International Journal of Current Research and Review
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IJCRR - 6(1), January, 2014

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USE OF LOCKING PLATES IN FRACTURE MANAGEMENT

Author: Raza A., Kailash K., Mahalingam S.

Category: Healthcare

Abstract:The history of fracture management can be traced back to the prehistoric times. It was not until the late nineteenth and early twentieth century that operative treatments of fractures were contemplated. However operative treatment of fractures at that time was associated with devastating results secondary to infection with high morbidity and mortality. As a result, the mainstay of treatment of fractures remained traction and closed reduction within plaster of Paris. On the other hand, non-operative treatment of fractures was associated with the development of joint stiffness, disuse osteopenia and muscle atrophy, collectively described as „Fracture disease?. During 1950s, the Swiss AO group standardized the use of plating systems. The AO group revolutionized the concept of rigid stable internal fixation with early functional mobilisation which resulted in a positive impact on fracture disease. With time, surgeons started gaining more confidence in the operative management of fractures when better results were obtained while adhering to the principles of strict asepsis and using antibiotics. The article describes the use of modern locking plates in the management of fractures in different areas. Overall, the literature supports using locking plates for fixation of periarticular fractures of long bones, multifragmentary fractures of diaphysis and metaphysis and periprosthetic fractures. Locking plates are not the panacea for all type of fractures. As clinical experience with locking plate broadens, new indications and applications will emerge.

Keywords: Locking plate, Internal fixation.

Full Text:

INTRODUCTION

The history of fracture management can be traced back to the prehistoric times. Analysis of bones of Neolithic man shows both successful and unsuccessful attempts in fracture fixation [16]. It was not until the late nineteenth and early twentieth century that operative treatments of fractures were contemplated. Later, devices were developed that could be applied to the broken bone either externally or internally to hold the fracture and let it heal in the required position. External fixation was first attempted by Albin Lambotte in 1902 [49] and Gerhard Kuntscher developed his intramedullary nail in 1938. However operative treatment of fractures at that time was associated with devastating results secondary to infection with high morbidity and mortality. As a result, the mainstay of treatment of fractures remained traction and closed reduction within plaster of Paris. On the other hand, nonoperative treatment of fractures was associated with the development of joint stiffness, disuse osteopenia and muscle atrophy, collectively described as „Fracture disease?.During 1950s, the Swiss AO group standardized the use of plating systems [24]. The AO group revolutionized the concept of rigid stable internal fixation with early functional mobilization which resulted in a positive impact on fracture disease. With time, surgeons started gaining more confidence in the operative management of fractures when better results were obtained while adhering to the principles of strict asepsis and using antibiotics. The contribution by AO group in the understanding of fracture healing, management and internal fixation is undisputedly enormous.

Development of Locking plates

The fixation achieved by conventional plate-bone construct is based on friction between the plate and bone interface. As the plate is firmly pressed against the periosteum, it impairs the periosteal blood supply with subsequent poor and slower bone healing. With time surgeons and researchers recognised the importance of biological environment of the fracture. The principle of “Biological Internal Fixation” emphasized more flexible fixation to encourage the callus formation, with less precise direct reduction thus reducing surgical trauma [54]. As a result Zespol plates and Schuhli nuts were introduced to convert conventional plate into fixed-angle device with plate acting as internal fixator. Later, the point contact fixator (PC-Fix) and Less Invasive Stabilisation Systems (LISS) were developed by AO, which had even minimal contact areas on the bone with improved preservation of periosteal and endosteal blood supply [47]. Thus locking plates were developed to achieve biological internal fixation with relative stability, yet strong enough to allow early functional mobilisation.

How Locking Plates Work

Conventional plates owe their stability to firm contact with bone surface, and reducing this contact also reduces the stability of implant-bone construct. In order to maintain such low contact to allow for biological fixation and yet stay stable,  locking plates are designed as „fixed angled devices?. „Fixed-angle device? means that when screws are placed in the plate and stress is applied, the angle between the plate and screws does not change. In order to achieve this, locking head screws were developed which can lock within the screw holes of the locking plate by virtue of their threaded heads. Once locked, these screws even under stress maintain their relative position with respect to the plate, thus providing both angular and axial stability. In a conventional plate, loosening of one screw renders instability by reducing the contact pressure between the plate and bone. Thus loosening of even one screw can potentially jeopardize the overall stability with rapid sequential loosening, as is seen in osteopenic and osteoporotic bones. This however is not seen in locking plates where stability is not based on interface friction as the plate-screw construct acts as a composite structure. Currently locking plates are being used for treating a wide variety of fractures. Let us briefly consider different areas of the body where these plates have been used while comparing them with other treatment modalities.

