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Letters to the Editor to:

Scientific Articles:
Rad Zdero, Richard Walker, James P. Waddell, and Emil H. Schemitsch
Biomechanical Evaluation of Periprosthetic Femoral Fracture Fixation
J Bone Joint Surg Am 2008; 90: 1068-1077 [Abstract] [Full text] [PDF]
*Letters to the Editor: Submit a response to this article

Electronic letters published:

[Read Letter to the Editor] Locking Compression Plate Fixation for Periprosthetic Femoral Fracture
Werner Kolb, MD, Klaus Kolb, MD   (6 October 2008)

Locking Compression Plate Fixation for Periprosthetic Femoral Fracture 6 October 2008
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Werner Kolb, MD,
Orthopaedic Surgeon
Orthopaedic practice,
Klaus Kolb, MD

Send letter to journal:
Re: Locking Compression Plate Fixation for Periprosthetic Femoral Fracture

drwerner.kolb{at}t-online.de Werner Kolb, MD, et al.

To the Editor:

We read the article by Zdero and colleagues(1) with great interest. We have used the LCP for six years and find that it offers several advantages over larger constructs. Biologically, in addition to the wider exposure of the bone, larger implant-bone contact will result in a reduction of bone perfusion, as bone receives its blood supply through the periosteal and endosteal lining.(2). We would also offer some technical tips on use of the LCP.

The biomechanical advantages of internal fixators include the ability to use longer splints with less pullout force and a larger distance between the two screws adjacent to the fracture, which allows for lower elastic deformation of the plate and the interfragmentary tissue. Screw to plate hole ratios of less than 0.5 create a long lever arm and decrease the bending loads on the distal screws.(3) An 18-24 hole plate in the femur with few screws should be used to increase the lever arm and distribute the bending forces.(4)

3) If the vascularity of bone and surrounding soft tissue has not been overly disturbed, the physiological response to this relatively flexible construct is rapid callus formation that bridges the fragments, as occurs in nonoperative treatment or after intramedullary nailing.(5)

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

References

1. Rad Zdero, Richard Walker, James P. Waddell, and Emil H. Schemitsch Biomechanical Evaluation of Periprosthetic Femoral Fracture Fixation J Bone Joint Surg Am 2008; 90: 1068-1077

2. Keita I, Perren SM. Biology and biomechanics in bone healing. In Rüedi TP, Buckley RE, Moran CG, editors. AO principles of fracture management, Vol. 1-principles. New York: Thieme;2007:9-31.

3. Field JR. Törnkvist H, Hearn TC, Sumner-Smith G, Woodside TD. The influence of screw omission on construction stiffness and bone surface strain in the application of bone plates to cadaveric bone. Injury 1999;30:591-598.

4. Gautier E, Sommer C. Guidlines for the application of the LCP. Injury 2003; 34 Suppl 2: B63-76.

5. Lorich DG, Gardner MJ. Plates. In Rüedi TP, Buckley RE, Moran CG, editors. AO principles of fracture management, Vol. 1-principles. New York: Thieme;2007:227-247.