Role of locking compression plate in long bone fractures in adults - a ...

Role of locking compression plate in long bone fractures
in adults - a study of 50 cases
JPS Walia MS*, Avinash Gupta MS**, Girish Sahni MS***, Gagandeep Gupta MBBS****,
Sonam Kaur Walia MBBS*****
*Professor, **Associate Professor, ***Senior Resident, ****Junior Resident, *****Intern
Department of Orthopaedics,
Government Medical College, Patiala
ABSTRACT
In the modern world with increase in speed and fast moving vechicles, there has been a continous upsurge
in the number as well as the severity of high energy fractures. Implants like Lc-Dcp and more recently the
locking compression plate helps to achieve satisfactory results in these cases. The present study was conducted
to evaluate the results of Locking Compression Plate in 50 cases of long bone fractures(25 femur , 15 tibia,
10 humerus fractures) admitted at GMC, Rajindra Hospital, Patiala. The age group of patients in the study
varied between 18 – 70 years. The fractures were 60 % closed and 40 % open in nature. Patients were
evaluated and locking compression plate was done under general,spinal,epidural anesthesia. The patients
were evaluated periodically both clinically and radiologically. 72 % of our cases achieved excellent to
good results.
Keywords : Locking compression plate, long bone fractures.
INTRODUCTION
Conventional plate and screw osteosynthesis has proved to
be very successful in fracture fixation. These techniques require
compression of the plate to the bone and rely on friction at the
bone-plate interface. This biomechanical prerequisite of
conventional plates is associated with biological pitfalls due
to compression of periosteal blood supply and compromise of
the vascularity of the fracture. With increasing axial loading
cycles, the screws can begin to toggle, which decreases the
friction force and leads to plate loosening. If this occurs
prematurely, fracture instability will occur, leading to implant
failure. Thus, the more difficult it is to achieve and
maintain tight screw fixation (as for example, in metaphyseal
and osteoporotic bone), the more difficult it is to maintain
stability 1 .
A newer concept of internal fixation, the locking
compression plate (LCP) was introduced to overcome the
drawbacks of conventional plating systems. This system
Corresponding Author:
Dr JPS Walia, Professor
Department of Orthopaedics,
Government Medical College, Patiala.
E-mail : doc_jpswalia@yahoo.co.in
provides angular stability through the use of locking screws . 2
The LCP system consists of a range of anatomically shaped
plates with specially designed combination holes. The unique
design of these combination holes allows the system to be
used both as a conventional compression plate and as a locked
internal fixator; it also allows internal fixation with a combination
of conventional and locking head screws 3 . This is particularly
valuable in cases of epimetaphyseal fractures. The system
therefore has a broad range of potential indications, including
compression fixation of simple fractures and bridging of
comminuted fractures 4 .
This paper is a prospective study of use of locking
compression plates in long bone fractures, which would have
been associated with high rates of failure using conventional
plating techniques.
MATERIAL AND METHODS
The present prospective study was done on patients with long
bone fractures admitted in our hospital. All patients were
evaluated clinically and radiographically at the time of
admission. Fracture patterns like comminuted fractures,
metaphyseal fractures and fractures in osteoporotic bones were
chosen for LCP fixation. Anterior/Anterolateral approach with/
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Walia et al
without radial nerve exploration for humerus and lateral
approach for fracture shaft femur was taken. Fracture tibia was
approached anterolaterally. All the fractures were fixed with
LCPs taking care to protect the periosteal blood supply. Bone
grafting was done in old ununited fractures and in fresh cases
with fracture comminution of high grade. Internal fixation in
open fractures was carried out after thorough irrigation and
debridement. Splintage and immobilization was applied as per
fixation achieved. Early range of motion exercises were started
where a stable construct was achieved.
RESULT
Table 1
Fracture Location
Fig. 1: LCP in tibia Preoperative and post-operative Xrays
No. Fresh Non-union
Closed Open
Femur 25 19 4 2
Tibia 15 6 5 4
Humerus 10 5 1 4
60% of cases were of closed nature. All 4 femur open fractures
were Gustillo Grade III open while 1 tibial and I humeral fracture
was grade III. Four tibial fractures were grade 1 open. 20% of
cases were old ununited fractures.
