Search

Abstract Background Distal femoral fractures account for less than 1% of all fractures. The therapy of choice is usually surgical stabilization. Despite advances in implant development over the past few years, complication rate remains comparatively high. The aim of this study is to analyze our results with plate fixation of distal femoral fractures with a focus on complication and fracture healing rates. Methods In this retrospective cohort study, patients (> 18 years) with distal femoral fractures treated at an urban level I trauma center between 2015 and 2022 were analyzed. Results In total, 206 patients (167 female, 39 male) with an average age of 75 (SD 16) years were diagnosed with a fracture of the distal femur. One hundred fourteen of these patients were treated surgically by means of plate osteosynthesis. In 13 cases (11.41%), a revision procedure had to be performed. The indication for surgical revision was mechanical failure in eight cases (7.02%) and septic complication in five cases (4.39%). Periprosthetic fractures were more likely to cause complications overall (19.6% versus 4.76%) and further included all documented septic complications. The analysis of modifiable surgical factors in the context of plate osteosynthesis showed higher complication rates for cerclage in the fracture area compared with plate-only stabilizations (44.44% versus 22.22%). Conclusions The data show an increased amount of revisions and a significantly higher number of septic complications in the treatment of periprosthetic fractures of the distal femur compared with non-periprosthetic fractures. The detected combination of plates together with cerclage was associated with higher complication rates. Level of evidence Level III retrospective comparative study.

Background: Distal femoral fractures account for less than 1% of all fractures. The therapy of choice is usually surgical stabilization. Despite advances in implant development over the past few years, complication rate remains comparatively high. The aim of this study is to analyze our results with plate fixation of distal femoral fractures with a focus on complication and fracture healing rates. Methods: In this retrospective cohort study, patients (> 18 years) with distal femoral fractures treated at an urban level I trauma center between 2015 and 2022 were analyzed. Results: In total, 206 patients (167 female, 39 male) with an average age of 75 (SD 16) years were diagnosed with a fracture of the distal femur. One hundred fourteen of these patients were treated surgically by means of plate osteosynthesis. In 13 cases (11.41%), a revision procedure had to be performed. The indication for surgical revision was mechanical failure in eight cases (7.02%) and septic complication in five cases (4.39%). Periprosthetic fractures were more likely to cause complications overall (19.6% versus 4.76%) and further included all documented septic complications. The analysis of modifiable surgical factors in the context of plate osteosynthesis showed higher complication rates for cerclage in the fracture area compared with plate-only stabilizations (44.44% versus 22.22%). Conclusions: The data show an increased amount of revisions and a significantly higher number of septic complications in the treatment of periprosthetic fractures of the distal femur compared with non-periprosthetic fractures. The detected combination of plates together with cerclage was associated with higher complication rates. Level of evidence Level III retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background: Functional recovery following the surgical fixation of acetabular posterior wall fractures remains a challenge. This study compares outcomes of posterior wall fracture reconstruction using an anatomical posterior acetabular plate (APAP) versus conventional reconstruction plates. Methods: Forty patients with acetabular fractures involving the posterior wall or column underwent surgery, with 20 treated using APAPs (APAP group) and 20 with conventional pelvic reconstruction plates (control group). Baseline patient characteristics, intraoperative blood loss and time, reduction quality, postoperative function, and postoperative complications were compared using appropriate non-parametric statistical tests. A general linear model for repeated measures analysis of variance was employed to analyze trends in functional recovery. Results: No significant differences were observed in baseline characteristics. APAP significantly reduced surgical time by 40 min (186.5 ± 51.0 versus 225.0 ± 47.7, p =0.004) and blood loss (695 ± 393 versus 930 ± 609, p = 0.049) compared to conventional plates. At 3 and 6 months following surgery, the APAP group exhibited higher functional scores (modified Merle d'Aubigné scores 10 ± 1.8 versus 7.8 ± 1.4, p < 0.001; 13.4 ± 2.8 versus 10.1 ± 2.1, p = 0.001), converging with the control group by 12 months (modified Merle d'Aubigné scores 14.2 ± 2.6 versus 12.7 ± 2.6, p = 0.072; OHS 31.6 ± 12.3 versus 30.3 ± 10.1, p = 0.398). Radiologically, the APAP group demonstrated superior outcomes (p = 0.047). Complication and conversion rates to hip arthroplasty did not significantly differ between groups (10% versus 15%, p = 0.633). Conclusions: The use of an APAP in reconstructing the posterior acetabulum significantly reduces surgical time, decreases intraoperative blood loss, and leads to earlier functional recovery compared to conventional reconstruction plates. The APAP provides stable fixation of the posterior wall and ensures the durable maintenance of reduction, ultimately yielding favorable surgical outcomes. [ABSTRACT FROM AUTHOR]

Refracture at the same site after implant removal is a rare complication, as fractures generally occur close to the plate end due to stress concentration. The reported case involves a patient with refractures of forearm bones at the previous site three months after implant removal. A 48-year-old, right-handed man complained of pain and swelling in his right hand after falling on a wet floor. He had a history of a similar injury three years earlier and was treated with plate osteosynthesis. The plates were removed three months before the present trauma. Radiographs revealed fractures of the distal one-third radius and distal one-fourth of the ulna with evidence of previous screw holes. He has been treated with a Low-contact Dynamic Compression Plate (LCDCP) and remains under follow-up. Refracture three months after implant removal at the site of the previous fracture site in both bones is a very rare occurrence and the present case report highlighted the importance of making a proper decision regarding union, when considering implant removal and post-implant removal care.

Abstract Background The use of continuous passive motion therapy (CPM) has led to promising results in the early phase of rehabilitation after surgical treatment of rotator cuff tears and arthrolysis of the elbow. However, its use has not been proven in other pathologies of the upper extremity. Therefore, the aim of the underlying study was to evaluate the use of CPM therapy after plate osteosynthesis of proximal humeral fractures. Methods 95 patients with isolated proximal humerus fractures were enrolled in a prospective, randomized study. Patients were assigned to a treatment group with (n = 48, CPM) or without CPM therapy (n = 47, CG). Four patients (2 of each cohort) violated the study protocol and were excluded. CPM therapy was used for 6 weeks after surgery 2–3 times daily. Functional (range of motion) and patient reported outcomes (PROM, Constant Score [CSS], QuickDASH, subjective shoulder value [SSV], pain on visual analogue scale [VAS]) were evaluated at 6 weeks, 3 and 12months. 60 patients completed the 1-year follow-up. Results The average patient age was 65.3 years (min: 27, max: 88, SD: ± 14.7). Seventy-two patients were female (79%). There was no difference regarding injury severity (2/3/4 part-fracture: 6/32/7 vs. 9/26/11, p = 0.867) and sex (p = 0.08). However, patients in the CPM group were significantly younger (CPM: 67 [min: 34, max: 82], CG: 74 [min: 27, max: 88], p = 0.032). After 6 weeks we observed a better range of motion for forward flexion (CPM: 90° [min: 50°, max: 180°] vs. CG: 80° [min: 20°, max: 170°] p = 0.035) and abduction (CPM: 80° [min: 40°, max: 180°] vs. CG: 70° [min: 20°, max: 180°], p = 0.048) in the CPM group. There was no difference regarding the further planes of motion or the assessed PROMs at 6 weeks. At 3 and 12 months the results between the treatment groups equalized with no further significant differences. Conclusion The treatment with CPM increases the range of motion after plate osteosynthesis of proximal humerus fractures in the first 6 weeks after surgery. This effect is not sustained after 3 and 12months. The evaluated PROMs are not being influenced by CPM therapy. Hence the results of this prospective randomized study suggest that CPM can be a beneficial asset in the early period of rehabilitation after proximal humerus plate osteosynthesis. Trial registration The study protocol was registered in the US National Institutes of Health’s database ( http://www.clinicaltrials.gov ) registry under NCT 05952622.

