Query: DHS Locking Ti/SS Plates  clinical report

title: Clinical outcomes and complications of pancarpal arthrodesis stabilised with 3.5 mm/2.7 mm locking compression plates with internal additional fixation in 12 dogs
abstract: To report the clinical outcomes and complications after the use of 3.5 mm/2.7 mm locking compression plates (LCP) with additional internal fixation for pancarpal arthrodesis (PCA) in dogs.  This was a retrospective study using medical records from a single orthopaedic referral hospital between December 2015 and April 2018. The inclusion criteria were the use of a dorsally applied LCP for PCA in dogs with a minimum follow up period of 12 months. Additional crossed 2.7 or 3.5 mm cortical screws or Kirschner wires were placed in all limbs to further stabilise the joints. A light dressing without external coaptation was applied postoperatively to all limbs. Postoperative lameness assessment was recorded at the last clinical evaluation.  Twelve dogs with 13 arthrodesed limbs were included, with carpal hyperextension injury being the most common indication for surgery (4/13; 31% One dog was recorded with a minor complication, which was a metacarpal fracture distal to the bone plate. Major complications were observed in 4/13 (31% limbs, with surgical site infection being recorded in all four limbs and screw loosening in one limb. No implant failure was reported. At the final clinical evaluation (43 437 days after surgery) none or mechanical lameness was recorded in 9/13 (69% limbs, mild lameness in 3/13 (23% limbs, and moderate lameness in one 1/13 (8% limb.  Locking plate and screw fixation with additional internal fixation resulted in comparable complication and infection rates in canine PCA to previous published studies using hybrid dynamic compression plates. No implant failure was reported for any of the limbs despite the use of a light dressing without external coaptation.

title: Pancarpal and partial carpal arthrodesis with 3 locking compression plates in 6 horses.
abstract: To report the outcome of horses after pancarpal or partial carpal arthrodesis with 3 locking compression plates (LCP)  Six horses ranging in age from 8 months to 16 years and weighing 227 580 kg with severe carpal pathology including acute fractures, chronic osteoarthritis, and chronic angular limb deformity.  Pancarpal or partial carpal arthrodesis was performed with 3 LCP. Autologous cancellous bone grafts were used in 5 of 6 cases to facilitate joint arthrodesis.  External coaptation was maintained for 4 to 6 weeks after surgery. Radiographic follow up was available in all 6 cases, all of which reached arthrodesis and pasture soundness by 4 5 months postoperatively. One case required implant removal at 6 months because of implant exposure through the skin but returned to pasture soundness after removal.  Carpal instability due to acute fractures or chronic disease was successfully stabilized with 3 short LCP, leading to pasture soundness in all 6 horses.  The use of 3 short LCP should be considered as a strategy to facilitate pancarpal or partial carpal arthrodesis by providing superior stability without placement of implants in the diaphysis of the radius and third metacarpus.

title: Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort
abstract: BackgroundPlate fixation is one of the standard surgical treatments for distal femoral fractures. There are few reports on the relationship between the screw position and bone union when fixing by the bridging plate (relative stability) method.MethodsThis retrospective study included 71 distal femoral fractures of 70 patients who were treated with the locking compression plate for distal femur (DePuy Synthes Co. Ltd, New Brunswick, CA, USA) The following measurements were evaluated and analyzed: (1) bone union rate, (2) bridge span length (distance between screws across the fracture) (3) plate span ratio (plate length/bone fracture length) (4) number of empty holes (number of screw holes not inserted around the fracture) and (5) medial fracture distance (bone fracture distance on the medial side of the distal femur) Patient demographics (age) comorbidities (smoking, diabetes, chronic steroid use, dialysis) and injury characteristics (AO type, open fracture, infection) were obtained for all participants. Univariate analysis was performed on them.ResultsOf 71 fractures, 26 fractures were simple fractures, 45 fractures were comminuted fractures, and 7 fractures resulted in non union. Non union rate was significantly higher in comminuted fractures with bone medial fracture distance exceeding 5 mm.Non union was founded in simple fractures with bone medial fracture distance exceeding 2 mm, but not significant (p 0.06) In cases with simple fractures, one non union case had one empty hole and one non union case had four empty holes, whereas in cases with comminuted fractures, five non union cases had two more empty holes.ConclusionsWe concluded that bone fragment distance between fracture fragments is more important than bridge span length of the fracture site and the number of empty holes. Smoking and medial fracture distance are prognostic risk factors of nonunion in distal femoral fractures treated with LCP as bridging plate.