Proximal Humeral Fractures

Proximal humeral fractures are the third most common osteoporotic fractures after hip and distal radius with females having higher risk than men [5]. The large majority of these fractures are managed non-operatively as they are mostly stable and minimally displaced ( <1 cm ) [19]. Various biomechanical studies have compared PHILOS (Proximal Humeral Internal Locking System) and LCP-PH (Locking Compression Plate-Proximal Humerus) with intramedullary nails and other conventional plates. Overall, the locking plate-bone construct has always been found to be more stiffer in torsion and bending when cyclical loads are applied as shown by Edwards et al. [23] and Kralinger et al. [45]. A study performed by Fuchtmeier et al, however, showed that intramedullary implants were superior in bending and torsional stiffness than extramedullary implants [33]. It is important to emphasize that results were based on only five loading cycles leading to implant failure whereas in the human body implant-bone constructs are subjected to different types of load. Cyclical loading as tested by Edwards et al [23] and Kralinger et al [45] predominates in human function. Thus studies performed using cyclical loading are a more true representation of normal physiological loading conditions. Increased rigidity of the implant; although both biomechanically and theoretically attractive, has been attributed to the enblock cutout of the whole implant [65]. According to a systematic review, one major factor of re-operations was cut-out after loss of reduction. They recommended that the ideal elastic to rigidity ratio still needs to be determined in order to achieve the best outcome [65]. Operative fixations of proximal humeral fractures are not devoid of complications. It has been shown that the risk of osteonecrosis, neurovascular complications and deep infections are minimal when a fracture is fixed with indirect techniques using percutaneous wire fixation or intramedullary nailing. Fenichel et al.[31] and Keener et al. [43] have shown no occurrences of any of the above mentioned complications by percutaneous wire fixation. According to a recent systematic review and other studies, the overall incidence of AVN ranges from 4% to 11.1% when locking plates are used [29,51,63,65]. The incidence of deep infection was shown to be mean 2.2% and loss of reduction ranging from 3.7% to as high as 12.2%. Primary implant failure, an uncommon complication, was found to be 0.7% [65]. The intraoperative error of choosing incorrect length of the screws is the commonest complication with the use of PHILOS plate, which ranges from 2% to 17.9% [65]. This has also been confirmed by a prospective multicentre study done by Sudkam et al. [63].

Humeral Shaft and Distal Humeral Fractures

The majority of humeral shaft fractures can be treated conservatively [12,58]. Conservative methods are associated with prolonged immobilisation and subsequent lengthy rehabilitation. Although conventional plating allows early mobilisation, it requires an extensive approach. This extensive approach can be detrimental to fracture healing and can cause iatrogenic nerve injury [20]. The use of an intramedullary nail has also been found to be associated with iatrogenic nerve injury along with high incidence of delayed union and shoulder pain [8,30]. Locking plates have been recommended to be used for comminuted fractures and osteopenic bones as they provide angular stability. In addition, these plates can be applied using a minimally invasive technique to avoid the complications associated with the extensive approach [1]. However, there is still a potential for iatrogenic nerve injury. In anterior approach, the injury to musculocutaneous nerve can be avoided by an extended distal incision with careful exposure of the nerve. In a cadaveric study, the author suggests to insert the distal locking screws by an open approach [2]. The radial nerve is most commonly injured in the spiral groove which can be avoided by using unicortical screws in the middle one third of the shaft of humerus. Distal humeral fractures constitute 2-6% of all fractures. The principle of treating distal humeral fractures involves anatomical reduction with primary stabilisation to allow early rehabilitation. These fractures are notoriously associated with stiffness even after short duration of immobilisation. Due to reduced cortical thickness, the adequacy of screw purchase with stable fixation is quite challenging. This can result in non-unions as high as 75% [38]. Both locking and conventional plates can be used in the operative treatment of distal humeral fractures, but the bility to achieve primary stable fixation with conventional plating is limited in those fractures which are associated with osteopenia, metaphyseal communition and inability to achieve cortical contact. These are the fractures where locking plate should ideally be used. Most support doublecolumn plating but the configuration in which the plates should be applied remains controversial. Overall, the plates are normally applied either orthogonally or in parallel configuration [66].

