Results in treatment of distal femur fractures using polyaxial locking plate

Indications and techniques of locked plate fixation for the treatment of challenging fractures continue to evolve. As design variant of classic locked plates, the polyaxial locked plate has the ability to alter the screw angle and thereby, enhance fracture fixation. The aim of this observational study was to evaluate clinical and radiographic results in 89 patients with 90 fractures of the distal femur treated, between June 2006 and November 2011, with such a polyaxial locked plating system (Polyax™ Locked Plating System, DePuy, Warsaw, IN, USA). Seventy-seven fractures formed the report of this study. These cases were followed up until complete fracture healing or for a mean time of 77 weeks. At the time of last follow-up, 58 of 77 fractures (75.3 %) progressed to union without complication and radiographic healing occurred at a mean time of 16.3 weeks. Complications occurred in ten fractures that did not affect the healing and in nine fractures that showed delayed or non-union. The mean American Knee Society Score at the time of final follow-up was 83 for the Knee Score and 71.1 for the Functional Score. In conclusion, there is a high union rate for complex distal femoral fractures associated with a good clinical outcome in this series.     

Treatment of periprosthetic femur fractures with the non-contact bridging plate: a new angular stable implant

Objectives

We report the application of a new fixed angle plate (NCB DF^®, Zimmer inc. USA, Warsaw, IN) in the treatment of periprosthetic femur fractures. The NCB DF^® combines conventional plating technique with polyaxial screw placement and angular stability.

Design

Prospective cohort study.

Setting

A single level-1 trauma center.

Patients

From May 2003 to December 2005, a total of 24 patients with periprosthetic femur fractures were treated. The NCB DF^® femur plate was used in all cases. The average follow-up period was 12 months (3–31 months). Twelve patients had a periprosthetic fracture after total knee replacement (TKA) and 12 patients after total hip replacement (THA). The mean period from primary joint replacement to periprosthetic fracture was 8.2 years for the THA group and 7.2 years for the TKA group.

Intervention

A combined conventional/locking surgical technique was performed in all the cases.

Main outcome measures

Union, non-union, mal-union, duration of surgery, range of motion, postoperative mobility, subjective patient satisfaction and complications.

Results

The union rate was 90%, the mal-union rate 5% and the re-operation rate 15%. Postoperative mobility reached the preoperative level in all but for two patients. Three complications occurred relating to the implant or the procedure: one fatigue failure of the plate (non-union), one screw breakage, and one wound infection.

Conclusions

The NCB DF^® combines conventional plating technique with polyaxial screw placement and angular stability. This combination technique shows promising results regarding union and mal-union rates in periprosthetic fractures in elderly and osteoporotic patients.

     

锁定接骨板治疗老年肱骨近端骨折

目的探讨肱骨近端锁定接骨板内固定治疗老年肱骨近端骨折的疗效。方法2002年1月～2004年1月对35例老年肱骨近端骨折予以锁定接骨板内固定治疗,术后早期功能锻炼。结果术后所有患者平均随访13.2个月,骨折愈合时间平均8.3周(7～12周),1例肱骨头缺血性坏死。按Constant评分标准,平均81.4分(39～95分),其中优22例,良8例,中4例,差1例,优良率85.7%。结论肱骨近端锁定接骨板对于骨质疏松的老年肱骨近端骨折是一种安全有效的治疗方法。     

锁定钢板与常规手术治疗肱骨近端骨折疗效比较

目的 :比较肱骨近端锁定钢板 (LockingProximalHumerusPlate)与常规手术方法治疗肱骨近端骨折疗效。方法 :回顾性分析比较肱骨近端锁定钢板治疗肱骨近端骨折与常规手术方法的疗效与并发症。结果 :锁定钢板治疗组的疗效及并发症发生率明显优于常规手术方法组 ,治疗组的满意率 87.5 %～ 76% ,断钉断板率 <16% ,感染率 <8% ,肩峰撞击 <2 0 % ,四部分骨折肱骨头坏死率 3 3 .3 %～ 60 % ,P <0 .0 5。结论 :治疗肱骨近端骨折方法多样 ,肱骨近端锁定钢板是一种创新、优异的方法。     