Background: The use of continuous passive motion therapy (CPM) has led to promising results in the early phase of rehabilitation after surgical treatment of rotator cuff tears and arthrolysis of the elbow. However, its use has not been proven in other pathologies of the upper extremity. Therefore, the aim of the underlying study was to evaluate the use of CPM therapy after plate osteosynthesis of proximal humeral fractures. Methods: 95 patients with isolated proximal humerus fractures were enrolled in a prospective, randomized study. Patients were assigned to a treatment group with (n = 48, CPM) or without CPM therapy (n = 47, CG). Four patients (2 of each cohort) violated the study protocol and were excluded. CPM therapy was used for 6 weeks after surgery 2–3 times daily. Functional (range of motion) and patient reported outcomes (PROM, Constant Score [CSS], QuickDASH, subjective shoulder value [SSV], pain on visual analogue scale [VAS]) were evaluated at 6 weeks, 3 and 12months. 60 patients completed the 1-year follow-up. Results: The average patient age was 65.3 years (min: 27, max: 88, SD: ± 14.7). Seventy-two patients were female (79%). There was no difference regarding injury severity (2/3/4 part-fracture: 6/32/7 vs. 9/26/11, p = 0.867) and sex (p = 0.08). However, patients in the CPM group were significantly younger (CPM: 67 [min: 34, max: 82], CG: 74 [min: 27, max: 88], p = 0.032). After 6 weeks we observed a better range of motion for forward flexion (CPM: 90° [min: 50°, max: 180°] vs. CG: 80° [min: 20°, max: 170°] p = 0.035) and abduction (CPM: 80° [min: 40°, max: 180°] vs. CG: 70° [min: 20°, max: 180°], p = 0.048) in the CPM group. There was no difference regarding the further planes of motion or the assessed PROMs at 6 weeks. At 3 and 12 months the results between the treatment groups equalized with no further significant differences. Conclusion: The treatment with CPM increases the range of motion after plate osteosynthesis of proximal humerus fractures in the first 6 weeks after surgery. This effect is not sustained after 3 and 12months. The evaluated PROMs are not being influenced by CPM therapy. Hence the results of this prospective randomized study suggest that CPM can be a beneficial asset in the early period of rehabilitation after proximal humerus plate osteosynthesis. Trial registration: The study protocol was registered in the US National Institutes of Health's database (http://www.clinicaltrials.gov) registry under NCT 05952622. [ABSTRACT FROM AUTHOR]

Titanium as the leading implant material in locked plating is challenged by polymers such as carbon fiber-reinforced polyetheretherketone (CFR-PEEK), which became the focus of interest of researchers and manufacturers in recent years. However, data on human tissue response to these new implant materials are rare. Osteosynthesis plates and peri‑implant soft tissue samples of 16 healed proximal humerus fractures were examined (n = 8 CFR-PEEK, n = 8 titanium). Soft tissue was analyzed by immunohistochemistry and µCT. The entrapped foreign bodies were further examined for their material composition by FTIR. To gain insight into their origin and formation mechanism, explanted and new plates were evaluated by SEM, EDX, profilometry and HR-CT. In the peri‑implant soft tissue of the CFR-PEEK plates, an inflammatory tissue reaction was detected. Tissues contained foreign bodies, which could be identified as tantalum wires, carbon fiber fragments and PEEK particles. Titanium particles were also found in the peri‑implant soft tissue of the titanium plates but showed a less intense surrounding tissue inflammation in immunohistochemistry. The surface of explanted CFR-PEEK plates was rougher and showed exposed and broken carbon fibers as well as protruding and deformed tantalum wires, especially in used screw holes, whereas scratches were identified on the titanium plate surfaces. Particles were present in the peri‑implant soft tissue neighboring both implant materials and could be clearly assigned to the plate material. Particles from both plate materials caused detectable tissue inflammation, with more inflammatory cells found in soft tissue over CFR-PEEK plates than over titanium plates. Osteosynthesis plates are ubiquitously used in various medical specialties for the reconstruction of bone fractures and defects and are therefore indispensable for trauma surgeons, ENT specialists and many others. The leading implant material are metals such as titanium, but recently implants made of polymers such as carbon fiber-reinforced polyetheretherketone (CFR-PEEK) have become increasingly popular. However, little is known about human tissue reaction and particle generation related to these new implant types. To clarify this question, 16 osteosynthesis plates (n = 8 titanium and n = 8 CFR-PEEK) and the overlying soft tissue were analyzed regarding particle occurrence and tissue inflammation. Tissue inflammation is clinically relevant for the development of scar tissue, which is discussed to cause movement restrictions and thus contributes significantly to patient outcome. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss – all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical reposition of multifragmentary fractures followed by increased risks of non-union are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of non-union and wound infection, as well as blood loss and time of surgery. Methods: According to the PRISMA guidelines we conducted this systematic review by searching the Cochrane, PubMed, Ovid, MedLine, and Embase databases. Inclusion criteria were the modified Coleman methodology score (mCMS) >60, age >18 years, and extra-articular fractures of the distal femur. Biomechanical and animal studies were excluded. By referring to title and abstract relevant articles were reviewed independently. In the consecutive meta-analysis, we compared 9 studies and 639 patients. Results: There is no statistically significant difference comparing superficial wound infections when RIMN was performed (OR = 0.50; 95% CI: 0.18 – 1.42; P = 0.19) as well as in deep wound infections (OR = 0.74; 95% CI: 0.19–2.81; P = 0.62). However, these results were not significant. We also calculated for potential differences in the rate of non-unions depending on the surgical treatment applied. Data of 556 patients revealed an overall number of 43 non-unions. There was no significant difference in rate of non-unions between both groups (OR = 0.97; 95% CI: 0.51–1.85; P = 0.92). Conclusion: No statistical difference was found in our study among RIMN and plate fixation in the treatment of distal femoral fractures with regard to the incidence of non-union and wound infections. Therefore, the indication for RIMN or plating should be made individually and based on the surgeon’s experience.

Refracture at the same site after implant removal is a rare complication, as fractures generally occur close to the plate end due to stress concentration. The reported case involves a patient with refractures of forearm bones at the previous site three months after implant removal. A 48-year-old, right-handed man complained of pain and swelling in his right hand after falling on a wet floor. He had a history of a similar injury three years earlier and was treated with plate osteosynthesis. The plates were removed three months before the present trauma. Radiographs revealed fractures of the distal one-third radius and distal one-fourth of the ulna with evidence of previous screw holes. He has been treated with a Low-contact Dynamic Compression Plate (LCDCP) and remains under follow-up. Refracture three months after implant removal at the site of the previous fracture site in both bones is a very rare occurrence and the present case report highlighted the importance of making a proper decision regarding union, when considering implant removal and post-implant removal care. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim: The aim of this study was to evaluate the functional and radiological results of patients who underwent plate osteosynthesis with the deltopectoral approach in proximal humerus fractures, according to the intact shoulder. Materials and Methods: Our study included 33 patients who underwent proximal humeral anatomic locking plate with deltopectoral approach due to proximal humeral fracture (PHF) between 2015 and 2017. Patients over 18 years of age, with closed humeral fractures, and with intact contralateral humerus and shoulder were included in our retrospective study. The functional results between the operated and healthy sides of the patients were evaluated by comparing the Constant-Murley score and radiological results with the full anteroposterior radiography and the collodiaphyseal angles. Results: According to the Constant Murley scoring categorical data structure of the patients, the operated side was 6.1% (n=2) poor, 6.1% (n=2) moderate, 39.4% (n=13) good, 48.5% (n=16) excellent, while the healthy side was %. Results were 0 (n=0) poor, 3% (n=1) moderate, 30.3% (n=10) good, and 66.7% (n:22) excellent. According to the Constant Murley scoring categorical data structure, a statistical difference was found between the operated side and the healthy side (p>0.05). While the mean Constant Murley score of the operated side was 85.82 ± 7.07, the mean Constant Murley score of the healthy side was 90.67 ± 5.76. While the average of the collodiaphyseal angles of the operated side was 130.03± 4.64; the mean of the angles of the intact side is 135.64 ± 5.04. In terms of Constant Murley shoulder scores and collodiaphyseal angle values of the patients; a statistical difference was observed between the operated side and the healthy side (p