Distal Radius Fractures

Distal radius fractures are the most commonly occurring fractures. Most of these fractures are treated conservatively in cast immobilisation. There are many surgical options available to operatively treat these fractures. Among these include closed reduction & pin fixation, external fixation and ORIF. Since a large majority of these fractures are also osteoporotic in nature, precontoured locking plates were developed with the view to provide stable fixation subsequently reducing the risk of loss of reduction and collapse of fracture site whilst facilitating early joint mobilization. The concept behind achieving fracture stability by using fixed angled devices is based on their ability to function as „neutralization devices? by supporting the subchondral bone without depending on distal screw purchase [52]. In osteoporotic fractures of distal radius, the strongest remaining bone is the subchondral plate; hence both smooth and threaded pegs provide reliable fixation if applied immediately below the subchondral bone [52]. The criss-cross orientation of the locking head screws and pegs provide a 3- dimentional scaffold that cradles the articular surface [52]. One of the most important aspects of treatment outcome is the functional status of the injured hand and wrist. Studies performed using conventional plating [7,13], external fixator [18,22,41] and volar locking plate [35] showed good to excellent functional outcome. However, the average grip strength was more than 90% in the case of conventional plating and externally fixation. Only 25% of the patients had excellent and 49% had good grip strength in the study performed by Hakimi et al. using volar locking plate [35]. Rizzo et al. compared volar locking plates, external fixation and pining [57]. The external fixation group was associated with higher DASH score and frequent hand therapy visits, thus volar locking plate was recommended to be more appropriate than external fixation. The use of external fixator also carries the risk of pin track infections, however most of these infections in the studies done were superficial and treated successfully with oral antibiotics leading to no subsequent complications [23,57]. One of the well known complications of using volar plating, whether locking or conventional, is rupture of flexor pollicis longus tendon. This complication is not seen with use of external fixator. The use of Kirschner wire for fixation of severely communited unstable intra-articular fracture is not recommended. K-wires are mostly indicated and appropriate for the Colle?s type distal radial fracture lying near to the joint which are deemed unstable by plaster immobilisation or similar fractures presenting with secondary displacement after initial plaster immobilisation [32]. Two common complications of K-wire fixation of distal radial fractures are nerve irritation (12%) and wire migration (10%) [62]. Locking plate fixation of those fractures amenable to treatment with K-wire fixation will not only be cost ineffective but should be considered an over treatment when good results have been shown by other studies [32,62].