单轴与多轴锁定接骨板治疗桡骨远端骨折的疗效比较

背景:切开复位锁定接骨板内固定是桡骨远端骨折的常用治疗方法。根据锁定方式的不同,锁定接骨板分为单轴与多轴两类,二者各有其特点。目的:比较单轴掌侧锁定接骨板(MA-VLP)与多轴掌侧锁定接骨板(PA-VLP)内固定治疗桡骨远端骨折的疗效。方法:回顾分析2014年1月至2018年6月接受手术治疗的77例桡骨远端骨折患者资料。采用MA-VLP固定37例(MA组),PA-VLP固定40例(PA组)。记录手术时间、骨折愈合时间、并发症,测量术后影像学参数,采用DASH评分和Mayo评分评估患肢功能。结果:两组患者均获得良好骨折复位、稳定内固定及骨折愈合。PA组手术时间显著短于MA组(P<0.05)。两组均未出现伤口深部感染、骨折不愈合或畸形愈合、内固定失效等并发症。两组患者骨折愈合时间、术后并发症、影像学参数比较,差异均无统计学意义(P>0.05)。术后6周、12周,PA组DASH评分显著低于MA组(P<0.05);术后6个月及末次随访,两组DASH及Mayo评分差异均无统计学意义(P>0.05)。结论:MA-VLP与PA-VLP内固定用于桡骨远端骨折,均可获得满意的临床疗效,但后者手术时间更短,更利于早期功能恢复。     

应用肱骨近端锁定型髓内针治疗肱骨近端骨折的临床疗效分析

目的探讨应用肱骨近端髓内针治疗肱骨近端两部分外科颈骨折的疗效。方法回顾性分析22例应用锁定型肱骨近端髓内针治疗两部分外科颈新鲜骨折患者的临床资料,患者平均年龄57岁。最终随访时拍摄肩关节X线片以评价愈合情况,并应用可视模拟评分法（VAS）评分,美国肩肘外科医师评分（ASES）,Constant-Murley评分,UCLA评分以及简易肩关节测验（SST）问卷评估。结果所有患者均获随访,平均随访时间为13个月,22例患者骨折均在术后8周内初步愈合。随访过程中未出现感染、肱骨头坏死以及任何与内固定物有关的并发症。术后患肢主动前屈上举平均为147．8°,主动体侧外旋平均为45．5°,主动内旋平均达T10水平。术后患者疼痛VAS评分平均为1．5。平均ASES评分为81．2,Constant-Murley评分为85．4,UCLA评分为29．9,SST评分为9．5。18例患者的肩关节功能评估为优或良,4例患者肩关节功能评估为差。结论闭合复位、锁定型肱骨近端髓内针固定术是治疗肱骨近端两部分外科颈骨折的一种有效的手术方式。     

LCP治疗肱骨近端骨折

目的 :探讨应用LCP (locking -compressionplate)治疗肱骨近端骨折的可行性及临床应用价值。方法 :2 0 0 2年 12月～ 2 0 0 3年 11月 ,对收治的 12例肱骨近端骨折病人 ,按AO分类 ,根据AO骨折内固定原则 ,采用切开复位、LCP解剖形钛板内固定治疗 ,部分病例进行植骨。结果 :随访 4～ 15个月 ,平均 9.2个月 ,评定结果采用Neer评分 ,总的优良率为 91.7%。结论 :肱骨近端LCP具有无需预弯、副损伤小、固定牢固的特点 ,能用于治疗大部分类型的肱骨近端骨折 ,尤其对于不稳定的、骨质疏松明显的肱骨近端骨折具有良好的治疗效果     

Mid term results of PlantTan plate in the treatment of proximal humerus fractures

This prospective study evaluates the clinical efficacy of a special implant, PlantTan plate used for fixation of displaced proximal humerus fractures. The PlantTan plate was used for internal fixation of closed displaced proximal humeral fractures in 68 patients from September 1999 to June 2002, in a University Hospital. One of the surgeries was for a non-union, and five patients were lost to follow-up. The patients' ages ranged from 19 to 76 years (mean 61 years and median 66 years). Of the remaining 62 patients, 42 were female and 20 were male. As defined using the Neer classification 19 patients had two part, 37 three part and 6 had four part fractures. Median follow-up was 19 months (11-38). The outcome was assessed using radiographs, American Shoulder and Elbow Surgeons (ASES) score and Hospital for Special Surgery (HSS) scoring system. Fifty-two patients achieved union in a median of 8 weeks. The median cumulative score of activities of daily living of ASES was 20.4/30 (13-27). According to HSS, 11 scored excellent, 26 good, 14 fair and 11 scored poor. Eight patients had fixation failure and two developed avascular necrosis. Eleven patients developed an infection. Six patients developed an infection resulting in implant removal. One had a transient and one permanent axillary nerve palsy. Since the PlantTan plate provides stability, early active rehabilitation can be instituted. The implant is distally placed reducing impingement symptoms. However, the implant requires wide surgical exposure, is bulky and has an unacceptable infection rate. The fixation failure is high in patients with osteoporosis. In view of the above encountered problems, the implant has been discontinued in our hospital.     

