Partial Fracture Research Articles

The forgotten fragment: additional lesser tuberosity fixation of 4-part proximal humeral fractures-a biomechanical investigation.

Fractures of the proximal humerus are common. The most frequent surgical treatment option is open reduction and locking plate fixation. Multifragmentary fractures, including 3- and 4-part fractures, are especially challenging to treat because they correlate with an increased risk of fixation failure. In the past, several mechanisms of additional fixation were investigated, but none directly addressed the lesser tuberosity (LT). The goal of this study was to investigate the biomechanical impact of additional anterior fracture fixation in lateral locked plating (LLP) of 4-part proximal humeral fractures (PHFs). Twenty-seven fresh frozen human shoulder specimens (mean age, 80 years) with intact rotator cuffs (RCs) were randomized into 4 groups: 3-part PHF with LLP and RC cerclage (n = 6); 4-part PHF with LLP and RC cerclage as standard of care (n = 7); 4-part PHF with LLP, RC cerclage, and 2 anterior 3.5-mm cortical screws (n = 7); and 4-part PHF with LLP, RC cerclage, and additional anterior one-third tubular plate (additional anterior plating [AAP], n = 7). Static load of the RC was simulated with weights. A force-controlled cyclic loading test was performed with a servo-hydraulic testing machine, followed by load-to-failure testing. An optical motion capture system recorded humeral head range of motion. LLP of a 4-part PHF showed more humeral head motion than LLP of a 3-part PHF without fracture of the LT (P < .001). Fixing the LT to the humeral head with two 3.5-mm screws significantly reduced humeral head motion compared with LLP with RC cerclage alone (P < .006). Using AAP significantly increased the construct stiffness compared with the standard of care (P = .03). LLP of a 4-part PHF is biomechanically less stable than LLP of a 3-part PHF without fracture of the LT. Additional screw fixation of the LT in 4-part PHFs improves stability compared with LLP alone. In case of metaphyseal comminution, AAP is favorable from a biomechanical perspective.

Radiographic evaluation of partial articular radial head fractures: assessment of reliability.

BackgroundHistorically, treatment of partial articular radial head fractures has hinged on radiographic assessment and application of the Mason classification. The inter- and intra-rater reliability of radiographic assessment and classification of radial head fractures may be lower than previously reported. We hypothesized that radiographic assessment leads to an underestimation of the number of fragments, percentage of articular surface involved, and displacement in millimeters.MethodsWe performed a retrospective review of all Mason II radial head fractures treated at our institution. Four independent observers performed radiographic assessment of the cohort. An independent observer performed these measurements on high-resolution computed tomography (CT) imaging, the reference standard. Radiographic assessments were then correlated with the CT findings using Pearson's correlation coefficient and Kappa statistic, where indicated.ResultsFifty-nine Mason II radial head fractures were reviewed. These results were not impressive, with all comparisons showing a Kappa statistic less than 0.5 (ie, weak agreement). Intra-rater reliability was similar: displacement (measured by Pearson's correlation coefficient) was 0.58, percent articular involvement was 0.74, and the number of fragments (measured by the Kappa statistic) was 0.28. Fracture displacement was generally underestimated on radiographic measurements when compared to CT scan. Nearly half (45%) of all cases demonstrated inaccurate fragment number assessment when compared to the reference standard.ConclusionRadiographs show poor inter- and intra-observer reliability for determining radial head fracture morphology. Assessment of the number of fragments was particularly inaccurate. High-resolution CT should be considered for patients with Mason II radial head fractures, especially in cases of poorly visualized fracture characteristics or borderline amounts of displacement, in an effort to appropriately indicate patients for the variety of treatment options available today.

Isolated Partial Femoral Avulsion Fracture of the Posterior Cruciate Ligament in Adults

