Osteosynthesis Plates

Osteosynthesis Plates-68
For distal fractures, they have used the same proximal approach and a distal limited approach performed by subperiosteal dissection of the lateral supracondylar ridge of the humerus, with retraction of brachioradialis and long carpal extensor muscle, as well as the radial nerve (even though unseen).A narrow DCP plate of 4.5 mm with 12 holes was molded and twisted medially to adapt to the anterior face of the humeral lateral column and diaphysis, thus avoiding occlusion of the coronoid or of the olecranon fossae.

For distal fractures, they have used the same proximal approach and a distal limited approach performed by subperiosteal dissection of the lateral supracondylar ridge of the humerus, with retraction of brachioradialis and long carpal extensor muscle, as well as the radial nerve (even though unseen).A narrow DCP plate of 4.5 mm with 12 holes was molded and twisted medially to adapt to the anterior face of the humeral lateral column and diaphysis, thus avoiding occlusion of the coronoid or of the olecranon fossae.

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Potential complications as infections, consolidation delays and construct damage due to nonunions undergo frequently (Bucholz et al., 1996).

At that time, standard operative procedures considered that in epiphyseal-metaphyseal fractures, each fragment either from the articular or metaphyseal area should be subject for anatomical reduction and stabilization.

After a short immobilization (1-2 weeks) the patients started rehabilitation.

All fractures healed within a mean time of 9 weeks following surgery, with good functional results regarding elbow and shoulder mobility (Fig. There were no vascular or nerve complications, except 2 postoperative temporary paresthesia for the radial nerve in distal fractures.

By the development of new plates (bridging plates, Limited Contact-Dynamic Compression Plate / LC-DCP, Point-Contact fixator / PC-Fix, plates with angular stability) and new surgical techniques (indirect reduction and Minimally Invasive Plate Osteosynthesis / MIPO), biological plate osteosynthesis is important to preserve bone vascularization, to improve consolidation, to decrease infection rate, to avoid iterative fractures or bone grafting.

While indirect reduction techniques (using a distractor) are limiting the medial dissection and avoid bone grafting, MIPO techniques are limiting both the medial and lateral dissection in complex extraarticular fractures of the proximal and distal femur (Krettek et al, 1997a).

Subtrochanteric area is submitted to an eccentric biomechanical stress, and compression forces in the medial cortex are overwhelming compression forces in lateral cortical area (Hoffmann et al., 1999).

Medial cortex comminution in high energy trauma involves major problems regarding reconstruction and internal fixation.

There were obtained superior biomechanical results (absolute stability) but poor long-term biological effects (Baumgaertel et al., 1998).

The main disadvantages of the anatomic reduction and rigid fixation by plates led to the development of the "biological plate osteosynthesis" concept.

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