应用肱骨近端锁定钢板治疗肱骨近端骨折

目的观察、评价肱骨近端锁定钢板（LPHP）治疗肱骨近端骨折的疗效。方法通过分析自2008—01—2012—10收治并随访的52例肱骨近端二部分以上骨折。采用有限切开、透视复位、肱骨近端锁定钢板内固定的方法治疗,骨缺损患者采用自体髂骨及人工骨植骨。结果本组获得随访8—25个月（平均15个月）,肱骨近端骨折均得到了愈合,按Neer肩关节功能评分标准：优25例,良18例,可6例,差3例,优良率82．7％。未发生断板、断钉,无肱骨头缺血坏死及肩峰撞击综合征。结论应用肱骨近端锁定钢板治疗肱骨近端骨折,骨缺损者取髂骨、人工骨植骨,根据骨折类型及稳定性等指导功能锻炼,骨折愈合良好、并发症少、关节功能恢复好。     

Radiographic and clinical results of tension suture fixation using two washers with PHILOS plate for proximal humeral fractures

IntroductionThe purpose of this study was to evaluate the radiographic and clinical results of tension suture fixation using two washers with PHILOS plate (Synthes, West Chester, PA, USA) for proximal humeral fractures.Patients and methodsConsecutive 39 patients were included and divided into two groups of adequate and inadequate medial support (MS (+) group vs MS (−) group). The mean follow-up period was 45months (range: 26–69 months). The mean age at the time of surgery was 59 years (range: 17–86 years) and there were 12 men and 27 women. The clinical results were evaluated using the visual analogue scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV). The radiographic results were evaluated by serial radiographs and Paavolainen method, which measures the neck-shaft angle (NSA). We used the Paired T and Kruskal-Wallis test to compare radiographic and clinical results between the two groups.ResultsBony union was achieved in 37 cases (94.9%). The mean NSA was changed from 133.5° postoperatively to 131.0° at the final follow-up period, but this change was not statistically significant. Thirty-five cases (89.8%) had good radiographic results as determined by the Paavolainen method. The mean final VAS pain score, ASES score, and SSV were 1.3, 87.3, and 86.0%, respectively. There were no significant differences between the two groups with respect to radiographic and clinical outcomes. Eight cases (20.5%) had complications including 5 with shoulder stiffness, 1 experiencing nonunion by fixation failure, 1 malunion, and 1 migration of greater tuberosity.ConclusionTension suture fixation using two washers with PHILOS plate for proximal humeral fractures yielded satisfactory radiographic and clinical results. It can be a treatment option that can reduce varus deformity and fixation loss.     

肱骨近端锁定接骨板治疗肱骨近端骨折

2010年3月～2012年12月,我科采用肱骨近端锁定接骨板(LPHP)治疗17例肱骨近端骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组17例,男13例,女4例,年龄20～72岁。骨折按Neer分型:Ⅱ型5例,Ⅲ型9例,Ⅳ型3例。均采用LPHP切开复位内固定。     

Biomechanical comparison of a lateral polyaxial locking plate with a posterolateral polyaxial locking plate applied to the distal fibula

