Search

This study investigated the muscle strength and performance fatigability of the forearms in eight male orthopaedic surgeons when performing bone screw fixations. Each surgeon performed an eight-bone screws operations in a porcine femur model to simulate fractural fixation using plating technique. The pre- and post-fatigue maximum isometric forces and corresponding electromyography responses were measured to assess the forearm muscle strength loss and fatigue due to screwing. Results showed that after eight bone screws were inserted, the maximal grip force, maximal driving torque and maximal push force losses were approximately 29%, 20% and 23%, respectively. While the grip force and/or driving torque acting, both the brachioradialis and extensor carpi ulnaris had a higher percentage change of EMG than the biceps brachii. The driving forces decreased with the number of screw insertions; however, the insertion time increased parabolically with the number of screws and significantly decreased the insertion rate of the screws, indicating that forearm muscle fatigue may occur in surgeons who treat fracture fixation using more than eight bone screws., Competing Interests: Declaration of competing interest There is no conflict of interest regarding the publication of this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: In the present retrospective study, we aimed to analyze the results of treatment for recalcitrant distal tibial nonunion using Masquelet technique with locking plate as a definitive external fixator., Materials: We included 15 consecutive cases of distal tibial nonunion treated at our hospital between January 2012 and December 2015. The reconstructive procedure comprised debridement of the nonunion site, deformity correction, stabilization with an external locked plate, defect filling with cement spacer for inducing membrane formation, and bone reconstruction using a cancellous bone autograft (Masquelet technique). All patients were followed-up for at least one year., Results: Fracture union occurred in all cases after a median of 6.5 months (range, 5-12 months). Mean ankle motion ranged from 12.3 (range, 5-20) degrees of dorsiflexion to 35 (range, 5-55) degrees of plantar flexion. At the final follow-up, the median Iowa ankle score was 83 (range, 68-91). Eight patients had excellent scores, six had good scores, and one had fail score., Conclusion: Although the current study involved only a small number of patients and the intervention comprised two stages, we consider that the used protocol is a simple and valuable alternative for the treatment of recalcitrant distal tibial nonunion., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: This study aimed to evaluate the outcome of using a metaphyseal locking plate as a definitive external fixator for treating open tibial fractures based on biomechanical experiments and analysis of clinical results., Methods: A metaphyseal locking plate was used as an external fixator in 54 open tibial fractures in 52 patients. The mean follow-up was 38 months (range, 20-52 months). Moreover, static axial compression and torsional tests were performed to evaluate the strength of the fixation techniques., Results: The average fracture healing time was 34.5 weeks (range, 12-78 weeks). At 4 weeks postoperatively and at the final follow-up, the average Hospital for Special Surgery knee score was 85 (range, 81-100) and 94 (range, 88-100), respectively, and the American Orthopaedic Foot and Ankle Society score was 88 (range, 80-100) and 96 (range, 90-100), respectively. Based on the static test result, the axial stiffness was significantly different among groups (p=0.002), whereas the torsional stiffness showed no significant difference (p=0.068)., Conclusions: Clinical outcomes show that the use of locking plate as a definitive external fixator is an alternative choice for tibial fractures after obtaining appropriate fracture reduction. However, external locked plating constructs were not as strong as standard locked plating constructs. Therefore, the use of external locked plating constructs as a definitive treatment warrants further biomechanical study for construct strength improvement., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

We evaluated both the outcome of using a locking plate as a definitive external fixator for treating open tibial fractures and, using finite element analysis, the biomechanical performance of external and internal metaphyseal locked plates in treating proximal tibial fractures. Eight open tibial patients were treated using a metaphyseal locked plate as a low-profile definitive external fixator. Then, finite element models of internal (IPF) as well as two different external plate fixations (EPFs) for proximal tibial fractures were reconstructed. The offset distances from the bone surface to the EPFs were 6 cm and 10 cm. Both axial stiffness and angular stiffness were calculated to evaluate the biomechanical performance of these three models. The mean follow-up period was 31 months (range, 18-43 months). All the fractures united and the mean bone healing time was 37.5 weeks (range, 20-52 weeks). All patients had excellent or good functional results and were walking freely at the final follow-up. The finite element finding revealed that axial stiffness and angular stiffness decreased as the offset distance from the bone surface increased. Compared to the IPF models, in the two EPF models, axial stiffness decreased by 84-94%, whereas the angular stiffness decreased by 12-21%. The locking plate used as a definitive external fixator provided a high rate of union. While the locking plate is not totally rigid, it is clinically stable and may be advisable for stiffness reduction of plating constructs, thus promoting fracture healing by callus formation. Our patients experienced a comfortable clinical course, excellent knee and ankle joint motion, satisfactory functional results and an acceptable complication rate., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

