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

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

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

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

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

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

Background: Shaft fractures account for 20% and 1-3% of all humerus fractures, respectively. Open dynamic compression plate fixation (Open fixation with DCP) with absolute stability is the current gold standard for treating shaft humerus fractures. The goal of MIPO was to provide a more stable fixation, which would increase the union rate and decrease open plating side effects including infection and radial nerve palsy. Aim: The purpose of this study was to assess the clinical and radiological outcomes of the MIPPO technique in the treatment of humeral shaft fractures. Patients and methods: thirty cases of shaft humerus fractures were examined during the period from August 2022 to March 2023. The history, clinical examination, and radiographic (X-ray) examination were used to select cases. According to UCLA score, the result was noted and filled up. Results: Union was achieved in 17 to 22 weeks with the mean 19.4±4.1. Only 5% nonunion was seen in our cases. It was observed that the median UCLA score was excellent (34). Conclusion: In shaft humerus fractures, results from minimally invasive plate osteosynthesis with anterior bridge plating were favorable. They offer the fracture site some support, and the fracture hematoma is not disturbed. MIPO keeps the blood vessels healthy, which lowers the danger of infection and wound disintegration. [ABSTRACT FROM AUTHOR]

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

Background. Lower limb bone injuries are one of the most severe traumas to the musculoskeletal system. Treatment of lower limb fractures is complicated in overweight and obese patients, in people with diseases of the bones, circulatory system, with diabetes mellitus and other age- and weight-related diseases. Today, four main methods and their modifications are used to treat bone fractures: blocking intramedullary osteosynthesis (BIOS), plate osteosynthesis (PO), external fixation devices (EFD), and plaster casts. The purpose of the study was to evaluate the results of treatment of overweight patients with tibia fractures using BIOS, PO and EFD. Materials and methods. The treatment of 42 patients with tibia fractures aged 21 to 71 years was analyzed. All of them were overweight. The average body mass index was 28.6 ± 1.8, with a range from 25.4 to 33.0. For the treatment of fracture, 27 patients (64.3 %) underwent BIOS, 9 (21.4 %) - PO, and 6 (14.3 %) had EFD. Patients were examined before treatment, after surgery, and at 1.5, 3.5, 6, and 12 months after the start of treatment for the degree of pain; score on the S.D. Tumian questionnaire, data of the system for assessing long-term treatment outcomes, the timing of recovery of the patient's functional abilities were evaluated as well. Results. Before the surgery, patients rated the pain in the injured limb as severe and very severe (8-10 points). After the surgery, it decreased more, but remained at an average level. According to the analysis, there is a statistically significant (p = 0.001) decrease in pain between the observation periods. After the bone fracture repair, patients in the BIOS group begin to load the limb earlier and reach full weight bearing a month earlier than in the other groups. Evaluating treatment outcomes on the S.D. Tumian questionnaire showed that the tendency to improvement persisted throughout the treatment period in all patients, but the best results were in the BIOS group, which had the highest score already at the 6th month of observation. The assessment of the functional abilities demonstrated that after 12 months, patients in the BIOS and PO groups reported either no pain (77.8 and 55.6 %, respectively) or moderate pain after prolonged walking (22.2 and 33.3 %, respectively), while the EFD group complained of pain after prolonged walking. After 12 months in the BIOS group, the number of patients without claudication was 74.1 %, in the EFD group, people had moderate and not significant claudication. Conclusions. The analysis of outcomes in patients with tibia fractures who were treated using blocking osteosynthesis, periosteal osteosynthesis and external fixation devices showed the feasibility of BIOS in overweight individuals. This makes it possible to start motor activity and the ability to take care of oneself earlier, which is important for such patients. [ABSTRACT FROM AUTHOR]

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Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

