Abstract
Introduction In a Finite Element Analysis we calculated that in order to obtain a dynamic plate osteosynthesis a long plate with few screws and if possible no lag screw must be applied. These principles were employed in most shaft fractures at our institution since January 1999. We present the preliminary results of tibial shaft fractures treated with dynamic plate osteosynthesis.
Methods Forty-seven consecutive patients treated from January 1999 until August 2001 were followed clinically and radiologically. Fractures of the distal third and mid-shaft not suitable for a nail such as anatomical bends or narrow intramedullary canal were fixed with a long plate (titanium LCDCP) and few screws. In eight cases no lag screws were used. Six fractures were open fractures. Two cases needed a local flap for coverage of the defect.
Results There were no deep infections. There was one delayed union necessitating re-osteosynthesis and cancellous bone graft after four months. All other fractures healed within six months. No axis deviation was noticed. Due to the dynamic osteosynthesis all cases without lag screws healed with visible callus formation. However, breakage of three screws was seen.
Conclusion Intramedullary nails have become the gold standard for most tibial shaft fractures. However, a significant risk of malunion is associated with nails and in some anatomical instances a nail is not feasible. Dynamic plate osteosynthesis allows good bone healing with callus formation and restores length, axis and rotation of the bone. We consider it a safe and biological method for the treatment of most tibial shaft fractures.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
