Biomechanics Laboratory, Legacy Research & Technology Center, Portland, OR 97215, USA.
J Orthop Trauma. 2010 Mar;24(3):156-62. doi: 10.1097/BOT.0b013e3181be6720.
Locked plating constructs may be too stiff to reliably promote secondary bone healing. This study used a novel imaging technique to quantify periosteal callus formation of distal femur fractures stabilized with locking plates. It investigated the effects of cortex-to-plate distance, bridging span, and implant material on periosteal callus formation.
Retrospective cohort study.
One Level I and one Level II trauma center.
Sixty-four consecutive patients with distal femur fractures (AO types 32A, 33A-C) stabilized with periarticular locking plates.
Osteosynthesis using indirect reduction and bridge plating with periarticular locking plates.
Periosteal callus size on lateral and anteroposterior radiographs.
Callus size varied from 0 to 650 mm2. Deficient callus (20 mm2 or less) formed in 52%, 47%, and 37% of fractures at 6, 12, and 24 weeks postsurgery, respectively. Callus formation was asymmetric, whereby the medial cortex had on average 64% more callus (P=0.001) than the anterior or posterior cortices. A longer bridge span correlated minimally with an increased callus size at Week 6 (P=0.02), but no correlation was found at Weeks 12 and 24 postsurgery. Compared with stainless steel plates, titanium plates had 76%, 71%, and 56% more callus at Week 6 (P=0.04), Week 12 (P=0.03), and Week 24 (P=0.09), respectively.
Stabilization of distal femur fractures with periarticular locking plates can cause inconsistent and asymmetric formation of periosteal callus. A larger bridge span only minimally improves callus formation. The more flexible titanium plates enhanced callus formation compared with stainless steel plates.
锁定接骨板的结构可能过于僵硬，无法可靠地促进二次骨愈合。本研究采用一种新的影像学技术来量化使用锁定板固定的股骨远端骨折的骨膜骨痂形成。它研究了皮质 - 接骨板距离、桥接跨度和植入物材料对骨膜骨痂形成的影响。
回顾性队列研究。
一个一级和一个二级创伤中心。
64 例股骨远端骨折患者（AO 类型 32A、33A-C），采用关节周围锁定板固定。
间接复位和桥接接骨板用关节周围锁定板固定。
侧位和前后位 X 线片上的骨膜骨痂大小。
骨痂大小从 0 到 650 毫米 2 不等。术后 6、12 和 24 周时，分别有 52%、47%和 37%的骨折出现骨痂不足（20 毫米 2 或更少）。骨痂形成不对称，内侧皮质的骨痂平均比前侧或后侧皮质多 64%（P=0.001）。桥接跨度较长与术后第 6 周骨痂大小增加有轻微相关性（P=0.02），但术后第 12 和第 24 周未发现相关性。与不锈钢板相比，钛板在第 6 周（P=0.04）、第 12 周（P=0.03）和第 24 周（P=0.09）时的骨痂分别多 76%、71%和 56%。
关节周围锁定板固定股骨远端骨折可导致骨膜骨痂形成不一致和不对称。更大的桥接跨度只能轻微改善骨痂形成。与不锈钢板相比，更灵活的钛板增强了骨痂形成。