High-energy proximal tibial fractures are complex injuries that may lead to significant complications. Staged treatment of these injuries using a spanning external fixator across the knee joint in the acute setting decreases the incidence of complications. This article is a prospective evaluation of outcomes using a two-stage procedure for treatment of 15 patients who sustained open proximal tibial fractures between April 2006 and January 2008. In the first stage, we used low profile, less-invasive stabilisation system (LISS) plates for temporary external fixation to immobilise the fractures after anatomic reduction, followed by soft-tissue reconstruction. In the second stage, we applied LISS plates for definitive internal fixation, using minimally invasive percutaneous osteosynthesis. All fractures were monitored for a mean of 20.4 months (range, 12-32 months). All fractures united at a mean of 38.6 weeks (range, 18-66 weeks). Knee motion ranged from a mean of 1 degrees (range, 0 degrees to 5 degrees ) to 125 degrees of flexion (range, 100 degrees to 145 degrees ). The reduction was scored as good in 13 patients and fair in two patients. At follow-up, 10 patients had excellent, and five had good knee scores. The complications included minor screw-track infections in three patients. In conclusion, the two-stage technique was well suited for treating these difficult injuries, and for patients who needed longer periods of external fixation. Surgeons were able to achieve gross anatomy restoration, soft-tissue reconstruction, stable fixation and high union rates. Patients obtained good-to-excellent motion, function and comfort after treatment., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Background: Most children with humeral supracondylar fractures can be treated with simple closed reduction and cross-fixation with Kirschner (K)-wires. However, in a small proportion of cases, an acceptable closed reduction cannot be obtained, and open reduction becomes necessary. An alternative to open reduction is the use of a temporary 3-mm K-wire to manipulate and reduce the distal fragment. This report introduces the method of manipulation, as well as indications, and draws comparisons with complete close reduction cases., Methods: Of 118 patients, 76 (64.4%) were managed with the standard closed reduction method and additional K-wire fixation to secure a good alignment (group 1). In the remaining 42 cases (35.6%), acceptable reduction could not be achieved by closed methods alone, and another temporary 3-mm K-wire was used to manipulate the distal fragment. After reduction of the fracture with the additional wire, standard cross K-wires were inserted to stabilize the fracture (group 2). As long as there was contact at the fracture site in cases of humeral supracondylar fracture, the traditional closed method was used easily to achieve excellent restoration. However, for cases in which the fracture site was totally displaced, and contact at the fracture site via traction was unsuccessful, a 3-mm K-wire was used to perform supplemental restoration treatment. All the patients, after the operation, were temporally immobilized with a long-arm splint for about 3 weeks. The fixation K-wires were removed after the radiograph had shown callus formation over the fracture site. Then the operation indications, operation methods and time, complications, and differences in range of motion were analyzed for these two sets of patients., Results: The average group 1 surgery time was 18 minutes (range, 9-32 minutes), whereas the average surgery time for group 2 was 33 minutes (range, 15-45 minutes). Three cases in group 1 were complicated with ulnar nerve injury caused by the fixation wire. There were no ulnar nerve injuries in group 2. However, the ulnar nerve injury complication rates for the two groups (3 in 76 for group 1; 0 in 40 for group 2) did not reach statistical difference (p = 0.5502, Fisher's exact test). The union times for the two groups were almost the same (average, 3 weeks; range, 2-5 weeks). The 3-mm K-wire manipulation reduction cases and the closed reduction cases seemed to yield the same healing results in all aspects, except for the longer surgery time in group 2 (p < 0.0001). Both groups achieved satisfactory results., Conclusions: The closed reduction method should be used for children with humeral supracondylar fractures, whenever possible. The 3-mm K-wire manipulation method reduces the probability that open reduction will be required in some severe cases. This is a simple method without complications. The prognosis is the same as for closed reduction cases.

