Development of Orthopedic Implants

Effective Selection of Trauma Plating Fixation Method in Treatment of Bone Fractures

Posted by Amirhossein Goharian,    

  • March 23, 2017

“Effective General and Specific Clinical-Biomechanical challenges of fracture fixation in selection of appropriate plating fixation method for successful clinical outcomes”

 

According to the type and severity of the bone fractures, an appropriate trauma fixation method is selected by the orthopaedic surgeons. Trauma plating fixation method (using plate and screws) are currently in high interest for fixation of bone fractures. Plating fixation have been found more effective in fixation of long and small bones compared to intramedullary nailing and external fixation methods. Plate can be manufactured in different shape, size, and various trajectories of the screw holes to be compatible with various aspects of the bones for effective buttressing and capturing of the bone fragments. Although various plates have been developed by the orthopaedic manufacturers, however, the selection of adequate plate based on the fracture type and severity has been the main challenge of orthopaedic surgeons. Normally, experienced surgeons are used to study the fracture characteristics by CT scan 3D reconstruction for better visualizing of the bone fracture site if required. Based on their experience and available plate and screw systems, they select various types of suitable plates to be prepared before the operation. This would allow them to have multiple solutions when the fracture site is opened.

 

Other than type and severity of the bone fracture, the associated biomechanical and clinical requirement and challenges of the fracture fixation would be greatly important for selecting of the proper plate. In respect to the trauma fracture fixation, straight plate or intramedullary nail would be alternative solutions for fixation of fracture at the shaft portion of the bone due to bone simple anatomy at this zone. In severe multi-fragmentary open fractures, external fixators are also utilized in combination with internal fixation methods (e.g. plating fixation) for temporary immobilization of the fracture site during primary healing of the soft tissues. However, when the fracture is occurred in proximal and distal portions of the bone, particularly with involvement of articular surface at the joints, biomechanical and clinical requirements of fracture fixation are more complicated than fixation of bone fracture at the shaft portion. In one hand, the plate shape is designing anatomically similar to the bone anatomy at the proximal and distal metaphyseal bone which challenges the biomechanical strength of the plate under various static and dynamic physiological loading conditions. On the other hand, lower soft tissue coverage and soft tissue attachments at the proximal and distal metaphyseal bone challenge the placement of the plate with no soft tissue irritation (or even soft tissue rupture) during healing of the fracture. Likewise, effective capturing of the bone fragments in multi-fragmentary fractures at metaphyseal portions of the bone would be crucial to be effectively managed. Furthermore, configuration and type of screws would be essential to achieve a good fracture fixation with optimal strength, stiffness, and flexibility during healing of the fracture. Other than these biomechanical and clinical challenges, understanding of the boundary and loading conditions at the proximal and distal portion of the bone could remarkably promote management of the fracture fixation at metaphyseal zones.

 

   

 

In addition of these general biomechanical and clinical challenges of trauma plating fixation, there would be other specific challenges for fracture fixation of each bone which need to be biomechanically and clinically contemplated. Trauma Plating Systems reviews and discusses the clinical and biomechanical aspects of trauma plating fixation while challenging the biomechanical evaluation methods of trauma plating systems. The general clinical-biomechanical topics are represented in section II (Chapter 4-6), while the specific clinical-biomechanical considerations are discussed in section IV (Chapter 10-16) for the humerus, forearm, femur, tibia, fibula, hand, foot, pelvic, and clavicle bones. For instance, the specific topics that are reviewed for fixation of humeral bone fractures (Chapter 10) are highlighted as following; 

      

Proximal humeral fracture fixation

  • Rotator cuff force during abduction of humeral head
  • Fixation of humeral head fracture with locking plates
  • Effect of bone density on fixation of humeral head fractures
  • Evaluation of humeral head fixation at early stage of fracture healing
  • Fixation with fragmentary involvement at medial side
  • Combination of locking plating and fibular allograft
  • Testing setup for biomechanical evaluation of humeral head fracture fixation
  • Fixation of multi-fragmentary humeral head fracture (type AO-C)
  • Consideration of muscle-tendon force in biomechanical evaluation of plating fixation
  • Stiffness of fracture fixation
  • Failure of proximal humerus plate
  • Clinical outcomes & complications

     

Distal humeral fracture fixation

  • Double plating fixation for extra-articular osteotomy
  • Double plating fixation with intra-articular osteotomy
  • Pre-countered plate vs. reconstruction plate
  • Preservation of distal humeral radial column
  • Plate and screw configuration in double plating fixation
  • Fixation of diaphyseal portion of distal humeral
  • Fixation of low transcondylar fractures at distal humerus bone

          

* Figure at opening of this post has been first published in the study “Park, S.-G., Medial and Lateral Dual Plate Fixation for Osteoporotic Proximal Humerus Comminuted Fracture: 2 Case Reports. Journal of the Korean Fracture Society, 2016. 29(1): p. 61-67″.