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Calcaneal body fractures are often associated with varying degrees of shortening deformities. Restoring calcaneal length is crucial for the functional prognosis of the foot. Through finite element analysis, this study compared the biomechanical effects of multiple fixation schemes for calcaneal fractures. We delineated and assembled the finite element model of the Sanders type II calcaneal fracture and four internal fixation simulations (namely distraction screw, lag screw, frame locking plate, and T-shaped locking plate). Different axial forces (350, 700, and 1400 N) were then applied to simulate various postures. We then compared the inner and outer shortening distances (D1 and D2, respectively), equivalent von Mises stress, and maximum von Mises stress of the calcaneus. In the individual model, with an increase in the pressure, D1, D2, and the maximum von Mises stress gradually increased. At 1400 N, D1 and D2 for the internal fixation schemes were as follows: distraction screw (0.03 mm, 0.1 mm) < T-shaped locking plate (0.45 mm, 0.26 mm) < frame locking plate (0.50 mm, 0.26 mm) < lag screw (0.66 mm, 0.64 mm). The maximum von Mises stress values for the internal fixation methods were as follows: lag screw (491.0 MPa) < distraction screw (663.1 MPa) < frame locking plate (772.7 MPa) < T-shaped locking plate (931.8 MPa). In patients with calcaneal body fractures, the distraction screw is a potential therapeutic option for resisting calcaneal shortening. [ABSTRACT FROM AUTHOR]

Summary This case report describes a novel fixation technique of scapular neck fracture in a 2‐week‐old Arabian foal using two 3.5 mm tibial‐plateau‐levelling‐osteotomy (TPLO) locking plates originally designed for small animal orthopaedic surgery. The foal presented with a traumatic short oblique scapular neck fracture. Fracture fixation was performed under general anaesthesia using two anatomically pre‐shaped 3.5 mm TPLO locking plates; one on each side of the spine of the scapula. Fracture fixation was successful using two TPLO locking plates. Minimal soft tissue manipulation and identification of the suprascapular nerve allowed for relatively atraumatic application of the implants. The implants were left in place. Follow‐up evaluation 2 years after surgical intervention confirmed the horse to be sound with no clinical or gait abnormalities. Stabilisation of a short oblique scapular neck fracture in a 2‐week‐old foal with an anatomically pre‐shaped implant led to a good outcome in this case report. No complications were encountered during the recovery period. The use of an anatomically pre‐shaped locking plate intended for use on dogs, which is widely available in the veterinary industry, has proven to be a viable alternative for a scapular neck fracture fixation in this foal. [ABSTRACT FROM AUTHOR]

Abstract Calcaneal body fractures are often associated with varying degrees of shortening deformities. Restoring calcaneal length is crucial for the functional prognosis of the foot. Through finite element analysis, this study compared the biomechanical effects of multiple fixation schemes for calcaneal fractures. We delineated and assembled the finite element model of the Sanders type II calcaneal fracture and four internal fixation simulations (namely distraction screw, lag screw, frame locking plate, and T-shaped locking plate). Different axial forces (350, 700, and 1400 N) were then applied to simulate various postures. We then compared the inner and outer shortening distances (D1 and D2, respectively), equivalent von Mises stress, and maximum von Mises stress of the calcaneus. In the individual model, with an increase in the pressure, D1, D2, and the maximum von Mises stress gradually increased. At 1400 N, D1 and D2 for the internal fixation schemes were as follows: distraction screw (0.03 mm, 0.1 mm)

Abstract Background Distal tibial fractures represent common lower limb injuries, frequently accompanied by significant soft tissue damage. The optimal surgical approach for managing these fractures remains a topic of considerable debate. The aim of this study was to perform a comparative analysis of the outcomes associated with retrograde intramedullary tibial nails (RTN) and minimally invasive plate osteosynthesis (MIPO) in the context of treating extra-articular distal tibial fractures. Methods A retrospective review was conducted on a cohort of 48 patients who sustained extra-articular distal tibial fractures between December 2019 and December 2021. Patients underwent either RTN or MIPO procedures. Various parameters, including operative duration, intraoperative fluoroscopy exposure, time to union, duration until full weight-bearing, American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications, were recorded and compared between the two treatment groups. Results No statistically significant differences were observed in operative duration, time to union, angulation of the distal tibial coronal plane, or AOFAS scores between the RTN and MIPO groups. However, the RTN group had a higher average number of intraoperative fluoroscopy images (8.2 ± 2.3) compared to the MIPO group (4.1 ± 2.0). The RTN group demonstrated shorter average hospital stays (7.1 ± 1.4 days) and a quicker return to full weight-bearing (9.9 ± 1.3 weeks), which were significantly superior to the MIPO group (9.0 ± 2.0 days and 11.5 ± 1.5 weeks, respectively). In terms of complications, the RTN group had one case of superficial infection, whereas the MIPO group exhibited two cases of delayed union and nonunion, two occurrences of deep infection, and an additional three cases of superficial infection. Conclusions Both RTN and MIPO are effective treatment options for extra-articular distal tibial fractures. However, RTN may offer superior outcomes in terms of decreased inpatient needs, faster return to full weight-bearing capacity, and a lower rate of complications.

Abstract Background Due to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus. Case presentation A 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient’s elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications. Conclusion In this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

Abstract Background The calcar of the proximal humerus is a fundamental structure for medial humeral column support. This study aimed to assess the outcome of osteosynthesis across cases of unstable proximal humerus fractures (PHFs) with medial calcar comminution, following treatment with a PHILOS locking plate and medial support screw (MSS). Methods Between January 2010 and December 2018, we retrospectively analyzed the outcomes of 121 cases of osteosynthesis for PHFs with medial column disruption. For the medial support, at least one oblique screw was inserted within 5 mm of the subchondral bone in the inferomedial quadrant of the humeral head. All patients were categorized into two groups: 26 patients in the single MSS group, and 95 in the multiple MSS group. Follow-up after at least an year involved clinical and radiographic outcome evaluations, and correspondingly measuring the Constant-Murley score, University of California, Los Angeles (UCLA) shoulder scale, pain visual analogue scale (VAS), major complications, neck-shaft angle (NSA), humeral head height (HHH), and the eventual time to bone union. Risk factors for the major complications were assessed by multivariate logistic regression analyses. Results The cohort’s mean age was 64.4 ± 15.4 years, and the mean follow-up duration was 19.5 ± 7.6 months. At the final follow-up, between the single MSS and multiple MSS groups, no significant differences in the Constant-Murley score (p = 0.367), UCLA score (p = 0.558), VAS (p = 0.571), time to bone union (p = 0.621), NSA loss (p = 0.424), and HHH loss (p = 0.364) were observed. The incidence of complications (p = 0.446) based on the number of MSS were not significantly different. The initial insufficient reduction after surgery (of NSA

Abstract Background The aim of this study was to explore the efficacy of a novel intramedullary fixation technique using the ortho-bridge system (OBS) for midshaft clavicle fractures. Methods A total of 63 patients were included in this study: 35 underwent plate internal fixation (LP group) and 28 underwent OBS intramedullary fixation (OBS group). Surgical time, intraoperative blood loss, incision length, fracture healing time, removal of the internal fixation agent, visual analog scale (VAS) score for shoulder pain, Constant–Murley shoulder score and complication occurrence were compared between the two groups. Results Preoperative general data, such as sex, age and fracture type, were not significantly different between the two groups (P > 0.05). However, the OBS group exhibited better outcomes than the LP group exhibited in terms of surgical time, intraoperative blood loss and total incision length (P 0.05). None of the patients in the OBS group experienced scarring of the surgical incision, and 6 patients in the LP group experienced scarring of the surgical incision. Finally, the complication incidence in the OBS group was lower than that in the LP group. Conclusion For midshaft clavicle fractures, OBS intramedullary fixation is better than locking-plate internal fixation because it led to less trauma, a faster recovery, better efficacy, and better esthetic outcomes and comfort. Therefore, this technique may have potential as a novel treatment for midshaft clavicle fractures. Level of evidence: III, retrospective observational study.

