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Objective: To develop and validate the efficacy of a 3D-printed screw-rod auxiliary system for unstable atlas fractures., Methods: This research is a retrospective analysis, and a total of 14 patients, including 11 males and three females, were enrolled in our hospital from January 2017 to March 2019 who underwent occipitocervical fusion assisted by the 3D-printed screw-rod auxiliary system were reviewed, and with an average age of 53.21 ± 14.81 years, an average body mass index (BMI) of 23.61 ± 1.93 kg/m 2 . The operation time, blood loss and radiation times during the operation were recorded. The maximum fracture displacement values of pre- and post-operation were measured based on CT imaging. All screw grades were evaluated after surgery. The occipital-cervical 2 (O-C 2 ) angle and occipitocervical inclination (OCI) angle of pre-operation, post-operation and the last following-up were measured. The dysphagia scale 3 months after surgery and at the last follow-up, the Neck Disability Index (NDI) 3 months after surgery and at the last follow-up were assessed., Results: All patients were completed the surgery successfully. There was no patient with severe dysphagia or aggravation of nerve injury. The follow-up was from 12 to 14 months, and with an average of 12.5 months. The average surgery time, average blood loss and average radiation times for the 14 patients were 112.14 min, 171.43 mL and 5.07 times, respectively. There was a significant difference in maximum fracture displacement between pre- and post-operation values (P < 0.05). A total of 56 screws were inserted in 14 patients, among them, three screws were classified as grade 1, and the other screws were classified as grade 0. There was a significant difference in the O-C 2 between pre-operation and 3 days after operation (P = 0.002); There was a significant difference in OCI angles between pre-operation and 3 days after operation (P < 0.05); there was no significant difference in the O-C 2 or OCI angle between 3 days after the operation and the last follow-up (P = 0.079; P = 0.201). The dysphagia scales of two patients were assessed as mild at 3 months after surgery, and the others were assessed as normal at 3 months after surgery. All patients' dysphagia scores returned to normal at the last follow-up. The average NDI and average neck Visual Analogue Scale (VAS) scores at the last follow-up were 2.53 and 8.41, respectively., Conclusion: It can objectively restore the OCI to normal with few post-operative complications under the assistance of a screw-rod auxiliary system to perform occipitocervical fusion for unstable atlas fractures and atlantooccipital joint instability., (© 2021 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

Introduction: Young femoral neck fracture patients require surgical fixation to preserve the native hip joint and accommodate increased functional demands. Recent reports have identified a high incidence of fracture shortening and this may have negative functional consequences. We sought to determine if fracture shortening is associated with poor functional outcome in young femoral neck fracture patients., Patients and Methods: One hundred and forty-two patients with femoral neck fractures age 18-55 were recruited in this prospective cohort study across three Level 1 trauma hospitals in Mainland China. Patient-reported and objective functional outcomes were measured with the Harris Hip Score (HHS), Timed Up and Go (TUG), and SF-36 Physical Component Summary (SF-36 PCS) at 12 months. Radiographic fracture shortening was measured along the long axis of the femoral neck and corrected for magnification. Severe shortening was defined as ≥10mm. The primary analysis measured associations between severe radiographic shortening and HHS at one-year post-fixation., Results: One hundred and two patients had complete radiographic and functional outcomes available for analysis at one year. The mean age of participants was 43.7±10.8years and 53% were male. Fifty-five percent of fractures were displaced and 37% were vertically orientated (Pauwels Type 3). The mean functional outcome scores were: HHS 90.0±10.8, TUG 12.0±5.1s, and PCS 48.5±8.6. Severe shortening occurred in 13% of patients and was associated with worse functional outcome scores: HHS mean difference 9.9 (p=0.025), TUG mean difference 3.2s (p=0.082), and PCS mean difference 5.4 (p=0.055)., Conclusions: Severe shortening is associated with clinically important decreases in functional outcome as measured by HHS following fixation of young femoral neck fractures, occurring in 13% of patients in this population. The principle of fracture site compression utilized by modern constructs may promote healing; however, excessive shortening is associated with worse patient-reported outcomes and objective functional measures., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The aim of this study was to compare the effects and indications of minimally invasive plate osteosynthesis (MIPO) and limited open reduction (LOR) for managing distal tibial shaft fractures. A total of 79 cases of distal tibial shaft fractures were treated surgically in our trauma center. The 79 fracture cases were classified into type A, B, and C (C1) according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, with 28, 32, and 19 cases, respectively. Among the 79 fracture cases, 52 were closed fractures and 27 were open fractures (GUSTILO, I-II). After adequate preparation, 48 cases were treated with LOR and 31 cases were treated with MIPO. All cases were followed up for 12 to 18 months, with an average of 16.4 months. During the follow-up period, 76 fracture cases were healed in the first stage, whereas the 3 cases that developed non-union were treated by changing the fixation device and autografting. For types A, B, and some of C simple fractures (C1), LOR accelerated the fracture healing and lowered the non-union rate. One case suffered from regional soft tissue infection, which was controlled by wound dressing and intravenous antibiotics. Another case that developed local skin necrosis underwent local flap transplant. LOR promoted bone healing and lowered the non-union rate of several simple-distal tibial shaft fractures. Thereafter, the incidence of soft tissue complication was not significantly increased. However, for complex and comminuted fractures, MIPO was the preferred method for correcting bone alignment and protecting soft tissue, leading to functional recovery.

