Abstract
The purpose of this study was to evaluate the clinical efficacy of internal fixation with locking compression plates (LCP) in the treatment of patients with extremity fractures and the effect on the recovery of limb function. A total of 488 patients with extremity fractures admitted to our hospital from June 2019 to December 2022 were retrospectively analyzed and divided into open reduction and internal fixation (ORIF) group (n = 236) and internal fixation with LCP group (n = 252) according to the surgical procedure. Outcome indicators included intraoperative bleeding, operative time, length of hospital stay, pain duration, quality of life, healing time of the fracture, postoperative complications, and restoration of limb function as per the X-ray examination results and Johner-Wruhs criteria. Self-rating Depression Scale and Self-rating Anxiety Scale were used to evaluate the changes of patients’ negative emotions before and after treatment. LCP group was associated with significantly less intraoperative bleeding and shorter operative time, length of hospital stays, and pain duration compared with ORIF group (P < .05). Compared with ORIF group, LCP group provided more rapid fracture healing in tibial fractures, ulnar fractures, radial fractures, and external ankle fractures (P < .05). Compared with the ORIF group, patients in the LCP group showed better quality of life in terms of physical, psychological and social functions after surgery (P < .05). The incidence of postoperative complications in the LCP group was significantly lower than that in the ORIF group (19.92% vs 7.14%, P < .001). The Self-rating Depression Scale and Self-rating Anxiety Scale scores of the LCP group were lower than those of the ORIF group (P < .05). The recovery of limb function was significantly better in the LCP group than in the ORIF group (97.22% vs 85.17%, P < .001). The overall satisfaction rate of treatment in the LCP group was higher than that in the ORIF group (92.06% vs 81.90%, P < .001). Internal fixation with LCP in patients with extremity fractures can effectively promote the recovery of limb function, reduce the incidence of complications and improve the quality of life of patients.
Keywords: fractures of the extremities, internal fixation with locking compression plates, LCP, open reduction and internal fixation, restoration of limb function
1. Introduction
Extremity fracture is the damage to the integrity or connectivity of the bone structure of the extremities due to violent injuries, such as falls from height, car accidents, and falls.[1] Open fractures are associated with massive blood loss and hematoma at the fracture site, and even local inflammatory infections and shock. Fractures of the extremities can cause restrictions on the patient’s daily activities and require a lengthy recovery, seriously compromising the patient’s physical and mental health and quality of life.[2] The 3 main principles of limb fracture treatment are repositioning, fixation, and functional exercise. The goal of repositioning is to restore the normal anatomy of the fracture site to the maximum extent possible, fixation is to provide a stable healing environment for the fracture site and maintain the results of repositioning, and functional exercise is to avoid complications such as joint adhesions and muscle contractures due to long-term fixation.[3,4] Previously, traditional approaches such as splint fixation and plate and screw internal fixation were mostly used for fracture reduction, which, however, are associated with drawbacks such as long surgical incisions, heavy intraoperative bleeding, and large trauma.[5,6] With the advancement of medical technology, internal fixation with locking compression plates (LCP) has been extensively used due to its benefits such as less trauma and fewer postoperative complications.[7,8] To this end, the present study was performed to evaluate the clinical efficacy of internal fixation with LCP in the treatment of patients with extremity fractures and the effect on the recovery of limb function.
2. Materials and methods
2.1. Clinical data
This was a retrospective study. A total of 488 patients with extremity fractures admitted to our hospital from June 2019 to December 2022 were retrospectively analyzed and divided into open reduction and internal fixation (ORIF) group (n = 236) and internal fixation with LCP group (n = 252) according to the surgical procedure. Informed consent was signed by all patients and approved by the ethics committee of Suzhou Hospital of Integrated Traditional Chinese and Western Medicine.
2.2. Inclusion and exclusion
2.2.1. Inclusion criteria.
Patients with a confirmed diagnosis of extremity fracture by CT and X-ray; indications for surgery; complete clinical data; and good cooperation and good compliance.
2.2.2. Exclusion criteria.
Patients with osteomyelitis; large skin lesions or severe infectious diseases; abnormal coagulation; and patients who rescinded their consent.
2.3. Methods
2.3.1. ORIF treatment.
General anesthesia was performed with the patient in the supine position, an incision was made at the fracture site, and the periosteum was incised longitudinally to expose the fracture and determine the extent of fracture dislocation; the plate was placed on the bone surface under the guidance of a C-arm X-ray machine to ensure a close fit with the fracture site; after adjusting the position of the fracture fixator and plate installation, screws were applied for fixation; the wound was cleaned, the incision was closed according to the levels after thorough hemostasis, and a drainage tube was indwelt; postoperative antibiotics were used to prevent infection.