BACKGROUND: Proximal humerus internal locking system locking plate is the most commonly used fixation method for proximal humeral fractures, but its failure rate is still high in clinical practice. Reasonable screw placement is an important factor affecting the stability of internal fixation. OBJECTIVE: To investigate the distribution of humeral head screws in the treatment of proximal humeral fractures with proximal humerus internal locking system plate and its influence on internal fixation failure. METHODS: From January 2017 to December 2021, data from patients with proximal humeral fractures undergoing proximal humerus internal locking system plate in Third Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively analyzed. A total of 124 patients were enrolled, including 16 males and 108 females, at the age of ≥60 years. According to whether there was internal fixation failure after operation, they were divided into normal group (n=101) and internal fixation failure group (n=23). The patient's age, gender, fracture type, the integrity of the medial column, plate height, neck-shaft angle, whether the talus screw was inserted, and the number of humeral head screws, were collected. The humeral head was divided into eight zones according to the postoperative digital radiography anteroposterior film, and the distribution characteristics of the screws in each zone were collected, and the heat map of the screw distribution was drawn. RESULTS AND CONCLUSION: (1) There were no significant differences between the two groups in age, gender, fracture type, the integrity of the medial column, plate height, neck-shaft angle, whether to insert talus screws, and the number of humeral head screws (P > 0.05). (2) The heat map showed that the humeral head screws were evenly distributed in the normal group, mainly scattered in zones 4, 6, and 7. However, the screw distribution in the internal fixation failure group was not uniform, mainly concentrated in zones 4 and 6. In addition, in the ideal area of talus screws (7/8 zone), there were significantly more screws in the normal group than in the internal fixation failure group. (3) It is indicated that in the treatment of proximal humeral fractures with proximal humerus internal locking system plate, the uniform distribution of humeral head screws is the key to ensuring the internal fixation effect. A reasonable distribution of humeral head screws helps to improve the treatment effect and the success rate of internal fixation. [ABSTRACT FROM AUTHOR]

Background: Distal tibial fractures represent common lower limb injuries, frequently accompanied by significant soft tissue damage. The optimal surgical approach for managing these fractures remains a topic of considerable debate. The aim of this study was to perform a comparative analysis of the outcomes associated with retrograde intramedullary tibial nails (RTN) and minimally invasive plate osteosynthesis (MIPO) in the context of treating extra-articular distal tibial fractures. Methods: A retrospective review was conducted on a cohort of 48 patients who sustained extra-articular distal tibial fractures between December 2019 and December 2021. Patients underwent either RTN or MIPO procedures. Various parameters, including operative duration, intraoperative fluoroscopy exposure, time to union, duration until full weight-bearing, American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications, were recorded and compared between the two treatment groups. Results: No statistically significant differences were observed in operative duration, time to union, angulation of the distal tibial coronal plane, or AOFAS scores between the RTN and MIPO groups. However, the RTN group had a higher average number of intraoperative fluoroscopy images (8.2 ± 2.3) compared to the MIPO group (4.1 ± 2.0). The RTN group demonstrated shorter average hospital stays (7.1 ± 1.4 days) and a quicker return to full weight-bearing (9.9 ± 1.3 weeks), which were significantly superior to the MIPO group (9.0 ± 2.0 days and 11.5 ± 1.5 weeks, respectively). In terms of complications, the RTN group had one case of superficial infection, whereas the MIPO group exhibited two cases of delayed union and nonunion, two occurrences of deep infection, and an additional three cases of superficial infection. Conclusions: Both RTN and MIPO are effective treatment options for extra-articular distal tibial fractures. However, RTN may offer superior outcomes in terms of decreased inpatient needs, faster return to full weight-bearing capacity, and a lower rate of complications. [ABSTRACT FROM AUTHOR]

Objective: To analyze the short-term and long-term efficacy and complications of different internal fixation in the treatment of elderly patients with unstable intertrochanteric fracture of femur (IFF). Methods: 60 elderly patients with unstable IFF admitted to our hospital from January 2020 to January 2023 were selected as research samples. According to different surgical methods, they were divided into two groups, including 30 cases in PF-LCP group (receiving PF-LCP surgery) and 30 cases in PFNA group (receiving PFNA internal fixation surgery). The surgical conditions, hip function (HHS), bone metabolism indexes and inflammatory factors levels[type I procollagen amino terminal peptide (PINP), type I collagen carboxy terminal peptide (CTX), serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)], quality of life and complications were compared between the two groups. Results: The surgical time, hospital stay and fracture healing time in the PFNA group were shorter than those in PF-LCP group, and the intraoperative blood loss was less (P＜0.05). The HHS score of the two groups at 3 months, 6 months and 12 months after surgery was gradually higher than that before surgery, and the HHS scores in the PFNA group at 3 months and 6 months after surgery were higher than those in the PF-LCP group (P＜0.05). There was no significant difference in HHS score between the two groups at 12 months after surgery (P＞0.05). The PINP level in the two groups at 6 months after surgery was higher than that before surgery, and the PFNA group had higher PINP level than the PF-LCP group (P＜0.05). The levels of CTX, IL-6 and TNF-α were reduced than those before surgery, and the levels in the PFNA group were lower (P＜0.05). At 12 months after surgery, the quality of life scores of the two groups were higher than before surgery, and the PFNA group had higher scores than the PF-LCP group (P＜0.05). After 12 months of follow-up, there were 4 cases of internal fixation failure in PFNA group (including 3 cases of main nail fracture and 1 case of screw blade withdrawal), and the failure rate was 13.33%. There was no case of internal fixation failure in PF-LCP group, and the failure rate of internal fixation in PFNA group was higher than that in control group (P＜0.05). There was no significant difference in the total incidence of other postoperative complications between the two groups (P＞0.05). Conclusion: Both PFNA and PF-LCP can effectively treat unstable IFF in the elderly. Compared with PF-LCP, PFNA has faster postoperative recovery and better short-term efficacy, but the risk of internal fixation failure is relatively greater. [ABSTRACT FROM AUTHOR]

Background: Due to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus. Case presentation: A 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient's elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications. Conclusion: In this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case. [ABSTRACT FROM AUTHOR]