Our aim was to compare polylevolactic acid screws with titanium screws when used for fixation of the distal tibiofibular syndesmosis at mid-term follow-up. A total of 168 patients, with a mean age of 38.5 years (18 to 72) who were randomly allocated to receive either polylevolactic acid (n = 86) or metallic (n = 82) screws were included. The Baird scoring system was used to assess the overall satisfaction and functional recovery post-operatively. The demographic details and characteristics of the injury were similar in the two groups. The mean follow-up was 55.8 months (48 to 66). The Baird scores were similar in the two groups at the final follow-up. Patients in the polylevolactic acid group had a greater mean dorsiflexion (p = 0.011) and plantar-flexion of the injured ankles (p < 0.001). In the same group, 18 patients had a mild and eight patients had a moderate foreign body reaction. In the metallic groups eight had mild and none had a moderate foreign body reaction (p < 0.001). In total, three patients in the polylevolactic acid group and none in the metallic group had heterotopic ossification (p = 0.246). We conclude that both screws provide adequate fixation and functional recovery, but polylevolactic acid screws are associated with a higher incidence of foreign body reactions.

Background: The percutaneous three-dimensional (3D)-fluoroscopic-navigated screw directing to the quadrilateral plate was attempted., Materials and Methods: Five patients with acetabular fractures were treated by 3D navigated percutaneous screw. The quadrilateral plate was involved in all the patients. The Arcadis 3D (ARCADIS Orbic 3D(®); Siemens AG Healthcare Sector, Erlangen, Germany) and computer navigation system (stryker navigation system) were employed, screwing trajectory was attempted to anchor the quadrilateral plate perpendicularly to the fracture line and close to the joint cartilage as much as possible. Parameters including fracture gap closure (P1), distance to the joint cartilage (P2), angulations between the screw and the fracture line (P3), were measured with the software installed on the machine of Arcadis 3D., Result: Seven screws were inserted with the use of 3D fluoroscopic navigation. The quadrilateral plate was hold by percutaneous screws. The closure of fracture gap was achieved in 3 patients by 2-3mm. The nearest distance from the screw to the joint cartilage was ranged from <1mm to 6mm. The angulations between the screw and the fracture line was 80-90° in three patients, it was 60° and 65° respectively on the rest two patients. All patients felt pain free 1week after the operation. No complication was noted postoperatively., Conclusion: The surgical technique of percutaneous screwing for the acetabular fracture with three-dimensional fluoroscopy-based navigation was demonstrated., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Titanium elastic nails (TENs) are commonly used to repair displaced midshaft clavicular fractures. Although several clinical studies have shown that the use of TENs is more effective and less invasive than traditional plate fixation, high rates of complications associated with TENs have been reported. This retrospective study compared the use of TENs with reconstruction plates in the treatment of displaced midshaft clavicular fractures., Materials and Methods: From January 2005 to July 2007, 141 patients with displaced midshaft clavicular fractures were treated with TEN or plate fixation. At 6 and 24 months postoperatively, we evaluated the patients' general health, operative complications, and functional recovery., Results: The mean bone union time of TEN patients was 12.4 ± 3.4 weeks, whereas that in the plate group was 14.4 ± 3.7 weeks. The time of union was significantly shorter in the TEN group than that in the plate group. There was no significant difference between these 2 groups' rates of complications such as nonunion or malunion. Shoulder function scores were significantly better in the TEN group than in the plate group at 6 months postoperatively. There was no significant difference at 24 months postoperatively. Patients were more satisfied with the cosmetic appearance and overall outcome after TEN repair than after plate fixation., Conclusions: TEN fixation of displaced midshaft clavicular fractures allows for a faster functional recovery, higher patient satisfaction, and a more cosmetically satisfactory appearance than plate fixation. The complication rates of both TENs and reconstruction plates were similar., (Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