Background. The most severe type of injuries of the proximal epiphysis of the humerus are intraarticular fractures. One of the main complication is the development of avascular osteonecrosis, which is caused by the peculiarities of blood supply of the humeral head and its compromised vascularization as a result of trauma. Current osteosynthesis techniques for intraarticular fractures of the proximal humerus (PH) do not reduce the risk of avascular osteonecrosis of the humeral head (AONHH) and do not reduce the risk of nonunion. To prevent ischemic changes in the humeral head, osteosynthesis with reparative osteogenesis stimulation is recommended. Aim of the study to specify indications for various fixation techniques of intraarticular fractures of the proximal humerus. Methods. The study enrolled 48 patients with AO/ASIF type 11C1 and 11C2 intraarticular PH fractures requiring surgical treatment. All patients were allocated into 2 groups. Retrospective (control) group included 25 patients who were treated using locking plate osteosynthesis or intramedullary locking osteosynthesis with proximal humeral nails. Prospective (main) group included 23 patients who were additionally treated with a vascularized musculoskeletal graft from the coracoid process of the scapula transplanted to the fracture area. Results. Functional treatment results of patients who underwent surgery using vascularized musculoskeletal grafts from the coracoid processes of the scapula (71.50% were excellent and 14.3% were good) were better than those of the control group (35.28% were excellent and 17.64% were good). Consolidation of the fracture in the control group occurred in 92% of cases (23 patients); the remaining 8% (2) of patients had pseudoarthrosis of the anatomical or surgical neck of the humerus developed within 6 months after the surgery. In the main group, the fractures consolidated in all patients. Conclusion. Fractures with no damage to the bicipital groove should be considered an indication for performing plate osteosynthesis without vascularized musculoskeletal grafting. Locking osteosynthesis in case of intraarticular PH fractures makes it much more difficult to reduce the humeral head and the tubercular area. Locking osteosynthesis decreases the rigidity of fixation of fragments, which may contribute to their secondary displacement.

Background: Plate osteosynthesis for the tibial fracture is one of the alternative treatments with satisfactory outcomes. Appropriate surgical techniques, including an open or minimally invasive approach, absolute or relative stability regarding fracture characteristics, and construct stiffness, could lead to proper fracture healing. However, in some circumstances the nonunion might be a problem. The treatment of the healing disturbance is challenging as more complex procedures, such as compression plating, bone grafting, or conversion to nailing, are considered. Dynamization, which aims to optimize the rigidity of the construct, was an alternative to stimulate bone healing. Case: We present two cases of tibial nonunion following open reduction internal fixation (ORIF) with plating. The dynamization concept by percutaneously removing screws close to the fracture site to reduce fixation stiffness for appropriate relative stability, promote callus formation, and facilitate fracture healing without additional bone grafting. This simple procedure could be an alternative option in selected healing problem cases. Conclusion: These cases highlight the importance of considering fixation construct rigidity in fracture management. Too rigid fixation with a simple fracture gap or in comminuted fracture led to delayed healing. Dynamization of plating should be considered when delayed healing is related to the fixation construct's stiffness. Screw removal, as demonstrated in this case report, can be done under local anesthesia as a simple procedure to stimulate fracture healing before more complex surgical options. However, individualized analysis of nonunion causes is essential for successful bone healing.

Background: Diaphyseal forearm fracture is one of the most commonly encountered fractures of the upper extremity. The literatures comparing the outcome of plate fixation and intramedullary nailing in adults are scarce and therefore the consensus on superiority of one over the other is lacking. This study was undertaken to compare the outcome of these operative techniques in adults with diaphyseal fracture of both bone forearm. Aims and Objectives: This study was undertaken to compare the outcome of plate fixation and intramedullary nailing in adults with diaphyseal fracture of both bone forearm. Materials and Methods: Patients of 18–70 years of age, with diaphyseal fractures of both bones of the forearm of

Background: Humeral shaft fracture management has always been controversial. There are proponents for both conservative and operative management with intramedullary nailing as well as plate osteosynthesis. Anteromedial plating of shaft fractures has not been regularly described. This study was conducted to evaluate the viability of anteromedial plating as an alternative to anterolateral and posterior plating for diaphyseal humerus fractures. Materials and Methods: The study was conducted at a tertiary care center. Inclusion criteria comprised: age more than 18 years, and diaphyseal humerus fracture treated with anteromedial plating using the anterolateral approach with a minimum follow-up of 6 months. Exclusion criteria included: pathological fracture, grade open III fractures, nonunion, intra-articular fractures, preoperative radial nerve palsy, nonconsent, and loss to follow-up. Functional outcome was evaluated at 6 months using the QuickDASH score. Results: Out of 44 volunteers, 28 (64%) were male and 16 (36%) were female. The mean age of the volunteers was 36 ± 13 years. The most common fracture type encountered was 12-A2 (41%). The mean operative time was 61.27 ± 10.3 min, and the mean perioperative blood loss was 308 cm3. The mean time for the radiological union was 13.9 weeks. One patient developed postoperative radial nerve palsy. The mean DASH score at 6 months was 13.5 ± 3.2. Conclusion: Anteromedial plating humerus using anterolateral approach provides a safe and viable alternative to lateral and posterior plating with regard to operative time, perioperative blood loss, complications, and functional recovery.

Abstract Background Patella fractures account for approximately 1% of all skeletal injuries. Treatment options are vast and no definitive conclusion on what option is the most beneficial could be made so far. Plate osteosynthesis appears to gain in importance. We aim to give insight into the more recent trends and developments as well as establish the epidemiology of patella fractures in Germany by analysing treatment and epidemiological data from a national database. Methods Anonymised data was retrieved form a national database. In the period of 2006 to 2020, all patients with patella fractures as defined in ICD-10 GM as their main diagnosis, who were treated in a German hospital were included. Patients were divided into subgroups based on gender and age. Age groups were created in 10-year intervals from 20 years old up to 80 years old with one group each encompassing all those above the age of 80 years old and below 20 years old and younger. Linear regression was performed were possible to determine statistical significance of possible trends. Results A total of 151,435 patellar fractures were reported. 95,221 surgical interventions were performed. Women were about 1.5 times more likely to suffer from patella fracture than men. The relative number of surgical interventions rose from about 50% in 2006 to 75% in 2020. Most surgical interventions are performed in those over the age of 50. The incidence of complex fractures and plate osteosynthesis has significantly increased throughout the analysed period. Conclusions We found a clear trend for surgical treatment in Germany with an increase in surgical procedures. We could also show that this ratio is age-related, making it more likely for younger patients in the age groups from 0 to 70 years old to receive surgical treatment for their patella fracture.

RELEVANCE. The surgical treatment of patients with diaphyseal forearm fractures has a variety of methods and requires a precision technique. The need for postoperative immobilization after osteosynthesis of diaphyseal fractures remains a controversial issue, since osteosynthesis failure and the formation of a pseudoarthrosis are sometimes observed.In addition, very little information about the role of the interosseous membrane in the rotational function of the forearm during osteosynthesis is available in the literature.The OBJECTIVE was to determine the forces occurring during rotational movements of the forearm that lead to the above complications.METHODS AND MATERIALS. The clinical part included the results of surgical treatment of 330 patients with diaphyseal fractures of the forearm; it consisted of the main group (170 - interlocking osteosynthesis) and the comparison group (138 - plate osteosynthesis). The third group consisted of 22 patients with complications of surgical treatment of diaphyseal fractures of the forearm. We performed a comparative assessment of plate and interlocking osteosynthesis of radial bone fractures by mathematical modelling to determine the forces occurring during forearm rotation that lead to nonunion, instability and plate fractures.RESULTS. In the main group, healing was achieved in all (170 patients), in the comparison group, healing was achieved in 128 (92.8 %), consolidation was achieved in all 22 patients with fracture complications who underwent reconstruction. A comparative assessment revealed that during plate osteosynthesis, zones of high stress concentration were located around the plate opening above the area of fracture and the nearest to it holes from both sides. In interlocking osteosynthesis of the radius, the stresses are evenly distributed around the nail. Pronation-supination movements with an amplitude of (±90)°, according to the experimental results, should lead to the destruction of the cortical plate fairly soon after implantation, while the nail made of ultra-fine Ti-6Al-7Nb alloy will maintain its integrity.CONCLUSION. Based on these findings, external immobilization is advisable to avoid complications such as osteosynthesis instability or plate fracture.

