locking compression plate

suggested that a locking compression plate should be used as a bridging plate in order to achieve relative stability. J Bone Joint Surg Am. In these circumstances, take the opportunity to remove the implants. Check the reduction of the dorsal fracture line.Confirm using image intensification. Only smoking and medial fracture distance were statistically significant (p < 0.05) independent risk factors predictive of nonunion requiring intervention. Lujan TJ, Henderson CE, Madey SM, Fitzpatrick DC, Marsh JL, Bottlang M. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. 2010 Mar;24(3):156–62. PubMed  [15]. In compliant patients with stable fixation, the splint can be removed under the supervision of a physical therapist, and early active motion exercises started after a few days. 2.0 mm and 2.4 mm LCP were used to manage appendicular fractures in cats and small dogs. Bottlang M, Doornink J, Lujan TJ, Fitzpatrick DC, Marsh JL, Augat P, von Rechenberg B, Lesser M, Madey SM. Be careful not to overbend, as there is a comminuted zone at the opposite cortex, which can not withstand compression. The mechanism locking the screw in the plate also comes in two types: in the first the screw head is locked in its chamber by a threaded locknut. Conclusive rules by Gautier et al. Injury. 2014 Feb;28(2):83–9. Successful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: comparative study of multiply injured and isolated femoral fractures. Healing results of periprosthetic distal femur fractures treated with far cortical locking technology: a preliminary retrospective study. Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q. Distal femoral fractures: current concepts. Locking plates allow screws to be threaded into the plate, creating a fixed-angle device, without the need for friction between the plate and bone. Correspondence to 2013;33:7–11. Weight M, Collinge C. Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3). Google Scholar. The present study was approved by Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital (Ethics Committee No. J Orthop Trauma. Well-known risk factors include smoking, bone defects, and comminuted fractures, which were supported by this study’s results. Limited contact dynamic compression plates were designed with recesses or undercuts in the plate to reduce contact between the plate and the bone, therefore reducing the risk of plate-associated osteoporosis. Google Scholar. Of the cases with simple fractures, there was one non-union case with one empty hole and one non-union case with four empty holes (Table 3). 1994 Sep;15(9):483–9. When the pain and swelling have reduced, a custom thermoplastic splint is applied for a period of time depending on patient comfort and fracture stability.The implants may need to be removed in cases of soft-tissue irritation.In case of joint stiffness, or tendon adhesions’ restricting finger movement, tenolysis or arthrolysis become necessary. Use bending pliers to contour the plate. Reducing comminuted bone fragments is difficult when the inner portion of the fracture site also exhibits comminuted fracture. a Conclusive rules of simple fracture for 33A2 and 33C1. Non-union was defined as a state in which bone union was not achieved within 4 months after the initial surgery. Extraarticular fractures of the base of the thumb metacarpal are often displaced, with a flexion deformity and may show palmar comminution (Winterstein fracture). For this procedure the following approaches may be used: Angularly stable plate fixation in the proximal fragment allows for reduction using the plate as a lever (as described below). Plate fixation is one of the standard surgical treatments for distal femoral fractures. Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques. Acta Orthop Scand. Patient demographics (age), comorbidities (smoking, diabetes, chronic steroid use, dialysis), and injury characteristics (AO type, open fracture, infection) were obtained for all participants. Article  Smoking and medial fracture distance are prognostic risk factors of nonunion in distal femoral fractures treated with LCP as bridging plate. Guidelines for defining the terms “plate span ratio,” “empty hole,” and “medial fracture distance” are provided in Fig. 2004 Sep;18(8):503–8. For proximal fixation, 2, 3, and 4 locking screws were used. Cite this article. The guidelines reported by Gautier et al. https://doi.org/10.1186/s13018-019-1401-9, DOI: https://doi.org/10.1186/s13018-019-1401-9. Sliding screw plate. Plates used for buttressing prevent collapse by supporting an area of thin cortex or cancellous bone graft. Introduction: fracture and dislocation classification compendium-2018: International Comprehensive Classification of Fractures and Dislocations Committee. J Bone Joint Surg Am. Injury. The locking head screws have threads on its head, which engages it firmly with the plate. Kellam JF, Meinberg EG, Agel J, Karam MD, Roberts CS. The Synthes Locking Compression Plates—Narrow and Broad, are intended for fixation of various long bones, such as the humerus, femur and tibia. Univariate analysis was performed on them. Case 1 was distal femur fracture in a 74-year-old woman with TKA after a fall. Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF. The Synthes 4.5 mm Locking Compression Plate (LCP) System is indicated for fixation of various long bones, such as the humerus, femur and tibia and for use in fixation of peri-prosthetic fractures, osteopenic bone and fixation of non-unions or malunions in adult patients. suggested that a locking compression plate should be used as a bridging plate in order to achieve relative stability. d Screws were inserted near the fracture during re-operation. Injury. The Synthes Locking Compression Plates—T-Plates are intended to buttress metaphyseal Distal femoral fractures comprise only 0.4% of all fractures and 4–6% of femoral fractures [1, 2]. In this study, we investigated (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). Regarding the number of empty holes, Stoffel et al. Therefore, in this study, we examined the correlation between bone union and screw position, as the X-ray parameter. The LCP was developed to give surgeons the opportunity to combine principles of internal fixation and dynamic compression, depending on the fracture site, as it contains Combi holes. We believe that non-union was influenced by the instability of the fracture segment; therefore, another plate was added on the medial side (Fig. Insert a second screw using the same technique. 2013;80(3):185–91. Insert a screw through the most distal plate hole. Lee CH, Shih KS, Hsu CC, Cho T. Simulation-based particle swarm optimization and mechanical validation of screw position and number for the fixation stability of a femoral locking compression plate. Moreover, it is impossible to achieve absolute stability with rigid internal fixation in comminuted fractures. Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association, Locking compression plate for distal femur. The number of empty holes near the fracture site and the rate of bone healing were not clearly related. Cases in which the proximal and distal bone fragments were fixed using a lag screw and those in which the medial plate was used during the initial surgery were excluded. 4.6 out of 5 stars 113. Our new stainless steel plate, called the minimum contact locking compression plate (MC-LCP), has protrusions on the plate undersurface, two dynamic compression screw holes and six locking screw holes. The guidelines reported by Gautier et al. During surgery, it is sometimes difficult to properly determine screw position. The combi-hole is a combination of a DCP hole and a locking hole allowing the surgeon to place either a Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005). In most of our cases, non-union likely resulted from fracture site instability after reduction internal fixation. In such cases, shortening the fracture site to approximately 5–10 mm would be acceptable to decrease the distance between the proximal and distal bone fragments. 2010 Feb;26(1):10–6. PubMed Central  J Orthop Trauma. 2013 May;99(3):353–60. Additionally, none of the cases in the non-union group fit the plate length of > 8–10 times longer than the overall fracture length (Table 3). Kiyono, M., Noda, T., Nagano, H. et al. Of 26 simple fractures, there were 7 cases with a medial fracture distance of ≥ 2 mm, and the non-union rate was 28.5% (2 of the 7 cases) (Table 3). 2014 Nov;45(11):1665–73. As a salvage surgery for 7 non-union cases, two patients added a plate on the medial side of the femur (one case also used bone grafting), the other one performed only bone grafting, two cases left an existing plate with replacing the position of the screw, one case replaced with a long plate, and last case was shortened the fracture site and performed bone grafting and plate fixation. 