Less rigid stable fracture fixation in osteoporotic bone using locked plates with near cortical slots

Gardner, Michael J.; Nork, Sean E.; Huber, P.; Krieg, James C.

doi:10.1016/j.injury.2010.02.022

Cited by 71 publications

(58 citation statements)

References 43 publications

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“…Clinically, distal femoral fractures stabilized with far cortical locking constructs healed at a mean time of sixteen weeks with a 3% nonunion rate 18 . Far cortical locking has been implemented in commercial implants 7,[19][20][21][22] and has been simulated using standard locking screws by means of overdrilling 14 or slotting 23 of the near cortex.…”

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confidence: 99%

Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing

Bottlang

Tsai

Bliven

et al. 2016

The Journal of Bone and Joint Surgery

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Background: Axial dynamization of fractures can promote healing, and overly stiff fixation can suppress healing. A novel technology, termed active plating, provides controlled axial dynamization by the elastic suspension of locking holes within the plate. This prospective, controlled animal study evaluated the effect of active plates on fracture-healing in an established ovine osteotomy model. We hypothesized that symmetric axial dynamization with active plates stimulates circumferential callus and delivers faster and stronger healing relative to standard locking plates. Methods: Twelve sheep were randomly assigned to receive a standard locking plate or an active locking plate for stabilization of a 3-mm tibial osteotomy gap. The only difference between plates was that locking holes of active plates were elastically suspended, allowing up to 1.5 mm of axial motion at the fracture. Fracture-healing was analyzed weekly on radiographs. After sacrifice at nine weeks postoperatively, callus volume and distribution were assessed by computed tomography. Finally, to determine their strength, healed tibiae and contralateral tibiae were tested in torsion until failure. Results: At each follow-up, the active locking plate group had more callus (p < 0.001) than the standard locking plate group. At postoperative week 6, all active locking plate group specimens had bridging callus at the three visible cortices. In standard locking plate group specimens, only 50% of these cortices had bridged. Computed tomography demonstrated that all active locking plate group specimens and one of the six standard locking plate group specimens had developed circumferential callus. Torsion tests after plate removal demonstrated that active locking plate group specimens recovered 81% of their native strength and were 399% stronger than standard locking plate group specimens (p < 0.001), which had recovered only 17% of their native strength. All active locking plate group specimens failed by spiral fracture outside the callus zone, but standard locking plate group specimens fractured through the osteotomy gap. Conclusions: Symmetric axial dynamization with active locking plates stimulates circumferential callus and yields faster and stronger healing than standard locking plates. Clinical Relevance: The stimulatory effect of controlled motion on fracture-healing by active locking plates has the potential to reduce healing complications and to shorten the time to return to function.

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confidence: 99%

Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing

Bottlang

Tsai

Bliven

et al. 2016

The Journal of Bone and Joint Surgery

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“…Several angular stable locking devices, such as anatomical pre-shaped plates and intramedullary nails have a relative high stiffness [9,10,31] compared to the humeral head; implant stiffness has been proposed as an important factor to achieve adequate fracture fixation [32]. In contrast, in patients with reduced bone mass, a large mismatch between the stiffness of the implant and the osteoporotic bone may lead to ''stress riser'' followed by screw cut out or fracture at the end of the plate [19,33,34]. Furthermore, too stiff fixation may reduce micromotion at the fracture site below the threshold required for callus formation leading to a potential nonunion [19].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, in patients with reduced bone mass, a large mismatch between the stiffness of the implant and the osteoporotic bone may lead to ''stress riser'' followed by screw cut out or fracture at the end of the plate [19,33,34]. Furthermore, too stiff fixation may reduce micromotion at the fracture site below the threshold required for callus formation leading to a potential nonunion [19]. In contrast, too elastic implants may not be able to hold reduction, and some biomechanical studies have shown that high elasticity may lead to early failure [20].…”

Section: Discussionmentioning

confidence: 99%

“…This may lead to early failure of relatively stiff constructs like angular stable plates or nails [18], especially in patients with reduced bone quality. In addition, too stiff constructs may reduce micromotion at the fracture site below the threshold required for callus formation [19]. In contrast, too high elasticity of the construct may lead to early failure [20].…”

Section: Introductionmentioning

confidence: 99%

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The Humerusblock NG: a new concept for stabilization of proximal humeral fractures and its biomechanical evaluation

Brunner

Resch

Babst

et al. 2012

Arch Orthop Trauma Surg

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“…However, studies, with and without the use of locking plates, have demonstrated good to excellent outcomes of operative treatments of ankle fractures in the elderly individuals. 12,[15][16][17][18]25,26 Additionally, in studies comparing operative versus nonoperative techniques, better outcomes using surgery have also been demonstrated due to the ability of the implant to maintain the reduction until healing has occurred. 13,14,[19][20][21]29,33,35,38 Since locked plates have shown an improvement in the fixation of osteopenic and osteoporotic bone, they should be used.…”

Section: Ankle Fracturesmentioning

confidence: 99%

Management of High-Energy Foot and Ankle Injuries in the Geriatric Population

Herscovici

Scaduto

2012

Geriatr Orthop Surg Rehabil

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By the year 2035 almost 20% of the US population of 389 million people will be 65 years and older. What this group has, compared with aged populations in the past, is better health, more mobility, and more active lifestyles. From January 1989 through December 2010, a total of 494 elderly patients with 536 foot and ankle injuries were identified. Within this group, 237 (48%) patients with 294 injuries were sustained as a result of a high-energy mechanism. These mechanisms consisted of 170 motor vehicle accidents, 30 as a result of high (not ground level) energy falls, 2 from industrial accidents, and 35 classified as other, which included sports, blunt trauma, bicycle, airplane or boating accidents, crush injuries, and injuries resulting from a lawn mower. The injuries produced were 17 metatarsal fractures, 9 Lisfranc injuries, 10 midfoot (navicular, cuneiform, or cuboid) fractures, 23 talus fractures, 63 calcaneal fractures, 73 unimalleolar, bimalleolar, or trimalleolar ankle fractures, 45 pilon fractures, and 3 pure dislocations of the foot or ankle. Overall, 243 (83%) of these injuries underwent surgical fixation and data have shown that when surgery is used to manage high-energy injuries of the foot and ankle in the elderly individuals, the complications and outcomes are similar to those seen in younger patients. Therefore, the decision for surgical intervention for high-energy injuries of the foot and ankle should be based primarily on the injury pattern and not solely on the age of the patient. Keywords elderly, geriatric, high-energy injuries, foot and ankleThe 2010 census demonstrated that of the 308 million people living in the United States, 13% were aged 65 and older 1 and that, except for those in the 45 to 65 years bracket, this group grew at a faster rate than any other segment of the population. 2 Extrapolation data have estimated that by the year 2035, almost 20% of the US population of 389 million people will be 65 years and older. 3

show abstract

Less rigid stable fracture fixation in osteoporotic bone using locked plates with near cortical slots

Cited by 71 publications

References 43 publications

Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing

Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing

The Humerusblock NG: a new concept for stabilization of proximal humeral fractures and its biomechanical evaluation

Management of High-Energy Foot and Ankle Injuries in the Geriatric Population

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