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

Background: Metacarpal fractures represent about one-third of all hand fractures. The principles of fracture management are to restore full hand function and minimizing additional soft tissue injury. Our study aimed to evaluate the functional and radiological outcome of metacarpal fractures, treated by open reduction and internal fixation using mini-plate and screws. Methods: A prospective cohort study included 12 patients with metacarpal fracture were operated at Orthopedic Surgery Department, Zagazig University Hospitals. All patients were managed by open reduction internal fixation (ORIF) and fixed using mini-plates and mini-screws and were evaluated both clinically and radiologically. The functional outcome was evaluated by TAM score and Quick DASH score. Results: The mean patient’s age was 35.67 ±10.16 years ranged from 27-69 years. According to AO/OTA classification the most common fractures were 77.3.4.2C followed by 77.1.1C and 77.4.2A by 16.7% for each one. The mean TAM score was 230.3 ± 39.1 ranged from 125 to 255. 83.4% of patients were satisfied. According to Quick DASH score, 25% of patients (3 patients) were unsatisfied, two of three were had fair and one had poor satisfaction, while about 75% were satisfied. Most of the studied group had grip strength between 80 and 89% in compare to the contra-lateral side. While 4 patients had grip strength more than 90% in compare to the normal hand and one patient had grip strength < 70%. Conclusion: Plate osteosynthesis is an excellent choice for treatment of metacarpal bone fractures. Fixation of metacarpal fractures by mini-plate and screws lead to anatomical reduction of fractures with stabilization that is rigid enough to allow early mobilization and preventing stiffness with good functional outcome. [ABSTRACT FROM AUTHOR]

Background. Bone fractures are a public health concern. In recent years, there has been an upward trend in body weight of people of all age groups. Obesity has long been thought to help protect against fractures, but recent studies have shown that for every 5 cm increase in waist circumference, the risk of any fracture is 3 % higher. The purpose: according to the meta-analysis of modern medical literature, to determine the main directions of surgical treatment for long bone fractures, their advantages, and disadvantages, including in overweight patients, the features of diaphyseal fracture fixation in overweight patients. Materials and methods. A meta-analysis of special literature from scientific databases was conducted: Cochrane Library, Scopus, National Library of Medicine — National Institutes of Health, ReLAB-HS Rehabilitation Resources Repository. One hundred and thirty articles were analyzed, from them 31 were selected, which, in our opinion, reflect the purpose of the study. Results. All methods of surgical fixation of fractures have their advantages and disadvantages. The frequency of nonunions caused by intramedullary fixation of the femoral shaft can reach 10 %, and varus/ valgus and rotational deformities and shortening can also be observed. But the use of locking screws prevents the occurrence of most complications. When fixing the fractures with plates, the main complications are related to superficial and deep infections, which were more often observed in overweight patients. The analysis demonstrated that in overweight and obese patients, the main complicating factor is not the method for fixing the fracture zone, but factors related to the health of the patient himself. So, despite the fact that the results of treatment of fractures in patients with normal weight and obesity did not have a statistically significant difference, an increase in cardiovascular complications, exacerbation of chronic respiratory diseases was observed. Moreover, it is the presence of concomitant diseases that often makes surgical intervention impossible. Conclusions. There is a large amount of research on surgical methods of fixing tibial diaphyseal fractures, but data on the choice of fixation method in overweight and obese patients as a separate approach were not found. There are data on complicating factors of excess weight in the treatment of fractures and surgical interventions. Systematic studies related specifically to the algorithm for choosing the method of fracture fixation and complications have also not been found. [ABSTRACT FROM AUTHOR]

Fractures of the clavicle are among the most common fractures. They typically result from a fall onto the lateral shoulder or the extended arm and are often related to sports and bicycle accidents. Obtaining the exact trauma mechanism, proper clinical findings and adequate X‑rays usually lead to the correct diagnosis. Non-displacement fractures can be treated conservatively with good results. Unstable and displaced fractures should be treated operatively. Open fractures or looming penetration are emergencies und should be treated immediately. In addition to fracture classification and morphology, other factors such as additional injuries and patient-related factors need to be considered in order to make an individualized therapy decision. In operative treatment, angular stable plating is the therapy of choice, and in most cases early functional aftercare is possible. [ABSTRACT FROM AUTHOR]