Background. Fractures of the proximal humerus are common injury, especially among older age group patients. For the treatment of most cases, conservative tactics are required, some require surgery: osteosynthesis, arthroplasty. Proximal humerus fractures with extension to the metadiaphyseal and diaphyseal zones uncommon, and treatment of this type of injuries is complex for trauma surgeons. The aim of the study is to demonstrate successful experience of two-stage treatment of the proximal humerus fracture with extension to the diaphysis middle third in an older age group patient. Case presentation. The clinical case presents successful two-stage treatment of the proximal humerus fracture with extension to the middle third of the diaphysis in an older age group patient. The first stage was performed osteosynthesis of the humerus with the PHILOS Long plate, the second stage reverse shoulder arthroplasty. Conclusion. Consistent performing of osteosynthesis and total reverse shoulder arthroplasty allows to achieve satisfactory treatment results with restoration of the injured limb function and relief of pain syndrome.

Abstract Background Distal ulna head or neck fracture is commonly associated with distal radius fracture. Treatment of these fractures remains controversial. Plate osteosynthesis is commonly performed. The purpose of this study was to observe clinical and radiological outcomes in ulna hook plate osteosynthesis for distal ulna fracture associated with distal radius fracture. Materials and methods This retrospective study between 2010 and 2018 included patients presenting combined displaced distal ulna fracture and distal radius fracture who were treated with ulna hook plate osteosynthesis. Patient evaluation included pain measurement with the visual analog scale, wrist range of motion, grip and pinch strengths, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and Mayo wrist score. Preoperative radiographs were reviewed to classify the distal ulna fracture according to Biyani. Bone union was evaluated on postoperative X-rays. At final follow-up, the usual radiographic parameters were measured and distal radioulnar joint (DRUJ) osteoarthritis was assessed. Results A total of 48 patients were included. Mean age was 63 years old and mean follow-up was 28 months. According to the Biyani classification, there were 12 type I, 4 type II, 8 type III, and 24 type IV distal ulna fractures. Wrist flexion was 60°, extension 57°, pronation 85°, and supination 80°. Grip strength was 21 kg (86% of the uninjured opposite side). Pinch strength was 6.6 kg (92% of the uninjured opposite side). Clinical scores were very good to excellent, with a mean Q-DASH of 12 and a Mayo wrist score of 90. Discomfort or pain due to the implant that required implant removal was reported in 29%, and was higher in younger patients. Nonunion was observed in two cases and secondary implant displacement in one case. These three cases required secondary intervention with ulna head resection, which was higher in Biyani type IV. DRUJ osteoarthritis was observed in 12 patients (31%) and was higher in older patients. Conclusions Ulna hook plate fixation gives good clinical results and a high rate of fracture union, but complications are common. Implant irritation is a frequent complication, especially in young patients, and often requires implant removal. Level of evidence: IV

Background: Diaphyseal forearm fracture is one of the most commonly encountered fractures of the upper extremity. The literatures comparing the outcome of plate fixation and intramedullary nailing in adults are scarce and therefore the consensus on superiority of one over the other is lacking. This study was undertaken to compare the outcome of these operative techniques in adults with diaphyseal fracture of both bone forearm. Aims and Objectives: This study was undertaken to compare the outcome of plate fixation and intramedullary nailing in adults with diaphyseal fracture of both bone forearm. Materials and Methods: Patients of 18-70 years of age, with diaphyseal fractures of both bones of the forearm of <21 days old, were recruited. Patients were randomly allocated to two treatment groups: intramedullary nailing and plate osteosynthesis. Patients were followed up at 4th week, 12th week, and 24th week post-operative period. Functional outcome was measured at the end of 24th week based on the Clinical and Radiological parameters by Anderson et al., Score, Grace-Eversman Score, and Disabilities of the Arm, Shoulder and Hand (DASH) Score. Results: This study comprised of 40 cases (n=40) who completed the follow-up period of 24 weeks. Most of the patients treated with plate (80%) demonstrated excellent outcome as per Anderson et al., score while the outcome was unsatisfactory in 50% of those treated with nails. About 90% of the patients of plate group had excellent result in contrast to 50% in case of nail group following Grace Eversman criteria. Considering DASH score, the former group showed mostly excellent (40%) and good (45%) outcome while the latter exhibited mostly fair (55%) and good (30%) result. Conclusion: It may be stated that plate osteosynthesis is a better option in the treatment of diaphyseal fracture of both bones forearm in adults. [ABSTRACT FROM AUTHOR]

Distal humeral fractures are challenging injuries seen in the elderly. Open reduction and internal fixation (ORIF) are the gold standard treatments. Total elbow arthroplasty (TEA) is an alternative to ORIF. This study aimed to pool and analyze the outcomes and complications in elderly patients with distal humeral fractures treated with either ORIF or TEA by performing a meta-analysis. We searched the PubMed, Embase, Google Scholar, and Cochrane Library databases for studies that compared the clinical and functional outcomes of ORIF and TEA in patients aged 60 years or older. After screening and performing a quality assessment of the articles, we obtained one randomized control study and nine retrospective comparative studies. The odds ratio and standardized mean difference were used to analyze the differences in outcomes between the two surgical options. In terms of the flexion/extension arc, TEA produced significantly better outcomes than ORIF (p = 0.02). The rates of reoperation and elbow stiffness were significantly lower in the TEA group than in the ORIF group (p = 0.003 and p = 0.04, respectively). However, the functional scores and other ranges of motion (flexion, loss of extension, pronation, supination) after surgery were similar between the two groups. The outcomes from the present meta-analysis can provide guidance when selecting a surgical option for distal humeral fractures in the elderly. [ABSTRACT FROM AUTHOR]