Purpose: Common surgical procedures in the treatment of periprosthetic distal femur fractures (PPFF) include osteosynthesis with fixed angle locking plates (LP) and retrograde intramedullary nails (RIN). This study aimed to compare LPs to RINs with oblique fixed angle screws in terms of complications, radiographic results and functional outcome. Methods: 63 PPFF in 59 patients who underwent treatment in between 2009 and 2020 were included and retrospectively reviewed. The anatomic lateral and posterior distal femoral angle (aLDFA and aPDFA) were measured on post-surgery radiographs. The Fracture Mobility Score (FMS) pre- and post-surgery, information about perceived instability in the operated leg and the level of pain were obtained via a questionnaire and previous follow-up (FU) examinations in 30 patients (32 fractures). Results: The collective (median age: 78 years) included 22 fractures treated with a RIN and 41 fractures fixed with a LP. There was no difference in the occurrence of complications (median FU: 21.5 months) however the rate of implant failures requiring an implant replacement was higher in fractures treated with a LP (p = 0.043). The aPDFA was greater in fractures treated with a RIN (p = 0.04). The functional outcome was comparable between both groups (median FU: 24.5 months) with a lower outcome in the post-surgery FMS (p = < 0.001). Conclusion: Fractures treated with RIN resulted in an increased recurvation of the femur however the rate of complications and the functional outcome were comparable between the groups. The need for implant replacements following complications was higher in the LP group. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intramedullary nails and locking plates are widely used in the treatment of proximal humeral fractures, but there is no consensus on the choice of internal fixation. OBJECTIVE: To compare the biomechanical stability of intramedullary nails and locking plates in the treatment of two-part and three-part proximal humeral fractures by finite element analysis. METHODS: CT data of the humerus of a volunteer were collected and imported into Minics 21.0, Geomagic Wrap, Soildwork 2017, and Abaqus 2021 to establish finite element models of two-part and three-part fractures treated with two internal fixation methods, respectively. Group A: two-part fracture fixed with intramedullary nail model; group B: two-part fracture fixed with locking plate model; group C: three-part fracture fixed with intramedullary nail model; group D: three-part fracture fixed with locking plate model. The stress distribution, displacement degree, and maximum value of the humerus and internal fixation were compared and analyzed. RESULTS AND CONCLUSION: (1) The maximum stress and maximum displacement of the humerus were the smallest in the model of group A, and the maximum stress and maximum displacement of the humerus were the largest in the model of group D. The stress of the locking plate group was mainly concentrated in the medial inferior part of the humeral head and the screw hole area, while the stress of the intramedullary nail group was mainly concentrated around the fracture line and the lateral inferior part of the surgical neck of the humerus. There is no significant difference in displacement distribution between the two. It is mainly concentrated in the distal humerus. (2) The maximum stress value of the intramedullary nail was the lowest in the model of group A, and the maximum stress value of the locking plate was the highest in the model of group D. The maximum stress of the two internal fixations was mainly concentrated in the talar screw and the connection with the internal fixation. The stress cloud distribution of the locking steel plate was concentrated, while the stress cloud distribution of the intramedullary nail was more uniform. (3) The results showed that compared with the locking plate, the intramedullary nail had more biomechanical advantages, and this advantage was more obvious in three-part fractures. [ABSTRACT FROM AUTHOR]

Background: The calcar of the proximal humerus is a fundamental structure for medial humeral column support. This study aimed to assess the outcome of osteosynthesis across cases of unstable proximal humerus fractures (PHFs) with medial calcar comminution, following treatment with a PHILOS locking plate and medial support screw (MSS). Methods: Between January 2010 and December 2018, we retrospectively analyzed the outcomes of 121 cases of osteosynthesis for PHFs with medial column disruption. For the medial support, at least one oblique screw was inserted within 5 mm of the subchondral bone in the inferomedial quadrant of the humeral head. All patients were categorized into two groups: 26 patients in the single MSS group, and 95 in the multiple MSS group. Follow-up after at least an year involved clinical and radiographic outcome evaluations, and correspondingly measuring the Constant-Murley score, University of California, Los Angeles (UCLA) shoulder scale, pain visual analogue scale (VAS), major complications, neck-shaft angle (NSA), humeral head height (HHH), and the eventual time to bone union. Risk factors for the major complications were assessed by multivariate logistic regression analyses. Results: The cohort's mean age was 64.4 ± 15.4 years, and the mean follow-up duration was 19.5 ± 7.6 months. At the final follow-up, between the single MSS and multiple MSS groups, no significant differences in the Constant-Murley score (p = 0.367), UCLA score (p = 0.558), VAS (p = 0.571), time to bone union (p = 0.621), NSA loss (p = 0.424), and HHH loss (p = 0.364) were observed. The incidence of complications (p = 0.446) based on the number of MSS were not significantly different. The initial insufficient reduction after surgery (of NSA < 125°) was found to be a significant risk factor for post-surgical complications. Conclusions: To treat unstable PHFs, the use of at least one MSS along with a locking plate system is sufficient to achieve satisfactory outcomes. Successful operative treatment using a locking plate for PHF treatment is inherent in anatomical fracture reduction, coupled with medial column support. [ABSTRACT FROM AUTHOR]

Background: Operative treatment of the distal tibia fractures have higher rate of non-union and infection rates. Minimally Invasive Plate Osteosynthesis (MIPO) is one treatment option with added advantages of minimal soft tissue dissection. In this paper we explained the radiological and functional outcome of closed distal tibial fractures treated by MIPO. The objectives of this study were to determine the radiological and functional outcome of closed tibial fractures treated by Minimally Invasive Plate Osteosynthesis (MIPO). Material and Methods: This descriptive study was conducted in Orthopaedic Division Lady Reading Hospital Peshawar from 30th July 2021 to 30th June 2023. In this study all patients of distal tibia fracture fulfilling the inclusion criteria were treated with MIPO. Post-operative radiological outcomes was determined using Radiologic Union Scale in Tibia(RUST) and functional outcome using Knee Society Clinical Rating and Olerud-Molander Ankle Score(OMAS) respectively. The data was analyzed with SPSS version 29. Results: We treated 38 distal tibia fractures with MIPPO. Thirty-three patients were male and 5 females. The mean age was 31±3.2 years (ranged 20 to 60 years). At 9±5.3 months 35(92.1%) patients were radiologically healed with RUST score of 3. At one year 32 (91.42%) patients had excellent outcome and 3 (8.57%) had acceptable outcome using Knee Society Clinical Rating. The Olerude-Molander Ankle score was excellent in 30(85.71%) and good in 5(14.28%) patients. Conclusion: Minimally Invasive Plate Osteosynthesis (MIPO) produced excellent radiological and functional results in majority of our patients. We therefore recommend MIPO as treatment of first choice for closed distal tibial fractures. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical efficacy of the minimally invasive locking plate technique (Philos plate) and interlocking intramedullary nailing technique (TRIGEN intramedullary nail) in the treatment of Neer two-part and three-part proximal humeral fractures. Methods and materials: The clinical data of 60 patients with Neer two-part and three-part proximal humerus fractures admitted to the hospital from April 2017 to April 2021 were retrospectively analyzed. Thirty-two patients were treated with the minimally invasive locking plate technique (minimally invasive plate group), and 28 patients were treated with the interlocking intramedullary nailing technique (intramedullary nail group). The operation time, intraoperative blood loss, incision length, fracture healing time, and postoperative complications were compared between the two groups. The ASES score and Constant–Murley score were used to evaluate the shoulder joint function of the two groups one year after surgery. Results: All 60 patients were followed up for 12 to 24 months, with an average of 16 months. There was no significant difference in operation time, intraoperative blood loss, incision length, or fracture healing time between the two groups (P > 0.05). The incidence of postoperative complications in the intramedullary nail group was significantly lower than that in the minimally invasive steel plate group, and the difference between the groups was statistically significant (P < 0.05). There was no significant difference in the ASES score or Constant–Murley score between the two groups one year after surgery (P > 0.05). Conclusion: The use of the minimally invasive locking plate technique and interlocking intramedullary nailing technique in the treatment of Neer two-part and three-part proximal humerus fractures has the advantages of a small incision, less blood loss, and a high fracture healing rate, and both can achieve satisfactory clinical effects. The internal nail technique is more convenient than the minimally invasive locking plate technique in controlling postoperative complications. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to explore the efficacy of a novel intramedullary fixation technique using the ortho-bridge system (OBS) for midshaft clavicle fractures. Methods: A total of 63 patients were included in this study: 35 underwent plate internal fixation (LP group) and 28 underwent OBS intramedullary fixation (OBS group). Surgical time, intraoperative blood loss, incision length, fracture healing time, removal of the internal fixation agent, visual analog scale (VAS) score for shoulder pain, Constant–Murley shoulder score and complication occurrence were compared between the two groups. Results: Preoperative general data, such as sex, age and fracture type, were not significantly different between the two groups (P > 0.05). However, the OBS group exhibited better outcomes than the LP group exhibited in terms of surgical time, intraoperative blood loss and total incision length (P < 0.05). Additionally, the OBS group exhibited a significantly shorter fracture healing time and internal-fixation removal time than the LP group exhibited (P < 0.05). The VAS scores on postoperative day 1, week 1, month 1 and month 3 were lower in the OBS group than in the LP group (P < 0.05). Furthermore, the Constant–Murley shoulder scores at 1, 3, and 6 months postoperatively were higher in the OBS group than in the LP group (P < 0.05), with no significant difference at 1 year after surgery (P > 0.05). None of the patients in the OBS group experienced scarring of the surgical incision, and 6 patients in the LP group experienced scarring of the surgical incision. Finally, the complication incidence in the OBS group was lower than that in the LP group. Conclusion: For midshaft clavicle fractures, OBS intramedullary fixation is better than locking-plate internal fixation because it led to less trauma, a faster recovery, better efficacy, and better esthetic outcomes and comfort. Therefore, this technique may have potential as a novel treatment for midshaft clavicle fractures. Level of evidence: III, retrospective observational study. [ABSTRACT FROM AUTHOR]

