‘Modern’ distal femoral locking plates allow safe, early weight-bearing with a high rate of union and low rate of failure

Poole, W. E.; Wilson, Dirk G.; Guthrie, H C; Bellringer, Simon; Freeman, Richard B.; Guryel, Enis; Nicol, Stephen

doi:10.1302/0301-620x.99b7.bjj-2016-0585.r1

Cited by 47 publications

(59 citation statements)

References 18 publications

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“…This is often a necessity in periprosthetic fractures where the position of the femoral component may preclude optimal plate positioning. Although a number of studies have shown difficulties in achieving optimal plate fit in locking plate designs, there is as yet no clinical evidence to show any downside to this [7, 36]. As demonstrated in this study however, without bony union, locking plates still have a tendency to fail.…”

Section: Discussionmentioning

confidence: 64%

“…As the practice of the study location was to make all patients non-weightbearing for a minimum of 6 weeks, analysis was not possible in this regard. Although non-weightbearing is commonly the practice followed in many centres, recent studies [7, 46] have shown successful outcomes including high union rates in patients allowed full weightbearing after locked plating of distal femoral fractures. Although no biomechanical proof currently exists, there may be a beneficial effect on fracture site biology from weightbearing.…”

Section: Discussionmentioning

confidence: 99%

“…The aims of surgical treatment are to achieve stable anatomical reduction allowing for analgesia, ease of care, and early mobilization [6, 7]. These fractures have been shown to have problematic healing, with reported non-union rates of 6–25% [8, 9].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of outcomes and analysis of risk factors for non-union in locked plating of closed periprosthetic and non-periprosthetic distal femoral fractures in a retrospective cohort study

et al. 2019

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Background The primary aim was to compare the outcomes of locked plating of closed distal femur periprosthetic and non-periprosthetic fractures by testing the hypothesis that outcomes would be worse in the periprosthetic group. The secondary aim of this study was to identify risk factors for non-union. Methods A single-center study over an 8-year period utilizing a retrospective cohort design was performed. Sixty-eight patients with periprosthetic fractures and 57 patients with non-periprosthetic fractures met inclusion criteria for the study. There was a significant difference between groups in mean age (80.1 years periprosthetic vs. 70.9 years non-periprosthetic ( p < 0.001)). Statistical analysis between groups was used to assess the outcomes of time to union, incidence of non-union, post-operative functionality, incidence of complications, progression to revision surgery, and mortality. A secondary multivariable analysis was used to assess risk factors for non-union and factors positively associated with union. Results There were no significant differences in outcomes between groups. Union rates were 83.8% (57/68) in the periprosthetic group and 78.9% (45/57) in the non-periprosthetic group ( p = 0.648). Comminution was identified as a significant risk factor for non-union ( p = 0.005). Use of a submuscular technique had a significant positive association with union ( p = 0.006). Conclusions Outcomes of surgical treatment for periprosthetic and non-periprosthetic distal femur fractures are similar. There is a significant risk of non-union in locked plating of both groups.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Comparison of outcomes and analysis of risk factors for non-union in locked plating of closed periprosthetic and non-periprosthetic distal femoral fractures in a retrospective cohort study

et al. 2019

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“…Although various surgical techniques have been described for the unstable PHF, proximal humeral internal locking systems (PHILOS) are increasingly popular for treating these fractures because they offer improved biomechanical properties by providing divergent and convergent fixed‐angle screws that improve fixation and pullout strength in osteoporotic bone. It is also known to be clinically and biomechanically effective in elderly patients with PHF. However, it is difficult to obtain stable fixation in osteoporotic patients even with PHILOS.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Effects of Proximal Humeral Internal Locking System (PHILOS) Alone and PHILOS Combined with Fibular Allograft in the Treatment of Neer Three‐ or Four‐part Proximal Humerus Fractures in the Elderly