2.3.2. LCP treatment.
Under general anesthesia in the supine position, an incision of approximately 2 cm was made at the proximal and distal ends of the fracture site, and the soft tissue was separated in the periosteal area under the deep fascia to form a soft tissue tunnel; under the guidance of the C-arm X-ray machine, a locking compression plate suitable for the curvature of the injured segment was inserted onto the bone surface, the position of the plate was adjusted appropriately, and the proximal and distal ends of the fracture site were fixed with screws and Kirschner wires; the fractured end was accurately repositioned by C-arm X-ray machine and then locked screws were placed to adequately secure the compression plate; the incision was irrigated with saline, the bone and soft tissue debris and foreign bodies were removed, the incision was sutured, and a drainage tube was indwelt; and postoperative antibiotics were used to prevent infection.
2.4. Observation indicators
The surgical indices of the patients were recorded, including intraoperative bleeding volume, operative time, length of hospital stay, and pain duration. The Generic Quality of Life Inventory-74[9] was used to assess the quality of life of the patients before and after treatment, mainly in terms of physical, psychological, and social functions. Each index was scored 100 points, with higher scores indicating better quality of life. Patients were followed up for 6 months after surgery to record the fracture healing time, functional recovery of limbs, and post-operative complications. Postoperative complications include postoperative infection, loosening of the internal fixation, fracture deformity, and venous embolism. Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) were used to evaluate the changes of patients’ negative emotions before and after treatment.[10,11] The lower the SDS and SAS scores, the less negative emotions the patient has. The patient’s functional recovery was assessed on the basis of radiographic findings and Johner-Wruhs criteria.[12] Excellent: no pain, complete fracture healing, normal fracture end on imaging, normal joint movement, and no discomfort; Well: Patients with occasional mild pain, basic healing of the fracture, basic recovery of the fracture end on imaging and 70% of normal joint mobility; Badly: Patients with frequent pain symptoms, delayed fracture healing, joint mobility not reaching 50% of normal, with significant bone scabs and deformities. The overall satisfaction rate of treatment includes: very satisfied, basically satisfied and dissatisfied.
2.5. Statistical analysis
SPSS 22.0 statistical software was used for data analysis. Measurement data conforming to a normal distribution were expressed as mean ± standard deviation, and t test was used for comparison between groups. Count data were expressed as n (%) and examined by chi-square test for comparison between groups. Statistical significance was indicated by P < .05.
3. Results
3.1. General information
In the ORIF group, there were 19 male and 21 female cases, aged between 32 and 49 years, with a mean age of 40.55 ± 8.06 years, 59 cases of fall from height, 141 cases of traffic accident and 36 cases of fall. There were 94 cases of tibial fracture, 77 cases of ulnar fracture, 41 cases of radius fracture and 24 cases of external ankle fracture. In the LCP group, there were 113 male and 139 female patients, aged between 33 and 51 years, with a mean age of 41.31 ± 7.82 years, 57 cases caused of fall from height, 161 cases by traffic accident and 34 cases of fall. There were 107 cases of tibial fracture, 69 cases of ulnar fracture, 57 cases of radius fracture and 19 cases of external ankle fracture. No significant difference was found between the 2 groups in terms of baseline information (P > .05), as shown in Table 1.
Table 1.
General information.
| Groups | n | Sex | Age (yr) | Causes of fractures | Fracture site | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Male | Female | Fall from height | Traffic accident | Fall | Tibia | Ulna | Radius | External ankle | |||
| ORIF group | 236 | 112 | 124 | 40.55 ± 8.06 | 59 | 141 | 36 | 94 | 77 | 41 | 24 |
| LCP group | 252 | 113 | 139 | 41.31 ± 7.82 | 57 | 161 | 34 | 107 | 69 | 57 | 19 |
| t/χ2 | 0.336 | 0.528 | 0.892 | 3.952 | |||||||
| P | .562 | .67 | .64 | .267 | |||||||
LCP = locking compression plates, ORIF = open reduction and internal fixation.
3.2. Comparison of surgery-related indices between the 2 groups
Observation group was associated with significantly less intraoperative bleeding and shorter operative time, length of hospital stays, and pain duration compared with ORIF group (P < .05), as shown in Table 2.
Table 2.
Comparison of surgery-related indices between the 2 groups.
| Groups | n | Operative time (min) | Intraoperative bleeding (mL) | Length of hospital stay (d) | Duration of pain (d) |
|---|---|---|---|---|---|
| ORIF group | 236 | 122.62 ± 10.25 | 190.20 ± 18.75 | 18.12 ± 3.07 | 20.78 + 2.55 |
| LCP group | 252 | 85.88 ± 9.85 | 155.46 ± 15.61 | 14.35 ± 2.69 | 15.69 + 3.04 |
| t | 16.346 | 27.152 | 4.842 | 5.113 | |
| P | <.001 | <.001 | .003 | .002 |
LCP = locking compression plates, ORIF = open reduction and internal fixation.