The posterolateral shearing tibial plateau fracture is uncommon in the literature, however with the increased usage of computer tomography (CT), the incidence of these fractures is no longer as low as previously thought. Few studies have concentrated on this fracture, least of all using a biomechanical model. The purpose of this study was to compare and analyse the biomechanical characteristics of four different types of internal fixation to stabilise the posterolateral shearing tibial plateau fracture. Forty synthetic tibiae (Synbone, right) simulated the posterolateral shearing fracture models and these were randomly assigned into four groups; Group A was fixed with two anterolateral lag screws, Group B with an anteromedial Limited Contact Dynamic Compression Plate (LC-DCP), Group C with a lateral locking plate, and Group D with a posterolateral buttress plate. Vertical displacement of the posterolateral fragment was measured using three different strengths of axial loading force, and finally loaded until fixation failure. It was concluded that the posterolateral buttress plate is biomechanically the strongest fixation method for the posterolateral shearing tibial plateau fracture., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: A special type of trimalleolar fracture with the involvement of the entire posterior tibial plafond has been reported recently. Because of the low incidence, the characteristics of the fracture in different studies have not been consistent. We describe our clinical experience with this fracture type., Materials and Methods: From January 2007 to December 2009, 12 patients were identified with a trimalleolar fracture with involvement of entire posterior tibial plafond. All the fractures were openly reduced and fixed through a combined operative approach (posterolateral and posteromedial). Ten of 12 patients were followed up. The clinical outcome was assessed with the Short Form-36 (SF-36) and standardized AAOS foot and ankle questionnaire, and the radiological evaluation with an osteoarthritis-score (OA-score)., Results: Based on the pathoanatomy of the posteromedial malleolar fragment, all the fractures could be classified into two types. Using a combined operative approach, anatomical reduction and stable fixation was accomplished in all 12 patients. At a mean followup of 18.9 (range, 12 to 30) months, 10 patients achieved a good radiological result and satisfactory clinical recovery., Conclusion: This fracture pattern may be classified into two types with different injury mechanisms, which has not been described previously. After anatomic reduction and stable fixation through a combined operative approach, the short-term outcome was good.

Study Design: A retrospective study., Objective: To evaluate the clinical outcome, effectiveness, and security of the surgical management of acute thoracolumbar burst fracture with corpectomy, titanic mesh autograft, and Z-plate fixation by anterior approach., Summary of Background Data: Many surgical methods were adopted to treat acute burst thoracolumbar fracture. But the optimal surgical management remains controversial., Methods: A retrospective review of a consecutive series of 48 patients with thoracolumbar burst fracture treated with anterior corpectomy, titanic mesh autograft, and Z-plate internal fixation was carried out. Preoperative clinical and radiographic data of all cases were originally collected. Surgical indications were motor neurologic deficit and thoracolumbar column instability. Twenty-two patients (45.8%) with acute thoracolumbar burst fractures presented with a neurologic deficit. The postoperative recovery of neural function, restoration of anterior cortex collapse, kyphotic angle, and spinal canal compromise were observed., Results: The preoperative kyphotic angle was improved to a mean of 5.6°, radiographic height restored to 95.8% of the adjacent normal levels, and canal compromise was 0%. None of the patients had neurologic deterioration. Mean follow-up time was 32.4 months (range, 24-47 months). All 22 patients with neurologic deficit demonstrated at least one Frankel grade improvement on final observation, with 16 (73%) patients had accomplished complete neurologic recovery. Forty-six (96%) patients reported minimal or no pain at final follow-up observation, and 40 (83%) patients who had been working before injury returned to original work., Conclusion: The authors considered spinal cord decompression with anterior corpectomy and stability reconstruction with titanic mesh autograft and Z-plate fixation at same time in one incision as an effective technique for unstable thoracolumbar burst fracture with and without neurologic deficit.

