Internal plate fixation of fractures: short history and recent developments

Journal of Orthopaedic Science - Tập 11 - Trang 118-126 - 2006
Hans K. Uhthoff1, Philippe Poitras2, David S. Backman2
1Bone and Joint Research Laboratory, Faculty of Medicine, Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
2Orthopaedic Biomechanics Laboratory, Faculty of Medicine, Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada

Tóm tắt

Metal plates for internal fixation of fractures have been used for more than 100 years. Although initial shortcomings such as corrosion and insufficient strength have been overcome, more recent designs have not solved all problems. Further research is needed to develop a plate that accelerates fracture healing while not interfering with bone physiology. The introduction of rigid plates had by far the greatest impact on plate fixation of fractures. However, it led to cortical porosis, delayed bridging, and refractures after plate removal. These unwarranted effects were said to be caused by bone–plate contact interfering with cortical perfusion. Consequently, further plate modifications aimed to reduce this contact area to minimize necrosis and subsequent porosis. The advocates of limited-contact plates have not published measurements of the contact area or proof of the temporary nature of the porosis. Moreover, clinical studies of newer plate types have failed to show a superior outcome. Histomor-phometric measurements of the cortex showed no difference in the extent of necrosis under plates having different contact areas. Necrosis was predominant in the periosteal cortical half, whereas porosis occurred mostly in the endosteal cortical half. No positive correlation was found between either. The scientific evidence to date strongly suggests that bone loss is caused by stress shielding and not interference with cortical perfusion secondary to bone–plate contact. Consequently, an axially compressible plate (ACP) incorporating polylactide (PLA) inserts press-fit around screw holes was designed. The bioresorbable inserts should allow for (1) increased micromotion in the axial plane to promote healing during the union phase and (2) gradual degradation over time to decrease stress shielding during the remodeling phase. Results of ongoing experimental results are encouraging. Only plates allowing dynamic compression in the axial plane can lead to a revolution in fracture fixation.