BackgroundPolyaxial locking plates are becoming popular for the fixation of distal fibula fractures. This study establishes how construct stiffness and plate loosening, measured as range of motion, differs between lateral and posterolateral plate location.MethodsSeven matched pairs of cadaver fibulae were osteotomized in standardized fashion to produce a Weber type B distal fibula fracture. The fragments were fixated with an interfragmentary lag screw and polyaxial locking plates, with one fibula in each pair receiving a posterolateral anti-glide-plate, and the other a lateral neutralization-plate. In a biomechanical test, the bending and torsional stiffnesses of the constructs and the ranges of motion (ROM) were measured and subjected to a paired comparison.ResultsThe laterally plated group had a higher median (interquartile range) bending stiffness (29.2 (19.7) N/mm) and a smaller range of motion (2.06 (1.99) mm) than the posterolaterally plated group (14.6 (20.6) N/mm, and 4.11 (3.28) mm, respectively); however, the results were not statistically significant (p_bending = 0.314; p_ROM = 0.325). Similarly, the torsional stiffness did not differ significantly between the two groups (laterally plated: 426 (259) N mm/°; posterolaterally plated: 248 (399) N mm/°; p_torsion = 0.900). The range of motion measurements between the two groups under torsional loading were also statistically insignificant (laterally plated: 8.88 (6.30) mm; posterolaterally plated: 15.34 (12.64) mm; p_ROM = 0.900).ConclusionIn biomechanical cadaver-model tests of Weber type B fracture fixation with polyaxial locking plates, laterally plated constructs and posterolaterally plated constructs performed without significantly difference. Therefore, other considerations, such as access morbidity, associated injuries, patient anatomy, or surgeon's preference, may guide the choice of plating pattern. Further clinical studies will be needed for the establishment of definitive recommendations. Clinical relevance: Information on the behavior of polyaxial locking plates is relevant to surgeons performing internal fixation of distal fibula fractures.     

应用MIPPO技术PHILOS接骨板治疗肱骨近端骨折

目的：探讨采用微创经皮钢板内固定技术（minimally invasive percutaneous plate osteosynthesis,MIPPO）技术下应用PHILOS接骨板治疗肱骨近端骨折的疗效。方法：2008年1月至2009年7月,对22例肱骨近端骨折采用MIPPO技术用PHILOS接骨板内固定治疗。根据Neer分类,二部分骨折为7例,三部分骨折为12例,四部分骨折为3例。结果：本组患者均获随访,随访时间6．12个月,平均10个月,评定结果采用Neer评分,本组病例优9例,良10例,可3例,总的优良率为86．4％。结论：采用MIPPO技术应用PHILOS接骨板治疗肱骨近端骨折,具有创伤小、固定牢固、能够早期功能锻炼的优点,可以达到良好的疗效。     

A systematic review of locking plate fixation of proximal humerus fractures

Purpose

Technique for the fixation of two, three, and four part proximal humerus fractures has rapidly shifted towards the use of specially contoured proximal humerus locking plates. The purpose of this study is to evaluate the short to medium term functional results and common complications associated with the fixation of proximal humerus fractures with locking plates.

Methods

The PubMed and EMBASE databases were used to perform a systematic review of the English literature to assess the functional results and complications associated with proximal humerus locking plates. Our inclusion criteria were proximal humerus fracture due to trauma (excluding pathologic fractures), patients greater than 18 years of age, more than 15 patients in the study or subgroup of interest, at least 18 months follow-up, at least one relevant functional outcome score, and quality outcome score of at least 5/10. Studies that did not meet these criteria were excluded. All institutional, author, and journal information was concealed to minimize reviewer bias.

Results

Twelve studies including 514 patients met the inclusion criteria. At most recent follow-up patients achieved a mean Constant score of 74 and a mean DASH score of 27. The overall rate of complications was 49% including varus malunion, 33% excluding varus malunion, and reoperation rate was 14%. The most common complications included varus malunion 16%, AVN 10%, screw perforation of the humeral head into the joint 8%, subacromial impingement 6%, and infection 4%.

Discussion

Fixation of proximal humerus fractures with proximal humerus locking plates is associated with a high rate of complications and reoperation. Further study is needed to determine what technical errors and patient characteristics are risk factors for failure of this now common fixation technique.     

肱骨近端锁定钢板与传统AO钢板治疗老年肱骨近端骨折的比较

目的比较肱骨近端锁定钢板与传统AO钢板治疗老年肱骨近端骨折的疗效。方法2002年7月-2005年5月间收治37例老年肱骨近端骨折患者,采用肱骨近端锁定钢板(LPPH)治疗18例,年龄65-82岁(平均69岁),Neer分型三部分骨折12例,四部分骨折6例;采用传统AO钢板治疗19例,年龄65-84岁(平均71岁),Neer分型三部分骨折12例,四部分骨折7例。术后肩关节功能评估采用肩关节疼痛和功能障碍指数(SPADI)量表评分,对两组疗效进行比较。结果术后6周、12周、1年随访肩关节功能、骨折愈合及肱骨头坏死情况,发现LPPH治疗组的钢板螺丝钉松动发生率、术后肩关节评分均优于传统AO钢板治疗组。结论LPPH治疗老年骨质疏松患者的肱骨近端骨折相比传统AO钢板有明显的优势。     