title: High failure rate of proximal femoral locking plates in fixation of trochanteric fractures
abstract: BackgroundThe aim of this study was to report our previous results of treatments for trochanteric fractures with proximal femoral locking plates (PFLP) and to analyze the underlying mechanisms and possible risk factors associated with the high failure rate of this technique.MethodsFrom January 2010 to October 2014, 273 consecutive patients with trochanteric femoral fractures were identified, and 95 patients (with 97 fractures) ultimately met the inclusion criteria. Clinical records regarding demographic features and intraoperative data including total incision length, operation time, blood loss, and failures detected in radiographs were documented and assessed. The collected data were analyzed with SPSS 19.0 software.ResultsThe stable group (AO/OTA 31 A1 and A2.1) had less blood loss than the unstable group (AO/OTA 31 A2.2, A2.3, and A3) The ultimate failure rate was 36% in 97 fractures. The obvious complications in this study included nonunion in 7 (7.2% fractures, implant breakage in 4 (4.1% fractures, varus deformity in 34 (35% fractures, and loosening of the proximal femoral screw in 21 (21.6% fractures. Six patients received reoperations. The total failure rate in the stable group was 17% and was 50% in the unstable group. In patients greater than 60 years old in the unstable group, the failure rate was 60.5%.ConclusionsHigh failure rates of PFLP were observed in patients with trochanteric fracture, especially in patients who were greater than 60 years old with unstable fracture types. PFLP was not an appropriate treatment for trochanteric fractures.

title: Clinical and radiological outcomes of 40 cases of SLAC and SNAC wrist treated by four corner arthrodesis with locking plate.
abstract: The treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist varies. No clear consensus exists on surgical indications. Scaphoid excision and four corner arthrodesis with locking plate is one of preferred treatments for these lesions. The purpose of this study was to assess the clinical and radiological outcomes of locking plates for treating SNAC and SLAC wrist after a mean follow up of 5 years and to compare these outcomes with the results reported in the literature. A retrospective study was conducted in two hospitals, involving 40 patients who underwent scaphoid excision and four corner arthrodesis with locking plate between January 2006 and September 2016. All patients were reviewed as outpatients with clinical and radiographic measurements. At the last follow up, the mean pain level on visual analog scale (VAS) was 2.5/10 [0 7] (SD: 1.7) Patients had a mean flexion of 46% and a mean extension of 46% compared to the contralateral side. An 18% gain was observed in grip strength. The mean postoperative QuickDASH score was 30 [0 57] (SD: 15.3) Seventy percent of patients were satisfied with the operation. Complete (all four joint interfaces) joint space fusion was achieved in 55% of patients. Only one patient (2.5% had no joint fusion. The joint between the lunate and the capitate was fused in 38 patients (95% Nine patients suffered complications; eight of them required surgical revision (20% Four corner arthrodesis with locking plate is a valuable surgical technique for treating SLAC and SNAC wrist because it preserve satisfactory range of motion and grip strength (64% compared to the non operated side) maintains the height of the carpus and prevents the premature appearance of radiocarpal osteoarthritis, as long as the technical challenges of this procedure are mastered.

title: Outcome of 3.5 mm Anatomical Locking Plates for the Treatment of Proximal Tibia Fractures Involving the Meta Diaphyseal Junction.
abstract: The clinical and radiological outcomes of proximal tibia fractures involving the meta diaphyseal junction treated with unilateral 3.5 mm locking precontoured anatomical plates are reported. Thirty nine patients (41 proximal tibia fractures) who had proximal tibia fractures with complete meta diaphyseal dissociation were enrolled in the study. For all patients, immediate postoperative and final follow up simple radiographs were evaluated to determine the quality of the reduction by assessing coronal and sagittal alignment. In cases of intra articular involvement, articular reduction quality and condylar width were additionally assessed. Clinical outcomes were assessed by knee range of motion and Lysholm knee score at final follow up. Immediate postoperative radiographs showed satisfactory results: medial proximal tibial angle within 87deg+ 5deg in 87.8% (36 of 41) posterior tibia slope within 9deg+ 5deg in 85.4% (35 of 41) less than 2 mm articular step or gap in 79.3% (23 of 29) and a condylar width difference within 5 mm compared with the femoral condyles in 93.1% (27 of 29) All reductions but 1 were found to have satisfactory maintenance of the initial reduction. At final follow up, the mean knee range of motion and Lysholm knee score were 122.5deg (range, 100deg 135deg) and 75.8 (range, 50 100) respectively. A single lateral 3.5 mm plate fixation for proximal tibia fractures involving the meta diaphyseal junction offers mechanically stable fixation with satisfactory clinical and radiological outcomes.  2018; 41(6):e777 e782.