Tài liệu tham khảo

WA Lane (1895) ArticleTitleSome remarks on the treatment of fractures BMJ 1 861–3 Occurrence Handle10.1136/bmj.1.1790.861 Occurrence Handle20755458 A Lambotte (1909) ArticleTitleTechnique et indication des prothèses dans le traitement des fractures Presse Med 17 321 WO Sherman (1912) ArticleTitleVanadium steel bone plates and screws Surg Gynecol Obstet 14 629–34 GWN Eggers (1948) ArticleTitleInternal contact splint J Bone Joint Surg Am 30 40–52 R Danis (1949) Théorie et pratique de l’ostéosynthèse Masson Paris GW Bagby JM Janes (1958) ArticleTitleThe effect of compression on the rate of fracture healing using a special plate Am J Surg 95 761–71 10.1016/0002-9610(58)90625-1 Occurrence Handle10.1016/0002-9610(58)90625-1 Occurrence Handle1:STN:280:DyaG1c%2FmsVSmtw%3D%3D Occurrence Handle13521188 ME Müller M Allgöwer H Willenegger (1965) Compression fixation with plates Technique of internal fixation of fractures Springer Berlin 47–51 SM Perren J Cordey BA Rahn E Gautier E Schneider (1988) ArticleTitleEarly temporary porosis of bone induced by internal fixation implants: a reaction to necrosis, not to stress protection? Clin Orthop 232 139–51 Occurrence Handle3289811 SM Perren M Russenberger S Steinemann ME Müller M Allgöwer (1969) ArticleTitleA dynamic compression plate Acta Orthop Scand Suppl 125 31–41 R Schenk H Willenegger (1967) Morphological findings in primary fracture healing S Krompecher E Kerner (Eds) Callus formation symposium on the biology of fracture healing Akadémiai Kiadó Budapest 75–86 SB Kessler S Deiler M Schiffl-Deiler HK Uhthoff L Schweiberer (1992) ArticleTitleRefractures: a consequence of impaired local bone viability Arch Orthop Trauma Surg 111 96–101 10.1007/BF00443475 Occurrence Handle10.1007/BF00443475 Occurrence Handle1:STN:280:DyaK383it1Ortg%3D%3D Occurrence Handle1562432 CR Berkin DV Marshall (1972) ArticleTitleThree-sided plate fixation for fractures of the tibial and femoral shafts: a follow-up note J Bone Joint Surg Am 54 1105–13 Occurrence Handle1:STN:280:DyaE383mvFCltw%3D%3D Occurrence Handle5057109 E Gautier SM Perren (1992) ArticleTitleDie limited contact dynamic compression plate (LC-DCP): Biomechanische Forschung als Grundlage des neuen Plattendesigns Orthopade 21 11–23 Occurrence Handle1:STN:280:DyaK387psFKgsQ%3D%3D Occurrence Handle1549332 S Tepic SM Perren (1995) ArticleTitleThe biomechanics of the PC-Fix internal fixator Injury 26 IssueIDSuppl 2 S-B5–10 JR Field TC Hearn CB Caldwell (1997) ArticleTitleBone plate fixation: an evaluation of interface contact area and force of the dynamic compression plate (DCP) and the limited contact-dynamic compression plate (LC-DCP) applied to cadaveric bone J Orthop Trauma 11 368–73 10.1097/00005131-199707000-00013 Occurrence Handle10.1097/00005131-199707000-00013 Occurrence Handle1:STN:280:DyaK2svktVGrtg%3D%3D Occurrence Handle9294802 R Jain N Podworny TM Hupel J Weinberg EH Schemitsch (1999) ArticleTitleInfluence of plate design on cortical bone perfusion and fracture healing in canine segmental tibial fractures J Orthop Trauma 13 178–86 10.1097/00005131-199903000-00005 Occurrence Handle10.1097/00005131-199903000-00005 Occurrence Handle1:STN:280:DyaK1M3itFSqsg%3D%3D Occurrence Handle10206249 WH Akeson SLY Woo L Rutherford RD Coutts M Gonsalves D Amiel (1976) ArticleTitleThe effects of rigidity of internal fixation plates on long bone remodeling Acta Orthop Scand 47 241–9 Occurrence Handle1:STN:280:DyaE283kvFCmsg%3D%3D Occurrence Handle952210 P Slätis P Paavolainen E Karaharju T Holström (1980) Structural and biomechanical changes in bone after rigid plate fixation HK Uhthoff (Eds) Current concepts of internal fixation of fractures Springer Berlin 291 L Strömberg N Dalén P Låftman F Sigurdsson (1980) Atrophy of cortical bone caused by rigid plates and its recovery HK Uhthoff (Eds) Current concepts of internal fixation of fractures Springer Berlin 289–90 HK Uhthoff DI Bardos M Liskova-Kiar (1981) ArticleTitleThe advantages of titanium alloy over stainless steel plates for the internal fixation of fractures: an experimental study in dogs J Bone Joint Surg Br 63 427–34 Occurrence Handle7263759 HK Uhthoff FL Dubuc (1971) ArticleTitleBone structure changes in the dog under rigid internal fixation Clin Orthop 81 165–70 Occurrence Handle10.1097/00003086-197111000-00026 Occurrence Handle1:STN:280:DyaE38%2FnslyisA%3D%3D Occurrence Handle5133037 HK Uhthoff M Finnegan (1983) ArticleTitleThe effects of metal plates on post-traumatic remodelling and bone mass J Bone Joint Surg Br 65 66–71 Occurrence Handle1:STN:280:DyaL3s7gvFajtA%3D%3D Occurrence Handle6822605 MA Gunst C Suter BA Rahn (1979) ArticleTitleBone perfusion after plate osteosynthesis: a study of the intact rabbit tibia with disulfin blue vital staining Helv Chir Acta 46 171–5 Occurrence Handle1:STN:280:DyaE1M3jvV2ktA%3D%3D Occurrence Handle89107 HK Uhthoff D Boisvert M Finnegan (1994) ArticleTitleCortical porosis under plates: reaction to unloading or to necrosis? J Bone Joint Surg Am 76 1507–12 Occurrence Handle1:STN:280:DyaK2M%2FhsVKhug%3D%3D Occurrence Handle7929498 ZFG Jaworski M Liskova-Kiar HK Uhthoff (1980) Regional disuse osteoporosis and factors influencing its