Femoral Fractures

The LISS (Less Invasive Stabilisation System) and LCP (Locking Compression Plate) have been there since 1980?s for the treatment of femoral fractures. Although the starting point of locking devices in femur was for the treatment of sub-trochanteric fractures, LISS plate and LCP are developing a place in the treatment of the diaphyseal and distal femoral fractures. Intramedullary nails are in widespread use for femoral shaft fractures. Clinically significant rotational malunion have been found to be as high as 30% in femoral shaft fractures treated with intramedullary devices [10]. A biomechanical study performed by Citak, et al. comparing rotational strain pattern of intramedullary devices with both conventional and locking plates has shown clinically significant rotation in both statically and dynamically locked nails averaging 14.2o and 15.7o respectively [15]. Only 3.8o of rotational strain was seen when comparable physiological loads were applied to a locking plate-bone construct and this was found to be statistically significant. This demonstrates the superiority of the locking plates in controlling the rotational deforming forces under laboratory physiological loads. Supracondylar fractures of femur are one of the most challenging fractures to treat. These fractures can vary from purely supracondylar to fractures with intra-articular extension. Marked communition is a hallmark of these injuries especially in osteoporotic bones and multiple trauma. These injuries can sometime present as periprosthetic fractures in elderly patient with knee arthroplasty. Many different implants have been used to fix fractures of the distal femur namely condylar blade plate, intramedullary nail, DCS and buttress plating. Earlier results of fixing these fractures internally were not encouraging. Neer et al. showed 90% satisfactory results with nonoperative treatment in comparison to 52% with internal fixation [51]. Later studies performed by applying AO principles of fracture management markedly improved the outcome in these fractures. Thus Schatzker et al. quotes 75% good results with internally fixed supracondylar fractures in comparison to 32% managed non-operatively [59]. Severely comminuted and osteoporotic supracondylar fractures still pose a major challenge. Since the advent of the concept of „Biological plate fixation? more emphasis has been placed on preserving bone biology. The use of a LISS and LCP were developed in order to minimise the problems associated with other internal fixation devices, most of which rely on the friction between bone and implant for stability. The use of LISS plate in treating such complex and challenging fractures has resulted in a reasonably satisfactory outcome. In one study, Schutz, et al. achieved 90% union rate [60]. In another study, Syed et al. has reported 88% union rate in 25 patients of supracondylar fractures being treated with LISS plate [64]. Overall there was 12% infection rate including two superficial and one deep infection, both successfully treated with antibiotics [64]. Interestingly, Schutz et al. and Syed et al.showed a revision rate of 23% and 12% respectively [60,64]. The main reason of revision was found to be delayed/non-union in both studies. A comprehensive systematic review on using LISS plate in supracondylar fractures of 663 patients with 694 fractures, revealed a 40% complication rate. The common complications were residual deformity (38.4%), implant malpositioning (11.2%) and infection (9.8%) [61].

Tibial Fractures

Tibial plateau fractures involve proximal tibia in its articular and meta-epiphyseal segments [6]. The normal valgus alignment of lower limb with reduced bone strength of lateral tibial plateau relative to medial results in a greater frequency of lateral than medial tibial plateau fractures [50]. Minimally displaced fractures are treated nonoperatively, however, displaced fractures mostly require surgical fixation. Complex proximal tibial fractures are high energy injuries with severe soft tissue damage and extensive comminution. The use of locking plates is recently being explored in the management of such fractures [9,17,25,34,56]. Locking plates respect the biological environment of fracture and can be also applied by minimally invasive technique, however a prospective randomized study on the treatment of bicondylar tibial plateau fractures has failed to reveal any obvious advantage over conventional plates in terms of fracture healing, infection rate and adequacy of fixation [39]. Diaphyseal and extra articular distal tibial fractures are frequently treated with intramedullary devices. Studies have revealed good outcome with the use of reamed intramedullary nails in terms of fracture union and functional status [48]. Kayali et al. did not find any statistically significant difference between two groups of patients treated with either an intramedullary nail or locking plate [42]. However, patients treated with an intramedullary nail can have symptoms of anterior knee pain which can be as high as 29% [67]. In these cases, even if the nail is removed, 50% have persistent anterior knee pain. The tibia is a subcutaneous bone and distal part of this bone has limited muscle attachments, thus making it prone to delayed and non-unions. One of the most challenging varieties of distal tibial injuries are pilon fractures. These fractures involve distal tibial metaphysis with intra articular extension into the ankle joint. A number of different devices are available for the treatment of these fractures namely conventional plates and screws and external fixation. Complications range from 20-50% [49]. Joveniaux et. al. reported an overall 30% complication rate of conventional plating, limited internal fixation using screws/Kwires and external fixation in distal tibial fractures [40]. Whereas Hazarika et al. showed better results using LISS plate and 10% non-union rate [37]. Hasenboehlr et al. also showed comparable results with LCP used in a minimally invasive fashion [36]. In this study, two out of three non-unions were seen in patients with history of peripheral vascular disease and chronic alcohol abuse with heavy smoking. The high profile of the locking plate with limited soft tissue cover over distal tibia can result in pressure ulcers or hardware irritation requiring removal [36].

