Treatment of Palatal Fractures by Osteosynthesis with 2.0-mm Locking Plates as External Fixator.
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ABSTRACT:
SUBMITTER: Cienfuegos R
PROVIDER: S-EPMC3052710 | biostudies-other | 2010 Dec
REPOSITORIES: biostudies-other
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Project description:PurposeThe present study aimed to evaluate the efficacy and stability of 2.0 mm Titanium plates in treatment of mandibular angle fractures.Materials and methodsA randomized, prospective study was carried out on 17 patients treated by ORIF with 2.0 mm titanium plates. Operative handling of the plate and clinical stability were qualitatively analyzed.ResultsThe 2.0 mm plate showed good intra-operative handling and adequate clinical stability with follow up of 6 months showing good soft tissue healing.ConclusionA single 2.0 mm titanium plate provides easy handling and adequate occlusal stability in the post-operative phase as compared to the traditional 2.5 mm plate without post-operative MMF.Electronic supplementary materialThe online version of this article (doi:10.1007/s12663-010-0128-2) contains supplementary material, which is available to authorized users.
| S-EPMC3177482 | biostudies-literature
Project description:Locked bridge plating relies on secondary bone healing, which requires interfragmentary motion for callus formation. This study evaluated healing of fractures stabilized with a locked plating construct and a far cortical locking construct, which is a modified locked plating approach that promotes interfragmentary motion. The study tested whether far cortical locking constructs can improve fracture-healing compared with standard locked plating constructs.In an established ovine tibial osteotomy model with a 3-mm gap size, twelve osteotomies were randomly stabilized with locked plating or far cortical locking constructs applied medially. The far cortical locking constructs were designed to provide 84% lower stiffness than the locked plating constructs and permitted nearly parallel gap motion. Fracture-healing was monitored on weekly radiographs. After the animals were killed at week 9, healed tibiae were analyzed by computed tomography, mechanical testing in torsion, and histological examination.Callus on weekly radiographs was greater in the far cortical locking constructs than in the locked plating constructs. At week 9, the far cortical locking group had a 36% greater callus volume (p = 0.03) and a 44% higher bone mineral content (p = 0.013) than the locked plating group. Callus in the locked plating specimens was asymmetric, having 49% less bone mineral content in the medial callus than in the lateral callus (p = 0.003). In far cortical locking specimens, medial and lateral callus had similar bone mineral content (p = 0.91). The far cortical locking specimens healed to be 54% stronger in torsion (p = 0.023) and sustained 156% greater energy to failure in torsion (p < 0.001) than locked plating specimens. Histologically, three of six locked plating specimens had deficient bridging across the medial cortex, while all remaining cortices had bridged.Inconsistent and asymmetric callus formation with locked plating constructs is likely due to their high stiffness and asymmetric gap closure. By providing flexible fixation and nearly parallel interfragmentary motion, far cortical locking constructs form more callus and heal to be stronger in torsion than locked plating constructs.
| S-EPMC2897208 | biostudies-literature
Project description:BackgroundThe locking plate is a useful treatment for lateral clavicle fractures, however, there are limits to the fragment size that can be fixed. The current study aimed to measure the screw angles of three locking plates for lateral clavicle fractures. In addition, to assess the number of screws that can be inserted in different fragment sizes, to elucidate the size limits for locking plate fixation.MethodsThe following three locking plates were analyzed: the distal clavicle plate [Acumed, LLC, Oregon, the USA], the LCP clavicle plate lateral extension [Depuy Synthes, LLC, PA, the USA], and the HAI clavicle plate [HOMS Engineering, Inc., Nagano, Japan]. We measured the angles between the most medial and lateral locking screws in the coronal plane and between the most anterior and posterior locking screws in the sagittal plane. A computer simulation was used to position the plates as laterally as possible in ten normal three-dimensional clavicle models. Lateral fragment sizes of 10, 15, 20, 25, and 30 mm were simulated in the acromioclavicular joint, and the number of screws that could be inserted in the lateral fragment was assessed. Subsequently, the area covered by the locking screws on the inferior surface of the clavicle was measured.ResultsThe distal clavicle plate had relatively large screw angles (20° in the coronal plane and 32° in the sagittal plane). The LCP clavicle lateral extension had a large angle (38°) in the sagittal plane. However, the maximum angle of the HAI clavicle plate was 13° in either plane. The distal clavicle plate allowed most screws to be inserted in each size of bone fragment. For all locking plates, all screws could be inserted in 25 mm fragments. The screws of distal clavicle plate covered the largest area on the inferior surface of the clavicle.ConclusionsScrew angles and the numbers of screws that could be inserted in the lateral fragment differed among products. Other augmented fixation procedures should be considered for fractures with fragment sizes < 25 mm that cannot be fixed with a sufficient number of screws.