Introduction: Proximal humerus fractures are prevalent, especially among the elderly, and pose significant challenges in treatment, particularly for displaced fractures. Despite the availability of various surgical techniques, outcomes remain inconsistent, often due to poor anatomical reduction and fixation. This study examines the correlation between specific radiographic parameters and functional outcomes, aiming to identify key predictors of recovery. By focusing on these parameters, we aim to refine surgical approaches and improve follow-up strategies, ultimately enhancing patient outcomes., Materials and Methods: A retrospective study involved 40 patients aged 18-75 with proximal humerus fractures, treated with open reduction and plate fixation at Chettinad Hospital between April 2022 and April 2024. All surgeries were performed through anterior deltopectoral approach. Radiographic parameters were evaluated postoperatively, with patients followed for a period of 1 year. Functional outcomes were correlated with radiological parameters using follow-up radiographs and Constant-Murley (C-M) scores., Results: In this study of 40 patients with proximal humerus fractures, the mean age was 53.24 years, and the majority (60%) were male. The fractures predominantly affected the right side (62.5%), with road traffic accidents and falls being the leading causes. Neer's classification identified 10 patients with two-part fractures, 21 with three-part fractures, and 9 with four-part fractures. The average neck-shaft angle (NSA) was 138.62° ± 11.09°. Four patients with an NSA of ≤120° had fair to good functional outcomes, while those with an NSA >130° and a well-positioned greater tuberosity (GT) generally had better outcomes. The average distance between the GT and the acromion surface (AS) was 6 mm ± 1.4 mm, influencing shoulder abduction and functional results. Patients with an alpha/beta ratio below 1.40 mm, indicating lower bone density, had a higher incidence of screw cut-out. The mean C-M score at 6 months was 80.72, with 87.5% of patients achieving abduction above 90°. Complications occurred in 8 patients (20%), including varus collapse (10%), abduction <90° (12.5%), infection (2.5%), and screw cut-out (5%). Larger head diameters and heights were associated with better functional scores., Conclusion: Radiographic parameters such as the NSA, GT to AS distance, head diameter, head height, and alpha/beta ratio are crucial predictors of functional outcomes in proximal humerus fractures treated with PHILOS plates. Accurate reduction and medial column stabilization are a key to minimizing complications and improving patient recovery. Despite generally positive outcomes, challenges such as screw cut-out and varus collapse persist, highlighting the need for meticulous surgical technique and thorough post-operative management., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Tibial plateau fractures, which constitute approximately 1% of all fractures with an incidence of 10.3/100,000 annually, result from varus or valgus forces combined with axial loading in the knee. These fractures display a bimodal distribution, affecting younger individuals through high-velocity trauma and older individuals through low-energy trauma. Proper management is critical due to the tibial plateau's role as a load-bearing surface; inadequate treatment can lead to functional impairment and early osteoarthritis. Utilizing the Schatzker classification, this study categorizes tibial plateau fractures to streamline treatment and reproducibility., Objectives: The objective of the study was to assess the functional and radiological outcomes in the patients operated with arthroscopic assisted reduction and internal fixation (ARIF)., Materials and Methods: This prospective analytical study conducted at a tertiary care hospital evaluates the functional and radiographic outcomes of 20 patients with Schatzker Type 1-4 tibial plateau fractures treated using ARIF. Patients excluded were those with Schatzker Type 5 and 6 fractures due to the increased risk of compartment syndrome from fluid extravasation during arthroscopy. Surgical procedures aimed to achieve anatomical reduction, proper alignment, stable fixation, early mobilization, and minimal soft-tissue damage., Results: The study conducted in the cohort which constituted of 20 patients with a mean age of 44.3 years with 9 males and 11 females and fracture distribution being Schatzker 1/2/3/4: 3/5/10/2, respectively, found ARIF advantageous in diagnosing and treating articular cartilage and soft-tissue injuries, minimizing soft-tissue dissection, and reducing the need for extensive arthrotomy. The results demonstrated good to excellent outcomes in 85% of patients, with no depression in 70% of cases and no varus/valgus malalignment in 80% of cases after 18 months. However, the technique posed challenges such as increased operative time and a steep learning curve., Conclusion: ARIF had favorable radiological and functional outcomes in the patient who was selected after careful evaluation., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Infected gap non-union is a serious complication seen in cases of diaphyseal fracture of forearm bones. It carries high morbidity in the form of severe functional impairment and poses a challenge to treat due to the complex anatomical relationship and articulations involved. Though there are multiple treatment options available, there are no guidelines for its management. Each case is unique and requires a customized, patient-specific approach., Case Report: A 43-year-old man sustained a road traffic accident with closed both bone forearm fracture 6 months ago and was treated elsewhere with open reduction plate fixation of the radius, and Kirchner wire fixation of the ulna at an outside centre. Subsequently, he developed a purulent discharging sinus from the surgical site. After 7 months, following a trivial injury, the patient developed a deformity in his forearm. X-ray findings revealed a bent radial plate, signs of osteolysis, implant loosening along with displaced shaft of ulna fracture. The patient underwent implant removal with radial shortening and plate osteosynthesis for the radius and ulna., Conclusion: In cases of infected gap non-union of radius and ulna, the key for management is thorough debridement with retention of vascularity by minimal soft tissue damage, followed by rigid fixation of the fracture. Simultaneously, adequate steps should be taken to manage the infection, such as culture-specific antibiotics and monitoring of inflammatory markers such as complete blood count, Erythrocyte sedimentation rate, and C-reactive protein., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Background. The treatment of post-traumatic of the clavicle false joint remains a subject of discussion regarding the technology of the surgical intervention. Recently, the use of vascularized fibular flap reconstruction technique has been popularized, but the potential of the external osteosynthesis remains relevant. Clinical case description. A 70-year-old patient got a fracture of the middle third of the left clavicle diaphysis as a result of a fall. He underwent four surgical treatment options: plate osteosynthesis; plate osteosynthesis + bone autoplasty; plate osteosynthesis + vascularized fibular flap reconstruction; external osteosynthesis. A month after the fourth attempt of surgical treatment, fusion, improvement of the function of the right upper limb and the quality of life of the patient were achieved. Technological inaccuracy, namely, the lack of the fragments fixation stability due to the incorrectly chosen length of the plate, as well as an incomplete assessment of the anamnesis and the identified cognitive behavioral features of the patient, are considered as possible reasons for the treatment failure. Conclusion. Attempts of surgical treatment using plates in combination with bone autoplasty, including vascularized skin-bone flaps, do not always ensure the achievement of clavicle fractures fusion. In such situations, it is advisable to use the potential of external osteosynthesis with the reasonable planning.

Background: Distal ulna head or neck fracture is commonly associated with distal radius fracture. Treatment of these fractures remains controversial. Plate osteosynthesis is commonly performed. The purpose of this study was to observe clinical and radiological outcomes in ulna hook plate osteosynthesis for distal ulna fracture associated with distal radius fracture.Materials and Methods: This retrospective study between 2010 and 2018 included patients presenting combined displaced distal ulna fracture and distal radius fracture who were treated with ulna hook plate osteosynthesis. Patient evaluation included pain measurement with the visual analog scale, wrist range of motion, grip and pinch strengths, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and Mayo wrist score. Preoperative radiographs were reviewed to classify the distal ulna fracture according to Biyani. Bone union was evaluated on postoperative X-rays. At final follow-up, the usual radiographic parameters were measured and distal radioulnar joint (DRUJ) osteoarthritis was assessed.Results: A total of 48 patients were included. Mean age was 63 years old and mean follow-up was 28 months. According to the Biyani classification, there were 12 type I, 4 type II, 8 type III, and 24 type IV distal ulna fractures. Wrist flexion was 60°, extension 57°, pronation 85°, and supination 80°. Grip strength was 21 kg (86% of the uninjured opposite side). Pinch strength was 6.6 kg (92% of the uninjured opposite side). Clinical scores were very good to excellent, with a mean Q-DASH of 12 and a Mayo wrist score of 90. Discomfort or pain due to the implant that required implant removal was reported in 29%, and was higher in younger patients. Nonunion was observed in two cases and secondary implant displacement in one case. These three cases required secondary intervention with ulna head resection, which was higher in Biyani type IV. DRUJ osteoarthritis was observed in 12 patients (31%) and was higher in older patients.Conclusions: Ulna hook plate fixation gives good clinical results and a high rate of fracture union, but complications are common. Implant irritation is a frequent complication, especially in young patients, and often requires implant removal.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Objectives– the development of a preoperative planning method for long tubular bone osteosynthesis using the contralateral healthy bone. Material and methods.To justify the usage of the opposite limb’s intact segment model in order to reconstruct the damaged one, their matching in shape and size was analyzed. We built three-dimensional models of the right and left segments of the upper limbs of 20 people and compared them using the Hausdorff distance calculation algorithm. For treatment of a 24-year-old patient with a closed humerus fracture, an individual stereolithographic surgical template with fracture lines was created with the help of computed tomography data of the healthy humerus bone processed by AUTOPLAN EXPERT software. This template was used for pre-bending the plate for osteosynthesis. The plate positioning on the template defined the surgical approach, taking into account the anatomical structures located in the projection of the fracture line and the plate. The technique of "reverse bone reposition" on the prepared plate was applied. Results.With the help of the created 3D models we revealed the size differences of the symmetrical segments of upper limbs. The greatest difference in the limits was registered in the area of the epiphyses (heads of the humeri) – up to 6.8 mm, and the smallest – throughout the entire diaphysis, less than 1.5 mm. Due to preoperative planning there were no intraoperative and postoperative complications, the installation of the plate and osteosynthesis was convenient. The fracture consolidation took place in 3 months. Conclusion.The proposed method has a number of advantages. It is possible to make a stereolithographic template even for a seriously damaged bone with a copied fracture line. This allows the surgeon to plan the details of osteosynthesis, to model the plate according to the template, to determine the required length and shape of the surgical approach, thus reducing the surgical risks and injury for the patient.

