Abstract
Background
The locked screw plate construct is often cited as being too rigid and prolonging healing in patients with metaphyseal fractures. The newly introduced dynamic locking screws (DLS) allow 0.2 mm of axial motion, which should optimize healing near the near cortex. The purpose of this study was to analyze the clinical results of dynamic locking screws in distal tibia fractures.
Methods
Data were acquired retrospectively. Only distal meta-diaphyseal tibia fractures treated with minimally invasive plate osteosynthesis and DLS were evaluated. Cortical and locking head screws were used for distal plate fixation to minimize soft tissue irritation over the medial malleolus, and DLS were used in the proximal plate fixation. Clinical and radiographic data were evaluated after 6 weeks, 3 months, 6 months and 1 year until fracture union.
Results
Twenty-two patients were treated with minimally invasive plate osteosynthesis and DLS. Six patients could not be evaluated because they returned to a foreign residence after the procedure. Fourteen fractures healed after a mean of 3.1 months. Two fractures with insufficient reduction showed delayed union and healed after 9 and 9.5 months, respectively. The callus index peaked at 6 months.
Conclusions
Dynamic fracture fixation might be a promising concept to reduce the frequency of metaphyseal non-unions in distal tibia fractures. But nevertheless, the dynamic construct cannot compensate for insufficient reduction.
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References
Ahmad MA, Sivaraman A, Zia A, et al. Percutaneous locking plates for fractures of the distal tibia: our experience and a review of the literature. J Traum Acute Care Surg. 2012;72:E81–7.
Bottlang M, Doornink J, Lujan TJ, et al. Effects of construct stiffness on healing of fractures stabilized with locking plates. J Bone Joint Surg Am Vol. 2010;92(Suppl 2):12–22.
Bottlang M, Lesser M, Koerber J, et al. Far cortical locking can improve healing of fractures stabilized with locking plates. J Bone Joint Surg Am. 2010;92:1652–60.
Dijkman BG, Sprague S, Schemitsch EH, et al. When is a fracture healed? Radiographic and clinical criteria revisited. J Orthop Trauma. 2010;24(Suppl 1):S76–80.
Dobele S, Horn C, Eichhorn S, et al. The dynamic locking screw (DLS) can increase interfragmentary motion on the near cortex of locked plating constructs by reducing the axial stiffness. Langenbeck Arch Surg/Deutsche Gesellschaft Chirurgie. 2010;395:421–8.
Duda GN, Sollmann M, Sporrer S, et al. Interfragmentary motion in tibial osteotomies stabilized with ring fixators. Clin Orthop Relat Res. 2002;396:163–72.
Fitzpatrick DC, Doornink J, Madey SM, et al. Relative stability of conventional and locked plating fixation in a model of the osteoporotic femoral diaphysis. Clin Biomech Bristol Avon. 2009;24:203–9.
Freude T, Schroter S, Gonser CE, et al. Controlled dynamic stability as the next step in “biologic plate osteosynthesis”—a pilot prospective observational cohort study in 34 patients with distal tibia fractures. Patient Saf Surg. 2014;8:3.
Gardner MJ, Nork SE, Huber P, et al. Stiffness modulation of locking plate constructs using near cortical slotted holes: a preliminary study. J Orthop Trauma. 2009;23:281–7.
Gardner TN, Hardy J, Evans M, et al. Temporal changes in dynamic inter fragmentary motion and callus formation in fractures. J Biomech. 1997;30:315–21.
Goodship AE, Kenwright J. The influence of induced micromovement upon the healing of experimental tibial fractures. J Bone Joint Surg Br. 1985;67:650–5.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–8.
Horn C, Dobele S, Vester H, et al. Combination of interfragmentary screws and locking plates in distal meta-diaphyseal fractures of the tibia: a retrospective, single-centre pilot study. Injury. 2011;42:1031–7.
Joslin CC, Eastaugh-Waring SJ, Hardy JR, et al. Weight bearing after tibial fracture as a guide to healing. Clin Biomech Bristol Avon. 2008;23:329–33.
Leunig M, Hertel R, Siebenrock KA, et al. The evolution of indirect reduction techniques for the treatment of fractures. Clin Orthop Relat Res. 2000;375:7–14.
Plecko M, Lagerpusch N, Pegel B, et al. The influence of different osteosynthesis configurations with locking compression plates (LCP) on stability and fracture healing after an oblique 45 degrees angle osteotomy. Injury. 2012;43:1041–51.
Ring D, Kloen P, Kadzielski J, et al. Locking compression plates for osteoporotic nonunions of the diaphyseal humerus. Clin Orthop Relat Res. 2004;425:50–4.
Stoffel K, Dieter U, Stachowiak G, et al. Biomechanical testing of the LCP—how can stability in locked internal fixators be controlled? Injury. 2003;34:11–9.
Whelan DB, Bhandari M, Stephen D, et al. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Traum. 2010;68:629–32.
Conflict of interest
Yves Acklin declares that he has no conflict of interest, Ulrich Stöckle has received honorarium from Depuy-Synthes, Christoph Sommer has received honorarium from Depuy-Synthes.
Compliance with ethical requirements
The study was conducted in compliance with the ethical requirements and approved by the local ethical commission of Zürich (KEK-ZH-Nr. 2014-0042).
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Acklin, Y.P., Stöckle, U. & Sommer, C. Clinical and radiologic outcomes associated with the use of dynamic locking screws (DLS) in distal tibia fractures. Eur J Trauma Emerg Surg 42, 351–356 (2016). https://doi.org/10.1007/s00068-015-0543-7
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DOI: https://doi.org/10.1007/s00068-015-0543-7