Abstract
Introduction: Since the introduction of periarticular locking plates (PLP) open reduction and internal fixation of periarticular fractures has gained popularity. Although initial trials have shown encouraging results, no studies to date has focused on its use for metaphyseal fractures. The purpose of this study is to report on the performance of PLP for fixation of periarticular fractures.
Material and Methods: 49 with at least one year follow up were included in this prospective review. All fractures involved the metaphyseal area and 39 had an intraarticular extension as well. Fixation was performed by a combined locking-regular screws technique. The parameters included in the analysis were fracture displacement, type of callus formation, healing of the fracture, screw pull-out, screw breakage, plate breakage, stress rising and stress shielding with subsequent bone loss.
Results: At one year follow up the results showed that: 1 fracture had lost reduction in the early post op; 2 locking screws had backed up despite being initially locked to the plate; 1 screw broke, 1 plate broke. There were no problems with stress rising or stress fractures at the end of the plate. The most impressive finding was the high rate of stress shielding with subsequent bone loss within the range delimited by the locking screws (27 %). Callus formation: 18 % had no visible callus on plain radiographs despite being clinically healed. 62% had very little callus. 15 % had moderate callus and 5% had robust callus formation.
Discussion and conclusion: The use of PLP appears to have some unique characteristics, different than conventional plating.: 80 % of the fractures healed with no or very little callus. The use of locking screws in the shaft portion of the fixation may have been the cause for the high rate of stress shielding, which typically occurred within the locking screws in our series. Since the review of our data we are no longer using locking screws in the shaft portion of the fixation.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