2). Additionally, although we did not consider bone mineral densities and BMI, there is a possibility that they might have influenced bone union. reported that increasing fracture site flexibility promotes initial bone formation, but had no correlation with bridge span length [23]. Note the visible break in the ulna. Fourteen of all comminuted fracture cases and bone union were treated through shortening the fracture site as Rekha reported [16], and non-union was not observed in these cases. PubMed Google Scholar. A compression plate anastomosis apparatus as recited in claim 1, wherein the locking means comprises means for guiding the movement of one compression plate relative to the other, wherein the guiding means extend from one of the compression plates to enable one compression plate to be moved in a fixed parallel orientation relative to the other compression plate, wherein the guiding … 1712-035). Stoffel K, Dieter U, Stachowiak G, Gächter A, Kuster MS. Biomechanical testing of the LCP-how can stability in locked internal fixators be controlled? 4). 2006 Aug;37(8):691–7. The present study was approved by Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital (Ethics Committee No. Of 71 fractures, 26 fractures were simple fractures, 45 fractures were comminuted fractures, and 7 fractures resulted in non-union. Performing shortening and fixation of up to 5–10 mm was effective for achieving bone union in several comminuted fracture cases (Fig. J Am Acad Orthop Surg. Tomoyuki Noda. Read about company. This 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). 2007 Sep;12(5):458–65. 99. Locking compression plates, lambda (or “arms-down” Y) design, and 3.5-mm reconstruction plates have been used to address this injury. Simple fractures were defined as 33A2 and 33C1 classifications and comminuted fractures were classified as 33A3, 33C2, and 33C3 according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) fracture classification [11]; we excluded 33B type AO/OTA fractures. Risk factors for non-union and delayed bone union in distal femoral fractures include the presence of open fracture(s), medial bone defects, and comminuted fracture(s) [3, 24]. If standard plates are used, bone graft from the distal radius may be necessary to avoid delay in bone healing and consequent secondary displacement, or failure of fixation. Confirm using image intensification.Drill through the threaded drill guide. Internal fixation allows for anatomical reduction. Courses, webinars, and online events, in your region or worldwide, Pediatric distal femur module is now online, Radiopalmar approach to the base of the thumb. These locking bone plates function as a fixed-angle device. There were 26 simple fractures and 45 comminuted fractures based on plain antero-posterior (AP) and lateral X-ray images (Table 2). The pull of the thenar muscles results in palmar flexion of the distal fragment. Int J Res Orthop. By using this website, you agree to our In locking plate fixation, the locking plate is applied through an incision over the volar (palm) aspect of the wrist. The requirement for informed consent was waived due to this study’s retrospective design. Angularly stable plate fixation, using a locking compression plate (LCP), prevents secondary displacement without the need of bone grafting. reported that callus formation decreases as the bridge span length increases [22]. Court-Brown CM, Caesar B. ABN Automotive Car Steering Wheel Puller Compressor Remover Set – Vehicle Steering Wheel Lock Plate Removal Tool Kit. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. Furthermore, 36 of 40 (90%) cases with comminuted fractures in the bone union group fit the plate length that was > 2–3 times longer than the overall fracture length, whereas 4 of 40 (10%) cases did not. Compared with traditional compression plating, locking plates can provide more stability in comminuted or osteoporotic fractures. Our study also showed no significant differences between groups (Tables 2, 3, and 4). Kanchanomai C, Muanjan P, Phiphobmongkol V. Stiffness and endurance of a locking compression plate fixed on fractured femur. J Orthop Trauma. c Radiograph and CT showed callus formation 2 months postoperatively; left knee range of motion was 0–140°. 2.0 mm and 2.4 mm LCP were used to manage appendicular fractures in cats and small dogs. For cases in whom the bone fracture site was shortened by surgeon, the medial distance was regarded as 0 mm. Based on our findings, we 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. A senior medical doctor with > 15 years of experience as an orthopedic surgeon operated on these cases; therefore, a certain surgery quality (reduction of fractures, treatment of soft tissues) was guaranteed. In these circumstances, take the opportunity to remove the implants. Powerbuilt Steering Wheel Lock Plate Remover - 648466. 