Zhao

Yang

et al. 2019

Orthopaedic Surgery

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Objective: To compare and analyze the clinical outcomes of the proximal humeral internal locking system (PHILOS) alone and the PHILOS combined with fibular allograft in the treatment of Neer three-and four-part proximal humerus fractures (PHF) in the elderly. , a total of 42 elderly patients with Neer three-or four-part PHF admitted to our hospital were randomly divided into observation group and control group, with 21 patients in each group. The observation group was treated with the PHILOS combined with fibular allograft. The control group was treated with the PHILOS alone. Perioperative parameters and fracture classification were recorded in the two groups. Function results were assessed by Visual Analog Scale (VAS), Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, and the Disability of Arm-Shoulder-Hand (DASH) score. Radiological results were evaluated using the neck-shaft angle (NSA) and humeral head height (HHH), and complications were also recorded in each group.Results: There were no significant differences between the two groups in terms of preoperative status, age, gender, cause of trauma, fracture site, and fracture classification. The average follow-up time was 12 months. At the last follow-up, the VAS and DASH observation groups were lower than the control group, and there was significant difference between the two groups (P < 0.05). The CMS and ASES were higher in the observation group than the control group, and there was significant difference between the two groups (P < 0.05). The mean difference in the NSA and HHH were lower in the observation group than the control group, and there was a significant difference between the two groups (P < 0.05). There was one postoperative complication in the observation group, which was humeral head avascular necrosis (AVN). There were seven postoperative complications in the control group, including three cases of humeral head collapse and three cases of screw cutout and one case of humeral head AVN. The incidence of postoperative complications in the observation group was significantly lower than the control group (P < 0.05), there was a significant difference between the two groups.Conclusions: For Neer three-or four-part PHF in the elderly patients, PHILOS fixation with fibular allograft shows satisfactory short-term results with respect to humeral head support and maintenance of reduction, and may reduce the incidence of complications associated with fixation using a PHILOS alone.

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“…Locking plates can provide high fixation stability for fracture healing and good functional recovery in fracture treatment, 1-3 particularly when they are applied using minimally invasive surgical techniques. 4 The advantage of using locking plates is firm screw locking, which can prevent loosening of screws, loss of fracture reduction, and disturbance of bone circulation.…”

Section: Introductionmentioning

confidence: 99%

Screw head plugs increase the fatigue strength of stainless steel, but not of titanium, locking plates

Hung

Chao

Huang

et al. 2018

Bone & Joint Research

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ObjectivesScrew plugs have been reported to increase the fatigue strength of stainless steel locking plates. The objective of this study was to examine and compare this effect between stainless steel and titanium locking plates.MethodsCustom-designed locking plates with identical structures were fabricated from stainless steel and a titanium alloy. Three types of plates were compared: type I unplugged plates; type II plugged plates with a 4 Nm torque; and type III plugged plates with a 12 Nm torque. The stiffness, yield strength, and fatigue strength of the plates were investigated through a four-point bending test. Failure analyses were performed subsequently.ResultsFor stainless steel, type II and type III plates had significantly higher fatigue strength than type I plates. For titanium, there were no significant differences between the fatigue strengths of the three types of plates. Failure analyses showed local plastic deformations at the threads of screw plugs in type II and type III stainless steel plates but not in titanium plates.ConclusionThe screw plugs could increase the fatigue strength of stainless steel plates but not of titanium plates. Therefore, leaving screw holes open around fracture sites is recommended in titanium plates.Cite this article: L-W. Hung, C-K. Chao, J-R. Huang, J. Lin. Screw head plugs increase the fatigue strength of stainless steel, but not of titanium, locking plates. Bone Joint Res 2018;7:629–635. DOI: 10.1302/2046-3758.712.BJR-2018-0083.R1.

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‘Modern’ distal femoral locking plates allow safe, early weight-bearing with a high rate of union and low rate of failure

Cited by 47 publications

References 18 publications

Comparison of outcomes and analysis of risk factors for non-union in locked plating of closed periprosthetic and non-periprosthetic distal femoral fractures in a retrospective cohort study

Comparison of outcomes and analysis of risk factors for non-union in locked plating of closed periprosthetic and non-periprosthetic distal femoral fractures in a retrospective cohort study

Comparison of the Effects of Proximal Humeral Internal Locking System (PHILOS) Alone and PHILOS Combined with Fibular Allograft in the Treatment of Neer Three‐ or Four‐part Proximal Humerus Fractures in the Elderly

Screw head plugs increase the fatigue strength of stainless steel, but not of titanium, locking plates

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