ObjectiveTo investigate the manifestation, mechanisms, and treatment of isolated partial femoral avulsion fractures of the posterior cruciate ligament (PCL) in adults.MethodsFrom January 2011 to December 2018, we retrospectively reviewed the clinical data of three patients with isolated partial femoral avulsion fractures of the PCL who were admitted to our institution. All of these patients were admitted to our emergency department within 24 h after injury. After physical examination and radiographs were taken and reviewed, all patients were admitted and underwent surgical treatment. In a 26‐year‐old man who underwent arthroscopic surgery through the traditional medial and lateral approach before finally converting to open surgery with the posterior approach, the fragment that was finally removed was partially attached to the PCL. In the other two patients, women aged 63 and 68 years, who underwent arthroscopic surgery via the traditional medial and lateral approach, the fragments were large and attached to most fibers of the PCL. We fixed the fragments using hollow screws in arthroscopic view. In addition, in the 63‐year‐old patient, an anchor was embedded to restore the tension of the PCL. Four weeks after surgery, the patients started to wear long leg braces in full extension with the tibia blocked up by cushion. Physical examinations were conducted and radiographs were taken preoperatively and at 4 weeks and 3 months after surgery to evaluate the condition of the injury. The range of motion and the Lysholm knee scoring scale for the knee joint were compared before and after the surgery.ResultsFor the three patients, the radiographs taken at 3 months postoperatively showed that the fixation of the screws did not fail, and the subchondral bone was generally normal compared to the preoperative radiographs. CT scanning at 3 months after surgery showed that the fracture healed in the original position of the avulsion site. For all patients, the affected knees presented as stable at physical examination 3 months after surgery; the Lachmann test and the anterior drawer test results were negative. In addition, the flexion–extension, internal rotation, and external rotation were approximately 0°–130°, 0°–30°, and 0°–40° in the 26‐year‐old patient, respectively. The flexion–extension, internal rotation, and external rotation were approximately 0°–100°, 0°–20°, and 0°–35° for the 63‐year‐old patient, respectively. The flexion–extension, internal rotation, and external rotation were approximately 0°–100°, 0°–15°, and 0°–20° for the 68‐year‐old patient, respectively. There was no pain or only little pain 3 months after surgery. There was no swelling or discomfort at the 3‐month follow up. The Lysholm knee scores of the 68‐year‐old, 63‐year‐old, and 26‐year‐old patient were 80, 87, and 95 at 3 months after surgery, respectively, which were obviously improved postoperatively.ConclusionThe manifestation of isolated partial femoral avulsion fractures of the PCL in adults is often related to the injury mechanism, and surgery is essential for the treatment of these patients. Most of these fractures can be repaired by arthroscopic surgery, but some have to be treated by open surgery.

Experimental Study on Triaxial Unloading Failure of Deep Composite Coal-Rock

With the deep mining of coal, the phenomenon of high ground stress is more likely to cause dynamic disaster. In view of the above problems, this paper takes the unloading process of coal mining as the background to study the effects of mining rates under different conditions on the mechanical properties and triaxial failure criterion of composite coal-rock, so as to provide a theoretical basis for the prevention and control of dynamic disasters in coal mines. The composite coal-rock models with a composite ratio of 1 : 1 : 1 were tested under different unloading rates or confining pressures. The results show that the triaxial unloading process of coal-rock can be divided into five stages: compaction, single elasticity, elastic-plastic unloading, partial fracture, and complete fracture. In this paper, the failure criterion of composite coal-rock triaxial unloading is derived. The unloading rate has an exponential relationship with the triaxial compressive strength, and the relationship between initial confining pressure and compressive strength is linear. The triaxial compressive strength is determined by both. The peak strains ε of all samples under different unloading conditions were around 0.01. And initial confining pressure had an influence on the strain variation trend during the unloading of composite coal-rock. The higher the initial confining pressure, the greater the elastic modulus. In addition, an increase of initial confining pressure led to the increase of the total energy converted into dissipated part in the process of fracture and caused the obvious increase of the rebound characteristics of the curve. However, the unloading rate had no influence on the strain trend.

Functional outcome of proximal humerus fracture management with proximal humerus internal locking system plate

Background: Proximal humerus fractures are the 2nd most common fractures of upper extremity and one of the most common fractures in osteoporotic bone. 85% of these fractures are undisplaced or minimal displaced fractures which can be treated with conservative management. 15% fractures are displaced and unstable and which may need surgical management. The surgical procedure remains a challenging and unsolved problem to the surgeon especially because of its high complication rate. Internal locked plating becoming more popular, to maximize clinical outcome with our experience of surgical procedure in using system pate. In our study, the plate provides stable fixation with a goal of early restoration of a painless shoulder. Methods: A prospective study was conducted in department of orthopaedics in Adichunchanagiri institute of medical sciences, B.G. Nagara, mandya from June 2018 to August 2020. Displaced Neer’s part 2, part 3 or part 4 with age not less than 18 years and not more than 75 years. Twenty patients with proximal Humerus fractures were taken into study, all patients were fixed with PHILOS plate. Results: Functional outcome evaluated with CONSTANT – MURLEY score, we got excellent results in 04 cases, satisfactory in 09 cases, unsatisfactory in 05 and failure in 02 cases with a mean Constant-Murley score at the end of final follow-up period was around 80.2. Conclusion: Proximal humeral fractures managed by internal fixation with anatomic locking compression plates yields satisfactory results when provided the correct surgical technique. The anatomic locking compression plate is suitable for the stabilization of proximal humeral fractures (Neer’s 2-part, 3-part and 4-part fractures and osteoporotic fracture) and can lead to a good functional outcome.