The age group of the patients in this study varied between
18-70 years (average 53.1 years) with majority of the patients in
fifth to seventh decade of life.
Follow-up in our series ranged from 6-24 months.
All fractures united in this series without the need
for any supplemental procedure. The average time for union in
fresh femur fractures was 16.4 weeks. 2 of the 4 open fractures
and 1 of 2 non-unions in femur took more than 20 weeks to
unite.
The average time for union of fresh tibial fractures was
17.1 weeks while the non-unions united in an average of 17.75
weeks. The average time of union for fresh humeral fractures
was 13.3 weeks. The union time in non unions ranged from 12
to 20 weeks with a mean of 15.25 weeks
Full weight bearing in cases of fracture tibia and femur
was done in 14 cases within 12-16 weeks, 20 cases within 17-20
weeks and in 2 cases after 20 weeks.
Range of motion at knee in femoral fractures was more
than 90 degrees in 90% of the cases. Range of abduction was
more than 140 degrees in 80 % of the cases with fracture shaft
humerus and elbow flexion was more than 90 degrees in 85% of
the cases.
Fig. 2: LCP in femur pre and post operativeX rays
Fig. 3: Three months follow up X ray of proximal humerus fracture
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Role of locking compression plate in long bone fractures in adults
2 cases had wound infection problems which healed with
antibiotics and local wound care. Shortening was present in
one case that was operated more than 40 days after injury with
considerable fibrosis and overlapping of fragments; shortening
was done in this case to achieve compression at the fracture
site.
Results were unsatisfactory in 2 cases of fracture humerus
as both of them were having concomitant injury to the ipsilateral
elbow, which hampered early rehabilitation.
Evaluation of the results of fracture femur and tibia was
done by Modified Mehrotra’s grading. According to this
grading, 72% of the cases achieved excellent results, 20% fair
and 8% poor. In case with humerus fractures achieved 80%
satisfactory and 20% unsatisfactory.
DISCUSSION
Locking compression plates have been designed to overcome
the pitfalls of conventional plates particularly when dealing
with difficult problems such as comminuted, metaphyseal and
osteoporotic fractures. Locked plates have become an attractive
alternative to conventional plates as they can be used as “bridge
plates” to preserve fragmentary blood supply, they provide
fixed angular stability with the potential for improved fixation
in osteoporotic bone, and they reduce the risk of primary loss
of reduction as exact plate-contouring is not required 5
Wagner(2003) in his paper on general principles for the
clinical use of locking compression plate, made comment that
Internal fixator (A term used for locking compression plates) is
a construct in which the screws (Pins/Bolts) are locked in the
plate (Frame). Forces are transferred from the bone to the screw
plate threaded connection. Rigid compression of the Plate on
the bone is therefore not required to achieve stability. Locking
the screw in the internal fixator increases the stability, and the
risk of loss of reduction due to the toggling of the screws is
eliminated 3 .
Numerous case series have reported the successful use of
LCPs in a variety of clinical situations such as metaphyseal
fractures, intraarticular fractures, fractures in osteoporotic
bones as well as difficult non-unuions 6-10.
In our study, we found that the implant with locking head
screw, when used in difficult fractures like type C3 provided
good fixation. Even in osteoporotic bones, the locking implant
provided good anchorage. With locked fixation, a good
purchase is achieved between the threaded plate and threaded
screw head. The screws virtually act as pegs resisting axial
rotation, translation and bending, in porotic bone 10 . In our
study we found that we could achieve union in all the nonunions
and comminuted fractures. This compares well to the
reported results in literatures 11.12 .
In conclusion, it can be said that, if biomechanical principles
are followed, locking plates provide excellent fixation in difficult
situations like comminuted fractures, osteoporotic fractures
and periarticular fractures.
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