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Background: One of the body's main joints for bearing weight is the knee. Its issues are likewise difficult to resolve. Damage to this joint can cause abnormalities in the alignment, stability, and motion of the knee, which impairs function. Objective: To compare the functional and radiological outcome in AO type C1 distal femur fractures fixed with locking plate versus dynamic condylar screw. Methods: The study comprised 94 patients aged 18 to 60 years who had an isolated distal femur fracture and an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C1 closed fracture. Patients with diabetes mellitus, chronic renal disease, chronic liver disease, ischemic heart disease, pathological fractures, head injuries with a Glasgow coma scale of less than 14, and malignancy were excluded from the sample. The patients were assigned by lottery to groups A and B. In groups A and B, they were treated with dynamic condylar screws (DCS) and locking plate fixation, respectively.. Results: Of the 94 patients, 30 (63.8%) were men and 17 (36.2%) were women in Group A; similarly, 33 (70.2%) were men and 14 (29.8%) were women in Group B. Patients in group A had an average age of 38.8±6.19 years, whereas those in group B had an average age of 39.5±7.36 years. 02 patients (4.2%) in Group-A and 05 patients (10.6%) in Group-B experienced infection. The union rate was 45 (95.7%) in group A (locking plate fixation technique) and 40 (85.10%) in group B (dynamic condylar screw technique). 35 (74.46%) in group A, 08 (17.1%) in good, 03 (6.38%) in average, and 01 (2.1%) in poor; in group B, 25 (53.2%) in excellent, 09 (19.2%) in decent, and 10 (21.3%) had average and 03(6.3%) had poor functional outcome. Conclusion: In terms of clinical and radiological evaluation, the type C1 distal shaft femur fixation with locking plate performs better than the dynamic condylar screw, which has a lower infection rate and better union and functional success. [ABSTRACT FROM AUTHOR]

Background: Locked plating for distal femur fractures is widely recommended and used. We systematically reviewed clinical studies assessing the benefits and harms of fracture fixation with locked plates in AO/OTA Type 32 and 33 femur fractures. Methods: A comprehensive literature search of PubMed, Embase, Cinahl, Web of Science, and the Cochrane Database was performed. The studies included randomized and non-randomized clinical trials, observational studies, and case series involving patients with distal femur fractures. Studies of other fracture patterns, studies conducted on children, pathological fractures, cadaveric studies, animal models, and those with non-clinical study designs were excluded. Results: 53 studies with 1788 patients were found to satisfy the inclusion and exclusion criteria. The most common harms were nonunion (14.8%), malunion (13%), fixation failure (5.3%), infection (3.7%), and symptomatic implant (3.1%). Time to full weight-bearing ranged from 5 to 24 weeks, averaging 12.3 weeks. The average duration of follow-up was 18.18 months, ranging from 0.5 to 108 months. Surgical time ranged between 40 and 540 min, with an average of 141 min. The length of stay in days was 12.7, ranging from 1 to 61. The average plate length was ten holes, ranging from 5 to 20 holes. Conclusion: This review aimed to systematically synthesize the available evidence on the risk associated with locked plating osteosynthesis in distal femur fractures. Nonunion is the most common harm and is the primary cause of reoperation. The overall combined risk of a major and critical complication (i.e., requiring reoperation) is approximately 20%. [ABSTRACT FROM AUTHOR]

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Cite this article: Bone Joint Res 2024;13(3):124–126.

Abstract Background Insufficient interfragmentary compression force (IFCF) frequently leads to unstable fixation of osteoporotic lateral tibial plateau fractures (OLTPFs). A combined cancellous lag screw (CCLS) enhances IFCF; however, its effect on OLTPF fixation stability remains unclear. Therefore, we investigated the effect of CCLS on OLTPF stability using locking plate fixation (LPF). Materials and methods Twelve synthetic osteoporotic tibial bones were used to simulate OLTPFs, which were fixed using LPF, LPF-AO cancellous lag screws (LPF-AOCLS), and LPF-CCLS. Subsequently, 10,000 cyclic loadings from 30 to 400 N were performed. The initial axial stiffness (IAS), maximal axial micromotion of the lateral fragment (MAM-LF) measured every 1000 cycles, and failure load after 10,000 cycles were tested. The same three fixations for OLTPF were simulated using finite element analysis (FEA). IFCFs of 0, 225, and 300 N were applied to the LPF, LPF-AOCLS, and LPF-CCLS, respectively, with a 1000-N axial compressive force. The MAM-LF, peak von Mises stress (VMS), peak equivalent elastic strain of the lateral fragment (EES-LF), and nodes of EES-LF > 2% (considered bone destruction) were calculated. Results Biomechanical tests revealed the LPF-AOCLS and LPF-CCLS groups to be superior to the LPF group in terms of the IAS, MAM-LF, and failure load (all p 2% in the LPF were higher than those in the LPF-AOCLS and LPF-CCLS. Conclusion IFCF was shown to enhance the stability of OLTPFs using LPF. Considering overscrewing, CCLS is preferably recommended, although there were no significant differences between CCLS and AOCLS.

Background: About 20% of proximal humerus fractures (PHFs) are unstable and/or markedly displaced and therefore require surgery. Locking plate fixation after anatomical reduction has become the current treatment of choice for these fractures in the active population. However, studies have shown complication rates up to 36%, such as loss of reduction and avascular necrosis. To date, data from literature are inconclusive on outcomes following the use of an intramedullary fibula allograft in PHFs, possibly due to the case mix. It is hypothesized that the use of a fibula allograft is beneficial to prevent secondary displacement of the fracture in cases where the medial hinge is markedly displaced and unstable, resulting in better clinical and patient reported outcomes. Methods: In this multicenter matched cohort study, patients with an unstable, displaced PHF, including anatomic neck fractures and significantly displaced surgical neck fractures, were included. Patients that were treated with a locking plate augmented with a fibula allograft were matched to patients who had undergone locking plate reconstruction without the allograft. The matches were made based on fracture characteristics, age, and performance status. Functional outcomes, Patient Reported Outcome Measures, complications, and radiographic results were compared. Results: Twelve patients with fibula allograft augmented osteosyntheses were included and matched to 12 control patients. The mean age was 58 years in the fibula allograft group compared to 62 years in the control group. Minimum follow-up was 12 months. Disability of the Arm Shoulder and Hand score, Constant Shoulder score, abduction, and external rotation were significantly better in the fibula allograft group (17.4 ± 8.6 vs. 26.1 ± 19.2, P = .048; 16.5 ± 11.5 vs. 19.8 ± 16.5 P = .040; mean 127° ± 38° vs. mean 92° ± 49° P = −.045; 50° ± 21° vs. mean 26° ± 23°, P = .004). There was no statistically significant difference in the Oxford Shoulder score between groups (P = .105). The Visual Analog Scale was not significantly different between groups (3.1 ± 1.8 vs. 1.6 ± 1.9, P = .439). Radiographic union was reached in 11 patients of the fibula allograft group compared to 8 in the control group (P = .317). The complication rate was twice as high in the control group (3 vs. 7). Conclusion: Additional support of the medial hinge in unstable PHFs with a locking plate in combination with a fibula allograft appears to create a more stable construct without compromising the viability of the articular surface of the head. The use of a fibula allograft in selected complex cases could therefore result in better clinical outcomes with lower complication rates.

