Generally, direct bone healing with the help of absolute stability technique was generally suggested and applied in operative fracture treatment in former times but nowadays this method is not that much valid because the latest biological methods of fracture fixation prove to be more useful. However, firm fixation provided by locking compression plate in osteosynthesis is still considered in fracture treatment. Absolutely rigid internal fixation is still good for fractures with joint complicity. It generally includes plates. The anatomical reduction is desired in such fractures whereas the undesired thing is ample callus formation.
Some good sign for plating is transverse and short oblique fractures of the shaft of long bones on condition that intramedullary nailing techniques are not selected. In such cases, the plating can be done for an anatomical reason as for forearm, technical reason as short distal or proximal fragment, local reason like a contaminated wound, or general reasons. Plate osteosynthesis proves to be the equal of external fixation in the case of patients with multiple injuries, chest trauma, or local infections.
As far as less stable fixation is concerned the growth of callus is desirable but its emergence after rigid fixation is a matter of concern, as it indicates some degree of instability that can lead to weariness and failure of implant eventually. Fracture healing after stable osteosynthesis is likely to be prolonged specifically in the region just below a standard plate as compared to other techniques. A plate positioned in direct contact with and pushed to the bone surface can lead to a persistent disruption in the blood flow to the underlying cortex. The procedure of osteonal reshaping and revascularization is slow. It can be discerned as a porous state of the cortical bone mirroring the footprints of the plate. This disruption in the cortical blood supply can be reduced by lessening stripping of the periosteum, and a plate can be positioned on top of it. Small pointed hooks and pointed reduction clamps should be used gently for reduction.
In comparison to osteosynthesis designed for healing by callus formation that is a biological fixation, the classical plating technique designed for rigid fixation needs strict observance of the principles of inter-fragmentary compression. If the principles of inter-fragmentary compression are not followed strictly, it may lead to issues and complications like non-union, delayed healing, implant failure.
Dynamic compression plate (DCP) 3.5 and 4.5
It was in 1969 that a dynamic compression plate (DCP) was developed for the purpose of internal fixation in fractures. It was claimed to be a type of additional development of the Danis’ “coaptur” and redesigned version of Bagby and Janes’plate.
The DCP has a special feature of a new hole design that allows axial compression by screw insertion. Thus, it applies a dynamic pressure between the bone fragments that are to be transfixed. Basically, this plate works in three different ways:
- Compression
- Neutralization
- Tension band
- Buttress
Orthopedic implants manufacturing companies in India provide the DCP in three different sizes for large and small bones:
- The broad DCP 4.5 is used for fractures of the femur and humerus and exceptionally good in case of shaft fracture of the humerus.
- The narrow DCP 4.5 is used for the fractures of the tibia and humerus.
- The DCP 3.5 is used for the fractures of the fibula, forearm, pelvis, and clavicle.
In adolescents and adults Sickle cell disease is a known cause of avascular necrosis of the hip joint.
Until recently in Mumbai and even in India patients had access to only the conventional hip joints which provided very limited mobility to young hip replacement patients.
However, the latest anatomical hip replacement surgery in thane introduced by us offer much better mobility and range of activity to adolescent and young adults.Sickle cell disease (SCD) is a genetic disorder of the haemoglobin in RBC.
RBC;s that have normal Haemoglobin are disc shaped cells that carry oxygen to the various tissue and organs of the body.
The degeneration and death of a bone tissue due to lack of blood supply is called avascular necrosis (AVN).In SCD adolescent & young adult AVN is commonly seen in the hip joint.
However, in sever cases surgical cases decompression of the femur bone or knee replacement of the joint may be recommended.
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