Bone drilling is a common procedure used to create pilot holes for inserting screws to secure implants for fracture fixation. However, this process can increase bone temperature and the excessive heat can lead to cell death and thermal osteonecrosis, potentially causing early fixation failure or complications. We applied a three-dimensional dynamic elastoplastic finite element model to evaluate the propagation and distribution of heat during bone drilling and assess the thermally affected zone (TAZ) that may lead to thermal necrosis. This model investigates the parameters influencing bone temperature during bone drilling, including drill diameter, rotational speed, feed force, and predrilled hole. The results indicate that our FE model is sufficiently accurate in predicting the temperature rise effect during bone drilling. The maximum temperature decreases exponentially with radial distance. When the feed forces are 40 and 60 N, the maximum temperature does not exceed 45 °C. However, with feed forces of 10 and 20 N, both the maximum temperatures exceed 45 °C within a radial distance of 0.2 mm, indicating a high-risk zone for potential thermal osteonecrosis. With the two-stage drilling procedure, where a 2.5 mm pilot hole is predrilled, the maximum temperature can be reduced by 14 °C. This suggests that higher feed force and rotational speed and/or using a two-stage drilling process could mitigate bone temperature elevation and reduce the risk of thermal osteonecrosis during bone drilling. [ABSTRACT FROM AUTHOR]

Introduction: Treating a terrible triad injury of the elbow remains a challenge for orthopedic surgeons, especially in elderly patients due to the poor quality of the surrounding soft tissue and bony structures. In the present study, we propose a treatment protocol using an internal joint stabilizer through a single posterior approach and analyze the clinical results. Materials and Methods: We retrospectively reviewed 15 elderly patients with terrible triad injuries of the elbow who underwent our treatment protocol from January 2015 to December 2020. The surgery involved a posterior approach, identification of the ulnar nerve, bone and ligament reconstruction, and the application of the internal joint stabilizer. A rehabilitation program was initiated immediately after the operation. Surgery-related complications, elbow range of motion (ROM), and functional outcomes were evaluated. Results: The mean follow-up period was 21.7 months (range, 16-36 months). ROM at the final follow-up was 130° in extension to flexion and 164° in pronation to supination. The mean Mayo Elbow Performance Score was 94 at the final follow-up. Major complications included breaking of the internal joint stabilizer in 2 patients, transient numbness over the ulnar nerve territory in one, and local infection due to irritation of the internal joint stabilizer in one. Conclusions: Although the current study involved only a small number of patients and the protocol comprised two stages of operation, we believe that such a technique may be a valuable alternative for the treatment of these difficult cases. Level of Clinical Evidence: 4. [ABSTRACT FROM AUTHOR]

Introduction: Internal fixation is the treatment of choice for subtrochanteric fractures in most conditions. However, it may be an unsuitable procedure for patients with poor health status, osteomyelitis, and surrounding soft tissue compromise. This study aimed to ascertain the viability and reliability of using external locking plate fixation for these difficult cases. Methods: Eleven patients with femoral subtrochanteric fractures who received external locking plate fixation in our institute from January 2014 to December 2019 were enrolled in our study. The bone union time, wound complication, alignment, and necessity for narcotic agents were evaluated. Results: The average length of follow-up was 17.5 months (range, 14-26 months). The mean time for bone union was 17.7 weeks (range, 15-21 weeks). The indications included poor health condition, soft tissue compromise, and post-operative osteomyelitis. Pin tract infection was noted in two patients who were treated successfully with oral antibiotics administration and removal of the involved screws. Osseous union with varus deformity <10° was achieved in all patients except one. Three patients required an orally administered pain killer at the final visit. The average Harris Hip Score at one year post-operatively was 66.6 (range, 49-80). Conclusions: Although the current study only involved 11 patients, we believe that our method may serve as a valuable alternative for the treatment of a femoral subtrochanteric fracture in selected cases. Level of Evidence: Level IV, retrospective case series [ABSTRACT FROM AUTHOR]