The purpose of this study was to compare the biomechanical strength of four different fixation methods for a posteromedial tibial plateau split fracture. Twenty-eight tibial plateau fractures were simulated using right-sided synthetic tibiae models. Each fracture model was randomly instrumented with one of the four following constructs, anteroposterior lag-screws, an anteromedial limited contact dynamic compression plate (LC-DCP), a lateral locking plate, or a posterior T-shaped buttress plate. Vertical subsidence of the posteromedial fragment was measured from 500 N to 1500 N during biomechanical testing, the maximum load to failure was also determined. It was found that the posterior T-shaped buttress plate allowed the least subsidence of the posteromedial fragment and produced the highest mean failure load than each of the other three constructs (P=0.00). There was no statistical significant difference between using lag screws or an anteromedial LC-DCP construct for the vertical subsidence at a 1500 N load and the load to failure (P>0.05). This study showed that a posterior-based buttress technique is biomechanically the most stable in-vitro fixation method for posteromedial split tibial plateau fractures, with AP screws and anteromedial-based LC-DCP are not as stable for this type of fracture., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Background: Midclavicular fractures are common clinically, accounting for about 76% of all clavicular fractures. Recent studies have revealed a previously unrecognized incidence of nonunion and malunion after conservative treatment of more severe midclavicular fractures. Our aim was to evaluate the clinical outcomes of midclavicular fractures treated with titanium elastic nails., Methods: From February 2005 to February 2007, 41 patients with displaced midclavicular fractures received open reduction and internal fixation with a titanium elastic nail inserted through the sternal end of the clavicle. We evaluated the visual analogue scale (VAS), the Constant score and the Disabilities of the Arm, Shoulder and Hand (DASH) scale to determine outcomes., Results: A mean follow-up of 14.5 months (range 7-24 mo) revealed radiographic fracture union in all patients with an average clinical healing time of 2.2 months. Mean subjective pain 3 days after surgery was significantly lower than the day before surgery (p < 0.001). The mean range of motion 3 days after surgery was significantly improved compared with the day before surgery (p < 0.001). The nails were removed in all patients a mean of 7.2 months (range 5.4-9.5 mo) after surgery, and no fractures recurred. The mean postoperative DASH score was 2.5 (range 0.5-8.0) and the mean postoperative Constant score was 95.2 (range 86.5-97.0)., Conclusion: Limited open reduction and internal fixation with titanium elastic nails is a safe and minimally invasive surgical procedure for the treatment of displaced midclavicular fractures in adults and achieves good functional results and high patient satisfaction.

