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Loosening of the bone plate is a possible complication after bone plate fixation. If not handled properly, it may affect fracture healing and even lead to the failure of internal fixation. The following are the remedial measures for the loosening of the bone plate:
Evaluate the loosening situation
Symptom observation: Closely monitor the patient’s local symptoms. If the patient complains of increased pain at the fracture site, especially during activities or weight-bearing, it may be a signal of loose bone plates. At the same time, observe whether there is local swelling, abnormal movement and other conditions. If the swelling area expands and an abnormal movement sensation can be felt at the fracture site, it indicates that there may be a problem with the bone plate fixation.
Imaging examination: Through X-ray examination, the position of the bone plate, whether the screws are loose or broken, and the healing condition of the fracture end can be initially determined. If the X-ray shows that the gap between the bone plate and the bone has increased and the position of the screw within the bone has changed, it indicates that the bone plate is loose. For some complex situations, CT examination can also be conducted. It can more clearly display the three-dimensional relationship between the bone plate, screws and the bone, as well as the details of the fracture ends, which is helpful for accurately assessing the degree and extent of loosening.
Conservative treatment (applicable to cases of mild loosening and a good trend of fracture healing)
Limit activities: Reduce the activity level and weight-bearing of the affected limb to prevent the bone plate from being further loosened due to excessive stress. For example, for patients with loose bone plates in lower extremity fractures, crutches or wheelchairs can be used to assist in walking. The progressive principle of “partial weight-bearing – full weight-bearing” should be strictly followed, and the weight-bearing should be gradually increased according to the healing condition of the fracture. Generally, it starts with partial weight-bearing, such as 20% to 30% of body weight, and gradually increases to full weight-bearing as the fracture heals.
External fixation assistance: External fixation methods such as braces and plaster casts can be used to assist in the fixation of the affected limb, increasing the stability of the fracture site. Braces can be customized according to the shape of the patient’s limbs, providing a more fitting and stable fixation effect. Plaster fixation can provide strong rigid fixation, but it is necessary to pay attention to observing the blood circulation and sensation of the distal limb to prevent complications caused by overly tight fixation.
Drug treatment: Use drugs that promote fracture healing, such as bone peptides and calcium supplements, to accelerate the healing process of fractures, enhance bone strength, and thereby reduce the burden on the bone plate. At the same time, non-steroidal anti-inflammatory drugs can be given to relieve pain symptoms, such as ibuprofen and diclofenac sodium, but it is necessary to pay attention to the side effects of the drugs, such as gastrointestinal discomfort and liver and kidney function damage.
Surgical treatment (applicable to cases of severe loosening or ineffective conservative treatment)
Revision surgery
Remove the original bone plate: During the operation, carefully remove the loose bone plate and screws to avoid secondary damage to the surrounding tissues. During the removal process, it is important to protect the blood supply at the fracture end, as good blood supply is a crucial condition for fracture healing.
Clean the fracture ends: Thoroughly clean the fracture ends to remove granulation tissue, scar tissue and other factors that affect fracture healing, so that the fracture ends can better contact and heal. You can use tools such as a scraper or a bone knife for cleaning, but be careful with the force applied to avoid damaging the normal bone tissue.
Re-fixation: According to the type and location of the fracture, select an appropriate internal fixation device for re-fixation. If the bone condition of the original fracture site is good, a bone plate can be used for fixation again, but it is necessary to ensure that the length, width of the bone plate and the specifications of the screws match the fracture site, and the fixation should be firm. For some patients with complex fractures or osteoporosis, intramedullary nail fixation can also be considered. Intramedullary nails have good mechanical properties and anti-rotation ability, and can provide a more stable fixation effect.
Bone grafting surgery: If there is a bone defect or poor healing at the fracture end, bone grafting can be performed simultaneously with revision surgery. Bone graft materials can be autologous bone, allogeneic bone or artificial bone. Autologous bone has good bone induction and bone conduction effects, and there is no immune rejection reaction. However, bone removal will increase the patient’s pain and surgical trauma. Allogeneic bone sources are relatively abundant, but there may be risks of immune rejection reactions and disease transmission. Artificial bone has better biocompatibility and plasticity, but its bone induction ability is relatively weak. Doctors will select appropriate bone graft materials based on the specific conditions of the patients.
Postoperative rehabilitation
Rehabilitation plan formulation: Based on the surgical method and the patient’s physical condition, a personalized rehabilitation plan is developed. The rehabilitation plan should include early joint range of motion training, mid-term muscle strength training and later functional recovery training. For example, in the early postoperative period, passive activities of the distal joint of the affected limb can be carried out, such as flexion and extension movements of fingers and toes, to promote blood circulation and prevent joint stiffness. In the middle of the operation, gradually increase the isometric contraction training of the muscles, such as the static contraction of the quadriceps femoris, to enhance muscle strength; In the later stage after the operation, functional training of the affected limb can be carried out, such as walking and going up and down stairs, to restore the normal function of the limb.
Regular follow-up: Regular follow-up is necessary after the operation, usually once every 1 to 2 weeks, to monitor the healing of the fracture and the stability of the internal fixation device. As the fracture heals, the interval for re-examination can be gradually extended. During the follow-up examination, the doctor will adjust the rehabilitation plan and treatment plan based on the results of the imaging examinations and the patient’s functional recovery.