Locked Plating of Comminuted Distal Femur Fractures

Cui, Shari; Bledsoe, J. Gary; Israel, Heidi; Watson, J. Tracy; Cannada, Lisa K.

doi:10.1097/bot.0b013e31829f9504

Cited by 28 publications

(4 citation statements)

References 40 publications

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“…Field et al [7] found that the selectively reducing number of fixed screws had few impacts on the structural stiffness and bone surface stress of internal fixation system; however, optimized scheme of screw configurations was not obtained. Cui et al [8] reported that the axial strength of the device was not affected by the proximal screw, but in a certain working length of plate, proximal screws determined the strength of the internal fixation system. In Katthagen et al's study [9], different plate materials and screws can change the stiffness and limit stress of the locking plate; however, the structural parameters of the plate were not analyzed.…”

Section: Introductionmentioning

confidence: 99%

Finite Element- and Design of Experiment-Derived Optimization of Screw Configurations and a Locking Plate for Internal Fixation System

Sheng

Fang

et al. 2019

Computational and Mathematical Methods in Medicine

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Objectives. The optimization for the screw configurations and bone plate parameters was studied to improve the biomechanical performances such as reliable internal fixation and beneficial callus growth for the clinical treatment of femoral shaft fracture. Methods. The finite element analysis (FEA) of internal fixation system under different screw configurations based on the orthogonal design was performed and so was for the different structural parameters of the locking plate based on the combination of uniform and orthogonal design. Moreover, orthogonal experiment weight matrixes for four evaluation indexes with FEA were analyzed. Results. The analytical results showed the optimal scheme of screw configuration was that screws are omitted in the thread holes near the fracture site, and single cortical screws are used in the following holes to the distal end, while the double cortical screws are fixed in thread holes that are distal to the fracture; in the other words, the length of the screws showed an increasing trend from the fracture site to the distal end in the optimized configuration. The plate structure was optimized when thread holes gap reached 13 mm, with a width of 11 mm and 4.6 mm and 5 mm for thickness and diameter of the screw, respectively. The biomechanical performance of the internal fixation construct was further improved by about 10% based on the optimal strain range and lower stress in the internal fixation system. Conclusions. The proposed orthogonal design and uniform design can be used in a more efficient way for the optimization of internal fixation system, which can reduce the simulation runs to about 10% compared with comprehensive test, and the methodology can be also used for other types of fractures to achieve better internal fixation stability and optimal healing efficiency, which may provide a method for an orthopedist in choosing the screw configurations and parameters for internal fixation system in a more efficient way.

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Section: Introductionmentioning

confidence: 99%

Finite Element- and Design of Experiment-Derived Optimization of Screw Configurations and a Locking Plate for Internal Fixation System

Sheng

Fang

et al. 2019

Computational and Mathematical Methods in Medicine

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“…The LCP dynamization procedure modifies rigid locking compression plates into more flexible constructs, reducing strain on the plate and increasing axial strain on the fracture ends. In fact, the modification of the plate-screw interface at the diaphysis level provides axial micromovement without shear or fixation failure and promotes a more uniform annular callus [93][94][95]. However, LCP dynamization has clinical limitations, including an increased risk of infection due to re-incision to expose the soft tissues and the potential loss of stability during screw replacement, with the risk of re-fracture of the bridging callus if the timing is inappropriate.…”

Section: Locking Plate Dynamization (Active Dynamization or Temporal ...mentioning

confidence: 99%

Fixators dynamization for delayed union and non-union of femur and tibial fractures: a review of techniques, timing and influence factors

Hu,

Zeng,

Zhang

et al. 2023

J Orthop Surg Res

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The optimal balance between mechanical environment and biological factors is crucial for successful bone healing, as they synergistically affect bone development. Any imbalance between these factors can lead to impaired bone healing, resulting in delayed union or non-union. To address this bone healing disorder, clinicians have adopted a technique known as "dynamization" which involves modifying the stiffness properties of the fixator. This technique facilitates the establishment of a favorable mechanical and biological environment by changing a rigid fixator to a more flexible one that promotes bone healing. However, the dynamization of fixators is selective for certain types of non-union and can result in complications or failure to heal if applied to inappropriate non-unions. This review aims to summarize the indications for dynamization, as well as introduce a novel dynamic locking plate and various techniques for dynamization of fixators (intramedullary nails, steel plates, external fixators) in femur and tibial fractures. Additionally, Factors associated with the effectiveness of dynamization are explored in response to the variation in dynamization success rates seen in clinical studies.

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“…Here, we have used the term 'hybrid' construct in the latter context. Biomechanical studies have shown that only the locking screws placed in the distal segment are important for axial and torsional stiffness of the construct, with proximally unlocked (hybrid) plates showing equivalent axial and torsional stiffness, as fully locked plates [22]. Thus, the LCPs may be preferred over LISS plates in simple fracture configurations, where compression plating is required.…”

Section: Locked Versus Hybrid Platingmentioning

confidence: 99%

Distal femur AO type A fractures – Surgical options, techniques, results and complications

Agrawal¹

2016

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Background: Distal femur fractures are challenging injuries, frequently resulting in complications like non-unions, malunions, knee stiffness and infections. This article reviews the current concepts in the surgical management of extra-articular (AO/OTA type A) fractures of the distal femur, with an evidence-based approach. The role of newer and emerging techniques is also briefly discussed. Keywords: Supracondylar fractures of femur, AO type A fractures of distal femur, extra-articular fractures of distal femur, current concepts in distal femur fractures, recent advances in distal femur fractures.

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Locked Plating of Comminuted Distal Femur Fractures

Cited by 28 publications

References 40 publications

Finite Element- and Design of Experiment-Derived Optimization of Screw Configurations and a Locking Plate for Internal Fixation System

Finite Element- and Design of Experiment-Derived Optimization of Screw Configurations and a Locking Plate for Internal Fixation System

Fixators dynamization for delayed union and non-union of femur and tibial fractures: a review of techniques, timing and influence factors

Distal femur AO type A fractures – Surgical options, techniques, results and complications

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