Objective: To report the outcome of surgical treatment of tarsometatarsal joint complex injury., Methods: In the period from January 2003 to December 2008, 167 cases of closed tarsometatarsal joint injury were treated, including 35 cases of tarsometatarsal joint complex injury. Diagnosis was made by X-ray examination or/and CT scan. Either close or open reduction was performed and followed by internal fixation with screw or/and plate. X-ray examination was done in the regular follow-up and functional evaluation was carried out by AOFAS midfoot score system., Results: In this series 135 cases got a mean follow-up of 48 months, ranging from 12 to 75 months. Therein the 26 cases of tarsometatarsal joint complex injury had a mean postoperative AOFAS midfoot score of 67 (ranging from 48 to 75), and secondary post-traumatic arthritis in 16 cases, 12 of which had arthrodesis as a result of severe pain. The 109 cases of pure tarsometatarsal joint injury had a mean postoperative AOFAS midfoot score of 82 (ranging from 70 to 95), and secondary post-traumatic arthritis in 17 cases, only 5 of which had arthrodesis finally. Those cases of pure tarsometatarsal joint injury treated by close reduction and internal fixation with percutaneous screw got a mean postoperative AOFAS midfoot score of 87 (ranging from 82 to 95), demonstrating a significant deference (t = 2.651, P < 0.05) when compared with that of metatarsal joint complex injury., Conclusion: The tarsometatarsal joint complex injury has a prognosis inferior to that of the pure tarsometatarsal joint injury, and the keys to its successful treatment are appropriate diagnosis, anatomical reduction and secure fixation of all the components of the complex.

Background: Displaced comminuted of the distal humerus in adults are among the most complex fractures to be managed effectively. The ulnar nerve is at high risk of impingement secondary to injury, operation, and postoperative rehabilitation in these fractures. In this study we focus on the incidence, management, and prognosis of early ulnar nerve dysfunction in the course of treating type C fractures of distal humerus., Methods: We examine a patient sample of 117 consecutive AO type C fractures of distal humerus, between June 1998 and October 2005. Twenty-nine patients exhibited preoperative ulnar nerve compression symptoms (incidence 24.8%) and were divided into two groups randomly, which received treatment of anterior subfascial transposition or in situ decompression of the ulnar nerve respectively, in conjunction with internal fixation with medial and lateral plates., Results: The subgroup of 88 patients without preoperative ulnar nerve symptoms remained asymptomatic postoperatively (0% incidence of late ulnar nerve dysfunction). According to Bishop rating system, excellent and good results of ulnar nerve function were achieved in 13 of 15 patients (86.7%) in the transposition group, 8 of 14 patients (57.1%) in the in situ decompression group. The results difference is statistically significant (p < 0.05)., Conclusions: We conclude that neurolysis and anterior subfascial transposition of vascularized ulnar nerve during open reduction and internal fixation of type C fractures of the distal humerus is beneficial in cases of early ulnat nerve dysfunction.

Background: Although several studies reported good results of open reduction and internal fixation of displaced fracture of the adult distal humerus, few studies have specifically addressed the results of such surgical fixation in osteoporotic bone in the elderly., Methods: This study focused on AO type C fractures in the elderly by using 2 plates for fixation of the lateral and medial columns to reconstruct a stable triangular frame of the distal humerus. The study comprised 35 patients, and 32 were available for final evaluation at a mean follow-up of 24.5 months (range, 14-60 months)., Results: Mayo Elbow Function Score showed 25 patients (78%) achieved an excellent functional result, and 7 (22%) had a good result. No patients were considered to have a fair or poor result. At the final follow-up, the mean range of flexion to extension of the elbow was 22 degrees (range, 10 degrees -40 degrees) to 125 degrees (range, 100 degrees -140 degrees). All fractures united at average of 3.5 months (range, 2.5-5.3 months)., Conclusion: Open reduction and internal fixation using double-columned plating is a useful and effective technique in the management of displaced, comminuted, intra-articular fractures of the distal humerus in elderly patients., Level of Evidence: Level 4; Case series, treatment study.

We evaluated the healing rate, complications, and functional outcomes in 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia treated with a polyaxial locking system. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. All fractures healed and the average time to union was 14 weeks. Six patients (19%) reported occasional local disturbance over the medial malleolus. There were two cases of postoperative superficial infections and evidence of delayed wound healing. Using the American Orthopaedic Foot and Ankle Society ankle score, the average functional score was 87.3 points (of 100 total possible points). Our results show the polyaxial locking plates, which offer more fixation versatility, may be a reasonable treatment option for distal tibia fractures with very short metaphyseal segments.