锁定接骨板治疗肱骨近端骨折的近期疗效

目的探讨锁定接骨板治疗肱骨近端骨折的近期疗效。方法采用切开复位锁定接骨板内固定治疗28例肱骨近端骨折患者。结果 28例均获得随访,时间7个月~4年。骨折均获得骨性愈合。未出现切口感染、骨不连及内固定物松动断裂等并发症。肩关节功能按照Neer评分标准:优17例,良8例,可3例,优良率25/28。结论肱骨近端锁定接骨板治疗肱骨近端骨折损伤较小,固定可靠,可早期进行肩关节锻炼,术后功能恢复好,近期疗效满意。     

锁定接骨板治疗老年肱骨近端骨折

目的 探讨肱骨近端锁定接骨板(LPHP)治疗肱骨近端骨折的临床疗效。方法 采PHP治疗29例肱骨近端骨折，按Neer分类法，二部分骨折11例；三部分骨折12例；四部分骨折6例。结果 平均愈合时间7．4周(6～12周)：按照Constant评分标准，功能优18例，良为8例，中为3例，优良率为89．6％。结论 肱骨近端锁定接骨板治疗眩骨近端骨折手术简单、固定可靠、并发症少、骨折愈合率高特别是老年骨质疏松患者首选治疗方法。     

解剖型锁定加压钢板治疗肱骨近端复杂骨折

目的探讨解剖型锁定加压钢板治疗肱骨近端复杂骨折的临床疗效。方法应用解剖型锁定加压钢板治疗32例肱骨近端Neer分型三、四部分骨折患者。结果患者均获得随访,时间15~36个月。患者骨折均达临床愈合。按肩关节功能Neer评分评价:优26例,良4例,可2例,优良率93.75%。结论解剖型锁定加压钢板治疗肱骨近端复杂骨折操作简便,固定牢固,术后骨折愈合快、肩关节功能恢复良好,是一种有效的方法。     

锁定钢板治疗肱骨近端粉碎性骨折

目的 了解锁定钢板治疗粉碎性肱骨近端骨折的疗效及相关手术技术.方法 2003年2月-2007年3月,采用锁定钢板治疗肱骨近端粉碎性骨折34例,其中21例采用肱骨近端锁定钢板(locking proximal humerus plate,LPHP),13例采用肱骨近端锁定系统(proximal humerus interlockingsystem,PHILOS).根据Neer分型,三部分骨折30例,四部分骨折4例.结果 术后32例获得12～36个月随访,平均18.6个月.2例失访.术后骨折均愈合,无内固定失效,骨折平均愈合时间为10周.根据Constant评分标准评定:优4例,良23例,可4例,差1例;优良率为84.4%.其中60岁以下Constant评分平均为83(77～90),60岁以上平均为72(30～86).三部分骨折评分平均为76(70～90),而四部分骨折平均为60(30～74).结论 锁定钢板是治疗肱骨近端粉碎性骨折的有效方法.肱骨近端内侧的有效支撑以及减少软组织剥离是手术成功的关键.     

肱骨近端解剖锁定钢板与解剖钢板治疗肱骨Neer三、四部分骨折的疗效比较

【摘要】 目的〓探讨肱骨近端解剖钢板与肱骨近端解剖锁定钢板治疗老年肱骨近端Neer三、四部分骨折的功能及疗效差异。方法〓收集有完整随访资料的151例老年Neer三、四部分骨折患者,按手术方式分为肱骨近端解剖钢板组(A组,65例)和肱骨近端解剖锁定钢板组(B组,86例),在随访过程采用Constant评分及Neer评分评价并比较两组疗效。结果〓B组平均愈合时间显著短于A组(P<0.05)。两组的术后1年和术后2年功能比较:B组Neer评分的疼痛、功能、活动度及总分均显著优于A组(P<0.05);B组Constant评分的疼痛、日常生活活动、主动活动及总分显著优于A组(P<0.05)。结论〓肱骨近端解剖钢板与肱骨近端解剖锁定钢板均可用于老年Neer三、四部分骨折,但解剖锁定钢板愈合更快,功能恢复更好,临床推荐优先使用。