Locking Compression Plate loosening and plate breakage: A report of four cases

Surgical Department, Kantonspital Chur, Switzerland.
Journal of Orthopaedic Trauma (Impact Factor: 1.54). 10/2004; 18(8):571-7. DOI: 10.1097/00005131-200409000-00016
Source: PubMed

ABSTRACT The Locking Compression Plate (LCP) system offers a number of advantages in fracture fixation combining angular stability through the use of locking screws with traditional fixation techniques. This makes the implant particularly suitable for use in poor bone stock and complex joint fractures, especially in the epimetaphyseal area. However, the system is complex, requiring careful attention to biomechanical principles, and a number of potential pitfalls need to be considered. These pitfalls are illustrated in the 4 cases described herein, in which treatment was unsuccessful due to implant breakage or loosening. In each case, treatment failure could be attributed to the choice of an inappropriate plate and/or fixation technique, rather than to the features of the Locking Compression Plate system itself. Such experiences highlight the importance of detailed understanding of the biomechanical principles of plate fixation as well as careful preoperative planning for the successful use of the Locking Compression Plate system.

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    • "Several plate designs with different configurations of locking and non-locking screws have been used in the management of these fractures, however there have been a number of reported failures, particularly of locking plates [6] [7] [8] [9] which suggest that fractures have failed to heal. "
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    ABSTRACT: A variety of plate designs have been implemented for treatment of periprosthetic femoral fracture (PFF) fixation. Controversy, however, exists with regard to optimum fixation methods using these plates. A clinical case of a PFF fixation (Vancouver type C) was studied where a rigid locking plate fixation was compared with a more flexible non-locking approach. A parametric computational model was developed in order to understand the underlying biomechanics between these two fixations. The model was used to estimate the overall stiffness and fracture movement of the two implemented methods. Further, the differing aspects of plate design and application were incrementally changed in four different models. The clinical case showed that a rigid fixation using a 4.5 mm titanium locking plate with a short bridging length did not promote healing and ultimately failed. In contrast, a flexible fixation using 5.6 mm stainless steel non-locking plate with a larger bridging length promoted healing. The computational results highlighted that changing the bridging length made a more substantial difference to the stiffness and fracture movement than varying other parameters. Further the computational model predicted the failure zone on the locking plate. In summary, rigid fracture fixation in the case of PFF can suppress the fracture movement to a degree that prevents healing and may ultimately fail. The computational approach demonstrated the potential of this technique to compare the stiffness and fracture movement of different fixation constructs in order to determine the optimum fixation method for PFF.
    Medical Engineering & Physics 12/2011; 34(8):1041-8. DOI:10.1016/j.medengphy.2011.11.007
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    • "Unfortunately, diaphyseal fixation failure occurs even with bicortical fixation (Sommer et al., 2004; Vallier et al., 2006). Vallier et al. (2006) reported four cases of screw breakage at the screwplate interface in 46 distal femur fractures treated with the locking condylar plate (Synthes, Paoli, PA). "
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    ABSTRACT: Elevation of a locking plate over the bone surface not only supports biological fixation, but also decreases the torsional strength of the fixation construct. Biplanar fixation by means of a staggered screw hole arrangement may combat this decreased torsional strength caused by plate elevation. This biomechanical study evaluated the effect of biplanar fixation on the torsional strength of locking plate fixation in the femoral diaphysis. Custom titanium plates were manufactured with either a linear or staggered hole pattern to evaluate planar and biplanar fixation, respectively. Fixation strength under torsional loading was evaluated in surrogates of the femoral diaphysis representative of osteoporotic and non-osteoporotic bone. Furthermore, fixation strength was determined for plate fixation with unicortical or bicortical locking screws. Five specimens per configuration were loaded to failure in torsion to determine their strength, stiffness, and failure mode. In osteoporotic bone, biplanar fixation was 32% stronger (P=0.01) than planar fixation when unicortical screws were used and 9% stronger (P=0.02) when bicortical screws were used. In non-osteoporotic bone, biplanar fixation was 55% stronger (P<0.001) than planar fixation when unicortical screws were used and 42% (P<0.001) stronger when bicortical screws were used. A biplanar screw configuration improves the torsional strength of diaphyseal plate fixation relative to a planar configuration in both osteoporotic and normal bone. With biplanar fixation, unicortical screws provide the same fixation strength as bicortical screws in non-osteoporotic bone.
    Clinical biomechanics (Bristol, Avon) 06/2011; 26(5):484-90. DOI:10.1016/j.clinbiomech.2010.12.005
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    • "However, the surgeon cannot judge screw purchase when using a locking screw therefore a specific and uniform torque needs to be applied to each screw. Sommer et al. (2004) reported on four cases of implant failure as a result of technical error and not of the implant itself. Therefore it is evident that special training and care be taken in managing these implants. "
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    ABSTRACT: Open reduction and internal fixation of fractures involves the use of metallic implants to support bone reduction. This procedure is often used in situations in which adequate alignment and stability of the bone cannot be achieved using nonsurgical methods such as casting. The locking compression plate is a contemporary implant that allows for both conventional screw placement (using nonlocking screws) and locking screw placement (where screw heads lock into the plate at a predetermined angle). This allows for greater versatility in the application of internal fixation. This article presents a general overview of locking compression plate application along with a review of the locking compression plate literature.
    Journal of surgical orthopaedic advances 02/2008; 17(4):271-81.
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