reversal HK Uhthoff (Eds) Current concepts of internal fixation of fractures Springer Berlin 17–26 HK Uhthoff ZFG Jaworski (1978) ArticleTitleBone loss in response to long-term immobilization J Bone Joint Surg Br 60 420–9 Occurrence Handle681422 DL Korvick JW Newbrey GW Bagby GD Pettit JD Lincoln (1989) ArticleTitleStress shielding reduced by a silicon plate-bone interface Acta Orthop Scand 60 611–16 Occurrence Handle1:STN:280:DyaK3c7gtFymsA%3D%3D Occurrence Handle2557719 SM Perren (2002) ArticleTitleEvolution of the internal fixation of long bone fractures: the scientific basis of biological internal fixation; choosing a new balance between stability and biology J Bone Joint Surg Br 84 1093–110 10.1302/0301-620X.84B8.13752 Occurrence Handle10.1302/0301-620X.84B8.13752 Occurrence Handle12463652 LD Andersen D Sisk RE Tooms WI Park SuffixIII (1975) ArticleTitleCompression-plate fixation in acute diaphyseal fractures of the radius and ulna J Bone Joint Surg Am 57 287–97 MW Chapman JE Gordon AG Zissimos (1989) ArticleTitleCompression-plate fixation of acute fractures of the diaphyses of the radius and ulna J Bone Joint Surg Am 71 159–69 Occurrence Handle1:STN:280:DyaL1M7jvFGitg%3D%3D Occurrence Handle2918001 R Hertel M Pisan S Lambert FT Ballmer (1996) ArticleTitlePlate osteosynthesis of diaphyseal fractures of the radius and ulna Injury 27 545–8 10.1016/S0020-1383(96)00091-5 Occurrence Handle10.1016/S0020-1383(96)00091-5 Occurrence Handle1:STN:280:DyaK2s7ksl2htA%3D%3D Occurrence Handle8994558 MD McKee JG Seiler JB Jupiter (1995) ArticleTitleThe application of the limited contact dynamic compression plate in the upper extremity: an analysis of 114 consecutive cases Injury 26 661–6 10.1016/0020-1383(95)00148-4 Occurrence Handle10.1016/0020-1383(95)00148-4 Occurrence Handle1:STN:280:DyaK283oslSksA%3D%3D Occurrence Handle8745801 R Gupta A Raheja V Sharma (2000) ArticleTitleLimited contact dynamic compression in diaphyseal fractures of the humerus: good outcome in 51 patients Acta Orthop Scand 71 471–4 10.1080/000164700317381153 Occurrence Handle1:STN:280:DC%2BD3M%2Fps1eluw%3D%3D Occurrence Handle11186403 Occurrence Handle10.1080/000164700317381153 C Gerber JW Mast R Ganz (1990) ArticleTitleBiological internal fixation of fractures Arch Orthop Trauma Surg 109 295–303 10.1007/BF00636165 Occurrence Handle10.1007/BF00636165 Occurrence Handle1:STN:280:DyaK3M7lvFWhug%3D%3D Occurrence Handle2073446 E Van Frank Haasnoot TWH Münch P Matter SM Perren (1995) ArticleTitleRadiological sequences of healing in internal plates and splints of different contact surface to bone (DCP, LC-DCP and PC-Fix) Injury 26 IssueIDSuppl 2 S-B28–36 N Haas C Hauke M Schütz M Kääb SM Perren (2001) ArticleTitleTreatment of diaphyseal fractures of the forearm using the point contact fixator (PC-Fix): results of 387 fractures of a prospective multicentric study (PC-Fix II) Injury 32 S-B-51–62 10.1016/S0020-1383(01)00126-7 Occurrence Handle10.1016/S0020-1383(01)00126-7 R Hertel H Eijer A Meisser C Hauke SM Perren (2001) ArticleTitleBiomechanical and biological considerations relating to the clinical use of the point contact-fixator: evaluation of the device handling test in the treatment of diaphyseal fractures of the radius and/or ulna Injury 32 S-B-10–14 10.1016/S0020-1383(01)00121-8 Occurrence Handle10.1016/S0020-1383(01)00121-8 AA Fernandez Dell’Oca R Masliah Galante (2001) ArticleTitleOsteosynthesis of diaphyseal fractures of the radius and ulna using an internal fixator (PC-Fix): a prospective study Injury 32 S-B-44–50 SM Perren JS Buchanan (1995) ArticleTitleBasic concepts relevant to the design and development of the point contact fixator (PC-Fix) Injury 26 IssueIDSuppl 2 S-B-1–4 F Leung SP Chow (2003) ArticleTitleA prospective, randomized trial comparing the limited contact dynamic compression plate with the point contact fixator for forearm fractures J Bone Joint Surg Am 85 2343–8 Occurrence Handle14668503 M Schütz NP Südkamp (2003) ArticleTitleRevolution in plate osteosynthesis: new internal fixator systems J Orthop Sci 8 252–8 Occurrence Handle10.1007/s007760300044 Occurrence Handle12665968 GA Ilizarov (1990) ArticleTitleClinical application of the tension-stress effect for limb lengthening Clin Orthop 250 8–26 Occurrence Handle2403497 AE Goodship J Kenwright (1985) ArticleTitleThe influence of induced micromovement upon the healing of experimental tibial fractures J Bone Joint Surg Br 67 650–5 Occurrence Handle1:STN:280:DyaL2M3ovFCmsA%3D%3D Occurrence Handle4030869 A Foux AJ Yeadon HK Uhthoff (1997) ArticleTitleImproved fracture healing with less rigid plates: a biomechanical study in dogs Clin Orthop 339 232–45 Occurrence Handle10.1097/00003086-199706000-00032 Occurrence Handle9186225 D Backman H Uhthoff P Poitras A Schwamberger (2004) ArticleTitleMechanical performance of a fracture plate incorporating bioresorbable inserts J Bone Joint Surg Proceed Br 86 IssueIDSuppl III 300 Poitras P, Backman D, Uhthoff HK, Schwammberger A. Creep properties of a bioresorbable polymer for an axially compressible fracture plate. Presented at the 5th Combined Meeting of the Orthopaedic Research Societies of Canada, USA, Japan and Europe. Banff, AB. October 2004