| S-EPMC8456609 | biostudies-literature
Project description:BackgroundThe exact benefit of locking plates over nonlocking plates in patients with lateral malleolus fractures remains unclear. The primary aim of this study was to compare the functional outcome of locking plates vs nonlocking plates in patients with a lateral malleolus fracture. The secondary aims were to compare the number of complications and hardware removals and to compare whether results differed for older patients and for patients treated with anatomical locking plates.MethodsThe PubMed/MEDLINE, Embase, Cochrane, and CINAHL databases were searched for studies comparing locking plates with nonlocking plates in patients with fixated lateral malleolus fractures. All included studies were assessed on their methodologic quality using the MINORS. Subgroup analyses were performed on older patients and patients treated with anatomical locking plates.ResultsA total of 11 studies were included. The meta-analysis showed that functional outcome did not differ between patients treated with locking plates and nonlocking plates (MD 2.38, 95% CI -2.71 to 7.46). No difference in both complication rate (OR 1.10, 95% CI 0.74-1.63) and the amount of hardware removals (OR 0.77, 95% CI 0.52-1.14) was found. Even after analyzing older patients and patients treated with anatomical locking plates, no benefit was shown.ConclusionThis meta-analysis demonstrates no clear benefit in selecting locking plates over nonlocking plates in the treatment of lateral malleolus fractures.Clinical relevanceLocking plates are increasingly being used in the treatment of lateral malleolus fractures. Biomechanical studies have shown an increased stability with use of locking vs nonlocking plates. This clinical review does not support a benefit of use of locking plates for these fractures.
| S-EPMC8841627 | biostudies-literature
Project description:BackgroundThe management of displaced distal tibial fractures is still controversial. The different internal fixation techniques are often burdened by relatively high complication rates. Minimally invasive techniques with ring fixators have been introduced as an alternative allowing immediate reduction and stabilization, avoiding a staged protocol. The aim of this prospective study was to analyze the clinical and radiographic outcome the Ilizarov technique in patients with distal metaphyseal tibial fractures, with or without intra-articular involvement.MethodsThirty-nine consecutive patients with isolated fractures treated with the Ilizarov technique were followed prospectively for one year. Depending on the type of fracture, 4 or 5 rings were used, in some cases with additional foot extension. Unrestricted weight-bearing was allowed in all cases. Pre- and post-operatively conventional radiographs, post-operative pain assessment and complications were evaluated. The function was evaluated clinically and with self-appraisal protocols: EQ-5D, NHP and FAOS.ResultsNo patient developed compartment syndrome or deep venous thrombosis. Pin infections were frequent, but they were mostly superficial and were treated with antibiotics and/or the removal of isolated pins. Two patients required debridement. One of them had a deep infection and developed a residual deformity which was corrected and healed after re-operation. Another patient had a severe residual deformity. The fixator was removed after a median period of 16 weeks (range 11-30). The radiological results were poor in 5 patients but the overall self-appraisal showed satisfactory results in 36 patients.ConclusionsThe Ilizarov method allowed early definitive treatment with a low complication rate and a good clinical outcome.
| S-EPMC3626620 | biostudies-literature
Project description:Background and purposeHistorically, the treatment of periprosthetic femoral fractures (PFFs) has been associated with a high frequency of complications and reoperations. The preferred treatment is internal fixation, a revision of the femoral stem, or a combination of both. An improved understanding of plate use during internal fixation, and the introduction of locking-plate osteosynthesis may lead to improved outcome. We evaluated the outcome of Vancouver type B1 and C PFFs treated by locking-plate osteosynthesis, by assessing rates of fracture union and reoperations and by analyzing failure cases.Patients and methodsFrom 2002 through 2011, 58 consecutive patients (60 fractures) with low-energy PFF around or below a stable femoral stem, i.e. Vancouver type B1 and C fractures, underwent osteosynthesis with a locking plate. All patients had a total hip replacement (THR). They were followed up clinically and radiographically, with 6 weeks between visits, until fracture union or until death. Fracture union was evaluated 6 months postoperatively.ResultsAt a median follow-up time of 23 (0-121) months after PFF, 8 patients (8 fractures) had been reoperated due either to infection (n = 4), failure of fixation (n = 3), or loosening of the femoral stem (n = 1). All the patients who had been followed up for at least 6 months-and who did not undergo reoperation or die-went on to fracture union (n = 43).InterpretationLocking-plate osteosynthesis of periprosthetic Vancouver type B1 and C fractures gives good results regarding fracture union. It appears that spanning of the prosthesis to avoid stress-rising areas is important for successful treatment. Infection is the major cause of failure.
