Neurobionplus
Home About Journal AHEAD OF PRINT Current Issue Back Issues Instructions Submission Search Subscribe Blog    
Login 

Users Online: 2689 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
 


 
 Table of Contents    
LETTER TO EDITOR  
Year : 2017  |  Volume : 51  |  Issue : 3  |  Page : 348-349
Author's reply


Department of Orthopaedics, Noble Hospital, Pune, Maharashtra, India

Click here for correspondence address and email

Date of Web Publication4-May-2017
 

How to cite this article:
Dumbre Patil SS, Karkamkar SS, Dumbre Patil VS, Patil SS, Ranaware AS. Author's reply. Indian J Orthop 2017;51:348-9

How to cite this URL:
Dumbre Patil SS, Karkamkar SS, Dumbre Patil VS, Patil SS, Ranaware AS. Author's reply. Indian J Orthop [serial online] 2017 [cited 2020 Jan 22];51:348-9. Available from: http://www.ijoonline.com/text.asp?2017/51/3/348/205691
Sir,

Thank you for your interest [1] shown in the article, “Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures”[1] in Indian Journal of Orthopaedics.

Ipsilateral neck femur with shaft femur is a challenging condition in respect to implant selection. We have included this condition as we have demonstrated the successful outcome in this condition using distal femoral plate.

It is recommended to start the case in lateral position only when you are able to see a proper lateral view on the C-arm. Thickness of patient and quality of C-arm are the influencing factors. In supine position, managing these nonunions, we feel it difficult because of posterior sagging at fracture site.

The distal femoral locking compression plate (DF-LCP) is a fixed-angle device when locking screws are used. We have used 6.5 mm nonlocking cancellous screws in neck femur cases. Furthermore, the 95% angulations of locking screws help get purchase in already operated proximal femoral (PF) cases where the tracks of previous implants are a main issue for purchase. Multiple holes in distal part of plate give you many options to get adequate purchase in proximal femur.

We have included cases of nonunion and delayed union in the study while evaluating the DF-LCP. However, in concluding the study results, we talked only of nonunion, without mentioning of delayed union cases (14 cases of subtrochanteric delayed union – as mentioned in materials and methods). We accept it as a shortcoming.

As rightly mentioned by the authors in cases of nonunion, fixation in compression mode (absolute stability) is desirable, which they achieved using DF-LCP. However, authors have also talked about the use of long plates through minimally invasive surgical approach (relative stability). It seems that two philosophies (absolute and relative stability) were being combined in few of their cases.[3],[4] This fact should have been elaborated in the study. We have used minimally invasive surgery approach in few cases as it is mentioned in the paper. We have opened the fracture site and dynamic compression plate holes of the plate were used to achieve the compression.

Lack of anterior curvature and limited screw options in proximal femur were the limitations enumerated by the authors of PF-LCP. Nonetheless, screws in proximal part of PF-LCP are at different angles (95°, 120°, and 135°), meant to engage entire head of femur for adequate fixation of PF fractures. We have not compared this aspect of plate with distal femoral plate. We have ruled out infections clinically and with blood investigations. We could not mention the average time of union as different PF fractures were managed using this technique.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Siddiqui YS, Sherwani MK. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures. Indian J Orthop 2017;51:347-8.  Back to cited text no. 1
  [Full text]  
2.
Dumbre Patil SS, Karkamkar SS, Patil VS, Patil SS, Ranaware AS. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures. Indian J Orthop 2016;50:374-8  Back to cited text no. 2
    
3.
de Vries JS, Kloen P, Borens O, Marti RK, Helfet DL. Treatment of subtrochanteric nonunions. Injury 2006;37:203-11.  Back to cited text no. 3
[PUBMED]    
4.
Saarenpää I, Heikkinen T, Ristiniemi J, Hyvönen P, Leppilahti J, Jalovaara P. Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: A matched-pair study of 268 patients. Int Orthop 2009;33:255-60.  Back to cited text no. 4
    

Top
Correspondence Address:
Sampat S Dumbre Patil
Department of Orthopaedics, Noble Hospital, 153, Magarpatta City Road, Hadapsar, Pune - 411 013, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ortho.IJOrtho_435_16

Rights and Permissions




 

Top
 
 
 
  Search
 
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    References
 

 Article Access Statistics
    Viewed1012    
    Printed6    
    Emailed0    
    PDF Downloaded38    
    Comments [Add]    

Recommend this journal