Purpose: To compare union rate, union time, alignment, and complication rate in ipsilateral tibia plateau and shaft fractures treated via suprapatellar intramedullary nailing with screw fixation and minimally invasive locking plate fixation. Materials and methods: A retrospective study was conducted on 48 patients who underwent minimally invasive plate fixation (n = 35) or suprapatellar intramedullary nailing with screw fixation (n = 13), for the treatment of ipsilateral tibial plateau and shaft fractures with at least 1-year follow-up. Union rate, union time, radiologic alignment, and complication rate such as malalignment, nonunion, and fracture-related infection (FRI) were investigated. Results: Demographic data were not different between the two groups. Coronal plane alignment was 0.17 ± 4.23 in the plate group and −0.48 ± 4.17 in the intramedullary nail group (p = 0.637). Sagittal plane alignment was −0.13 ± 5.20 in the plate group and −1.50 ± 4.01 in the suprapatellar intramedullary nail group (p = 0.313). Coronal and sagittal malalignment recorded equal results: (p > 0.99), FRI (p = 0.602), nonunion and union times recorded (p = 0.656) and (p = 0.683, 0.829), respectively, and showed no significant difference between the two groups. Conclusion: Suprapatellar intramedullary nailing with screw fixation had similar surgical outcomes with minimally invasive locking plate fixation in ipsilateral tibial plateau and shaft fractures in terms of union rate, union time, alignment, and complication rate. Thus, frequent use of intramedullary nailing combined with screw fixation is anticipated in patients with ipsilateral tibial plateau and shaft fractures when the soft tissue condition is not desirable. Level of evidence: Level III [ABSTRACT FROM AUTHOR]

Purpose: A locking plate (LP) or non-locking plate (NLP) can be used for distal fibula fracture fixation. However, the advantages of LP over NLP in patients with distal fibula fractures are not clear. In terms of indications, the role of the two plates probably differs; however, to draw comparative conclusions, we conceptualized this systematic review and meta-analysis of studies that directly compared the two plates, wherein both groups' indications and baseline parameters were similar. Methods: An electronic literature search was performed using PubMed/Medline, Embase, Scopus, and Cochrane Library databases for studies comparing the LP versus NLP fixation for the lateral malleolus fracture. A total of 18 studies were included in qualitative and quantitative analysis. A subgroup analysis was performed for patients aged < 55 years and patients aged > 55 years. The statistical analysis was performed by Review Manager Software version 5.4.1. Results: A meta-analysis of 4243 fractures was performed across 18 studies. The rate of fracture union and overall complication rates did not differ between the two fixation groups with an OR of 0.71 (95% CI 0.26, 1.96, p = 0.51 and 1.11 (95% CI 0.84, 1.47, p = 0.47, respectively. There is no difference in the reoperation rate due to minor or major complications between the two groups. There was no difference in functional outcome (MD −0.85, with 95% CI −5.63, 3.93, p = 0.73), but NLP has a shorter surgical duration (MD 3.0, with 95% CI 0.26, 5.75, p = 0.03). A leave-one-out sensitivity analysis performed for overall complications affected the final outcome of the meta-analysis. Conclusion: This meta-analysis demonstrates no clear benefit in selecting LP over NLP for the fixation of lateral malleolus fractures. [ABSTRACT FROM AUTHOR]

Introduction: Orthopaedic doctors see many cases of distal tibial fractures every year. Our goal is to investigate and contrast the healing, functional, and complication rates of extra articular distal tibia fractures treated with multidirectional interlocking intramedullary nails and anterolateral locking compression plates. Materials and Methods: Our study utilized a sample size of 20 individuals who presented with distal tibial fractures. The age range of participants in the nail group was 33 to 55 years, whereas in the plating group, the age range was 27 to 60 years. The current investigation was carried out from August 2022 to July 2023 at the Department of Orthopaedics, King George Hospital, Visakhapatnam, Andhra Pradesh, India, utilizing both retrospective and prospective methodologies. Results: The average time for union in the multidirectional interlocking intramedullary group was found to be 4.5 months, but in the plating group, it was 6.4 months. This difference was statistically significant. Additionally, the mean duration for partial and full weight bearing in the nailing group was 4.2 weeks and 9.6 weeks, respectively, which exhibited a statistically significant reduction compared to 7.12 weeks and 13.42 weeks in the plating group. The interlocking group had reduced instances of implant discomfort, ankle stiffness, and infection in comparison to the plating group. Conclusion: Our research led us to conclude that closed intramedullary interlocking nailing is the treatment of choice for distal tibia fractures because it allows for early weight bearing, promotes early fracture union, and reduces implant-related complications. For distal tibiofibular fractures, intramedullary nailing or locking plate fixation is advised. [ABSTRACT FROM AUTHOR]

Purpose: To compare the radiological alignment, union time, union rate, and complication rate between suprapatellar intramedullary nails and minimally invasive locking plate fixation in the treatment of proximal tibial fractures. Materials and methods: We retrospectively analyzed 103 patients who underwent plate fixation (n = 50) or suprapatellar intramedullary nailing (n = 53) for proximal tibial fractures involving the meta-diaphyseal junction between November 2015 and October 2020 at our institution. The union rate, union time, radiologic alignments, and complications, such as malalignment, nonunion, and deep infection, were investigated. Results: The demographic data did not differ between the plate and suprapatellar intramedullary nail groups. The alignment of the coronal plane was 0.24 ± 3.19 in the plate group and − 0.49 ± 2.22 in the intramedullary nail group (p = 0.196). Sagittal plane alignment was − 0.29 ± 4.97 in the plate group and 0.24 ± 4.12 in the intramedullary nail group (p = 0.571), and coronal malalignment (p = 0.196), sagittal malalignment (p = 0.57), deep infection (p = 0.264), nonunion (p = 0.695), union time (p = 0.329), and final union rate (p = 0.699) were not significantly different between groups. Conclusion: Compared with the minimally invasive locking compression plate group, the suprapatellar intramedullary nail group yielded comparable results in terms of radiological alignment and complications. Considering that proximal tibial fractures are associated with high-energy trauma and severe soft tissue damage, we believe that a suprapatellar intramedullary nail may be a good alternative. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Depending on the fracture pattern and soft tissue mantle involvement, clavicle fractures can be treated surgically or non-operatively. Historically, displaced fractures of the clavicle shaft in adults have been treated non-operatively. However, the nonunion rate after non-operative therapy seems to be higher than reported in the past. Additionally, publications reporting better functional outcomes after surgical therapy are accumulating. The current literature suggests that primary surgical stabilization, especially of displaced fractures, provides more rapid functional exercise treatment and thus earlier physical recovery than nonoperative therapy. Individualized treatment is suggested, with careful consideration of the advantages and disadvantages of each therapeutic approach and patient preferences. [ABSTRACT FROM AUTHOR]