Background: Proximal humeral fractures treated with locking plate can fail due to varus collapse, especially in osteoporotic bone with medial cortex comminution. The use of an intramedullary strut together with locking plate fixation may strengthen fixation and provide additional medial support to prevent the varus malalignment. This study biomechanically investigates the influence of an intramedullary cortical bone strut on the cyclic stability of proximal humeral fractures stabilized by locking plate fixation in a cadaver model.Methods: Ten cadaveric humeri were divided into two groups statistically matched for bone density. Each specimen was osteotomized with 10 mm gap at the surgical neck. The non-augmented group stabilized with locking plate alone; in the augmented group, a locking plate was used combined with an intramedullary cortical bone strut. The strut was retrograded into the subchondral bone, and three humeral head screws were inserted into the strut to form a plate-screw-strut mechanism. The cyclic axial load was performed to 450 N for 6000 cycles and then loaded to failure. Construct stiffness, cyclic loading behavior and failure strength were analyzed to identify differences between groups.Results: The augmented constructs were significantly stiffer than the non-augmented constructs during cycling. On average, the maximum displacements at 6000 cycles for non-augmented and augmented groups were 3.10 ± 0.75 mm and 1.7 ± 0.65 mm (p = 0.01), respectively. The mean peak-to-peak (inter cycle) displacement at 6000 cycles was about 2 times lower for the augmented group (1.36 ± 0.68 mm vs. 2.86 ± 0.51 mm). All specimens showed varus collapse combined with loss of screw fixation of the humeral head. The failure load of the augmented group was increased by 2.0 (SD = 0.41) times compared with the non-augmented group (p < 0.001).Conclusions: The stability and strength of the locking plate augmented with an intramedullary strut were significantly increased. For bone with poor quality, the subsidence of the locked screws led larger displacement, decreased the stability of the constructs, however, the plate-screw-strut mechanism provided more rigidity to stabilize the fixation. This study emphasized the importance of intramedullary support for the proximal humeral fractures fixed with a locked plate under cyclic loading, especially in bone with poor quality. This work is based on the results of cadaver model, further in vivo analysis is necessary to determine if the clinical results can be extrapolated from this data. [ABSTRACT FROM AUTHOR]

Abstract: We retrospectively evaluate the efficacy of a clavicle hook plate as a fixation device for unstable distal end comminuted clavicle fractures. Seven patients who visited our hospital between March 2004 and January 2009 were included in this study. The patients'' age ranged from 26 years to 65 years, and the mean follow-up period was 6.9 months. All fractures were united, and there was no case of delayed union. There were no complications after surgery. At the final follow-up in January 2010, six excellent and one good Constant-Murley scores were noted. We conclude that the use of a hook plate is a reasonable option for fixation of an unstable distal end comminuted clavicle fracture, resulting in a high rate of union and satisfactory functional results. [Copyright &y& Elsevier]

Background and purpose Based on reported success with staged treatment of distal tibial fractures, we designed a 2-stage protocol including external/internal locked plating. We retrospectively assessed the outcome of open distal tibial fractures treated according to this protocol. Patients and methods From March 2006 through July 2008, 16 patients who sustained open distal tibial fractures were treated by a two-stage protocol. The first stage consisted of low-profile, locked plates for temporary external fixation after debridement and anatomic reduction, followed by soft tissue reconstruction. The second stage consisted of locked plates for definitive internal fixation, using minimally invasive percutaneous osteosynthesis. All fractures were followed for median 2 (1–3) years. Results The reduction was classified as being good in 15 patients and fair in 1 patient. All fractures united at a median of 6 (6–12) months. At the latest follow-up, 7 patients had excellent and 9 had good Iowa ankle scores; ankle motion ranged from a median of 10 (5–20) degrees of dorsiflexion to 40 (20–60) degrees of plantar flexion. Interpretation We believe that the 2-stage external/internal locked plating technique is an effective procedure for treatment of open distal tibial fractures in patients who need a long period of external fixation. We achieved good reduction with immediate ankle-sparing stable fixation. Soft tissue reconstruction and subsequent definitive fixation led to union of all fractures with good function. [ABSTRACT FROM AUTHOR]

Study Design: The aim of this case report is to examine the problem of serious pyogenic spondylitis that may follow vertebroplasty.Objectives: To report 1 case of serious pyogenic spondylitis caused by percutaneous vertebroplasty with polymethyl methacrylate.Summary Of Background Data: Serious pyogenic spondylitis caused by percutaneous vertebroplasty with polymethyl methacrylate is a rare complication. We herein report a case of pyogenic spondylitis that occurred after the patient had undergone vertebroplasty.Methods: A 78-year-old woman with a T12 osteoporotic compression fracture, and without a magnetic resonance imaging sign of infection, underwent percutaneous vertebroplasty using polymethyl methacrylate without complication. RESULTS.: About 1 month after the operation, the patient was readmitted because of severe backache, and the diagnosis of pyogenic spondylitis was made using radiograph and magnetic resonance imaging. Anterior inter-body fusion with a strut bone graft after debridement and posterior instrumentation were then performed.Conclusions: Vertebroplasty should proceed under sterile conditions. Excluding the possibility of spinal infection before surgery and a detailed evaluation assuring that the patient is without systemic infectious disease before the vertebroplasty procedure is crucial. [ABSTRACT FROM AUTHOR]