Risk factors and prognosis of humeral head inferior subluxation in proximal humeral fractures after osteosynthesis.

BackgroundHumeral head inferior subluxation often occurs immediately after osteosynthesis for proximal humeral fracture; however, the underlying cause remains largely unknown. In addition, the prognosis of postoperative inferior subluxation has not been fully investigated. This study aimed to clarify the predictive factors that affected the onset of postoperative inferior subluxation using multivariate analysis and examine the postoperative course of inferior subluxation and its influence on postoperative outcomes.MethodsWe retrospectively reviewed 212 patients who underwent osteosynthesis for Neer 2- or 3-part proximal humeral fractures. In the multivariate analysis, the dependent variable was set as the inferior subluxation observed 1 week after the surgery. The explanatory variables included age, sex, affected side, body mass index, smoking, local osteoporosis, preoperative axillary nerve injury, time from injury to surgery, fracture dislocation, fracture pattern, preoperative inferior subluxation, surgical procedure, surgical approaches, blood loss, operative time, and postoperative drainage. Baseline variables, which were observed to be significant in the univariate analysis, were included in multivariate models. Furthermore, based on the presence of inferior subluxation at 1 week after the surgery, we divided the patients into two groups: with inferior subluxation (+IS group) and without inferior subluxation (−IS group). We compared the postoperative outcomes (incidence of postoperative complications and range of motion) between these two groups.ResultsOf 212 patients, 64 (30.7%) experienced inferior subluxation at 1 week after the surgery. On multivariate analyses, preoperative inferior subluxation (odds ratio = 4.69; 95% confidence interval = 2.45-9.76; P < .001) and longer operative time (odds ratio = 1.01; 95% confidence interval = 1.00-1.02; P = .049) were the risk factors for postoperative inferior subluxation. In the +IS group, inferior subluxation resolved at 1 year after the surgery in 89.5% of patients. There was no significant difference in the postoperative outcome between the +IS and −IS groups. However, four of six patients with persistent inferior subluxation, more than 6 months after the surgery, experienced complications, such as varus angulation of the humeral head or screw joint perforation.ConclusionsThis study provides new information on the risk factors for and prognosis of postosteosynthesis inferior subluxation in patients with proximal humeral fracture. Longer operative time and presence of preoperative inferior subluxation was associated with an increased risk of postoperative inferior subluxation, although it was temporary in most cases, and had no significant influence on the postoperative outcomes. However, in patients with persistent inferior subluxation of more than 6 months duration, inferior subluxation may be related to postoperative complications.

Effect of Oxygen Content on Microstructure and Tensile Properties of a 22Cr-5Al ODS Steel.

The high tensile strength and irradiation resistance of oxide dispersion strengthened (ODS) ferritic steels is attributed to the ultrafine and dispersed oxides within the matrix. The high content of oxygen and yttrium is critical for the formation of dense Y-rich oxides. However, only few studies have reported the effect of oxygen content on the microstructure and mechanical properties of ODS steels. Herein, we employed gas atomization reactive synthesis to prepare pre-alloy powders and then hot isostatic pressing (HIP) to consolidate two 22Cr-5Al ODS steels with different oxygen content. Our results showed Y-rich precipitates at and near grain boundaries of the as-HIPed alloys. Moreover, with the oxygen content increasing from 0.04 to 0.16 wt%, more precipitates precipitated in the as-HIPed alloy, and the ultimate tensile strength of the alloy was improved. However, increasing the oxygen content to 0.16 wt% led to formation of stripe and chain precipitates at and near grain boundaries, which caused a partial intergranular fracture of the as-HIPed alloy.

