Abstract:Objective To compare the breakage rate of locking plate and traditional plate in treatment of femoral fractures, analyze failure reasons and offer a basis for decreasing breakage rate of the plates. Methods The study included 280 patients with femoral fractures managed by plate fixation from May 2009 and January 2011. There were 146 males and 134 females, at age of 18-92 years (mean 52.4 years). There were 136 patients with left femoral fractures and 144 patients with right femoral fractures. According to AO classification, there were 72 patients with type 31A fractures, 44 with type 32A fractures, 26 with type 32B fractures, 30 with type 32C fractures, 57 with type 33A fractures, 26 with type 33B fractures and 25 with type 33C fractures. A total of 175 patients were treated with locking plate and 105 with traditional plate. Results Follow-up ranged from 9 months to 40 months, which displayed implant breakage rate of 4.0 % in the locking plate group and of 2.9% in the traditional plate group (P>0.05). Breakage modes included plate fracture in six patients, screw fracture in three, plate combined with screw fractures in one. Causes for breakage were iatrogenic factors plus false rehabilitation training with implant breakage rate of 100%, simply iatrogenic factors with implant breakage rate of 36.4%, and simply false rehabilitation training with implant breakage rate of 5.4%. However, non-iatragenic factors plus correct rehabilitation training brought no implant breakage. Consequently, breakage rate of the implant related to iatrogenic factors plus false rehabilitation training were significantly higher than that associated with simply iatrogenic factors, simply false rehabilitation training, or non-iatragenic factors plus correct rehabilitation training. Conclusion Breakage rate of the locking plate and the traditional plate in treatment of femoral fractures shows no significant difference, but iatrogenic factors combined with false rehabilitation training are the leading cause for the implant breakage.
WU Shuai-shuai,CHEN Wei,WANG Juan et al. Comparative study on breakage rate of locking plate and traditional plate in treatment of femoral fractures[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(3): 254-257.
[2]Zhang YZ. Clinical epidemiology of orthopedic trauma.1st ed. Stuttgart; New York: Thieme, 2012:157.
[3]Strauss E, Schwarzkopf R, Kummer F, et al. The current status of locked plating: the good, the bad, and the ugly. J Orthop Trauma, 2008, 22(7):479-486.
[4]Miller DL, Goswami T. A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing. Clin Biomech (Bristol, Avon), 2007, 22(10):1049-1062.
[5]Egol KA, Kubiak EN, Fulkerson E, et al. Biomechanics of locked plates and screws. J Orthop Trauma, 2004, 18(8):488-493.
[6]Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop, 2009, 33(4):1119-1126.
[7]Kanchanomai C, Phiphobmongkol V, Muanjan P. Fatigue fail of an orthopedic implant—A locking compression plate. Eng Fail Anal, 2008, 15(5):521-530.
[8]Sommer C, Babst R, Müller M, et al. Locking compression plate loosening and plate breakage: a report of four cases. J Orthop Trauma, 2004, 18(8):571-577.
[10]Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury, 2007, 38(3):365-370.
[11] Ahmad M, Nanda R, Bajwa AS, et al. Biomechanical testing of the locking compression plate:when does the distance between bone and implant significantly reduce construct stability? Injury, 2007, 38(3):358-364.
[12]Smith WR, Ziran BH, Anglen JO, et al. Locking plates: tips and tricks. Instr Course Lect, 2008, 57:25-36.
[13]Phisitkul P, McKinley TO, Nepola JV, et al. Complications of locking plate fixation in complex proximal tibia injuries. J Orthop Trauma, 2007, 21(2):83-91.
[14]Weinraub GM. Midfoot arthrodesis using a locking anterior cervical plate as adjunctive fixation:early experience with a new implant. J Foot Ankle Surg, 2006, 45(4):240-243.
[15]Fulkerson E, Egol KA, Kubiak EN, et al. Fixation of diaphyseal fractures with a segmental defect:a biomechanical comparison of locked and conventional plating techniques. J Trauma, 2006, 60(4):830-835.