Although several treatment options for radial head fractures are available, no clear solutions exist. In this study we therefore compare open reduction and internal fixation (ORIF) with bipolar radial head prosthesis replacement in treatment of radial head fractures of Mason type III. Cement stem and bipolar radial prosthesis were used to treat 12 fresh cases and two old cases of Mason type III radial head fracture. As a control group, another eight cases of radial head type III fracture were treated with ORIF with cannulated screws and Kirschner (K) wires. The 14 patients who received radial head prosthesis replacement were followed-up for 15.9 months (range 10-27 months). According to elbow functional evaluation criteria by Broberg and Morrey, we found excellent results in nine cases, good in four, and fair in one. Mean follow-up of the eight cases in the ORIF group was 14 months (range 10-21 months), with good results in one case, fair in four, and poor in three. The result was good or excellent in 92.9% of prosthesis replacement patients and in 12.5% of ORIF patients. This difference is statistically significant (P = 0.0004; Fisher's exact test). We concluded that bipolar radial head prosthesis replacement is better than ORIF in treatment of Mason type III radial head fracture.

Background: Fracture dislocations of the knee involving the proximal tibia are difficult to treat because of the operative approach that maybe required and the instability of the construct. The optimal fixation method of these fractures remains controversial, improper fixations usually lead to an unsatisfactory prognosis. The purpose of this study was to compare the mechanical strength of four different fixation constructs for this kind of fracture., Methods: Twenty-eight Synbone simulated fracture models were created, reduced, and instrumented with one of four constructs: medial single plate, medial double plates, bilateral double plates, or lateral locked plate. Biomechanical testing was done to determine the postfixation construct stiffness, the maximum load to failure, and the medial condylar displacement for each of the four constructs., Findings: The medial double plates construct was shown to provide the highest overall construct stiffness and the least medial condylar displacement than each of the other three constructs (both P=0.000); The lateral locked plate construct was shown to provide the lowest overall construct stiffness and the largest medial condylar displacement than each of the other three constructs (both P=0.000); There was no significant difference measured between the medial single plate construct and the bilateral double plates construct for overall construct stiffness and medial condylar displacement., Interpretation: This study suggests that the medial double plates technique is biomechanically the best fixation method for fracture dislocations involving the proximal tibia, while lateral locked plate technique is not indicated to this kind of fracture due to its insufficient stability.

Objective: To report the outcome of long bone nonunion of humerus, femur and tibia treated with locking internal fixation and bone graft., Methods: From February 2003 to October 2006, locking internal fixation and bone grafting were employed to treat 5 cases at humerus, 33 cases at femur, 23 cases at tibia. Forty-four of the patients were men, and 17 were women. The mean age was 38 years (range 7-70 years). The nonunion had resulted from failure of internal fixation in 47 cases, failure of external fixation in 5 cases, infection in 9 cases. The history of nonunion lasted from 10 to 156 months (mean 19 months). There were 42 patients treated with locking compression plate (LCP), and 19 patients with less invasive stabilization system (LISS). For bone grafting, autogenous ilium was used in 55 patients, autogenous ilium and allograft bone was used in 3 patients, allograft bone and Wright DBM artificial bone was used in 3 patients., Results: All the 61 patients were followed up for an average 12 months (range 6-24 months) only to reveal solid bone union in all the fracture, with a mean healing time of 4.8 months (ranged from 4 to 6 months). No loosening or breakage of the implants occurred in this series. The Knee Society Scores (KSS) was used to evaluate knee function in 47 patients with peri-knee joint nonunion, excellent result were seen in 35 patients, good in 7 patients, fare in 1 patients, poor in 4 patients., Conclusion: Locking internal fixation can be used to treat effectively bone nonunion at the humerus, femur and tibia.

