dynamic compression plating

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B Y D R VA I B H AV A H U J A

R E S I D E N TD E P T O F O RT H O PA E D I C S

U N D E R T H E G U I D A N C E O FD R . P. P. G I R G U N E

A S S O C I AT E P R O F.D E P T O F O RT H O PA E D I C S

R M C , L O N I

MANAGEMENT OF FRACTURES OFRADIUS & ULNA IN ADULTS

TREATED BY DYNAMIC COMPRESSION PLATING



INTRODUCTION

In view of advancement of metallurgy and fast lifeof human beings , we are more prone to accidents.This is particularly true in road traffic accidents dueto high speed automobile trauma .

Forearm is the third most common injury particularly with motor cyclist. Every patient whohas forearm fracture wants 100% functional ability with 100% union in anatomical position .

Good result of treatment means anatomical, solidclinical & radiological union & 100% functionalability.



ANATOMY

y The forearm represents a critical anatomic unit of upper limb.

y It allows the hand to be placed in any position to

grasp & support the object.y It consists of two bones, radius & ulna, one of which

is rotating around the other.y The forearm includes proximal and distal radio ±

ulnar joints, the interosseous membrane &radioulnar articulation with the wrist joint.



Anatomy (contd)

y The articulation of radius & ulna is not a simplearticulation and in forearm bones injuries there islimitation of function of entire upper limb.

y Therefore accurate reduction of the fracture &maintenance of alignment is essential forrestoration of function of upper limb.



Different modalities of treatment of fractures of radius & ulna

Closed manipulation & reduction with castapplication.Open reduction & intramedullary nailing. Application of plates and screws



Application of plate & screws

y Dynamic compression platey Round hole platey Limited contact platey Locking compression plate.



Dynamic compression plating

y A dynamic compression plate (DCP) is a metallic plateused in orthopedics for internal fixation of bone, typically after fractures.

y

As the name implies, it is designed to exert dynamicpressure between the bone fragments to be transfixed



Dynamic compression plating

Internal fixation with dynamic compression platesallows excellent control of the fracture fragments

and therefore permits accurate restoration of theanatomy, which remains the key principle in treatingforearm fractures as it preserves maximal forearmfunction



Dynamic compression plates



PRINCIPLE OFDYNAMIC COMPRESSION PLATING

Compression is appied by eccentric insertionof screwsThe slot for compression has a sloping surface at one

end when the spherical head of the screw impinges onthis surface, plate move away from the fracture,thereby compressing fracture plane



SCHEMATIC REPESENTATION OF DYNAMIZATIONBETWEEN FRACTURED BONES



DYNAMIC COMPRESSIONPLATINGCOMPARED TO OTHER PLATING DEVICES

y Dynamic compression plate for fixation of displaceddiaphyseal forearm fractures in adults producessufficiently rigid fixation and compression of the fracture , and it can be inserted through asmaller incision than the standard plate becauseno external compression device is required.

y The design of the screw holes and screw headsproduces compression or impaction of the fracture asthe screw is seated

y The larger oval holes in the plate also permit variation in the angle at which the screw is inserted



ADVANTAGES OF PLATING

y Excellent control of fracture fragmentsy Perfect anatomical re-alignment possibley Can explore neurovascular structures when indicatedy Very low rate of nonuniony Good to excellent functional resultsy Very predictable outcome



COMPLICATIONS

y Compartment syndromey Maluniony Non uniony Infectiony Plate Removal and Refracturey Radio-Ulnar Synostosisy Neurovascular Complications



AIMS

y To assist and enhance the fracture healing .y To ensure early mobilization of adjacent joints.y To study the cost effectiveness of this method.y To reduce the morbidity of lying in bed.



OBJECTIVES

y To study the incidence of forearm bone fracturesrelated to age & sex of the patient.

y To study the incidence of level of fracture.y To study the complications.y

To compare the functional results.