Introduction: Scaphoid is the most fractured carpal bone, with a 5–10% nonunion rate. Treatment challenges include choosing the implant and graft that best corrects humpback deformity and carpal malalignment with higher chances of bony healing. Objective: Compare cortico-cancellous and cancellous grafts between two groups of patients treating scaphoid nonunion with locking plates using autologous bone graft and evaluate bone healing rates and radiographic, tomographic, and functional parameters before and after surgery. Methods: Non-randomized prospective study including 20 cases of scaphoid nonunion. Groups were divided into Group A (ten patients treated with cortico-cancellous iliac graft) and Group B (ten patients treated with cancellous iliac graft). Patients underwent pre- and postoperative radiographs, computed tomography, and functional evaluation. Results: In postoperative analysis, Group A showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle (p = 0.011) correction when comparing the pre- and postoperative periods. Group B showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle correction (p = 0.0018), grip strength (p = 0.002), and tip pinch strength (p = 0.001) when comparing the pre- and postoperative periods. By comparing both groups, Group B showed a statistically significant difference in intrascaphoid angle correction (p = 0.002), grip strength (p = 0.002), tip pinch strength (p = 0.002), and radial deviation (p = 0.0003). There was no statistical difference when comparing bony healing between groups. Conclusion: Scaphoid nonunion treatment with a locking plate was effective, showing a high bony healing rate and improved carpal alignment in imaging tests for both graft types. However, results for intrascaphoid angle correction, grip strength, tip pinch strength, and radial deviation were better in Group B. Level of evidence: IV, case series. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

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

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

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

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

In this investigation, it was assumed that it must be possible to visualize the intrapelvic aspect as accustomed by pelvic surgeons using the anterior intrapelvic (modified Stoppa) approach. Moreover, it was hypothesized, that plate mountings will not only be possible for the symphysis but also at the supra- and infrapectineal aspect as well as to the posterior column. Ten anonymized cadaveric specimens were included in this study. A standard laparoscopic totally extraperitoneal (TEP) approach was used. A total of 10 landmarks were defined that are usually within reach in the open anterior intrapelvic (AIP) approach. Moreover, five different plate mountings were tested. The locations were chosen in accordance with the indication spectrum suitable for open surgery through the traditional AIP approach. It was possible to gain intrapelvic visibility in seven of ten cases. In all of those seven cases, it was technically possible to place plates to the symphysis, superior pubic ramus, as well as longer anterior column plates up to the aspect posterior of the acetabulum. In the last four of the seven cases, it was possible to mount plates to the infrapectineal aspect as well as the posterior column, too. The team, previously trained in arthroscopic surgical techniques as well as pelvic trauma surgery, observed a steep learning curve. This investigation demonstrated, that endoscopic anterior intrapelvic plate osteosynthesis was feasible in the majority of the cases in a series of ten cadaveric models. New instruments will be needed such as extra-long rasp elevators, ball-spikes as well as devices to hold and position plates and extra-long self-holding screwdrivers. With these, endoscopic pelvic surgery will likely be a realistic option for selected pelvic trauma cases in the future. [ABSTRACT FROM AUTHOR]