| S-EPMC3555447 | biostudies-literature
Project description:PURPOSE: Fixed-angle devices have been a major advancement in orthopedic fracture care and have become an attractive option for fixation of distal radius fractures. Several volar locking plates exist, but there is insufficient literature comparing the strengths of these plates. This study compares the biomechanical strength of two popular volar locking plate systems (Synthes LCP and Hand Innovations DVR-A) along with a nonlocking volar T-plate (Synthes). METHODS: Twenty-three formalin-fixed cadaveric forearms were divided into three groups with similar ages and bone densities. An unstable extra-articular fracture was created using a standardized osteotomy. Each group was fixed with one of the three plates. Each specimen was loaded in axial compression for 2000 cycles at a force of 400 N. Each specimen that completed cyclic testing was loaded to failure. Stiffness, yield point, and ultimate strength were recorded for each construct. RESULTS: Each fixed-angle construct completed all 2000 cycles. The nonlocking plates failed at an average of 560 cycles. The mean stiffness of the DVR-A, LCP, and the volar T-plates were 277.00, 343.17, and 175.67 N/mm, respectively. There was a statistically significant difference between both fixed-angle plates and the nonlocking plate (p < 0.05). The difference between each fixed-angle construct did not reach significance. Yield point and ultimate strength could only be determined for the two fixed-angle devices. There was no statistically significant difference between the constructs for both yield point (DVR-A = 855.56 N, LCP = 894.15 N) and ultimate strength (DVR-A = 1,021.97 N, LCP = 1,114.87 N). CONCLUSIONS: Given our data, fixed-angle constructs withstand cyclical loading representing normal physiologic forces encountered during post-operative rehabilitation. There was no significant biomechanical difference between the two fixed-angle constructs. Our results support that volar fixed-angle locking plates are an effective treatment for unstable extra-articular distal radius fractures, allowing early postoperative rehabilitation to safely be initiated.
| S-EPMC2528971 | biostudies-other
Project description:Background:Joint stiffness and limited bone stock for fixation were the main problems in management of periarticular bone defects. The present study aimed to report clinical and radiographic outcome of periarticular, large (?8?cm) bone defects treated with ring external fixator. Materials and methods:Seventeen patients (10 males and 7 females) who had periarticular bone loss at the minimum of 8?cm were treated with ring external fixator. Acute shortening and subsequent lengthening at the corticotomy site were performed in 5 patients. Bone transport was performed in 12 patients. Clinical outcome and radiographic outcome were reviewed. Results:Seventeen patients (10 males and 7 females). Mean age was 31.1 years (9-52 years). Mean bone gap was 9.17?cm (8-14?cm.). Mean follow-up period was 39.7 months (30-60 months). Fracture united primarily in 14 cases and after iliac bone graft in 2 cases. One patient had nonunion. Based on ASAMI evaluation;The bone result was excellent, good, and poor in 13, 3, and 1 patients, respectively. The functional results were excellent and good in 14 and 3 patients respectively. Ten patients had superficial pin tract infection. Conclusion:Periarticular large bone defects were successfully treated with ring external fixator by bone transport or acute shortening and subsequent lengthening at corticotomy site. Superficial pin tract infection and joint stiffness were common problems in management of periarticular large bone defects. Early convert to internal fixation after achieve the acceptable length or after successfully bony contact of bone transport fragment to allowed early motion of the joint was recommend. Good to excellent functional outcomes were achieve in majority of the patients.
| S-EPMC6383181 | biostudies-literature
Project description: Not available
| S-EPMC6583366 | biostudies-literature
Project description:Management of distal humeral fractures remains to be one of the most challenging aspects in trauma surgery. Low profile plating systems with variable angle screw fixation represent a crucial advancement to the established angular stable locking plates with considerable attention in current research. The aim of the prospective randomized trial was to review the preliminary results and patients' outcome following treatment with these newly developed implants and to rule out potential differences in fracture treatment of two different plating systems.Twenty patients with distal humeral fractures (AO 13-A1 - AO 13-C3) were included in the current study since 2014. After completing the randomization plan, patients were distributed into two groups for different variable angle locking plates (DePuy Synthes® VA-LCP vs. Medartis® Aptus Elbow). Functional elbow scoring (ROM, MEPS, QuickDASH) served as primary outcome parameter, while radiological fracture consolidation served as secondary outcome parameter. Follow-ups were conducted 6 weeks, 12 weeks, 6 months and 12 months after the operation.Seventeen of 20 patients (85%) concluded all follow-up examinations. Postoperative elbow extension deficiencies showed significant differences between the two groups in all follow-up examinations with a mean of Ø 18 +/- 7.4 degrees in the DePuy Synthes® VA-LCP group compared to a mean of Ø 6.5 +/- 7.5 degrees in the Medartis® Aptus Elbow group (p?=?0.002) 12 months postoperatively. Functional scoring showed a disparate pattern. The Medartis® Aptus Elbow group achieved significantly better MEP scores during follow-up. However, the analysis of the QuickDash revealed better results of the DePuy Synthes® VA-LCP group in the first half and better results of the Medartis® Aptus Elbow group in the second half of the follow-up examination instead.Considering the complexity of distal humeral fractures, the usage of anatomically preshaped low profile variable angle locking plates for operative treatment leads to good clinical results. Even though there might be some advances of the Medartis® Aptus Elbow plating system concerning postoperative ROM and elbow function, a consistent difference in the overall clinical outcome between the two plating systems could not be detected.https://clinicaltrials.gov/ct2/show/NCT03272490 Retrospectively Registered 1. September 2017.
| S-EPMC5745613 | biostudies-literature