Locking Compression Plating for Osteoporotic and Peri-Articular Fractures: A Short Term Outcome Analysis

Navin, Balasubramanian (2010) Locking Compression Plating for Osteoporotic and Peri-Articular Fractures: A Short Term Outcome Analysis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Peri-articular and osteoporotic fractures of long bones are becoming more common and are very challenging injuries to treat even for a veteran orthopaedician. Peri-articular fractures occur in two different age groups -due to different types of injuries. In young patients peri-articular fractures occur due to high velocity injury such as road traffic accidents, fire arm injuries and sport’s injuries while in elderly patients with osteoporosis it occurs usually due to low velocity injury like fall during walking. Also these conditions do result from fractures in the young treated by conservative methods and which in the long term end up in non-unions and further more these conditions are compounded by disuse osteoporosis. Because of the proximity of peri-articular fractures to the corresponding joints, regaining full motion and function may be difficult. Also achieving full union rates are increasingly difficult because of the lack of availability of good bone stock which is very common in periarticular fractures because of the cancellous nature of the metaphyseal fragment. The incidences of malunion, nonunion, and infection are relatively high in many reported series. In older patients, treatment may be complicated by coexisting osteoporosis. AIM: The aim of the study is to analyze the short term results in terms of union and functional outcome for osteoporotic and periarticular fractures treated with locking compression plating. MATERIALS AND METHODS: This is a study conducted in the Department of Orthopaedics, Madras Medical College, Government General Hospital, Chennai. This study is a prospective study Conducted in the Department of Orthopaedics from September 2007 to September 2009 with a sample size of 21 cases. Patients were randomly selected from among the admissions to the Orthopaedic ward in the Department of Orthopaedics, Government General Hospital, Chennai and recruited into the study prospectively based on the following criteria: Inclusion criteria - 1. Age more than 16 years. 2. Osteoporotic bones either disuse or pathological bones. 3. Fractures occurring at or near joints namely distal femur, proximal humerus, distal radius, distal tibia, proximal tibia. 4. Osteoporotic non-unions. 5. Patients who consents to be included in the study. Exclusion criteria - 1. Exclusion criteria were skeletal immaturity 2. Patients with tumourous conditions. 3. Severe articular comminution not possible to be reconstructed with internal fixation. 4. Undisplaced fracture patterns needing only conservative management. 5. Patients not willing for internal fixation. RESULTS: There were a total of 3 complications in two patients, two were infections( one case of superficial and one case of deep infection) the infection rate which was 0.01% and is similar to other reported series [11,14].They were treated with thorough wound debridement and i.v antibiotics for six weeks which soon resolved. There was one case of non-union which was due to the infection. Solid union was observed in 21 out of the 24 cases ( 88 %) which are similar to other studies[4,5,8,11,14]. The range of movements attained at an average follow-up of 15.5 months was 87 % of which 17 had excellent results, 4 had good outcome, 2 had fair outcome and 1 case had poor functional results according to the respective scoring systems like DASH, Harris hip score and HSS (Hospital Severity Score) knee score. CONCLUSION: This study highlights the role of locking compression plating in complex osteoporotic and peri-articular fractures in which conventional dynamic compression plates and reconstruction plates would fail prematurely. The correct application of locking compression plates requires a long learning curve and spurious use will negate the advantages of the locking plates. The results of our study have confirmed earlier reports that locking compression plates provide better fixation in osteoporotic fractures. The chances of implant failure are less as the screws are firmly position inside the bone. Also since these plates are limited contact plates there is less contact between plate and the bone and hence there is minimal disruption of sub-periosteal blood supply to the fracture ends and this aids in fracture union. The locked nuts prevent further tightening of the screws and hence reduction is maintained and secondary angular deformities are prevented.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Locking Compression Plating ; Osteoporotic ; Peri-Articular Fractures ; Short Term Outcome Analysis.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 02:45
Last Modified: 14 Sep 2017 02:45
URI: http://repository-tnmgrmu.ac.in/id/eprint/3092

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