2018 Jan;32(Suppl 1):S1–10. On the other hand, the mean bridge span length of comminuted fractures in the bone union and non-union groups was 92.5 mm (range, 45–190 mm) and 81.2 mm (range, 40–110 mm), respectively (Table 4). Clin Biomech (Bristol, Avon). Med Eng Phys. J Orthop Trauma. We analyzed several independent variables to determine how they impacted fracture healing; however, it is possible that other variables that were not considered may have contributed to the outcomes. Plate screw – can be locking or non-locking head; non-locking produces friction between plate and bone due to compression; locking provides angular stability • Poller/blocking screw – used to redirect an IMN • Lag screw – Inter-fragmentary compression; both fully threaded and partially threaded screws can have a lag effect . The sliding screw plate (dynamic compression screw, dynamic hip screw) may be used to treat … Rekha YB, Reddy NB. Different types of screws Conventional screws Cortex screw (with or without shaft) Cancellous bone screw (with or without shaft) Locking head screws (LHS) Self-tapping LHS Self-drilling, self-tapping LHS 5. statement and Surgical treatment can either be retrograde intramedullary nail fixation or be plate fixation, with plate fixation having a wide indication for various fractures types [5, 6]. 1994 Jan;76(1):26–34. Although adopting the anatomical locking plates procedure revealed positive outcomes, the method is still debatable.Several studies describe a variety of surgical technique and implants to treat this complex fracture. Epidemiology of adult fractures: a review. Schütz M, Müller M, Regazzoni P, Höntzsch D, Krettek C, Van der Werken C, Haas N. Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study. Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults. A locking screw, using a threaded drill guide when drilling, may be inserted in osteoporotic bone, or when otherwise indicated.The second distal screw is inserted using the same technique. Always use a threaded drill guide when preparing for locking screws. Journal of Orthopaedic Surgery and Research J Orthop Surg Res 14, 384 (2019). Additionally, Henderson et al. Injury. Immediately postoperatively, a temporary plaster splint is applied which immobilizes the first MCP joint as well as the wrist. FREE Shipping by Amazon. Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. Age, open fracture, MIPO, diabetes, steroid use, infection, AO classification, plate span ratio, and bridge span length were of no predictive value. Manage cookies/Do not sell my data we use in the preference centre. Working length of a plate was defined as the distance between the first screws on either side of the fracture [13]. b Conclusive rules of comminuted fracture for 33A3, 33C2, and 33C3. Additionally, according to Stoffel et al., the number of empty holes, including the fracture site, should be between one and four in simple fractures, and in comminuted fractures, the screws should be inserted as close to the fracture site as possible [15]. volume 14, Article number: 384 (2019) b Postoperative radiograph. 1712-035). It is a single-beam construct where the 2011 Feb;25(Suppl 1):S8–14. c Radiograph and CT showed no callus at 6 months postoperatively. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Further study in large number of patients is required to comment regarding disadvantages and complications. Thus, Locking Compression Plate is an important armamentarium in treatment of the Distal femur fractures especially when fracture is closed, severely comminuted and in situations of osteoporosis. A prospective study of treatment of distal femur fractures with locking condylar plate. These results will be helpful in treating distal femoral fractures with plates. e Radiograph 1 year after re-operation, a Radiograph with Gustilo type-IIIA in a 73-year-old man. We … Schandelmaier P, Partenheimer A, Koenemann B, Grün OA, Krettek C. Distal femoral fractures and LISS stabilization. The plate has to be adapted accurately to the contour of the proximal fragment. The Locking Compression Plate System has many similarities to existing plate fixation methods, but with a few important improvements. Cookies policy. The bone fracture distance on the medial side of the distal femur was related to bone union rather than screw position. b Postoperative radiograph. Preliminary stabilization can be achieved with an obliquely inserted K-wire.If anatomical reduction is demonstrated using image intensification, a 2 mm LCP T-plate is fixed to the dorsal aspect of the first metacarpal using standard locking techniques. Additionally, of the 45 cases with comminuted fractures, 13 cases had a medial fracture distance of ≥ 2 mm, and non-union was observed in 4 of these 13 (30.7%) cases. Cut the 2.0 mm LCP to length so that 2 screws can be fixed in the distal diaphyseal fragment. CAS  Journal of Orthopaedic Surgery and Research, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s13018-019-1401-9. With this temporary fixation in place, the plate position and anatomical reduction is checked thoroughly and adjusted, if required. 