Peri-prosthetic Fractures

The incidence of peri-prosthetic fractures is only 0.3% to 2.5% [21]. These fractures pose a grave challenge to trauma surgeons as they are difficult to treat requiring lot of experience and novel approaches. Due to the presence of previous implant, there is already limited bone available to achieve fracture stability. Also the presence of cement can make it extremely difficult and often impossible to use intramedullary devices in the treatment of these fractures. Locking plates have been found to be an effective option in the treatment of these fractures particularly using MIPO technique. LCP is commonly used for proximal femoral periprosthetic fractures and LISS for the distal ones. These plates when applied using minimally invasive technique preserve periosteal circulation allowing biological fixation. In order to avoid compromising the cement mantle or prosthesis, unicortical locking screws can be used. This can be further augmented by the use of cerclage wires [11,69]. Those authors who have employed minimally invasive techniques have shown lower implant failure and non-union rates. Buttaro, et al. used LCP for Vancouver type B1 fractures using open technique [11]. He noticed 43% implant failure in those fractures where LCP was not augmented with cerclage wire and strut graft and recommends this combination. He attributes implant failure secondary to extensive soft tissue stripping thus compromising bone healing. According to a systematic review by Smith, et al. the non-union rate of LISS plate for distal femur peri-prosthetic fractures was 3.5% [61]. A meta-analysis of 195 periprosthetic fractures showed a complication rate as high as 30% [14]. Kobbe, et al. conducted a midterm follow up of patients with peri-prosthetic fractures treated with LISS plate and found Harris hip score of 79.5% [44]. He also noted two cases (13%) of screw pull out. The study by Kregor et al. on supracondylar fractures around total knee arthroplasty showed complete unions in all the treated patients with LISS plate [46]. There was no incidence of screw pull out in his study. Several other case series have shown benefit of locking plates in fixing periprosthetic fractures [26,27,28,68].

CONCLUSION

Locking plates were developed to overcome the problems associated with fracture management of osteoporotic bones. Locking plates are part of the evolution of extra-medullary techniques to preserve biology, allow controlled movement (relative stability), encourage fracture healing and yet still allow early mobilization [49]. The superiority of locking plates has been proven by many biomechanical studies. Although some clinical trials have shown benefit, conclusive evidence is still lacking. This is due to the relative lack of good high powered randomised control trials. Even systematic reviews have failed to give a final verdict due to the lack of well controlled studies. The literature supports using locking plates for fixation of periarticular fractures of long bones, multifragmentary fractures of diaphysis & metaphysis and periprosthetic fractures. Ultimately, locking plates are not the panacea for all type of fractures. As clinical experience with locking plate broadens, new indications and applications will emerge. Overall, surgeons have started using these devices confidently in treating fractures and with time more evidence will be generated to further define the role of locking plates in the treatment of fractures. Until then, the treatment choice is still largely based on surgeon?s preference.

ACKNOWLEDGMENTS

We acknowledge the valuable comments of Mr Robert Smith, Consultant Orthopaedic Surgeon, Wrightington, Wigan and Leigh NHS Trust in the preparation of this review article.

 

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58. Sarmiento A, Kinman PB, Galvin EG, Schmitt RH, Phillips JG. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am 1977;

59(5):596-601. 59. Schatzker J, Home G, Waddell J. The Toronto experience with the supracondylar fracture of the femur. Injury 1974; 6(2):113-28.

60. Schütz M, Müller M, Krettek C, Höntzsch D, Regazzoni P, Ganz R, Haas N. Minimally invasive fracture stabilization of distal femoral fractures with the LISS: a prospective multicenter study. Results of a clinical study with special emphasis on difficult cases. Injury 2001; 32( 3):48-54.

61. Smith TO, Hedges C, MacNair R, Schankat K, Wimhurst JA. The clinical and radiological outcomes of the LISS plate for distal femoral fractures: A systematic review. Injury 2009; 40(10):1049-63.

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63. Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, Luo C, Plecko M, Wendt K, Köstler W, Konrad G. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 2009; 91(6):1320-8.

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Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11
A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
A Study by Zahoor Illahi Soomro et al. entitled "Functional Outcomes of Fracture Distal Radius after Fixation with Two Different Plates: A Retrospective Comparative Study" is awarded Best Article for Vol 14 issue 05
A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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