Locked Internal Fixator

Kääb, Max J.; Frenk, A.; Schmeling, Arno; Schaser, Klaus‐Dieter; Schütz, Michael; Haas, N

doi:10.1097/00005131-200409000-00002

Cited by 107 publications

(25 citation statements)

References 12 publications

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“…Kaab et al 6 addressed this with a study focusing on variable cross-threaded angles of screw insertion into both PC-fix and plates with holes that accommodate both locking and nonlocking screws at different locations within the hole, the so-called Combi hole. The Combi hole design is different than the closed section locking holes tested in the current study.…”

Section: Discussionmentioning

confidence: 99%

“…This design allows the screw to fully engage the plate, reducing toggle of the screws. 6 However, the precise angle of insertion is at times difficult to achieve in severely osteoporotic bone and in cancellous metaphyseal bone. 1 In these settings of weakened bone, the screw can deviate from the predrilled path and ultimately rest in an off-axis position and cross-thread into the plate.…”

Section: Introductionmentioning

confidence: 99%

“…This off-axis angle weakens the screw–plate–bone construct and potentially results in early construct failure. 6 As the screw cross threads into the plate, it is tempting to increase the insertional torque to prevent the toggle that may occur when the screw is not fully engaged into the plate. Limited information is available to support this practice of over-tightening the cross-threaded screw to overcome the inherent weakness of the construct.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Off-Axis Screw Insertion, Insertion Torque, and Plate Contouring on Locked Screw Strength

Gallagher

Silva

Ricci

2014

Journal of Orthopaedic Trauma

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Objectives This study quantifies the effects of insertion torque, off-axis screw angulation, and plate contouring on the strength of locking plate constructs. Methods Groups of locking screws (n = 6–11 screws) were inserted at 50%, 100%, 150%, and 200% of the manufacturer-recommended torque (3.2 Nm) into locking compression plates at various angles: orthogonal (control), 5-degree angle off-axis, and 10-degree angle off-axis. Screws were loaded to failure by a transverse force (parallel to the plate) either in the same (“+”) or opposite direction (“−”) of the initial screw angulation. Separately, locking plates were bent to 5 and 10-degree angles, with the bend apex at a screw hole. Locking screws inserted orthogonally into the apex hole at 100% torque were loaded to failure. Results Orthogonal insertion resulted in the highest average load to failure, 2577 ± 141 N (range, 2413–2778 N), whereas any off-axis insertion significantly weakened constructs (165–1285 N, at 100% torque) (P < 0.05). For “+” loading, torque beyond 100% did not increase strength, but 50% torque reduced screw strength (P < 0.05). Loading in the “−” direction consistently resulted in higher strengths than “+” loading (P < 0.05). Plate contouring of 5-degree angle did not significantly change screw strength compared with straight plates but contouring of 10-degree angle significantly reduced load to failure (P < 0.05). Conclusions To maximize the screw plate interface strength, locking screws should be inserted without cross-threading. The mechanical stability of locked screws is significantly compromised by loose insertion, off-axis insertion, or severe distortion of the locking mechanism.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Off-Axis Screw Insertion, Insertion Torque, and Plate Contouring on Locked Screw Strength

Gallagher

Silva

Ricci

2014

Journal of Orthopaedic Trauma

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“…Using a limited incision, minimally invasive technology can be a very good solution to these problems [2, 5], reducing both iatrogenic soft tissue injury and damage to the blood supply. In recent years, locking plates techniques have gained popularity among orthopedic surgeons which can preserve the periosteal blood supply and increase stability [7-11]. Kim found that in the setting of elderly ankle fractures, locking plates are at least equivalent biomechanically to standard plates, but Minihane got different conclusions that the posterolateral antiglide plate demonstrated improved biomechanical stability as compared to the lateral locking plate in osteoporotic bone [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Locking versus Non-locking Neutralization Plates with Limited Excision and Internal Fixation for Treatment of Extra-articular Type a Distal Tibial Fractures

