- Forearm fracture types for which plate fixation may be used
Forearm fractures according to the region
Fractures around the elbow:
- Radial head fractures
- Olecranon fractures
Wrist fractures
Ulnar shaft fractures
Both forearm fractures
Forearm fracture according to the type of fracture
Ulna, radius intact
radius, Ulna intact
Both bones fracture
All these groups can have single, wedge or complex fractures, and for all these groups of fractures open reduction internal fixation can be used.
In general these plates can be used for Ulna, radius fractures:
Locking plates 2.0
Dynamic compression plates 2.4
Universal fracture plate 2.4
Locking reconstruction plates 2.4
All these plates have different sizes which according to the fracture are chosen.
- The intended effect of immobilisation at the fracture site
ORIF is an open surgery to set the broken bones as is necessary. This method prevents micro-movements across fracture line which is one of the main reasons of bad healing or not healing of different types of fractures. In comparison with other methods of fixation such as using cast, by using this method the broken parts of the bone are set together in most rigid situation and with minimum or no micro-motion and it just speeds up the healing process. Also one of the other positive effects is that during healing process or rehabilitation the patient can use the part of the body, in this case hand and it prevents debilitation of the muscles and muscular atrophy, again in comparison with other methods of treatment it is like a big plus for this method and another reason to be used instead of other methods.
- Common complications associated with plate fixation and how these common complications may be overcome
Different complications may happen after treatment using plate fixation su as:
Infection,
Infection can happen after any surgical operation. To prevent any infection antibiotic therapy is used but if an infection after fixation occurs, it might be necessary to remove metal plate and screws for treatment of the infection.
Non-healing fracture,
Persistent pain might be caused in result of inadequate healing of bones of forearm. It is common especially in forearm fractures when depending on type of fracture a part of the bone is lost or it is an open fracture. In such situations repeating the surgery plus bone grafting might be needed to reduce the pain and overcome this problem.
Decreased Motion,
Limitation of the movement is one of the most complications that occurs after forearm fracture. The wrist and elbow joint motions can be limited. Limitation of forearm rotation is most commonly observed as the patient faces limitation in turning a door handle or for opening a jar.
Painful Hardware,
Basically the metal plates used for fixation can be felt under the muscles or skin and it may cause pain, if such situation happens the metal plate can be removed of course after rehabilitation and complete healing of fracture, usually if they are painful the plates are removed at least one year after the surgery.
Of course choosing the type of plate during the surgery is very important so the best choice in size and thickness of the plate can have great effect in postoperative pain.
- Types of materials used to manufacture the fracture fixation plate
Basically metals are used for production of fracture fixation plates.
The first metal that we can mention is Titanium, it’s chemical make up is Ti6Al4V. Using Titanium is beneficial due to it’s yield strength in comparison with stainless steel, but Titanium also has some problems. The titanium has poor wear characteristic, it varies with very smooth or porous surface.
Next metal used for manufacturing fixation plates is steel. It’s chemical make up is Cr, Ni, Mo ( Cr: Oxide layer when dipped in Nitric acid which reduces corrosion.
Using Steel is beneficial because it’s strong, relatively biocompatible; annealed, cold worked or cold forged; relatively ductile-contouring of plates, and cheap.
The other material which is used is Cobalt-chromium-molybdenum. It’s chemical make up is 30-60%Co, 20-30% Cr, 7-10% Mo. It’s good to use it because it is stronger than stainless steel and also more corrosion resistant. It is also has an excellent resistance to stress, cracking , and fatigue.
Of course choosing plates produced using different material directly depends to the type of surgery and fracture.
References:
"http://wings.buffalo.edu/." http://wings.buffalo.edu/. N.p., n.d. Web. 4 Dec. 2013. <http://wings.buffalo.edu/academic/department/eng/mae/courses/417-517/Orthopaedic%20Biomechanics/Lecture%2014u.pdf>.
"http://www.wpi.edu."http://www.wpi.edu. N.p., n.d. Web. 4 Dec. 2013. <http://www.wpi.edu/Pubs/ETD/Available/etd-110512-223928/unrestricted/Tacvorian_Fracture_Fixation.pdf>.