Introduction: To perform a systematic review and assess the indications, outcomes, complications, and union rates associated with plate osteosynthesis in patellar fractures compared to tension band wiring. Methods: The systematic search was conducted for articles in PubMed, Embase Biomedical, Cochrane central, and LILACS databases (date of inception to July 30, 2020). Articles were included if they were randomized control trials, cohort studies, case-control studies, and case series (with more than five cases), which focused on the clinical outcomes of patients with plate osteosynthesis as a treatment for fracture of the patella and had a minimum follow-up of 3 months. All studies were assessed according to their level of evidence, the number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized. Meta-analysis could only be done for two parameters (complications and reoperations) due to the paucity of data and heterogeneity of studies' limited statistical analysis. The data are presented as a review table with the key points summarized. Results: Twenty studies (seven prospective and 13 retrospective articles) identified 533 patients with 534 fractures who had undergone plate osteosynthesis for fracture of the patella. The most common fracture treated with plate osteosynthesis was 34C. Conclusion: Basket plate was most commonly used for inferior pole fractures, while mesh plates were for intra-articular patella fractures. Overall plating was associated with better clinical outcomes, fewer complication rates, and high union rates compared to tension band wiring for patella fractures. [ABSTRACT FROM AUTHOR]

The diagnosis of fracture nonunion following plate osteosynthesis is subjective and frequently ambiguous. Initially following osteosynthesis, loads applied to the bone are primarily transmitted through the plate. However, as callus stiffness increases, the callus is able to bear load proportional to its stiffness while forces through the plate decrease. The purpose of this study was to use a "smart" fracture plate to distinguish between phases of fracture healing by measuring forces transmitted through the plate. A wireless force sensor and small adapter were placed on the outside of a distal femoral locking plate. The adapter converts the slight bending of the plate under axial load into a transverse force which is measurable by the sensor. An osteotomy was created and then plated in the distal femur of biomechanical Sawbones. Specimens were loaded to simulate single‐leg stance first with the osteotomy defect empty (acute healing), then sequentially filled with silicone (early callus) and then polymethyl methacrylate (hard callus). There was a strong correlation between applied axial load and force measured by the "smart" plate. Data demonstrate statistically significant differences between each phase of healing with as little as 150 N of axial load applied to the femur. Forces measured in the plate were significantly different between acute (100%), early callus (66.4%), and hard callus (29.5%). This study demonstrates the potential of a "smart" fracture plate to distinguish between phases of healing. These objective data may enable early diagnosis of nonunion and enhance outcomes for patients. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• The hospital frailty risk score (HFRS) is the main predictor for risk for complications following surgical treatment of proximal humerus fractures. • A preoperative evaluation of the HFRS for proximal humerus fractures can contribute to risk assessment, individual patient management and measurement of quality. • The HFRS therefore enables personalized treatment decisions for proximal humerus fractures. Approximately 70 % of proximal humerus fractures (PHF) occur after the age of 60. High complication rates have been described in correlation with the treatment of PHF. Major risk factors for the outcome might be frailty, mobility and comorbidities of patients at the time of hospital admission. The aim of this study was to create risk adjusted quality indicators for surgical treatment of proximal humerus fractures based on German claims data and to evaluate the impact of the Hospital Frailty Risk Score (HFRS) on risk adjustment. Retrospective claims data (2015–2021) were used to create risk adjusted quality indicators for eight outcomes by clustered multivariable logistic regression. The comparison of different risk adjustment model performances was done by ROC-AUC and Standardized Mortality/Morbidity Ratios. In total, N = 34,912 patients (median age 75 years, 80.3 % female) were included. The most common surgical procedure was open reduction and internal fixation with plate osteosynthesis with 39.7 %, followed by reverse shoulder arthroplasty with 25.3 %. The most influential risk factor for all outcomes was a high HFRS with an Odds Ratio of 2.0 (95 %-Confidence Interval 1.8–2.3) for any secondary surgery (365 days) up to an Odds Ratio of 17.6 (95 %-Confidence Interval 14.9–20.8) for general complications during the index stay. Comparative quality reporting for the surgical treatment of PHF appears feasible with the developed models for risk adjustment using claims data. Preoperative evaluation of HFRS in PHF can contribute to risk assessment, and individual patient management. It therefore enables personalized treatment decisions. [ABSTRACT FROM AUTHOR]

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

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

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