Effect of Post-weld Heat Treatment on the Cross Tensile Strength of Resistance Spot-Welded Medium Manganese Steel

The influence of the post-weld heat treatment (PWHT) on the cross tensile strength (CTS) of the resistance spot-welded medium manganese steel (MMS, 7Mn steel) is investigated in the present study. The results showed that the PWHT (tempering) could increase the CTS of the resistance spot-welded 7Mn steel to 5.4 kN, nearly 3 times compared with that for the as-welded specimen (~ 2.0 kN). The as-welded 7Mn steel contains fully dendritic martensite and revealed severe Mn segregation at the grain boundaries, leading to a weak zone adjacent to the centerline in the nugget. As a result, the fracture resulted in a complete intergranular fracture morphology, reflecting an interfacial fracture (IF) mode. On the other hand, the tempering of PWHT transformed the microstructure of 7Mn steel to tempered martensite. In addition, the PWHT introduced nano-sized Mn23C6-type carbides along the grain boundaries in the nugget, successfully relieved the Mn segregation and strengthened the grain boundaries. Consequently, the as-tempered 7Mn steel failed in partial interfacial fracture (PIF) mode with a large amount of dimples on the fracture surface. This experimental study shows the capability of PWHT to dramatically improve the CTS of 7Mn steel by microstructure manipulation.

Free Flap Reconstruction of Traumatic Pediatric Foot and Ankle Defects: An Analysis of Clinical and Functional Outcomes.

Traumatic lower extremity injuries involving the foot and ankle can have devastating consequences and represent a complex reconstructive challenge. To date, there are limited reports on microsurgical reconstruction for foot and ankle defects in children. This study aims to evaluate clinical and functional outcomes of free flaps for pediatric foot and ankle injuries. This is a retrospective review of patients undergoing free flaps for traumatic foot and ankle defects at a pediatric trauma center between 2000 and 2015. Patients with less than 5-year follow-up were excluded. Demographics, clinical characteristics, and postoperative outcomes were evaluated. Thirty patients undergoing 30 flaps were analyzed. The mean age was 11.9 years (range: 2 to 17 years). Muscle flaps (n = 21, 70%) were more common than fasciocutaneous flaps (n = 9, 30%). Limb salvage with functional ambulation was achieved in 96.7% of patients (n = 29). The complication rate was 33.3% (n = 10), with wound breakdown (n = 6, 20.0%) as most common feature. There were no significant differences in limb salvage, total or partial flap loss, fracture union, and donor-site complications based on flap type. Fasciocutaneous flaps were more likely to require revision procedures for contour compared with muscle flaps (55.6 vs. 9.5%, p = 0.013). Mean follow-up was 8.5 years. Microsurgical reconstruction of pediatric foot and ankle defects results in high rates of limb salvage. A defect- and patient-centered approach to reconstruction, emphasizing durable coverage and contour, is critical to facilitating ambulation and ensuring favorable long-term functional outcomes.

Investigating the influence mechanism of hydrogen partial pressure on fracture toughness and fatigue life by in-situ hydrogen permeation

In this work, we investigate the influence mechanism of hydrogen partial pressure on fracture toughness and fatigue life of a high strength pipeline steel. Both fracture toughness test and fatigue life test are carried out under different hydrogen partial pressure. The experimental results show that with the increasing of hydrogen partial pressure, fracture toughness and fatigue life decrease and the decrease trends gradually flatten out. Hydrogen has a larger effect on fatigue life than fracture toughness. Only 3% hydrogen gas can cause a 67.7% decrease of fatigue life. The in-situ hydrogen permeation test is performed respectively in 2 MPa, 5 MPa and 8 MPa hydrogen partial pressure. With the increasing of hydrogen partial pressure, the increase trend of hydrogen permeation current gradually tends to be gentle, which indicates that the hydrogen atoms entering into the material gradually become saturated. This result can be used to clarify the influence mechanism of hydrogen partial pressure on fracture toughness and fatigue life.

A comparative study on mechanical performance of traditional and magnetically assisted resistance spot welds of A7N01 aluminum alloy

In this paper, an external magnetic field was introduced to resistance spot welding (RSW) to improve the weldability of A7N01 aluminum alloy. Comparative studies of the macro- and micro-structures, microhardness, and the static and dynamic mechanical properties between welds produced by traditional RSW and magnetically assisted RSW (MA-RSW) were completed. The results show that the external magnetic field could enable larger nugget diameter, the softened columnar grain zone (CGZ-I), the hardened columnar grain zone (CGZ-II) and the finer equiaxed grain zone (EGZ). As a result, compared to traditional RSW joints, the MA-RSW joints exhibited better strength, improved toughness, and greater energy absorption capacity. This resulted in a transition of the failure mode from an interfacial fracture (IF) to a partial thickness fracture (PTF) in lap-shear tests and a BP fracture in cross-tension tests, respectively. In fatigue tests, the larger nugget diameter, hardened CGZ-II and finer EGZ in the MA-RSW welds can inhibit cracks from propagating from EGZ, but from the softened CGZ to the base metal. This change of fracture mode greatly improved the fatigue life of MA-RSW welds under both high and low load conditions.