1a, b, and c. Measurements of the medial fracture distance between the proximal fragment and the medial cortex of the distal fragment were based on plain AP and lateral X-ray images. 1982 Dec;53(6):957–62. Bottland et al. Remove the drill guide and measure the appropriate screw length with a depth gauge.Insert the locking screw without completely tightening it. Tables 2, 3, and 4 summarize the univariate analysis. 2007 Oct;89(10):2298–307. Regarding plate fixation, basic fixation is generally recommended to achieve absolute stability using lag screws in simple fractures; however, lag screw fixation cannot be performed in transverse fractures [7]. 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. The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. 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 A report of six cases. d Another plate was added during re-operation to shorten the fracture. Elkins J, Marsh JL, Lujan T, Peindl R, Kellam J, Anderson DD, Lack W. Motion predicts clinical callus formation: construct-specific finite element analysis of supracondylar femoral fractures. Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Gautier E, Sommer C. Guidelines for the clinical application of the LCP. The “far cortical locking technology” was demonstrated to increase fracture stability and flexibility; however, long-term results have not yet been obtained [18]. © 2021 BioMed Central Ltd unless otherwise stated. Introduction. J Bone Joint Surg Am. Study limitations included its retrospective design and the relatively small sample size. Even with relative fixation, the more the empty hole, the higher the risk of a non-union, because bone union was achieved during salvage surgery in non-union cases through plate replacement with a long plate or inserting a screw near the fracture site. We 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. The details of the surgical approach, the type of plate , and the number and configuration of screws were decided by the surgeon. All the cases in the non-union group fit the plate length of > 2–3 times longer than the overall fracture length (Table 4). b Postoperative radiograph. Hib Surgicals - Offering Locking Compression Plate, Size: 3.5 Mm at Rs 1589/piece in Mumbai, Maharashtra. J Bone Joint Surg Am. 2, 3, and 4. Orthopaedic Locking Compression Plates are fracture fixation devices that allow fitment of normal conventional bone screws as well as Locking head screws. (right forearm) A coronary stent — in this case a drug-eluting stent — is another common item implanted in humans. The final manuscript was approved by all authors. The LCP (Locking Compression Plate), the product of these combinations, is in line with the latest plating techniques, the aim of which is to achieve the smallest possible surgical incisions and to preserve the blood supply to the bone and the adjacent soft tissues. distally the plate was not extended beyond the joint line. Megas P. Classification of non-union. recommended opening 1–2 holes close to the fracture sites in simple fractures and inserting the screws as close as possible to the fracture sites in comminuted fractures [13]. Springer Nature. MK, TN, HN, and TM performed the statistical analysis and interpreted the results. Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Santolini E, Goumenos SD, Giannoudi M, Sanguineti F, Stella M, Giannoudis PV. Results with a p value of < 0.05 were considered significant. Direct plate-to- bone compression is not required, better preserving the blood supply to the bone. In order to prevent the screw from penetrating the joint, a slight bend is necessary. Injury. 