Background: Dorsal plate fixation is commonly used for first metatarsophalangeal joint (1st MTPJ) arthrodesis and plate design continues to evolve. A new staple compression plate (SCP) design attempts to utilize the continuous compression of a nitinol staple across the fusion site while simultaneously providing the stability of a dorsal locked plate. Herein, we compare the radiographic, clinical, and patient-reported outcomes of 1st MTPJ joint arthrodesis using 2 dorsal locking plate constructs including a novel SCP construct. Methods: Forty-four patients who underwent 1st MTPJ arthrodesis between 2016 and 2020 were retrospectively evaluated. There were 2 group cohorts. Group 1 cohort included 23 patients who received a CrossRoads Extremity SCP, and Group 2 cohort included 21 patients who received a Stryker dorsal locking precontoured titanium plate (LPP). All patients were evaluated with radiographs, Patient-Reported Outcomes Measures Information System (PROMIS) outcome scores, and Foot Function Index (FFI). Results: The complication and union rates did not vary between groups with a fusion rate of 95.7% in the SCP group and 90.5 % in the LPP group. Similarly, we found no significant differences in PROMIS or FFI scores between the SCP and LPP plates. Conclusion: Use of either dorsal locking plate construct for 1st MTPJ arthrodesis was associated with high union rates and comparable functional outcomes. As locked plate technology continues to evolve for 1st MTPJ arthrodesis, it is important that clinical outcomes are reported. Levels of Evidence: Level IV [ABSTRACT FROM AUTHOR]

This study investigates the optimal placement of locking plate screws for bone fracture stabilization in the humerus, a crucial factor for enhancing healing outcomes and patient comfort. Utilizing Finite Element Method (FEM) modeling, the research aimed to determine the most effective screw configuration for achieving optimal stress distribution in the humerus bone. A computer tomography (CT) scan of the humerus was performed, and the resulting images were used to create a detailed model in SOLIDWORKS 2012. This model was then analyzed using ANSYS Workbench V13 to develop a finite element model of the bone. Four different screw configurations were examined: 4 × 0°, 4 × 10°, 4 × 20°, 2 × 20°; 2 × 0°. These configurations were subjected to bending in the XZ and YZ planes, as well as tension and compression along the Z axis. The research identified the 2 × 20°+2 × 0° configuration as the most beneficial, with average stress values below 30 MPa and peak stress values below 50 MPa in 3-point bending at the first screw. This configuration consistently showed the lowest stress values across all loading scenarios. Specifically, stress levels ranged from 20 MPa to 50 MPa for bending in the XZ plane, 20 MPa–35 MPa for bending in the YZ plane, 20 MPa–30 MPa for extension in the Z-axis, and 18 MPa–25 MPa for compression in the Z-axis. The 4 × 10° and 4 × 20° configurations also produced satisfactory results, with stress levels not exceeding 70 MPa. However, the 4 × 0° configuration presented considerable stress during bending and compression in the Z-axis, with stress values exceeding 100 MPa, potentially leading to mechanical damage. In conclusion, the 2 × 20°; 2 × 0° screw configuration was identified as the most effective in minimizing stress on the treated bone. Future work will involve a more detailed analysis of this methodology and its potential integration into clinical practice, with a focus on enhancing patient outcomes in bone fracture treatment.

Abstract Background and objective Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. Methods A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. Results After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was

Introduction: Distal femoral shaft fractures are characterized by their increasing incidence and complexity, presenting a significant challenge in management. The objective of this retrospective study was to compare the clinical and radiological results of patients with extra-articular distal third femoral shaft fractures treated using either retrograde Talon Distal Fix nail or a distal femur locking plate. Material and Method: The study comprised 40 patients aged >18 years who presented at our hospital with a distal third femoral shaft fracture between January 2017 and January 2023. The patients were divided into two groups: Group TDN, treated with retrograde Talon Distal Fix nailing (n=18), and Group DLP, treated with a distal locking plate (n=22). Demographic data, follow-up period, operating time, time to union, range of motion (ROM), mechanism of injury (traffic accident, fall from height, workplace accident, gunshot injury), fracture type, complications, and surgical method were retrospectively recorded. Clinical evaluation included deformity, knee ROM, pain, and the knee total score (KSS) for walking and knee stability. Results: The mean age of the patients was 48.03±12.31 (min-max: 23-69) years, and the mean follow-up time for all patients was 15.88±2.32 (12-21) months. The mean time to union was 25.55±1.86 (22-30) weeks. Delayed union and non-union rates were similar between the research groups (P=1.000, P=0.673, respectively). Union time (weeks) and mean ROM were not significantly different between the groups (P=0.881, P=0.892, respectively). The mean operation time of the TDF group (48.78±3.94 minutes) was significantly lower than that of the DLP group (62.45±3.33 minutes) (P

Purpose: Although open reduction and internal fixation (ORIF) by plating are the treatment of choice for diaphyseal fractures of the forearm, delayed union and non-union remain as existing complications. This study aimed to analyze predictive factors for the union time in diaphyseal fractures of the forearm. Methods: A retrospective study was conducted on all adult patients with diaphyseal forearm fractures who underwent surgical treatment with plate fixation between 2007 and 2016 at a tertiary care referral center. The patients were divided into two groups based on their union times: ≤3 months or >3 months. They were then compared for demographics, fracture pattern and characteristics, associated injuries, type of fixation, and quality of postoperative reduction. Results: Eighty-six diaphyseal forearm bone fractures (radius, ulna, or both) were observed in 55 adults. Out of these fractures, 55 (65.1%) achieved union within ≤3 months, 26 (30.3%) took more than 3 months to achieve union, and 4 (4.6%) resulted in nonunion. The use of a locking plate in open reduction and internal fixation of diaphyseal forearm fractures significantly increased the likelihood of union within ≤3 months (p = 0.043). The parameter of gap width at the fracture site, as observed on postoperative X-rays, showed a qualitative and quantitative correlation with union time (p = 0.028). Conclusion: The use of a locking plate, combined with reducing the gap width at the fracture site after reduction during open reduction and internal fixation (ORIF) of diaphyseal forearm fractures, is significantly correlated with an increased likelihood of achieving bone union within 3 months.

Objective Implant failure is a disastrous complication of the operative treatment of midshaft clavicle fractures, and improving the osteosynthesis plate is a strategy for preventing this. We aimed to investigate whether canceling the notch and adding screw‐hole inserts enhanced the mechanical properties of the plate. Methods A clavicle model was generated based on the CT images of six adult volunteers (age range, 20–40 years; three males and three females; height range 160–175) using dedicated software, and a midshaft fracture model was created. The domestically made seven‐hole locking plate commonly used for midshaft clavicle fractures was simulated (Model I); modifications were made to the plate (Model II). Using 3D finite element analysis, we simulated the fracture construct under three different load conditions—downward cantilever bending, axial compression, and axial torsion—and compared the stress distribution. Results We found that under axial compression, Model II experienced its maximum stress on the plate at 551.9MPa, which was less than that in Model I (790.4 MPa). Moreover, a greater stress concentration at the fracture site was observed under axial torsion, despite the maximum stress of both the models being similar. Conclusion Canceling the notch and filling the screw holes near the fracture can ameliorate stress concentration on the internal fixation construct and enhance its reliability under axial compression. This improvement has substantial effects on the mechanical properties of implants and potentially prevents implant failure. Modern osteosynthesis anatomical implants need to be improved.

