Locking plate osteosynthesis of ..

Plate osteosynthesis may be preferred to external fixation in some cases of nonunion and in some ..

Bending irons are available to twist the plate

Intraarticular fractures require anatomical reduction and absolute stabilityand plates are often used for fixation of the metaphysis. In these fractures,anatomical reduction is essential to minimize arthrosis, and callus formationis not desired. Diaphyseal fractures of long bones are often treated withintramedullary nailing, but good indications for plating include the need foranatomical reduction (eg, forearm) and the presence of a short distal orproximal fragment, which makes nailing technically difficult. Plateosteosynthesis may be preferred to external fixation in some cases of nonunionand in some polytraumatized patients. Fixation with relative stability resultsin fracture healing by callus. Callus formation after attempts at fixation withabsolute stability indicates a degree of instability that ultimately may leadto implant fatigue and failure. Absolute stability results in direct fracturehealing and generally takes longer than healing by callus [3]. A plate—indirect contact and pressed down onto the bone surface—can disturb blood flow tothe underlying cortex. This may lead to local cortical necrosis [4]. Theprocess of bony remodeling and revascularization is slow and local osteoporosisis observed in cortical bone at the points of contact (footprints) with theplate.

Proximal Scaphoid Nonunion Osteosynthesis - 105580 …

Intraarticular fractures require anatomical reduction and absolute stabilityand plates are often used for fixation of the metaphysis. In these fractures,anatomical reduction is essential to minimize arthrosis, and callus formationis not desired. Diaphyseal fractures of long bones are often treated withintramedullary nailing, but good indications for plating include the need foranatomical reduction (eg, forearm) and the presence of a short distal orproximal fragment, which makes nailing technically difficult. Plateosteosynthesis may be preferred to external fixation in some cases of nonunionand in some polytraumatized patients. Fixation with relative stability resultsin fracture healing by callus. Callus formation after attempts at fixation withabsolute stability indicates a degree of instability that ultimately may leadto implant fatigue and failure. Absolute stability results in direct fracturehealing and generally takes longer than healing by callus [3]. A plate—indirect contact and pressed down onto the bone surface—can disturb blood flow tothe underlying cortex. This may lead to local cortical necrosis [4]. Theprocess of bony remodeling and revascularization is slow and local osteoporosisis observed in cortical bone at the points of contact (footprints) with theplate.

AB - Despite advances in surgical technique, fracture fixation alternatives, and adjuncts to healing, femoral nonunion continues to be a significant clinical problem. Femoral fractures may fail to unite because of the severity of the injury, damage to the surrounding soft tissues, inadequate initial fixation, and demographic characteristics of the patient, including nicotine use, advanced age, and medical comorbidities. Femoral nonunion is a functional and economical challenge for the patient, as well as a treatment dilemma for the surgeon. Surgeons should understand the various treatment alternatives and their role in achieving the goals of deformity correction, infection management, and optimization of muscle strength and rehabilitation. Used appropriately, nail dynamization, exchange nailing, and plate osteosynthesis can help minimize pain and disability by promoting osseous union. A review of the potential risk factors and treatment alternatives should provide insight into the etiology and required treatment of femoral nonunion. Copyright 2008 by the American Academy of Orthopaedic Surgeons.