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 Table of Contents    
LETTER TO EDITOR  
Year : 2012  |  Volume : 46  |  Issue : 3  |  Page : 375-376
Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate (Letter 2)


Department of Orthopaedic Surgery, Government Medical College and Associated Hospitals, Jammu, India

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Date of Web Publication18-May-2012
 

How to cite this article:
Sharma S, Singh M, Butt MF. Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate (Letter 2) . Indian J Orthop 2012;46:375-6

How to cite this URL:
Sharma S, Singh M, Butt MF. Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate (Letter 2) . Indian J Orthop [serial online] 2012 [cited 2019 Dec 11];46:375-6. Available from: http://www.ijoonline.com/text.asp?2012/46/3/375/96375
Sir,

We read with great interest the article by Saikia et al. entitled "Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate". [1] We would like to highlight a few important issues regarding this topic:

  1. The authors have not mentioned whether any of their patients had osteoporosis and whether the distribution of such patients was equal in both the limited contact dynamic compression plate (LCDCP) and locked compression plate (LCP) groups. Osteoporosis is a major determinant in the final outcome of any fracture and any comparative study should ensure that this confounding factor is taken care of.
  2. The authors seem to have mixed two implants and two principles. They mention the use of "bridging technique" and "axial compression." Both principles can be applied to select fracture patterns. Though mentioned in the section Materials and Methods, the authors fail to mention how many cases of "bridging" and "compression" were done in the LCP and LCDCP groups. It would have been more meaningful to compare the two implants when used for either of the two principles, i.e. compression or bridging. Henle et al. compared LCP with the LCDCP when used for bridging plate fixation and concluded that the LCP did not demonstrate any superiority over LCDCP in terms of functional or clinical outcomes. Also, implant removal was found to be more problematic in the LCP group which was primarily attributable to cold welding of the screws into the plate. [2] Stevens et al. compared the results of LCP and dynamic compression plates (DCPs) when used for simple fracture patterns. They found that fractures that had been compressed united 10 weeks faster than those that were not compressed, regardless of the implant used. [3]
  3. The authors have mentioned about formation of callus in this study. They observed that callus formation was more in the LCP group than in the LCDCP group. Callus formation depends on the type of bone healing. Primary (direct) bone healing occurs without visible fracture callus formation and secondary healing shows callus. When the principle of compression is applied, direct bone healing is the result and this can be achieved by either LCP or LCDCP. [4] Perhaps more fractures were taken up for bridging in the LCP group, instead of compression and this fact can account for the authors' observation.
  4. It is of paramount importance to take the cost of implant also into account. Addition of locking screws to the construct increases the overall cost of the implant. Most studies conducted so far have failed to demonstrate the superiority of LCP over the LCDCP, when used for either compression or bridging plating. [1],[3],[5] In view of the higher cost and problems with hardware removal, [2] it would be prudent to restrict the use of LCP for osteoporotic and extensively comminuted forearm bone fractures.


 
   References Top

1.Saikia K, Bhuyan S, Bhattacharya T, Borgohain M, Jitesh P, Ahmed F. Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate. Indian J Orthop 2011;45:417-21.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Henle P, Ortlieb K, Kuminack K, Mueller CA, Suedkamp NP. Problems of bridging plate fixation for the treatment of forearm shaft fractures with the locking compression plate. Arch Orthop Trauma Surg 2011;131:85-91.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Stevens CT, ten Duis HJ. Plate osteosynthesis of simple forearm fractures: LCP versus DC plates. Acta Orthop Belg 2008;74:180-3.  Back to cited text no. 3
[PUBMED]    
4.Buckwalter JA, Einhorn TA. Bone and Joint Healing. In: Bucholz RW, Heckman JD, Court-Brown C, Editors. Rockwood and Green's Fractures in Adults. 6 th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. p. 298-311.  Back to cited text no. 4
    
5.Leung F, Chow SP. A prospective, randomized trial comparing the limited contact dynamic compression plate with the point contact fixator for forearm fractures. J Bone Joint Surg Am 2003 Dec;85-A(12):2343-8.  Back to cited text no. 5
    

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Correspondence Address:
Siddhartha Sharma
Flat No. 2, B Block, Housing Colony, Pocket 3, Sector 2, Channi Himmat, Jammu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.96375

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