Background & Aims: Road traffic accidents and high-energy injuries are the leading cause of distal tibial metaphyseal fractures. The management of tibial fractures remains controversial despite advances in non-operative and operative care. Plates and intramedullary nails are well-accepted and effective methods, but each has been historically related to complications. The present study compared the results of displaced extra-articular distal metaphyseal tibia fractures. Materials & Methods: This descriptive cross-sectional study was conducted in the department of orthopedics at R. G. Kar medical college and hospital, Kolkata, West Bengal, India on 27 Locking Plate the 27 Multidirectional Plate patients attending orthopedics and emergency room with a tibia fracture from January 2019 to August 2020. All patients with extra-articular distal tibial fracture without distal neurovascular deficit, closed injury, or Gustillo Anderson type 1 were included. Post-operatively, X-rays were taken of the surgical site, and a series of X-rays were taken at 4, 16, 24, and 36 weeks’ intervals. SPSS v.27 and GraphPad Prism v.5 along with statistical tests were used. P values below 0.05 were considered significant. Results: In Locking Plate, 8(29.6%) patients were 21-30 years old, 10(37.0%) patients were 31-40 years old, and 9(33.3%) patients were 41-50 years old. In Multidirectional Nail, 6(22.2%) patients were 21-30 years old, 11(40.7%) patients were 31-40 years old, and 10(37.0%) patients were 41-50 years old. The Association of age with group was not statistically significant (p=0.8245). In Locking Plate, 11(40.7%) patients were female, and 16(59.3%) were male. In Multidirectional Nail, 10(37.0%) patients were female, and 17(63.0%) patients were male. The Association of sex with group was also not statistically significant (p=0.7801). Conclusion: We found that Fair outcome was more in Multidirectional Nails compared to Locking Plate for the AAOS Lower limb questionnaire at four weeks, which was not statistically significant. It was found that the excellent outcome was more in Multidirectional Nails compared to Locking Plate for the AAOS Lower limb questionnaire at five weeks, which was not statistically significant.

Abstract Background This study aimed to compare the clinical efficacy of locking plate and intramedullary nail fixations in the treatment of patients with OTA/AO type 11C proximal humerus fractures. Methods We retrospectively analyzed the data of patients with OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures who underwent surgery at our institution from June 2012 to June 2017. Perioperative indicators, postoperative morphological parameters of the proximal humerus, and Constant–Murley scores were evaluated and compared. Results Sixty-eight patients with OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures were enrolled in this study. Overall, 35 patients underwent open reduction and plate screw internal fixation, and 33 patients underwent limited open reduction and locking of the proximal humerus with intramedullary nail internal fixation. The total cohort had a mean follow-up duration of 17.8 months. The mean operation time of the locking plate group was significantly longer than that of the intramedullary nail group (P 0.05). Complications, including screw penetrations, acromion impingement syndrome, infection, and aseptic necrosis of the humeral head, occurred in 8 patients (8/35, 22.8%) in the locking plate group and 5 patients in the intramedullary nail group (5/33, 15.1%; including malunion and acromion impingement syndrome), with no significant difference between the groups (P > 0.05). Conclusions Similar satisfactory functional results can be achieved with locking plates and intramedullary nailing for OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures, with no significant difference in the number of complications between these two techniques. However, intramedullary nailing has advantages over locking plates for OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures in terms of operation time and bleeding volume.

BackgroundThe aim of this study was to assess the clinical and radiographic outcomes of cubitus varus treatments based on different fixation methods: Locking plate vs. Kirschner-wires (K-wires) and cast fixation.MethodsThis retrospective study of 28 patients was performed in lateral-wedge osteotomy for cubitus varus deformity in our hospital from July 2018 to July 2020. 14 patients in group A were treated by locking plate after lateral closing-wedge osteotomy, whereas other 14 patients were treated by K-wires in group B. We measured the bony union and carrying angle. The clinical and radiographic outcomes were assessed according to the Bellemore criteria.ResultsNo nonunion, neurovascular injury or myositis ossificans was noted at follow-up. In group A, 1 patient with lateral condylar prominence was found. In group B, 2 patients with pinning site infection were treated successfully with oral antibiotics and 2 patients needed revision surgery for residual varus. According to the Bellemore criteria, statistically significant difference was noted between the two groups (P = 0.0458). In the present study, no statistically significant difference was noted in the length of incision and operation time between the 2 groups (P > 0.05). However, the postoperative carrying angle was significantly different at final follow-up between the 2 groups (P

Background and objective: Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. Methods: A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. Results: After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was < 56 Mpa, and stress on the implants using the three techniques was less than the yield strength, with Technique C having the least stress. Conclusion: All three techniques were successful in providing a stable fixation for Sanders type II intra-articular calcaneal fractures, while the minimally invasive calcaneal locking plate with medial support screw fixation approach exhibited greater stability, leading to improved enhancement for the facet fragment; however, screw fixation dispersed the stress more effectively than the other two techniques. [ABSTRACT FROM AUTHOR]

Purpose: Cortical porosis, secondary to either vascular injury or stress-shielding, is a comorbidity of fracture fixation using compression bone plating. Locking plate constructs have unique mechanics of load transmission and lack of reliance on contact pressures for fixation stability, so secondary cortical porosis adjacent to the plate has not been widely investigated. Therefore, this study aimed to assess the effects of long-term locking plate fixation on cortical dimensions and density in a caprine tibial segmental ostectomy model. Methods: Data was acquired from a population of goats enrolled in ongoing orthopedic research which utilized locking plate fixation of 2 cm tibial diaphyseal segmental defects to evaluate bone healing over periods of 3, 6, 9, and 12 months. Quantitative data included tibial cortical width measurements and three-dimensionally reconstructed slab density measurements, both assessed using computed tomographic examinations performed at the time of plate removal. Additional surgical and demographic variables were analyzed for effect on cortical widths and density, and all cis-cortex measurements were compared to both the trans-cortex and to the contralateral limbs. Results: The tibial cis-cortex was significantly wider and more irregular than the trans-cortex at the same level. This width asymmetry differed in both magnitude and direction from the contralateral limb. The bone underlying the plate was significantly less dense than the trans-cortex, and this cortical density difference was significantly greater than that of the contralateral limb. These cortical changes were independent of both duration of fixation and degree of ostectomy bone healing. Conclusions: This study provides evidence that cortical bone loss consistent with cortical porosity is a comorbidity of locking plate fixation in a caprine tibial ostectomy model. Further research is necessary to identify risk factors for locking-plate-associated bone loss and to inform clinical decisions in cases necessitating long-term locking plate fixation. [ABSTRACT FROM AUTHOR]

Introduction: the use of coracoclavicular augmentation systems together with locking plates in the treatment of unstable distal clavicle fractures (Neer II and Neer V) is controversial. Material and methods: patients with unstable distal clavicle fractures treated between 2013-2022 were retrospectively reviewed. The patients were divided into two groups: patients treated with locking plates (P group) and patients treated with locking plates and coracoclavicular augmentation systems (PCC group). Postoperative complications, modified preoperative and final coracoclavicular distance (CC), and outcomes on the Visual Analog Scale (VAS) and Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) were recorded. Results: 16 of 23 patients were treated with plates only, and 7 of 23 were treated with plates and coracoclavicular augmentation systems. One case showed no fracture consolidation, and there was one case of cutaneous infection. The mean final CC distance was 23.7 in the P group and 22.1 in the PCC group. The mean VAS score was 1.3 in both the P and PCC groups, while the mean Quick DASH score was 5.5 in the P group and 8.1 in the PCC group. No significant differences were found in CC distance, VAS or Quick DASH scores. Conclusion: the use of locking plates is likely sufficient in the management of unstable distal clavicle fractures, as there were no significant differences in functional outcomes in this study when coracoclavicular augmentation systems were used together with locking plates. [ABSTRACT FROM AUTHOR]

