Angular Stability Plate System (LCP) - the new AO standard for plate osteosynthesis

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Abstract

Locking Compression Plate (LCP) represents the latest development of AO plates, combining the features of conventional plates and internal fixators. This is achieved by a so-called combi-hole merging the Dynamic Compression Unit (DCU) of the DCP and the threaded hole of locked plates. Therefore all kinds of conventional screws as well as threaded locking head screws (LHS) can be inserted through the plate depending on the specific local requirements. However, LCP represents not a new plate per se, but rather a plate/screw system to enrich the well known АО-plate designs with the option of interlocking. As the mechanical characteristics have not changed by adding a combi-hole the complete set of small (3,5 mm) and broad (4,5/5,0 mm) АО-plates is available. Additionally LCP-systems adapted to certain anatomic regions, like the proximal humerus and distal radius as well as Tomofix2 plates for osteotomies have been developed. We report about our first experience in clinical use of LCP. Prom April 2000 till December 2002,310 LCP systems have been implanted in 274 patients. 303 plates (97,7%) were implanted for fixation of 285 fractures with different localization in 267 patients, including 17 pediatric fractures (5,9%),9 periprosthetic fractures (3,2%),5 delayed-unions (1,8%) and 4 pathologic fractures (1,4%). Seven plates (2,3%) were implanted to fix osteotomies. Of all plates 111 (35,8%)) implants were fixed with locking head screws,194 (62,6%) with both types of screws and only in 5 plates (l,6%o) conventional screws were used. 73 (23,5%o) of all plates were inserted using a minimal-invasive approach and 237 (76,5%) via an open procedure. Postoperative complications occurred in 14/267 patients (5,2%) exclusively treated for fractures, representing a complication rate of 5,2%o in 15/285 fractures. Loosening of implants were seen in 1,4%), deep wound infection in 1,05%), osteomyelitis, refracture and postoperative hematoma in 0,7%o, respectively. Secondary malalignment and problems with implant removal occurred in 1 patient (0,35%), respectively. No delayed or non-unions were observed. In LCP all options of plate osteosynthesis are included, so fixation can be adapted more accurately to the local situation and operative procedure is facilitated.

About the authors

Th. Neubauer

Department of Traumatology, Wilhelmenspital Clinic

Email: info@eco-vector.com
Austria, Vienna

M. Wagner

Department of Traumatology, Wilhelmenspital Clinic

Email: info@eco-vector.com
Austria, Vienna

Ch. Hammerbauer

Department of Traumatology, Wilhelmenspital Clinic

Author for correspondence.
Email: info@eco-vector.com
Austria, Vienna

References

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Supplementary files

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2. Fig. 1. In traditional plate osteosynthesis (a), stability is based on the friction between the plate and the bone achieved by compression, so uniform bone quality is required. When using an internal fixator with rigid contact between the screw and the plate (b), stability does not depend on the quality of the bone, since the latter is not loaded.

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3. Fig. 2. Combination hole is the main feature of LCP insert. The smooth part of the hole is intended for the introduction of standard screws, the threaded part is for the introduction of locking screws.

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4. Fig. 3. With a combination hole, both standard screws and threaded screws can be used.

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5. Fig. 4. Straight LCP plates can be bent sequentially in several segments to create a wave-like surface, which provides different screw inclination and greater resistance to tearing loads.

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6. Fig. 5. In percutaneous osteosynthesis (MIPPO), the adjustable LCP drill sleeve can serve as a handle for plate insertion and placement.

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7. Fig. 6. In the metaphyseal part of pre-anatomically modeled plates (in this case, LPHP) with different screw inclinations, it is recommended to use a guide block to correctly position the threaded drill guides.

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8. Fig. 7. Precise positioning of the plate is essential to prevent incorrect insertion of the screws (arrow), as it is always difficult to determine the required torque when tightening the screws.

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9. Fig. 8. Patient W. 22 years old. Polytrauma resulting from an accident. a — on admission: an open 22-B2 fracture of both bones of the right forearm and a 23-C2 fracture of the distal right radius; b — for fixation of diaphyseal fractures of the radius and ulna, 3.5 mm LCP plates were used according to the traditional technique of compression osteosynthesis; locking screws were inserted through the plates only for additional fixation. In the distal radius, only a 3.5 mm LCP T-shaped plate was used to “bridging” the fractured metaphyseal zone after anatomical restoration of the articular surfaces.

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10. Fig. 9. Patient X. 19 years old. The injury was received while riding a horse. a — on admission: type 41-C2.2 fracture of the proximal tibia; b — after anatomical restoration of the articular surface using 4.5/5.0 mm lag screws, an LCP T-shaped plate was used to “bridging” the zone of a multi-comminuted fracture in the metaphyseal region with fixation only with locking screws; c — 1 year after the operation, the implant was removed (no pain, full range of motion in the joint).

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