Zhou¹,

Chen²

2017

TOORTHJ

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Purpose:This study aimed to compare the clinical, radiologic, and cost-effectiveness results between locking and non-locking plates for the treatment of extra-articular type A distal tibial fractures.Methods:We performed a retrospective review of AO/OTA 42-A1, A2 distal tibial fractures treated by plates from January 2011 to June 2013. Patients were divided to the locking plate group or the non-locking plate group. Clinical outcomes, radiographic outcomes, and hospitalization fee were compared between the two plates groups.Results:28 patients were treated with a locking plate and 23 patients were treated with a non-locking plate. The mean follow-up was 18.8 months (12-23 months). There were no significant differences between the groups in surgical time, bleeding, bone union time, or AOFAS scores. The cost of the locking plate was ¥24,648.41 ± 6,812.95 and the cost of the non-locking plate was ¥11,642 ± 3,162.57, p < 0.001. Each group had one patient that experienced superficial infection these wounds were readily healed by oral antibiotics and dressing changes. To date, five patients in the locking group and ten patients in the non-locking group had sensations of metal stimulation or other discomfort (X2 = 3.99, p < 0.05) Until the last follow-up, 14 patients in the locking plate group and 18 patients in the non-locking plate group had their plates removed or wanted to remove their plates (X2 = 4.31, p < 0.05).Conclusion:The use of locking or non-locking plates provides a similar outcome in the treatment of distal fractures. However the locking plate is much more expensive than the non-locking plate.

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“…In the past, 4.5 mm plates were used, but some surgeons now tend to use 3.5 mm locking plates (3). These plates are less bulky and easier to adapt on the bone, and good outcomes have been reported with regard to utilizing them in comminuted tibial plateau fractures (4).…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of Tibial Plateau Fractures With 3.5 mm Simple Plates

Bagherifard¹,

Hadi²,

Rahbar³

et al. 2016

Trauma Mon

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BackgroundTibial plateau fractures can be successfully fixed utilizing 3.5 mm locking plates. However, there are some disadvantages to using these plates.ObjectivesIn the current prospective study, we investigated the outcome of treating different types of tibial plateau fractures with 3.5 mm simple plates which, to our knowledge, has not been evaluated in previous studies.Materials and MethodsBetween 2011 and 2013, 32 patients aged 40 ± 0.2 years underwent open reduction and internal fixation for tibial plateau fractures with 3.5 mm simple plates. The patients were followed for 16.14 ± 2.1 months. At each patient’s final visit, the articular surface depression, medial proximal tibial angle, and slope angle were measured and compared with measurements taken early after the operation. The functional outcomes were measured with the WOMAC and Lysholm knee scores.ResultsThe mean union time was 13 ± 1.2 weeks. The mean knee range of motion was 116.8° ± 3.3°. The mean WOMAC and Lysholm scores were 83.5 ± 1.8 and 76.8 ± 1.6, respectively. On the early postoperative and final X-rays, 87.5% and 84% of patients, respectively, had acceptable reduction. Medial proximal tibial and slope angles did not change significantly by the last visit. No patient was found to have complications related to the type of plate.ConclusionsIn this case series study, the fixation of different types of tibial plateau fractures with 3.5 mm simple non-locking and non-precontoured plates was associated with acceptable clinical, functional, and radiographic outcomes. Based on the advantages and costs of these plates, the authors recommend using 3.5 mm simple plates for different types of tibial plateau fractures.

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Locked Internal Fixator

Cited by 107 publications

References 12 publications

Effect of Off-Axis Screw Insertion, Insertion Torque, and Plate Contouring on Locked Screw Strength

Effect of Off-Axis Screw Insertion, Insertion Torque, and Plate Contouring on Locked Screw Strength

Locking versus Non-locking Neutralization Plates with Limited Excision and Internal Fixation for Treatment of Extra-articular Type a Distal Tibial Fractures

Surgical Management of Tibial Plateau Fractures With 3.5 mm Simple Plates

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