A randomized controlled study of Dynamic compression plating (Dcp) versus locking compression plating (Lcp) in treatment of forearm bone Fractures in adults (Age 18-60 years)

Abstract

BACKGROUND and OBJECTIVES KLE DR.PRABHAKAR KORE HOSPITAL and MRC, BELGAUM being located in a urban area, deals with lot number of polytrauma and fractures of the forearm bones. Fractures of the forearm bones may result in severe loss of function unless adequately treated. Severe loss of function may result even though adequate healing of the fracture occurs. To study the principles of dynamic and locking compression plate. To assess the functional outcome of patients with reference to rate of fracture union and its complications. To study follow-up and restoration of function of the forearm. METHODS On an average 50 cases were operated for plating of forearm bones in one year. Sample size was taken as 40 with equal distribution of cases ( using randomization list ) i.e. 20 cases with dynamic compression plating ( DCP ) ( Group A ) and 20 cases with locking compression plating ( LCP ) ( Group B ) . Here prospective randomized clinical trial was done using the sealed envelope technique . A total of 72 bones were fixed in 40 patients of which 37 were ulna and 35 were radius. In Group A there were 15 both bone ( 75% ) , 3 isolated ulna ( 15% ) , 1 isolated radius ( 5% ) and 1 galeazzi ( 5% ) fracture. In Group B there were 17 both bone ( 85% ) , 2 isolated ulna ( 10% ) and 1 isolated radius ( 5% ) fractures. All the 40 patients were followed up at 4-6 weeks, 11-14 weeks and 6 months for functional and radiological review. RESULTS In Group A the average follow up was 12.8 months range ( 6-20 months) . Group B the average follow up was 13.1 months range ( 6-18 months) . Using the criteria of Anderson et al 20 ( 1975) the results were graded . Using the above criteria for radiological union. In groupA the average time for radiological union was 9.1 weeks ( 6- 22 weeks ) and in Group B the average time was 6.4 weeks ( 4- 12 weeks) . Further using Anderson’s et al criteria for functional results we had 75% excellent, 10% good, 10% fair and 5% poor results in Group A and 90% excellent, 5% good and 5% fair results in Group B. CONCLUSION The locking compression plating of diaphyseal bones produced excellent results, the advantages being early mobilization, early union and hence prevention of fracture disease. The only disadvantage is that it is more expensive than the DCP. The conclusion of our study is that locking compression plate ( LCP ) has a definite advantage over dynamic compression plating ( DCP ) with respect to time to union and screw placement in comminuted fractures, but the complications, duration of surgery and surgical technique virtually remains unchanged.