A new beta TiNbSn alloy with a low Young’s modulus of approximately 40 GPa has been developed to resolve the stress shielding by Young’s modulus divergence. In this study, the efficacy of TiNbSn alloy locking plates on bone repair is compared to that of commercially pure titanium (CP-Ti). The TiNbSn alloy and CP-Ti, which have Young’s moduli of 49.1 GPa and 107 GPa, respectively, were compared. Male Japanese white rabbits were anesthetized, and osteotomy and osteosynthesis with locking plates were performed on the right tibia. The bone repair was assessed using micro-computed tomography (CT), histomorphometry, immunohistochemistry, and mechanical testing. Micro-CT, histomorphometry, immunohistochemistry, and mechanical testing were performed four weeks after osteotomy. Six weeks after surgery, micro-CT and mechanical testing were performed. Micro-CT analysis at four weeks after surgery showed that the intramedullary fracture callus in the TiNbSn alloy group had more bone volume and numerous bridging structures compared to the CP-Ti group (CP-Ti vs. TiNbSn alloy, 34.3 ± 13.1 mm3 vs. 61.3 ± 19.6 mm3, p = 0.02; mean ± standard deviation). At four weeks post-osteotomy, the healed tibia showed significantly higher strength in the TiNbSn alloy group compared with CP-Ti (CP-Ti vs. TiNbSn alloy, 81.3 ± 31.2 N vs. 133.7 ± 46.6 N, p = 0.04). TiNbSn alloy locking plates had a more positive impact on bone formation and bone strength restoration than the CP-Ti locking plates during the early phase of bone healing. [ABSTRACT FROM AUTHOR]

BACKGROUND: The intramedullary fixation treatment for the middle clavicle fracture is effective and safe. However, issues such as nail loosening and displacement, as well as soft tissue irritability of the nail tail, are prevalent. Some interlocking intramedullary nails are demanding to operate; thus, their widespread utilization is confined. Treatment of intramedullary clavicle fracture can be further refined. Accordingly, to alleviate these issues, a novel intramedullary fixation instrument needs to be developed. OBJECTIVE: To explore the biomechanical stability of ortho-bridge system intramedullary fixation in the treatment of middle clavicle fracture by means of finite element analysis so as to offer a scientific foundation for clinical application. METHODS: The finite element model of transverse middle clavicle fracture was established by relevant software utilizing the CT data of the clavicle from a young volunteer. The locking plate, ortho-bridge system, and titanium elastic nail finite element models were assembled in accordance with the principle of internal fracture fixation. Finally, meshing, applying loads, and data processing were accomplished with the ANSYS 15.0 program. In each model, the stress distribution, maximum Von Mises stress and maximum displacement of clavicle and internal fixation were compared. RESULTS AND CONCLUSION: (1) Under different loads, the stress distribution of the ortho-bridge system intramedullary fixation of the middle clavicle fracture was comparable to that of the titanium elastic nail fixation. Near the fractured end of the intramedullary connecting rod, the phenomenon of stress concentration was observed. The secondary stress concentration occurred in the extramedullary locking area of the ortho-bridge system, causing the overall stress of the ortho-bridge system group to be more dispersed than that of the titanium elastic nail group. (2) Under the axial compression force, the maximum Von Mises stress of the clavicle in the ortho-bridge system group 251.96 MPa was greater than that of the other groups, whereas the maximum Von Mises stress of the fractured surface 33.79 MPa was lower than the two control groups. Under cantilever bending and clockwise/counterclockwise torsion loads, the maximum Von Mises stresses of the clavicle and the fractured surface of the ortho-bridge system group were less than those of the titanium elastic nail group, but greater than those of the locking plate group. (3) Under varying loads, the maximum Von Mises stress of the implant in the three groups of internal fixation appeared near the fractured end. Among them, the titanium elastic nail exhibited the highest peak implant stress, followed by the ortho-bridge system, and the locking plate exhibited the least. (4) Under different loads, the maximum displacement of the clavicle in each group occurred primarily at its distal clavicle. Among them, the titanium elastic nail group displayed the greatest maximum displacement of the distal clavicle and fractured end, followed by the ortho-bridge system group, the locking plate group, and the normal clavicle. (5) The findings indicate that the biomechanical stability of ortho-bridge system intramedullary fixation is superior to that of titanium elastic nail in the treatment of middle clavicle fracture. The risk of loosening and displacement of the internal fixation is lower than the titanium elastic nail; however, the fixation strength is not as strong as the locking plate. [ABSTRACT FROM AUTHOR]

Background: Locking a compression plate is a more favorable surgical technique than intramedullary nailing in the treatment of distal femur fractures. This study analyzed the risk factors of proximal screw breakage retrospectively, which was confirmed in the patients with plate removal after bony union. Methods: A total of 140 patients who were fixed by MIPO using ZPLP from 2009 to 2019 were identified. A total of 42 patients met the inclusion criteria and were included. The screw breakage group (12 patients) and the non-breakage group (30 patients) were compared. Results: Approximately 12 (28.6%) of 42 plate-removal patients showed proximal screw breakage. The breakage of proximal screws developed at the junction of the screw head and neck. The number of broken proximal screws averaged 1.4 (1~4). The breakage of the proximal screw even after the bony union is more frequent in older patients (p = 0.023), the dominant side (p = 0.025), the use of the cortical screw as the proximal uppermost screw (p = 0.039), and the higher plate-screw density (p = 0.048). Conclusions: Advanced age, dominant side, use of the cortical screw as the uppermost screw, and higher plate-screw density were related to proximal screw breakage. When the plate is removed after bony union or delayed union is shown in these situations, the possibility of proximal screw breakage should be kept in mind. [ABSTRACT FROM AUTHOR]

The management of gap non-union is a major challenge to both the clinician and the patient as it is technically difficult, time-intensive, and physically arduous for the patient along with an unpredictable result. Gap non-union can arise from extrusion of bony fragment at the time of trauma or after debridement of unhealthy bone later. Moreover, Tibia because of its subcutaneous anatomy can easily undergo bone-loss and segmental defect. Among various methods available for managing gap non-union of tibia distraction osteogenesis using either ilizarov fixator or mono-rail fixator is the most popular one. Here we present functional and bony outcomes of combined use of locking plate and Limb Reconstruction System (LRS) in tibial gap non-union and assess whether it decreases fixator time and related complications. A prospective intervention study constituting 10 patients with Paley's type B1 tibial gap non-union over a period of 22months. In first stage, debridement was done; tibial locking plate and mono-rail fixator were applied along with corticomy at proximal tibia. Distraction was started 7–14 days later. At the end of distraction phase, fixator was removed and transported segment was fixed with screws with or without bone grafting at docking site. Patients were followed up every 6 weeks for radiological and clinical assessment. Functional assessment using Application for the Study and Application of the Method of Ilizarov (ASAMI) functional score, and Musculoskeletal Tumour Society (MSTS) functional score while bone outcome was assessed with ASAMI bone score. Quality of regenerate was assessed by Fernandez-Esteve grading. Detailed scoring was done at the time of index surgery, at the time of LRS removal and at the time of consolidation phase. All the 10 patients were male with mean age of 33 years. The mean defect size was 4.94 cm after debridement. Minimum duration of follow up was 30 weeks after removal of LRS. Mean duration between trauma and inclusion in the study was 17.7 months. The median external fixator index was 15.63 days/cm. The complication rate was 1.3/patient. According to Paley's classification, there were eleven problems and two obstacles, and no true complications. Both ASAMI bone score and functional scores were excellent in three and good in six patients. The median MSTS composite score was 76.66%. The integrated fixation is an effective and satisfactory method enabling early external fixator removal with low rate of complication. So, this technique can be recommended for the management of segmental tibial defects. II. [ABSTRACT FROM AUTHOR]