment mobility should be balanced under the implant and at the opposite cortical (trans), respecting the concept of stress shielding 3,4,10 . This is clearly observed in fractures with simpler trace, such as AO 32-A3, in the presence of a correct alignment of proximal and distal fragments.…”

“…The construction of a model with absolute stability, although allowing anatomical and direct reduction of the fracture, requires some devitalization of neighbor tissues around the bone, implying in healing problems of soft tissue and delayed consolidation 1,2 . For those reasons, in view of the current concepts, the use of an indirect reduction technique is advised for a more elastic stabilization of the fracture [1][2][3][4][5] .…”