Comparative Study On Breakage Rate Of Locking Plate And Traditonal Plate In Treatment Of Femoral Fractures

Objectives: The femur fractures accounted for11.89%of the bonefractures, plate fixation is a common treatment of femur fractures. Thetraditional plate friction between the plate and bone formed by screwholding force on bone achieves the stability of the fracture, Thetraditional plate is used only for the treatment of simple shaft fracturesand simple periarticular fractures. Compared with the traditional plate,the locking plate’ s friction between nails and plate through threaded lock,the stability of the fracture no longer rely on friction between the plateand the bone surface, but to use the stability of the angulation between thenails and plate to form bone and steel an integral part, constitute a’internal fixator’, finally to achieve stable fixation. The locking screwcompared to conventional screw, has enough riveting, anti-rotation abilityto reduce the incidence of the breakage of fixation. The locking platemainly used for severe comminuted fractures, osteoporotic fractures,periarticular fractures and periprosthetic fractures. With plate fixation fora wide range of applications, the fracture of fixation has also occurred.We compare the breakage rate of locking plate fixation and traditionalplate fixation in the treatment of femoral fracture, analyze the cause ofthe breakage, in order to provide the Theoretical basis to reduce theincidence of the breakage of fixation.Methods: From May,2009to January,2011,280cases of patients(M146, F134) suffering from femoral fractures (left136, right144) wereadmitted to our center for treatment. Their age ranged from18to92years old(average52.4years). According to AO classification,72cases were type31A;44cases were type32A,26cases were type32B,30cases were type32C;57cases were type33A,26cases were type33B,25cases were type33C.175 patients were fixed by using locking plates, while,105patients were fixed byusing traditional plates. Follow-up medical records and access to the patient’sfemur fracture plate fixation of X-ray, we point fracture healing as the primaryendpoint, plate and screw selection and placement error, steel sheets principlesand operational errors or fracture fixation, bone graft defect not given as theiatrogenic factors. Follow-up rehabilitation exercises of the patients, we pointbeginning partial weight-bearing exercise time in8weeks or weight did notfollow the step-by-step principle as the rehabilitation errors. Acquisition offracture fixation, plate fracture, screw breakage; statistical age, gender, thefracture site, whether open fractures, the severity of the fracture, osteoporosis,overweight (BMI≥25), other relevant medical diseases, iatrogenic factors andrehabilitation exercises errors which impact the stability of the fixation. Otherrelevant medical diseases include diabetes, blood diseases, hyperthyroidism,kidney disease and so on. Collect the breakage rate of locking plate fixationand traditional plate fixation. The proportion of each factor accounted forlocking plate group and traditional plate group, causes for breakage includingsimply iatrogenic factors, simply false rehabilitation exercises, the iatrogenicfactors plus false rehabilitation exercises, non-iatrogenic factors and correctrehabilitation exercises accounted for the impact factors for breakage. Wecompare the breakage rate of locking plate fixation and traditional platefixation in the treatment of femoral fracture, analyze the cause of the breakage.Results: Follow-up ranged from9months to40months, whichdisplayed implant breakage rate of4.0%in the locking plate group and of2.9%in the traditional plate group (P>0.05). Breakage modes included plate fracturein six patients, screw fracture in three, plate combined with screw fracture inone. Causes for breakage were iatrogenic factors plus false rehabilitationtraining with implant breakage rate of100%, simply iatrogenic factors withimplant breakage rate of36.4%, and simply false rehabilitation training withimplant breakage rate of5.4%. However, non-iatrogenic factors plus correctrehabilitation training brought no implant breakage. Consequently, breakagerate of the implant related to iatrogenic factors plus false rehabilitation training were significantly higher than that associated with simply iatrogenic factors,simply false rehabilitation training, or non-iatrogenic factors plus correctrehabilitation training.Conclusions: Breakage rate of the locking plate and the traditional platein treatment of femoral fractures shows no significant difference, but iatrogenicfactors combined with false rehabilitation training are the leading cause for theimplant breakage.