3.3. Comparison of fracture healing time between the 2 groups
Compared with ORIF group, LCP group provided more rapid fracture healing in tibial fractures, ulnar fractures, radial fractures, and external ankle fractures (P < .05), as shown in Table 3.
Table 3.
Comparison of fracture healing time between the 2 groups.
| Groups | n | Fracture of tibia (d) | Fracture of ulna (d) | Fracture of radius (d) | Fracture of external ankle (d) |
|---|---|---|---|---|---|
| ORIF group | 236 | 80.68 ± 13.23 | 85.20 ± 12.12 | 81.57 ± 13.75 | 84.06 + 11.58 |
| LCP group | 252 | 73.83 ± 13.05 | 76.46 ± 11.87 | 72.80 ± 12.82 | 76.79 + 12.10 |
| t | 3.012 | 3.258 | 2.95 | 2.745 | |
| P | .008 | .003 | .004 | .007 |
LCP = locking compression plates, ORIF = open reduction and internal fixation.
3.4. Comparison of quality of life between the 2 groups
Compared with the ORIF group, patients in the LCP group showed better quality of life in terms of physical, psychological and social functions after surgery (P < .05), as shown in Table 4.
Table 4.
Comparison of quality of life between the 2 groups.
| Groups | n | Somatic functions | Psychological functions | Social functions | |||
|---|---|---|---|---|---|---|---|
| Before treatment | After treatment | Before treatment | After treatment | Before treatment | After treatment | ||
| ORIF group | 236 | 62.92 ± 3.70 | 75.76 ± 5.11 | 61.85 ± 4.53 | 77.69 ± 5.72 | 60.68 ± 5.38 | 78.45 ± 4.90 |
| LCP group | 252 | 63.14 ± 3.58 | 83.88 ± 5.24 | 61.78 ± 4.29 | 85.17 ± 4.96 | 60.31 ± 5.45 | 85.34 ± 4.78 |
| t | 0.27 | 7.017 | 0.071 | 6.249 | 0.306 | 6.366 | |
| p | .788 | .003 | .944 | <.001 | .761 | .002 | |
LCP = locking compression plates, ORIF = open reduction and internal fixation.
3.5. Comparison of postoperative complications between the 2 groups
In the ORIF group, there were 12 cases of postoperative infection, 18 cases of loosening of internal fixation, 11 cases of fracture deformity, and 6 cases of venous embolism among 236 patients. In the LCP group, there were 3 cases of postoperative infection, 7 cases of loosening of internal fixation, 6 cases of fracture deformity, and 18 cases of venous embolism in 252 patients. The incidence of postoperative complications in the LCP group was significantly lower than that in the ORIF group (19.92% vs 7.14%, P < .001), as shown in Table 5.
Table 5.
Comparison of postoperative complications between the 2 groups.
| Groups | n | Postoperative infection | Loosening of internal fixation | Fracture deformity | Venous embolism | Total incidence |
|---|---|---|---|---|---|---|
| ORIF group | 236 | 12 (5.08) | 18 (7.63) | 11 (4.67) | 6 (2.54) | 47 (19.92) |
| LCP group | 252 | 3 (1.19) | 7 (2.78) | 6 (2.38) | 2 (0.79) | 18 (7.14) |
| χ2 | 17.22 | |||||
| P | <.001 |
LCP = locking compression plates, ORIF = open reduction and internal fixation.
3.6. Comparison of negative emotions between the 2 groups
There was no statistically significant difference between the SDS and SAS scores of the LCP group and the ORIF group before surgery treatment, and the SDS and SAS scores of the LCP group were significantly lower than those of the ORIF group after surgical treatment (P < .05), as shown in Table 6.
Table 6.
Comparison of negative emotions between the 2 groups.
| Groups | n | SDS | SAS | ||
|---|---|---|---|---|---|
| Before treatment | After treatment | Before treatment | After treatment | ||
| ORIF group | 236 | 52.87 ± 8.57 | 25.90 ± 5.02 | 53.47 ± 8.14 | 24.69 ± 3.82 |
| LCP group | 252 | 53.45 ± 8.32 | 22.35 ± 5.13 | 53.08 ± 7.89 | 21.17 ± 3.95 |
| t | 0.307 | 3.128 | 0.218 | 4.051 | |
| P | .76 | <.001 | .828 | .004 | |
LCP = locking compression plates, ORIF = open reduction and internal fixation, SAS = Self-rating Anxiety Scale, SDS = Self-rating Depression Scale.