Background. Fracture-dislocation of the proximal humerus is a severe injury that equally affects both young and old people. Such injuries are often accompanied by the high risk of neurocirculatory and other complications, which defines their great medical and social importance. The purposes of this study were: 1) to compare the mid-term results of the surgical treatment of the patients with dislocation-fractures of the proximal humerus when they were managed according to the standard algorithm or the new one developed by the authors of this study; 2) to evaluate the effectiveness of the proposed protocol in relation to the patients with neurological complications in order to elaborate a universal approach to the optimal treatment tactics. Patients and Methods. The treatment results of 73 patients with proximal humerus fracture-dislocation undergone the surgery from 2012 to 2018. The patients were divided into 2 groups, which were managed according to the traditional (control group) or the new algorithms (main group), differing in the time of the surgery, a set of diagnostic methods, and an approach to the prevention and treatment of complications. The patients’ examination included taking patients’ anamnesis, their physical examination, X-rays and multispiral computed tomography of the injured shoulder, electromyoneurography, ultrasound of the upper limb blood vessels, patients’ questioning. Results. A year after the surgery, a statistically significant difference in the functional results was revealed in the patients of the main and control groups by the Constant Shoulder Score (p = 0.0063). In the control group, there was a statistically significant difference of the functional results by Constant Shoulder Score between the patients with and without neurological complications (p = 0.003). There was no statistically significant difference among such patients in the main group (p = 0.387). Conclusion. The main group patients, including those with neurological complications, achieved higher functional results in comparison with the control group. Thus, the authors’ treatment algorithm showed its effectiveness. The surgery within 6 hours from the moment of admission of the patients with humerus fracture-dislocation, as well as the earliest possible diagnosis of neurological injury and treatment of complications significantly improved the prognosis and outcome the main group patients.

Introduction: Calcaneal fractures are rare injuries constituting 2% of all fractures. Fractures of calcaneum correspond to nearly 60-75% of the tarsal bone fractures. The calcaneum is the most commonly fractured tarsal bone 90% occur in males between 21 and 45 years of age. The calcaneal fracture may be extra-articular (sparing the subtalar joint) and intra-articular involving the subtalar joint. Intra-articular fractures account for approximately 75% of calcaneal fractures and have been associated with poor functional outcomes. In this study, we aim to assess the functional outcome of internal fixation in displaced intra-articular calcaneal fractures., Materials and Methods: A prospective interventional study was conducted on patients with only intra-articular calcaneal fractures admitted to Chettinad Hospital and Research Institute, Kelambakkam during the period from May 1, 2022, to February 29, 2024, and a total of 32 patients were considered. The functional outcome was assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scoring System., Results: The average age of the patients in our study was 39 years of which all were male. Fall from height is the most common mode of injury. The right calcaneum is more commonly involved than the left. The mean duration of hospital stay was around 10 days. The fracture classification was based on the sanders and Essex-Lopresti classification of which 17 patients were sanders type 3 and 13 patients were sanders type 2 and 1 patient was sanders type 4. The mean time for radiological union is 12 weeks. The Bohler's angle and Gissane's angle preoperatively 16.16 ± 8.87 and 121.48 ± 7.47 restored to near normal values after fixation 27.77 ± 6.02 and 113.485 ± 44, respectively. Heel height and heel width restored to near normal values of (pre-operative heel height - 24.74 ± 3.71 and heel width - 39.97 ± 4.11 and post-operative heel height - 31.55 ± 3.38 and heel width - 34.0 ± 3.1), respectively. The most common complications were wound-related complications (superficial wound infection - 9.7%, deep wound infection - 3.2%, and wound margin necrosis and wound dehiscence 6.4%) and the most common late complications were complex regional pain syndrome - 9.7% and subfibular lateral impingement with peroneal tendinitis - 6.5%. AOFAS grading of functional outcome had shown good to excellent results in 83.8% (26 patients) of the cases. The mean AOFAS score was 83.39 in our study., Conclusion: The present study shows that open reduction and internal fixation give superior radiographic results as shown by the restoration of Bohler's and Gissane's angle and height and width of the calcaneus to near normal values, indicating anatomical restoration of calcaneal shape. The functional outcome by AOFAS score showed good to excellent results in most of the patients with minimal wound complications., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Abstract Background Surgical implant material has changed over time, from metal to stainless steel to titanium. In recent decades a new material, carbon-fibre-reinforced polyether ether ketone, has been introduced. The aim of this study was to assess the clinical and radiological feasibility and functional outcome after treatment of distal radius fractures with this new implant. Methods Inclusion criteria: AO type B distal radius fractures treated with 2.7 mm CF/PEEK plates at one Level 1 trauma centre between 2016 and 2017. Follow-up period 1 year, measurement of range of motion and radiographic assessment, histological analysis of debris only after plate removal. Results Out of 112 eligible patients, 10 (8.9%) patients were included. Mean operation time was 65 ± 10 min. Radiographic healing was confirmed by radiologists at 6 weeks follow-up. During one-year follow-up, no adverse events were reported and functionality and patients subjective satisfaction improved significantly (p

Plate osteosynthesis for oblique fracture of the manubrium sterni is quite rare. We present a case of a 37-year-old man with oblique fracture of the manubrium sterni caused by a traumatic injury. He was operated on using a variable-angle locking compression plate Mesh Plate 2.4/2.7 and had a good postoperative result. We also discuss intraoperative safe techniques such as use of a cement spatula for reduction support tools and depth-limited drilling to prevent excess drilling of the opposite cortex.

Background: One of complications of the reverse shoulder arthroplasty is acromion fractures, and its therapy is controversial. The aim of the study was to investigate the double-plate osteosynthesis for these fractures., Methods: An acromion type III fracture according to classification of Levy was simulated in 16 human shoulder cadavers, and the specimens were randomly divided into two groups. Single-plate osteosynthesis was performed in the first group (locking compression plate) and double-plate osteosynthesis (locking compression plate and one-third tubular locking plate) in the second group. Biomechanical testing included cycling load and load at failure on a material testing machine. During the test, the translation was measured using an optical tracking system., Results: The load at failure for the single-plate osteosynthesis was 167 N and for the double-osteosynthesis 233.7 N ( P = 0.328). The average translation was 11.1 mm for the single-plate osteosynthesis and 16.4 mm for the double-plate osteosynthesis ( P = 0.753). The resulting stiffness resulted in 74.7 N/mm for the single-plate osteosynthesis and 327.9 N/mm for the double-plate osteosynthesis ( P = 0.141)., Discussion: Results of the biomechanical study showed that double-plate osteosynthesis had biomechanical properties similar to those of single-plate osteosynthesis for an acromion type III fracture at time point zero. The missing advantages of double-plate osteosynthesis can be explained by the choice of plate configuration., Competing Interests: MFP receives speaker fees from Depuy Synthes, TS is consultant of Depuy Synthes. DN, AD, RK, HH and AE declared to have no conflict of interest.