2010 Oct;18(10):597–607. Lujan et al. Locking compression plate (LCP) dynamic compression unit conical and threaded unit 4. We believe that by decreasing the number of empty holes around the fracture site (i.e., inserting the screw near the fracture site), fracture site stability increased. This Surgical Technique applies to the Depuy Synthes LCP Locking Compression Plate Systems and product lines listed below, which include but are not limited to the : osn i owndingt al c i i ol f Get it as soon as Tue, Nov 24. In the second, the screw head is itself threaded and screws into the plate or into an adapted lip. Department of Orthopedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan, Masahiro Kiyono, Yusuke Mochizuki, Takahiko Uchino, Suguru Yokoo, Koji Demiya, Kenta Saiga, Yasunori Shimamura & Toshifumi Ozaki, Department of Musculoskeletal Traumatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama City, Okayama, 700-8558, Japan, Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-Machi, Takamatsu City, Kagawa Prefecture, 760-8557, Japan, Department of Orthopedic Surgery, Kagawa Rosai Hospital, Jotocho, Marugame, Kagawa Prefecture, 763-8502, Japan, Department of Community and Emergency Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan, You can also search for this author in This screw would normally be a standard screw, as it engages in thick cortical bone. $25.99 $ 25. It showed that the plate length was 196 mm, fracture distance was 5 mm, plate span ratio was 196/5 = 39.2, bridge span length was 100 mm, medial fracture distance was 4 mm, and empty hole number was 4. Reports published by various authors are listed in Table 5 [3, 23, 24, 26,27,28,29,30,31]. In our study, 7 of 26 simple fracture cases had a medial fracture distance of ≥ 2 mm, and non-union was observed in 2 of these 7 (28.5%) cases. Case 2 was distal femur fracture with Gustilo IIIA in a 73-year-old man; he was run over by a shovel car. No statistically significant difference in the working lengths of the fracture site was observed between simple fractures and comminuted fractures in both groups (Tables 3 and 4). Non-union was diagnosed 2 of 26 (7.7%) cases with a simple fracture and 5 of 45 (11.1%) cases with a comminuted fracture (Table 2). c Radiograph and CT showed non-union 8 months postoperatively. Megas et al. In distal femoral fractures, non-union sometimes may occur, despite improvements in implant and reduction techniques. The optimal insertion holes for the screws on the proximal side of the locking plate (when used as a bridge) are currently debated [9, 10]. Non-union rate was significantly higher in comminuted fractures with bone medial fracture distance exceeding 5 mm. Put the plate on the dorsal aspect of the proximal fragment, with a threaded drill guide in one of the outer holes. Bone union was observed in all cases with simple or comminuted fractures with respective medial fracture distances of ≤ 2 mm or ≤ 5 mm. Hunt SB, Buckley RE. Part of Terms and Conditions, Get contact details and address | ID: 6724282412 A small incision over the proximal portion of the plate enabled reduction of the fracture and placement of compression screws/locking screws as necessary11. In such cases, it is necessary to use a locking plate as a bridging plate to fix the fracture site [8]. Injury. reported that fracture site instability prevents bone callus formation, even with good blood supply [19]. There are few reports on the relationship between the screw position and bone union when fixing by the bridging plate (relative stability) method. This study included 71 distal femoral fractures in 70 patients (23 males, 47 females; mean age, 68.0 years [range, 16–91 years]) who were treated using the locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA) at a university hospital and related facilities between April 2005 and December 2015. Pressing the plate down to the diaphyseal fragment with a periosteal elevator will automatically tilt the articular fragment into its correct position. Non-union was founded in simple fractures with bone medial fracture distance exceeding 2 mm, but not significant (p = 0.06). J Appl Biomech. We have a wide range of locking plates and screws at competitive prices in the market. 2003 Nov;34(Suppl 2):B11–9. In case 3, it showed that plate length was 196 mm, fracture distance was 65 mm, plate span ratio was 196/65 = 3.01, bridge span length was 85 mm, medial fracture distance was 0 mm (because of shortening fracture site), and empty hole number was 1. MK drafted the manuscript. Additionally, there were 13 comminuted fractures with a medial fracture distance of ≥ 2 mm, and the non-union rate was 30.7% (4 of the 13 cases). In Henderson et al.’s study involving 70 patients, the average number of empty holes proximal to the fracture site was 0.3 in the non-union group and 1.1 in the bone union group [20]. Fisher’s exact test was performed for statistical comparisons of open fractures, minimally invasive plate osteosynthesis, plate span ratio, and medial fracture distance between those with bone union (bone union group) and those with non-union (non-union group).

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