DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20171913

Stabilisation of diaphyseal fractures of both bones forearm with limited contact dynamic compression or locked compression plate: comparison of clinical outcomes

S. P. S. Gill, Ankit Mittal, Manish Raj, Pulkesh Singh, Sunil Kumar, Dinesh Kumar

Abstract


Background: The inception of Locking Compression Plate (LCP) has revolutionized fracture management. With their dramatic success for articular fractures, there is a speculation that they might be more appropriate for diaphyseal fractures as well.

Methods: In this randomized prospective cohort study, 56 patients with diaphyseal fractures involving both bones of forearm were segregated into two groups based on internal fixation with Limited contact dynamic compression plate (LC-DCP)(n=28) or with Locking compression plate (LCP)(n=26). Clinical and radiological parameters were studied and functional evaluation was done with Disabilities of arm, shoulder, and hand (DASH) score.

Results: Andersons’ criteria was employed to categorize the functional results. The mean duration of surgery and time to union were discovered to be less in favor of LCP group although statistically insignificant. No significant differences in two groups with respect to the functional evaluation (range of movement, Andersons’ criteria and DASH score) and complications could be discerned. No incidence of refracture or synostosis was encountered in any of the group.

Conclusions: Although LCP is an effective treatment alternative and may have a subtle edge over LC-DCP in the management of these fractures, their supremacy could not be certified. We deduce that surgical planning and expertise rather than the choice of implant are more pivotal for outstanding results.


Keywords


Limited contact dynamic compression plate (LC-DCP), Locking compression plate (LCP), Fractures both bones of forearm

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References


Chow SP, Leung F. Radial and ulnar shaft fractures. In: Bcholz RW, Charles MC, James DH, Paul T, editors. Rockwood and Green’s Fractures in adult. 7th ed. Lippincott. Robert WB, Williams & Wilkins; 2010: 882-893.

Andrew 11, Crenshaw Jr, Edward A. Perez. Fractures of Shoulder, arm, and forearm. In: Canale ST, Beaty JH, editors. Campbell’s operative orthopaedics. 11thedition: Mosby; 2008: 3425-3433.

Aljo Matej E, Lvica M, Tomljenocie M, Krolo 1. Forearm shaft fractures: result of 10 year follow up. Acts Clin Croat. 2000;39(3):147-53.

Knight RA, Purvis GD. Fractures of both bone forearm in Adults. J Bone Joint Surg Am. 1949;31:755–64.

Leung F, Chow SP. Locking compression plate in the treatment of forearm fractures: A prospective study. J Orthop Surg (Hong Kong). 2006;14:291–4.

Anderson LD, Sisk D, Tooms RE, Park WI., 3rd Compression-plate fixation in acute diaphyseal fractures of the radius and the ulna. J Bone Joint Surg Am. 1975;57:287–7.

Bagby GW, James JM. The effect of compression on the rate of Fracture healing using a special plate. Am J Surg. 1958;95:761–71.

Müller ME, Allgöwer M, Willenegger H. Technique of internal fixation of fractures. NewYork: Springer; 1965.

Leung F, Chow SP. A prospective, randomized trial comparing the limited dynamic compression plate with the point contact fixation for forearm fractures. J Bone Joint Surg Am. 2003;85:2343–8.

Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked screws and screws. J Orthop Trauma. 2004;18:488–3.

Broos PL, Sermon A. From unstable internal fixation to biological osteosynthesis.A historical overview of operative fracture treatment. Acta Chir Belg. 2004;104:396–400.

Perren SM, Klaue K, Pohler O, Predieri M, Steinemann S, Gautier E. The limited contact dynamic compression plate (LC-DCP). Arch Orthop Trauma Surg. 1990;109(6):304-10.

Frigg R. Locking compression plate (LCP): an osteosynthesis plate based on the dynamic compression plate and the Point Contact Fixator (PC-Fix). Injury. 2001;32(2):63-6.

Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602-8.

Rao MR, Kader E, Sujith S, Thomas V, editors. Nail plate combination in management of fracture both bone forearm. Orthop Proceedings. 2002;84(3):252-3.

Sommer C, Gautier E, Müller M, Helfet DL, Wagner M. First Clinical results of the locking compression plate. Injury. 2003;34:43–54.

Ling HT, Kwan MK, Chua YP, Deepak AS, Ahmad TS. Locking compression plate: A treatment option for diaphyseal nonunion of radius or ulna. Med J Malaysia. 2006;61:8–12.

Haidukewych GJ. Innovations in locking plate technology. J Am Acad Orthop Surg. 2004;12:205–12.

Dickson KF, Munz J. Locked plating: Clinical indications. Tech Orthop. 2007;22:181–5.

Atsunori S, Genzaburo N, Tsukasa I, Naoya T. Treatment of forearm fractures using locking compression plate (LCP, AO/ASIF) Orthop Surg Traumatol. 2004;47:1293–8.

Gardner MJ, Brophy RH, Campbell D, Mahajan A, Wright TM, Helfet DL, et al. The mechanical behavior of locking compression plates compared with dynamic compression plates in a cadaver radius model. J Orthop Trauma. 2005;19(9):597-603.

Snow M, Thompson G, Turner PG. A mechanical comparison of the locking compression plate (LCP) and the low contact-dynamic compression plate (DCP) in an osteoporotic bone model. J Orthop Trauma. 2008;22(2):121-5.

Doornink J, Fitzpatrick DC, Boldhaus S, Madey SM, Bottlang M. Effects of hybrid plating with locked and nonlocked screws on the strength of locked plating constructs in the osteoporotic diaphysis. J Trauma. 2010;69(2):411-7.

Saikia KC, Bhuyan SK, Bhattacharya TD, Borgohain M. Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate. Indian J Orthop. 2011;45(5):417–21.

Azboy I, Demirtas A, Uçar BY, Bulut M, Alemdar C, Ozkul E. Effectiveness of Locking Versus Dynamic Compression Plates for Diaphyseal Forearm Fractures. Orthopedics. 2013;36(7):917-22.

Stevens CT, Ten Duis HJ. Plate osteosynthesis of simple forearm fractures: LCP versus DC plates. Acta Orthop Belg. 2008;74:180–3.

Reddy BJ, Abhishek L, Kathyayini R. Comparative study of forearm fractures treated with locking compression plate or limited contact dynamic compression plate. J Evol Med Dental Sci. 2015;4(12):2001-10.

Chapman MW, Gorden JE, Zissimos AG. Compression plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am. 1989;71:159–69.

Goldfarb CA, Ricci WM, Tull F, Ray D, Borelli J., Jr. Functional outcome after fracture of both bones of the forearm. J Bone Joint Surg Br. 2005;87:374–9.

Wagner M. The general principles for the clinical use of LCP. Injury. 2003;34:31–42.

Hari Babu S, Rajesh M, Suresh Babu G, Anand L. Comparative study of dynamic compression plate versus locking compression plate in the management of diaphyseal fracture of both bones forearm. J Evidence Based Med Healthcare. 2015;2(40):6717-24.

Henle P, Ortlieb K, Kuminack K, Mueller CA, Suedkamp NP. Problems of bridging plate fixation for the treatment of forearm shaft fractures with the locking compres¬sion plate. Arch Orthop Trauma Surg. 2011;131(1):85-91.

Hidaka S, Gustilo RB. Refracture of bones of the forearm after plate removal. J Bone Joint Surg Am. 1984;66:1241–3.

Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plate. J Bone Joint Surg Am. 1988;70:1372–6.