title: Study protocol for the DEFENDD trial: an RCT on the Dynamic Locking Blade Plate (DLBP) versus the Dynamic Hip Screw (DHS) for displaced femoral neck fractures in patients 65 years and younger
abstract: The Dynamic Locking Blade Plate (DLBP) was recently introduced for fixation of displaced femoral neck fractures (FNF) and has been well received. Although the results of this implant in young patients are promising, the DLBP has not yet been compared to a standard device such as the Dynamic Hip Screw (DHS) The aim of this study is to compare the clinical outcome and costs of displaced FNF treated with internal fixation by means of either the DLBP or the DHS in patients up to 65 years of age. We hypothesize that the DLBP is superior compared to the DHS in terms of revision surgery rate, union rate, incidence of avascular necrosis and implant related failure.  The DEFENDD (DisplacEd Femoral Neck fractures Dlbp versus Dhs) trial is a multicentre randomized controlled trial that will include 266 patients of 18 65 years with a displaced FNF. Patients will be randomized to receive either a DLBP or a DHS with a 1:1 allocation using a random block size, stratified for centre. Clinical follow up will last 1 year and questionnaires will be obtained up to 2 years. The main outcome parameter is the incidence of revision surgery within 1 year, due to either non union, avascular necrosis (AVN) or cut out of the implant. Secondary study parameters are the incidence of avascular necrosis, non union, (implant related) complications, functional outcome, elective removal of the implant and health related quality of life and costs.  The outcome of the DEFENDD trial will provide high level evidence of which implant is favourable for the treatment of femoral neck fractures in young patients =65 years)

title: Clinical outcomes of dual 3.5 mm locking compression plate fixation for humeral shaft fractures: Comparison with single 4.5 mm locking compression plate fixation
abstract: Recently, several in vitro biomechanical studies that used dual small locking plate fixation for humeral shaft fractures have investigated. However, in vivo studies about dual plate fixation for humeral shaft fractures are limited. The purpose of our study was to report the outcomes of dual small plating for humeral shaft fractures in comparison with those of single large fragment plating.  Sixty consecutive patients who underwent an open reduction internal fixation for humeral shaft fractures at our institution from September 2014 to December 2017 were included. Single 4.5 mm locking compression plate (LCP) fixation was used in the first 40 cases, and dual 3.5 mm LCP fixation was used in the final 20 consecutive cases. Data were collected to define patient characteristics, injury mechanism, clinical outcomes, time to surgery, operative time, estimated blood loss, and complications. Using simple radiography during the follow up period (6, 12, 24, and 52 weeks after surgery) the shoulder and elbow joint ranges of motion (ROM) were also evaluated.  Demographic data, time to surgery, surgical time, and estimated blood loss had no significant differences between the two groups. No significant differences were observed in nonunion rate and union rate 3 months after surgery. However, two patients (5% in the single 4.5 mm LCP fixation group showed metal failure and breakage. No significant differences were found in postoperative shoulder and elbow ROM. Three patients (7.5% in the single plating group and one patient (5% in the dual plating group developed radial nerve palsy after surgery. No vascular injury and deep infection were observed in either group.  For diaphyseal humeral fractures, dual 3.5 mm LCP fixation to the humerus is a possible treatment choice. This method showed satisfactory union rate, ROM, and complication rate, without increasing surgical time, in comparison with the conventional single 4.5 mm LCP fixation.

title: Clinical Observation of the Locking Compression Plates for the Intertrochanteric Fractures in the Aged(32 Cases Report)
abstract: To explore the clinical effects of locking compression plates(LCP) internal fixation for the old people suffered from the intertrochanteric fractures. Retrospective analysis of 32 old cases of intertrochanteric fractures was used.According to the Tronzo Evans typing,the preoperative intertrochanteric fracture types were 2 cases of type I,11 cases of type II,13 cases of type III,4 cases of type IV and 2 cases of type V.The intertrochanteric fractures got closed reduction under the C arm X ray equipment followed by proximal femoral LCP internal fixation. All cases were followed up for 6 to 18 months,11.5 months in average.29 cases got good reduction,but 4 cases suffered from entotrochanter malreduction.The mean bone union time was 14(10~16) weeks.And Harris standardization of the hip joints was 19 of excellent,10 of fine and 3 of fair. LCP internal fixation is a good method with little trauma,reliable fixation,less complications,early positive joint function exercises and short bed time,which can improve the quality of life in the old patients.

title: Tibial plateau levelling osteotomy locking compression plates for stabilisation of canine and feline ilial body fractures
abstract: To evaluate the clinical and radiographic outcomes following surgical stabilisation of ilial fractures in dogs and cats using a laterally applied Synthes TPLO locking compression plate.  Medical records and radiographs of seven dogs and two cats which had undergone surgical repair of an ilial body fracture with a TPLO locking compression plate were reviewed. Long term clinical follow up was obtained from an owner or referring veterinarian questionnaire.  Fracture reduction was anatomic in six of nine ilia and near anatomic in three of nine. All but one fracture achieved osseous union by 6 weeks after surgery. No screw loosening or implant related complications occurred in any patient. There was pelvic canal narrowing in six of nine patients (median reduction in pelvic canal diameter was 4*9% No intraoperative or postoperative complications were reported.  Lateral plating of canine and feline ilial fractures with a Synthes TPLO locking compression plate was associated with a low complication rate and satisfactory radiographic and clinical outcomes in this small case series.