MATERIAL & METHODS

y 20 cases of fractures of radius & ulna in adultsattending OPD/Casualty from august 2010 to 2012 will be included in the study.

y Stainless steel dynamic compression plates and3.5mm cortical screws will be used in this study.

y Jig to promote compression and anatomicalreduction



INCLUSION CRITERIA

y Fractures of radius and ulna in adults in both malesand females.

y Simple transverse, spiral and short oblique fractures

of radius and ulna will be included in the study.y Closed fracturesy Minimally communited fracturesy Non union in fractures of radius and ulna



EXCLUSION CRITERIA

y Compound grade III fractures of radius and ulna.y Severely communited fracturesy Segmental fracturesy Severely osteoporotic bones



OBSERVATION

y Total number of cases according to the age and sexdistribution

y Total number of cases according to the type of injury

sustainedy Total number of cases according to the level and

configuration of fracturey To observe the functional results in all the casesy Total time taken for union in all the cases



PROFORMA

y Namey Agey Sexy Admn noy Regd noy IPD noy OPD no



y Date of admissiony Date of operationy Injury to surgery intervaly Date of dischargey Site of injury - right / lefty Nature of injury - simple / compoundy Grade according to classification



y Type of fracturey Associated injuries

headchestabdomenpelvis

lower limb(ipsilateral/contralateral)



y Intraoperativedate of surgery operating surgeonoperating timetype of reductionplate size

supplementary fixation



y Post operative range of motiony Union (in weeks)

clinicalradiological

y Complications



REFERENCES

y 1. Griggs SM, Weiss AP. Bony injuries of the wrist, forearm, and elbow. Clin SportsMed 1996;15(2):373â¼³400.

y 2. Goldberg HD, Young JW, Reiner BI, et al. Double injuries of the forearm: acommon occurrence. Radiology 1992;185(1):223â¼³227.

y 3. Galeazzi R. Ueber ein besonderes Syndrom bei Verletzungen im Bereich derUnterarm knochen. Arch Orthop Unfallchir 1934;35:557â¼³562.

y

4. Rang M. Anthology of Orthopaedics. Edinburgh: E & S Livingstone; 1968.y 5. Hughston JC. Fracture of the distal radial shaft: Mistakes in Management. J BoneJoint Surg 1957;39A:249â¼³264.

y 6. Nicolaidis SC, Hildreth DH, Lichtman DM. Acute injuries of the distal radioulnar joint. Hand Clin 2000;16(3):449â¼³459.

y 7. Bruckner JD, Lichtman DM, Alexander AH. Complex dislocations of the distalradioulnar joint. Recognition and management. Clin Orthop 1992;(275):90â¼³103.

y

8. Monteggia GB. Instituzioni Chirurgiche Vol. 5. Milano: Maspero; 1814.y 9. Bado JL. The Monteggia lesion. Clin Orthop 1967;50:71â¼³86.y 10. Jupiter JB, Leibovic SJ, Ribbans W, et al. The posterior Monteggia lesion. J

Orthop Trauma 1991;5(4):395â¼³402.y 11. Morris AH. Irreducible Monteggia lesion with radial nerve entrapment. J Bone

Joint Surg 1974;56A:1744.



y 12. Jessing P. Monteggia lesions and their complicating nerve damage. Acta Orthop Scand1975;46:601â¼³609.

y 13. Neiman R, Maiocco B, Deeney VF. Ulnar nerve injury after closed forearm fractures inchildren. J Pediatr Orthop 1998;18(5):683â¼³685.

y 14. Stahl S, Rozen N, Michaelson M. Ulnar nerve injury following midshaft forearm fractures inchildren. J Hand Surg (Br) 1997;22(6):788â¼³789.

y 15. Huang K, Pun WK, Coleman S. Entrapment and transection of the median nerve associated

with greenstick fractures of the forearm: case report and review of the literature. J Trauma1998;44(6):1101â¼³1102.y 16. Jupiter JB, Kleinert HE. Vascular injuries in the upper extremity. In: Tubiana R, ed. The

Hand. Philadelphia: W.B. Saunders; 1988:593.y 17. Levin LS, Goldner RD, Urbaniak JR, et al. Management of severe musculoskeletal injuries of

the upper extremity. J Orthop Trauma 1990;4(4):432â¼³440.y 18. Eaton RG, Green WT. Volkmann's ischemia. A volar compartment syndrome of the forearm.

Clin Orthop 1975;(113):58â¼³64.y 19. Blick SS, Brumback RJ, Poka A, et al. Compartment syndrome in open tibial fractures. J

Bone Joint Surg Am 1986;68(9):1348â¼³1353.y 20. Hargens AR, Akeson WH, Mubarak SJ, et al. Kappa Delta Award paper. Tissue fluid

pressures: from basic research tools to clinical applications. J Orthop Res1989;7(6):902â¼³909.



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dynamic compression plating

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