Osteosynthesis of the acetabulum is complex and requires very careful planning and preoperative preparation. The goal is to achieve anatomical reduction without steps or gaps in the articular surface. If it has not been possible to achieve an optimal reconstruction, one has to consider whether it makes sense to carry out reosteosynthesis or revise the fixation. The risk of infection, heterotopic ossification, avascular necrosis of the femur and cartilage damage is much higher than with the primary procedure. Often, especially in older patients, it may make more sense to achieve fracture union and to implant a total hip prosthesis in due course. In younger patients, every attempt should be made to achieve optimum anatomical reduction and this may mean consideration of reosteosynthesis after careful planning and counselling of the patient. If reosteosynthesis is considered adequate imaging including a postoperative CT is essential as part of the planning. This article looks at the possible solutions for failed osteosynthesis of the acetabulum. [ABSTRACT FROM AUTHOR]

Background: The treatment of fracture-related infections (FRI) is still a challenge for orthopedic surgeons. The prevalence of FRI is particularly high in open fractures with extensive soft-tissue damage. This study aimed to develop a new two-step animal model for non-unions with segmental bone defects, which could be used to evaluate new innovative bone substitutes to improve the therapeutic options in humans with FRI and bone defects.Methods: After randomization to infected or non-infected groups, 30 Sprague-Dawley rats underwent a transverse osteotomy of the mid-shaft femur with a 5 mm defect. Additionally, the periosteum at the fracture zone was cauterized at both sides. After intramedullary inoculation with 103 CFU Staphylococcus aureus (infected group) or PBS (non-infected group), a fracture stabilization was done by intramedullary K-wires. After 5 weeks, the bone healing process was evaluated, and revision surgery was performed in order to obtain increased bone healing. The initial K-wires were removed, and debridement of the osteotomy-gap was done followed by a more stable re-osteosynthesis with an angle-stable plate. After further 8 weeks all rats were euthanized and the bone consolidation was tested biomechanically and the callus formation quantitatively by micro-CT analysis.Results: We developed and presented a new two-stage non-union animal model through a targeted S. aureus infection. After 5 weeks, all animals showed a non-union irrespective of assignment to the infected and non-infected group. Lane and Sandhu score showed a higher callus formation in the infected group. In all infected animals, the inoculated S. aureus strain was detected in the revision surgery. The second surgery did not improve bone healing, as shown by the Lane Sandhu score and in the μ-CT analysis. Similarly, biomechanical testing showed in both groups a significantly lower maximum torque as compared to the contralateral side (p < 0.0001).Conclusions: We were able to successfully develop a new two-stage non-union animal model, which reflects a genuine clinical situation of an infection-related non-union model with segmental bone defects. This model could be used to evaluate various therapeutic anti-infectious and osteoinductive strategies in FRIs. [ABSTRACT FROM AUTHOR]

Elimination of congenital shortening of lower limb still remains a complex and unsolved orthopaedic task which requires an improved fixation technique as well as adjusted tactics of treatment and rehabilitation procedures.Purpose of the study — experimental approval of femur lengthening technique by external fixation with Ilizarov apparatus and internal fixation by plate.Materials and methods. Femur lengthening was performed in 6 mongrel dogs. Average animal age was 1,5±0,3 years, average weight — 20±5 kg, femur length — 22±2 sm. External apparatus with two supports and a titanium plate of an original design were applied under general anesthesia on the right femur of animals. Lengthening was performed manually at a rate of1 mm per day in 4 stages at a distance of 10% from initial segment length. External apparatus was removed on the last day of distraction after locking the plate. X-ray examination was done on the day of surgery, in 7, 14 and 25 days from the onset of distraction as well as in 14, 30, 60 and 90 days after completion of distraction and removal of external apparatus. Three animals were taken out of experiment in 30 days of fixation, remaining three animals — in 90 days. After euthanasia the authors performed autopsy of the organic femur complex and tissues contacting the plate.Results. The use of operated limb was not restricted during the whole distraction period. The authors observed first roentgenological signs of distraction osteogenesis on 7th day of lengthening. By the end of distraction period, at 25th day, shadows of regenerates demonstrated longitudinal striated structures in all cases. Median lucency area of 1–5 mm was located diagonally and across the regenerate or was intermittent. In 60 days of fixation X-rays demonstrated homogeneous regenerate. External fixation index was 13,9±1,5 days/sm (p≤0,05). The authors observed no cases of implants fracture or deformity during the experiment. Conclusion. Application of the developed plate in combination with external apparatus demonstrated high efficiency for femur lengthening in experiment study.

Purpose – to improve the tactics for surgical management of bicondylar tibia fractures to gain better outcomes. Materials and methods. The authors analyzed outcomes of surgical management of 69 patients within 36 months after the procedures. Two comparison groups were created to assess the effectiveness of the proposed techniques: the main group of 27 patients (39.1%) and control group of 42 patients (60.9%). In the main group the advanced and new techniques were applied (two-staged protocol of surgical correction, internal fixation with joint distraction, a combination of new L-shaped external and L-shaped internal approaches, bone grafting with b-TCP, carbon nanostructure implant and «Osteomatriks» xenograft). In the control group the conventional internal fixation was used. The difference in tibiofemoral (ΔFTA) and plateau-diaphyseal (ΔPDA) angles at various follow up stages were checked to evaluate reduction stability. P.S. Rasmussen score was used to assess the functional status and life quality of patients. Statistical methods of evaluation included parametric and non-parametric test to check confidence value of variances.Results. In 36 months postoperatively ∆FTA >5° in the main group was observed 1.97 times less than in control group (23.1% and 45.5% respectively); ∆PDA >5° in the main group was observed 1.66 times less than in control group (30.8% and 51.5% respectively). Total number of excellent and good results the main group 36 months postoperatively according to P.S. Rasmussen score was reported as 1.81 times higher than in the control group (50% and 27.6% respectively). Conclusion. The paper proves the efficiency of the proposed surgical procedure for bicondylar tibia fractures management.

Abstract Background Implant breakage after the fixation of traumatic fractures is rare; however, when it occurs, it is debilitating for the patients and a challenge for surgeons. The purpose of this study was to analyze and identify the independent risk factors for implant breakage of traumatic fractures treated with plate osteosynthesis. Methods We reviewed the medical records of patients with a fracture to any part of their four extremities, clavicle, hand or foot, who underwent surgical plate osteosynthesis from January 2005 to January 2015, and who sustained a subsequent implant breakage. Kaplan–Meier univariate and multivariate Cox regressions were performed to identify independent associations of potential risk factors for implant breakage in this cohort. Results We identified 168 patients who underwent plate osteosynthesis surgery and had subsequent internal fixator breakage. The mean patient age was 40.63 ± 16.71 years (range, 3 to 78 years), with 72.0% (121) males and 28.0% (47) females. The average time between surgery and implant breakage was 12.85 ± 12.42 months (range, 1 to 60 months). In the final regression model, we show that inserting screws close to the fracture line is an independent predictive risk factor for implant breakage (HR, 2.165, 95%CI, 1.227 to 3.822; P = 0.008). Conclusions We found that inserting screws close to the fracture line is related to an increased risk of internal fixator breakage in patients treated with plate osteosynthesis after fracture. Plates with additional holes likely lead to an increased risk of implant breakage, presumably because surgeons cannot resist inserting extra screws into the holes adjacent to the fracture line, which reduces the stiffness of the plate. We have addressed this problem by designing a plate without holes adjacent to the fracture line.

Purpose: The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss - all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical reposition of multifragmentary fractures followed by increased risks of non-union are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of non-union and wound infection, as well as blood loss and time of surgery., Methods: According to the PRISMA guidelines we conducted this systematic review by searching the Cochrane, PubMed, Ovid, MedLine, and Embase databases. Inclusion criteria were the modified Coleman methodology score (mCMS) >60, age >18 years, and extra-articular fractures of the distal femur. Biomechanical and animal studies were excluded. By referring to title and abstract relevant articles were reviewed independently. In the consecutive meta-analysis, we compared 9 studies and 639 patients., Results: There is no statistically significant difference comparing superficial wound infections when RIMN was performed (OR = 0.50; 95% CI: 0.18 - 1.42; P = 0.19) as well as in deep wound infections (OR = 0.74; 95% CI: 0.19-2.81; P = 0.62). However, these results were not significant. We also calculated for potential differences in the rate of non-unions depending on the surgical treatment applied. Data of 556 patients revealed an overall number of 43 non-unions. There was no significant difference in rate of non-unions between both groups (OR = 0.97; 95% CI: 0.51-1.85; P = 0.92)., Conclusion: No statistical difference was found in our study among RIMN and plate fixation in the treatment of distal femoral fractures with regard to the incidence of non-union and wound infections. Therefore, the indication for RIMN or plating should be made individually and based on the surgeon's experience.