Mechanical properties and failure mechanisms of composite laminates with classical fabric stacking patterns

In the design of composite materials, the properties and failure modes/mechanisms are always of the main concern. In this work, the mechanical properties and failure mechanisms of composite laminates with classical fabric stacking patterns ([(0, 90)]8 and [(0, 90)/(± 45)]4) were systematically investigated through mechanical experiments and FEM (finite element method) numerical simulations. The results show that the tensile modulus and bending modulus of the laminates were reduced by 22.2% and 37% after partially changing the stacking angle to ± 45°, but corresponding elongation and bending displacement were increased by 8.8% and 11.7%, respectively. Bending failure mode changes from complete fracture to partial fracture. Meanwhile, the delamination damage and tow peeling from the matrix increase significantly. FEM simulations on tensile and bending processes of the composites indicate that the ± 45° stacking angle leads to the change of the axial stress direction from SX (0°) to SY (± 45°), which is difficult to be observed from mechanical experiments. The FEM simulation provides a cost effective and efficient way for the structural visual optimization design and failure prediction of the actual composite materials.

Bending performance of ECC-RC composite beam reinforced with textile

To investigate the bending performance of composite beams comprising engineered cementitious composites and reinforced concrete (ECC-RC), which are reinforced with a textile (TRECC-RC composite beams), thirteen beams were designed and tested, including one reinforced concrete (RC) beam, three ECC-RC composite beams and nine TRECC-RC composite beams. The test variables included the ECC height ratio and textile ratio. The results revealed that all TRECC-RC composite beams underwent ductile failure with the features of tension steel yielding, partial textile fracture, and concrete crushing. Compared with ECC-RC composite beam, the TRECC-RC composite beam also exhibited a remarkable capacity of crack control and the textile application further reduced the crack width. Both the ECC height ratio and textile ratio had a minor effect on the crack distribution of the TRECC-RC composite beam. The textile effectively improved the bearing capacity even if the ECC height was reduced. The ECC height ratio had a minor effect on the stiffness of the TRECC-RC composite beam; however, the textile ratio resulted in slight improvement. The plane section assumption is valid for all composite beams.

Radiographic parameter(s) influencing functional outcomes following angular stable plate fixation of proximal humeral fractures

PurposeRadiographic parameters which correlate with poor clinical outcome after proximal humeral fractures could be helpful indicators to answer the question which patients should be followed up closer. Moreover, during surgery, radiographic parameters correlating with unfavourable outcome should be avoided. The primary aim of the study was to compare radiographic measurements between the injured and the contralateral, uninjured shoulder. The secondary aim was to correlate these radiographic parameters with post-operative shoulder function.MethodsFifty-eight patients (age: 55.6 ± 14.4 years, age at surgery) following angular stable plate fixation of a proximal humeral fracture (2-part fractures according to Neer: 24, 3-part: 25, 4-part: 9) were included in this retrospective cohort study. All patients were followed up at least six years (7.9 ± 1.4 after surgical intervention). During follow-up examination, the Constant score (CS) was assessed, and radiographs of both shoulders were taken. Radiographs were analyzed regarding lateral humeral offset, distance between tuberculum and head apex, head diameter, head height, perpendicular height, perpendicular center, vertical height, and angles between head and humeral shaft (CCD and HSA). These parameters were compared between the injured and uninjured shoulder. The cohort was divided in two groups: patients with a CS category of excellent/good and satisfying/worse. Both groups were tested regarding differences of demographic and radiographic parameters.ResultsThe distance between tuberculum and head apex (2.6 ± 3.4 mm vs. 4.3 ± 2.1 mm; p = 0.0017), the CCD (123.1 ± 12.9° vs. 130.1 ± 7.3°; p = 0.0005), and the HSA (33.1 ± 12.8° vs. 40.1 ± 7.3°; p = 0.0066) were significantly smaller on the treated shoulder compared to the uninjured side. Patients reached a Constant score of 80.2 ± 17.4 (95% CI 75.6–84.8) points. Regarding outcome categories of the Constant score, 46 patients had a good to excellent outcome, and 12 patients had a satisfying or bad outcome. The comparison of these groups revealed that patients with inferior outcome in the long-term follow-up were older, female, had a more complex fracture type (AO classification), smaller lateral humeral offset, smaller head diameter and height, lower perpendicular height, and lower CCD and HSA angles.ConclusionIf the abovementioned parameters cannot be restored sufficiently during surgery, (reversed) shoulder arthroplasty might be a better solution to reach good post-operative outcome. Moreover, patients presenting these radiographic characteristics in the follow-up, older patients, and patients with a more complex fracture type should be followed up closer to possibly prevent poor shoulder function.Trial registration: 83 250/2011BO2

Retrospective clinical study of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions following the "3-step technique". Part 1: 6-year survival rates and technical outcomes of the restorations.