3.7. Comparison of recovery of limb function between the 2 groups
In the LCP group, there were 176 patients with excellent limb recovery, 69 with well recovery, and 7 with badly recovery. In the ORIF group, 112 patients had excellent limb recovery, 89 had well recovery, and 35 had badly recovery. The recovery of limb function was significantly better in the LCP group than in the ORIF group (97.22% vs 85.17%, P < .001), as shown in Figure 1.
Figure 1.
Comparison of recovery of limb function between the 2 groups.
3.8. Comparison of overall satisfaction rate between the 2 groups
In the LCP group, there were 94 patients with very satisfied limb recovery, 138 patients with basically satisfied, and 20 patients with dissatisfied. In the ORIF group, there were 76 patients with very satisfied limb recovery, 114 patients with basically satisfied and 42 patients with dissatisfied. The overall satisfied rate of treatment in the LCP group was higher than that in the ORIF group (92.06% vs 81.90%, P < .001), as shown in Figure 2.
Figure 2.
Comparison of overall satisfaction rate between the 2 groups.
4. Discussion
With the development of medical technology and the continuous research on bone physiology and bone biomechanics involved in fracture healing, the concept and treatment techniques of internal fixation of fractures have evolved with the times.[13,14] The ORIF, which has been widely used in previous practice, has poor internal fixation stability, and requires the separation of multiple layers of tissue during manipulation, which is highly exposing and prone to infection.[15,16] The advent of LCP is a milestone in the history of internal fracture fixation, as it allows direct stabilization of the fracture site using a compression plate without stripping the periosteum.[17,18] There is a large body of literature on the successful use of LCP in the treatment of extremity fractures.
In the current research, Internal fixation with LCP was associated with significantly less intraoperative bleeding and shorter operative time, length of hospital stay, and pain duration versus ORIF. Patients with LCP exhibited better postoperative quality of life versus those with ORIF. Internal fixation with LCP provided more rapid fracture healing than ORIF. A lower incidence of postoperative complications in the LCP arm suggested a higher safety profile of LCP over ORIF. The SDS and SAS scores of the LCP group were lower than those of the ORIF group. Internal fixation with LCP resulted in significantly better limb function recovery of patients than ORIF. The overall satisfaction rate of treatment in the LCP group was higher than that in the ORIF group. These results show that internal fixation with LCP can effectively improve fracture healing and recovery of limb function, reduce the incidence of complications and enhance patients’ quality of life.
ORIF and LCP are both fracture reduction and internal fixation procedures. Their differences lie in the fact that LCP internal fixation is a minimally invasive procedure in which an incision is made proximally and distally to create a subcutaneous tissue tunnel for placement of a compression plate, thereby reducing surgical trauma, protecting the patient’s periosteum and surrounding soft tissues, and minimizing damage to the blood flow to the fracture site.[19,20] In addition, the plate has a locking threaded hole, which provides a more stable angle between the plate and the locking screw, and enables a stronger bond between the bone structure, the plate and the locking screw, effectively avoiding postoperative displacement.[21,22] Because of its rapid healing, patients will benefit from early functional limb training, which will improve their quality of life.[23,24]
5. Conclusions
In conclusion, internal fixation with LCP in patients with extremity fractures can effectively promote the recovery of limb function, reduce the incidence of complications and improve the quality of life of patients.
Author contributions
Data curation: Jun Wu.
Formal analysis: Jun Wu.
Funding acquisition: Jun Wu, Pengpeng Ren, Feng Cao.
Investigation: Jun Wu, Yang Chen, Yin Zhu, Xiaodong Wu, Pengpeng Ren, Feng Cao.
Methodology: Yang Chen, Yin Zhu, Xiaodong Wu, Feng Cao.
Project administration: Yang Chen, Yin Zhu, Xiaodong Wu, Pengpeng Ren, Feng Cao.
Resources: Yang Chen, Yin Zhu, Pengpeng Ren.
Software: Yin Zhu, Pengpeng Ren.
Abbreviations:
- GQOLI-74
- Generic Quality of Life Inventory-74
- LCP
- locking compression plates
- ORIF
- open reduction and internal fixation
- SAS
- Self-rating Anxiety Scale
- SDS
- Self-rating Depression Scale
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Wu J, Chen Y, Zhu Y, Wu X, Ren P, Cao F. Clinical efficacy of internal fixation with locking compression plates in the treatment of patients with extremity fractures and the effect on the recovery of limb function. Medicine 2023;102:48(e35884).
Contributor Information
Jun Wu, Email: 68608987@qq.com.
Yang Chen, Email: 874903458@qq.com.
Yin Zhu, Email: 8679725@qq.com.
Xiaodong Wu, Email: 68608987@qq.com.
Pengpeng Ren, Email: 987327685@qq.com.
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