Purpose This study aimed to compare the clinical outcomes of patients who underwent volar plate osteosynthesis for high-energy distal radius fracture (DRFx) and carpal tunnel release (CTR) for acute or subacute carpal tunnel syndrome (CTS) with patients who did not undergo CTR. Methods This study is a retrospective evaluation of all high-energy DRFx treated with volar plate osteosynthesis in a regional hospital between January 2021 and January 2023. All adult patients (≥18 years) who underwent open reduction and internal fixation were included in the study after obtaining approval from the internal review board of our institution. Only patients who underwent plate osteosynthesis of the volar aspect through a modified Henry incision and patients who underwent CTR through a classic separate incision were included in the study. Clinical results include hand dynamometry, visual analog scale (VAS) scores, and physical examination findings of patients who underwent volar plate osteosynthesis because of high-energy DRFx and CTR due to CTS in the acute and subacute periods were retrospectively examined. Results Among the patients who underwent volar plate osteosynthesis because of high-energy DRFx, no statistically significant difference was detected between the hand grip strength and VAS scores of patients who underwent CTR because of acute CTS and subacute CTS at the sixth postoperative week (p>0.05). Conclusion Prophylactic CTR may be performed in the same session in selected cases, such as DRFx caused by a high-energy injury, to establish a scale for DRFx at a high risk of CTS and avoid delays in treatment. CTR for transient CTS detected in the subacute period during outpatient follow-up does not improve clinical outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kazez et al.)

Background: We elucidated the effect of open reduction and internal fixation with locking plate for acute isolated displaced greater tuberosity fractures of humerus in elder adults (aged >60 years). Methods: From 2009 to 2015, data from 32 patients, aged between 60 and 88 years, who had acute unilaterally displaced greater tuberosity fractures of humerus were collected and evaluated retrospectively. All the fractures were managed with open reduction and internal fixation with locking plate. The follow-up period was 50.8 months on an average (range 22-80 months). Finally, 25 patients were available for final evaluation of radiographic and functional results. Results: All the 32 fractures had union with the average union time of 14 weeks (range 10-18 weeks) and with no complications. The average of preoperative Visual Analogue Scale (VAS) was 6.2 (range 4-8), ASES was 30.4 (range 13-45), and Constant score was 30.4 (range 20-45). At the last follow-up, the mean VAS was 1.3 (range 0-2.5), the mean ASES score was 90.1 (range 72-100), and the mean Constant score was 90.3 (range 80-100). There were statistically significant differences between preoperative and final follow-up in VAS, ASES, and Constant score. Hundred percent of patients had good or excellent results by Constant score, with excellent results (86-100) in 17 (68%) patients and good result (71-85) in 8 (32%). Conclusion: In conclusion, open reduction and internal fixation with locking plate is an effective treatment for acute displaced greater tuberosity fractures of humerus in elder adults. [ABSTRACT FROM AUTHOR]

The purpose - to analyze errors and complications in surgical treatment of patients with distal radius fractures and to determine methods of its prevention. Material and methods. 203 patients (62 male and 141 female ones) with 204 distal radius fractures were treated using plate osteosynthesis. 105 patients were operated ear-lier than 1 month after the injury (I group), 98 - in 1 month or later after the injury (II group). The results of the treatment were assessed with morphometric and clinical indi-cators, scheme offered by the authors and DASH questionnaire. Results. 88,68% of positive results in I group and 72,45% in II group were ob-served in a year after the operation. The frequency of complications on application of palmar surgical approach was 4,72% in I group and 17,35% (р=0,0001) in II group. The rate of hardware removal reduced to 6,6% in I group and to 11,22% - in II group of patients (р=0,245) that is in 3,3-4,75 times lower than the data given in the literature.

Background: Treatment of humeral shaft fractures has been a subject of debate for many decades. Even though a large majority of humeral shaft fractures can be treated by non operative methods, few conditions like open fractures, polytrauma, ipsilateral humeral shaft and forearm fractures require surgical intervention. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in anteromedial plate osteosynthesis with anterolateral approach and also to measure the functional outcome of this procedure. Method: A prospective study was conducted in the Department of Orthopaedics, PESIMSR, Kuppam, Andhra Pradesh, from August 2012 to August 2015 with a total of 54 patients who were operated with anteromedial plate osteosynthesis were included in the study. RodriguezMerchan criteria was used to grade the functional outcome. Results: Of the 54 patients, 28 (58.85%) were in the age group of 30-40 years. The most common fracture pattern identified was A3 type (48.14%).The mean (+ SD) duration of surgery for anteromedial humeral plating was 53 ± 5.00 minutes. The time taken for the fracture to unite was less than 16 weeks in the majority or 50 patients (92.59%). Four (7.40%) patients had delayed union. There was no incidence of iatrogenic radial nerve palsy. Rodriguez – Merchan criteria showed that 37(68.51%) of the patients had good and 12 (22.22%) had excellent functional outcome.

Intramedullary nailing (IMN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) fixation are both viable approaches for managing distal tibia fractures. IM nailing offers advantages in terms of shorter operation time, faster union, and reduced infection rates, yet it may lead to alignment issues and residual knee pain. Conversely, MIPPO fixation provides better alignment and minimizes knee discomfort but comes with a higher risk of soft-tissue complications and hardware irritation. Notably, this review reveals that MIPPO is associated with a greater risk of both superficial (15% vs. 7% for IMN) and deep infections (14% vs. 6.3% for IMN). This study aims to comprehensively assess the optimal surgical approaches for distal tibia fractures by comparing clinical and functional outcomes between MIPPO and interlocking IMN techniques in treating extra-articular distal tibial fractures. Key outcome parameters include operation duration, union time, non-union occurrence, malunion cases, infection rates, secondary surgical interventions, and functional results, as indicated by quality of life and ankle scores. Regarding union complications, it is notable that IMN demonstrates a higher incidence of malunion, affecting 14.7% of patients compared to 8.8% in the MIPPO fixation group. Interestingly, both treatment methods exhibit a similar incidence of non-union, occurring in 3.5% of patients in both groups. Furthermore, when assessing the union time, IMN fixation notably achieves significantly shorter union times, especially evident in AO 43A fracture types and closed fractures. The mean time for union is 18 weeks with IMN compared to 20 weeks with MIPPO fixation. In our analysis of nine studies involving 813 patients, the reported operation times revealed an overall weighted mean operation time of 74.1 minutes (ranging from 56.4 to 124 minutes) for IMN and 85.4 minutes (ranging from 51.4 to 124 minutes) for MIPPO fixation. Notably, the operation time for IMN was significantly shorter compared to MIPPO, showing a weighted mean difference (WMD) of -11.24 minutes, with a 95% confidence interval (CI) ranging from -15.44 to -7.05 (P<0.05). This difference exhibited significant moderate heterogeneity (I 2 = 68%). In light of this comprehensive study, both MIPPO and IMN emerge as equally effective therapeutic options for addressing functional outcomes in distal tibial extra-articular fractures. While IMN offers several advantages, including lower infection rates, reduced implant irritation, shorter operation time, and earlier weight-bearing and union, it is associated with a heightened risk of malunion and anterior knee pain. Consequently, the choice of implant should be tailored on a case-by-case basis. Patients at elevated infection risk, stemming from factors, such as advanced age, comorbidities, smoking, or severe soft tissue injuries, are better suited for nail treatment. Conversely, MIPPO fixation may present a more advantageous choice for young, active, and healthy patients, given its ability to mitigate the risk of knee pain and malunion., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Elnewishy et al.)