The present investigation is a prospective study comparing the use of locked plates and classic double plates for the repair of bicondylar tibial plateau fractures. Eighty-four patients with bicondylar tibial plateau fractures were treated with plate fixation by either a locked plate (Less Invasive Stabilization System, LISS) or classic double plates (DP). All patients were followed for a minimum of 24 months. Outcomes were assessed by recording the surgical experience with each approach, post-operative complications and improvements in knee function as measured by the Hospital for Special Surgery (HSS) score. For all patients, no differences in the mechanisms of injury, fracture type, open fracture grade, mean age, gender distribution, associated medical conditions, pre-surgical stay, surgical time, bony union rate or radiographic healing times were observed between the two groups. Also, the HSS score and incidences of infection, seroma, hematoma, deep venous thrombosis, loss of reduction, loss of alignment, hardware failure and overall post-operative complications were all similar in both groups (P>0.05). Wound size and blood loss were significantly less in the LISS group than in the DP group (both P<0.05). A significantly higher incidence of post-operative malalignment of the proximal tibia (P=0.041) and a trend toward significance of a higher incidence of symptomatic hardware irritation (P=0.057) were observed in the LISS group compared to the DP group. In conclusion, LISS provides an alternative treatment for bicondylar tibial plateau fractures, but it may not replace the conventional two-incision double plating technique as the standard of care.

Introduction: The treatment for humeral shaft fracture is still controversial, especially for complex fractures. The purpose of this study was to evaluate the clinical and radiographic outcomes of treating complex humeral shaft fractures by using locking compression plate with minimally invasive technique., Materials and Methods: A total of 21 patients with 21 acute complex humeral shaft fractures (AO type C) were included in this study. All were treated with locking compression plate in a minimally invasive way. The average age of the patients was 42.9 years and there were 14 males and 7 females. Plain radiographs of humerus were used to assess bony union. Functional recovery of the shoulder joint was assessed using the Constant and HSS scoring systems., Results: The patients were followed for a mean of 28.7 months (range 19-37). With one operation, nineteen fractures (90.4%) achieved a solid union in an average of 14.3 weeks. At final follow-up, 20 patients (95.2%) had satisfactory alignment, except for one associated with olecranon fracture, all patients had a good to excellent elbow function with a mean HSS score of 91.7 points. Eighteen patients (85.7%) achieved satisfactory shoulder function with a mean Constant score of 83.1 points. One superficial infection (4.8%) and two non-unions (9.6%) were found postoperatively., Conclusions: It was concluded that use of a minimally invasive plate osteosynthesis with locking compression plate is a safe alternative way to classic surgical methods in the treatment of complex humeral shaft fractures, which had a high union rate with less risk of complications.

Fracture dislocations of the knee involving the proximal tibia are difficult to treat because of the operative approach that maybe required and the instability of the construct. This paper evaluates the use of a two-incision approach with a medial double-plating technique. The clinical results of a case series of 42 patients collected prospectively are presented. At final follow-up 37 out of 42 (88%) had satisfactory reduction of the articular surface and 41 (98%) had satisfactory alignment. At one year postoperation there was no loss in reduction or alignment. The mean HSS score was 90.9 (s.d. 3.35, range 83 to 97). There were no superficial or deep infections, however four cases (10%) had a sanguinous effusion for more than one week postoperatively. It was concluded that the medial double-plating operation is an effective way of managing fracture dislocations involving the proximal tibia.

Objective: To study the clinical effect of tractive reduction with external fixator and arthroscopically assisted treatment for tibial plateau fractures., Methods: From February 2003 to January 2005, a total of 26 cases with tibial plateau fractures were reviewed. There were 4 cases of type I fracture, 5 type II, 4 type III, 6 type IV, 5 type V and 2 type VI based on Schatzker criteria. Before operation, X-ray examination and CT scanning were done. During operation, the dissociative fragments were reconstructed by tractive reduction with external fixator arthroscopically and fixated with screws or plates., Results: All the fractures were healed within 1.5 - 4 months, with no severe complications such as poor wound healing, infection or osteofascial compartment syndrome. All patients that were followed up for 7 - 21 months (mean, 16 months) showed no traumatic osteoarthritis, inversion or eversion of the knee. According to the Rasmussen scoring system, the outcome was excellent in 11 cases, good in 13 and fair in 2, with total score of 27 +/- 2., Conclusions: As for Schatzker type I - VI tibial plateau fractures, tractive reduction with external fixator and arthroscopically assisted treatment is characterized by minimal invasion, fast fracture healing. It broadens operative interspace of articular cavity, improves accuracy of reduction, is beneficial for knee joint function to recover.