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Evidence for Success with Locking Plates for Fragility Fractures

Authors
  • Cornell, Charles N.1, 2
  • Ayalon, Omri1
  • 1 Hospital For Special Surgery, 535 East 70th Street, New York, NY, 10021, USA , New York (United States)
  • 2 Weill Cornell College of Medicine, New York, NY, 10065, USA , New York (United States)
Type
Published Article
Journal
HSS Journal ®
Publisher
Springer New York
Publication Date
Feb 01, 2011
Volume
7
Issue
2
Pages
164–169
Identifiers
DOI: 10.1007/s11420-010-9194-8
Source
Springer Nature
Keywords
License
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Abstract

Fixation of fragility fractures with plates and screws often results in loss of fixation and need for revision surgery. Locking plates and screw were introduced to improve fixation of fragility fractures and have been in use for a decade. This review was conducted to compile evidence that locking plates and screws improve fixation of fragility fractures. A search of PubMed was performed to identify biomechanical studies as well as clinical series of fragility fractures treated with locking plates. Biomechanics papers had to use models of osteoporotic bone and had to directly compare locking plates with traditional plates. Clinical studies included case series in which locking plates were applied to elderly patients with fractures of the proximal humerus and periprosthetic distal femur fractures. Most studies are retrospective case series. Locking plates lead to greater stability and higher loads to failure than traditional plates. When applied to proximal humerus fractures, uncomplicated healing occurs in 85% of patients. Constant and Dash scores approach normal values. For distal femoral periprosthetic fractures, union rates of 75% are reported with a malunion rate of 10%. Early evidence suggests that locking plates improve results of treatment of proximal humerus fractures and distal femoral periprosthetic fractures in the elderly. Loss of fixation is associated with failure to achieve stability at the fracture site. Principles of fracture fixation in osteoporotic bone defined prior to the introduction of locking plates should still be applied.

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