To evaluate the survival rates and technical outcomes of minimally invasive full-mouth rehabilitations in patients affected by dental erosion and attrition. For this retrospective study, 28 subjects (8 women, 20 men; mean age: 45.6 years) who suffered from generalized erosions and attrition and who were treated according to the 3-step technique were invited to participate. The patient records were reviewed, and the restorations were clinically and radiographically examined. This part of the study (part 1) evaluated restoration survival and technical outcomes using the modified United States Public Health Service criteria (mUSPHS). Survival analysis was performed using Kaplan-Meier survival statistics, and comparison between subgroups was made using log-rank test. For all other comparisons, cross-tabulations of occurrence were performed, and significance was tested using Pearson chi-square test. The level of statistical significance was set at P < .05. A total of 19 patients (3 women, 16 men; mean age: 45.6 years) agreed to participate. In these patients, 406 restorations (149 direct composites, 110 onlays, 147 veneers) supported by 365 teeth were examined. The mean time in service was 71.8 ± 28.6 months. Six failed restorations were identified; all were direct composites. The 6-year survival rates were 97.3% for direct composites, 98.2% for onlays, and 100% for veneers (P > .05). No differences were found among materials and locations of the restorations. Nineteen technical complications included 14 partial fractures, 3 fissures, 1 wear, and 1 decementation. The mUSPHS evaluation showed good technical outcomes. Presence or absence of a nightguard influenced restoration survival (P = .003). Minimally invasive rehabilitations of patients with erosions/attrition with the 3-step technique are a reliable treatment option in the medium term. Protective nightguards are recommended.

Arthroscopic Reduction and Fixation With a Knotless Double-Row Construct Provides Good Results for Displaced Greater Tuberosity Fractures

PurposeThe purpose of the study is to describe the functional and structural outcomes of the arthroscopic 4-strand, knotless, double-row construct with suture tapes for the surgical treatment of displaced and/or comminuted greater tuberosity fractures of the humerus.MethodsPatients were enrolled between December 2012 and January 2018. The main inclusion criteria were a comminuted and/or displaced tuberosity fracture with a displacement of at least 5 mm in any plane fixed under arthroscopy using a 4-strand, knotless, double-row construct. The technique involves reducing the displaced fragment with 2 medially placed, transtendinous anchors and compressing the greater tuberosity using the tapes from these medial anchors in 2 laterally placed anchors. The exclusion criteria were a fracture that was more than 10 days old at the time of surgery or a history of shoulder surgery and 3- or 4-part fractures. The postoperative rehabilitation protocol was similar for all patients. Constant scores, Quick Dash, return to work and sport, and complications were reported after a minimum follow-up period of 24 months. Bone healing was systematically evaluated on standardized radiographs, including lateral scapula view and anteroposterior views.ResultsTwenty-one patients were enrolled in this study. One patient did not complete the follow-up examination period and thus was excluded, leaving 20 patients in this study. At a median (SD) follow-up of 32 (9) months, the median (SD) Constant score was 94.7 (7.3) points, the median (SD) Quick Dash was 1.7 (4) points, and median (SD) visual analog scale score was 0.5 (1.4). All patients returned to previous work and sport level. No malunions or nonunions were seen. One conversion to open surgery was required for failure of the lateral row during surgery in a 62-year-old woman with osteopenic bone. Two patients experienced complex regional pain syndrome in the postoperative period that resolved after nonoperative treatment.ConclusionsIn this series, the use of arthroscopy combined with the biomechanical properties of knotless double-row constructs contributed to postoperative satisfactory functional results and healing of greater tuberosity fracture. In addition, range of motion was early, and no hardware removal was required. However, care should be taken with osteopenic bone where anchorage can fail.Level of EvidenceLevel IV, case series.

Systematic use of short unicortical epiphyseal locking screws versus full-length unicortical locking screws in distal radius fracture volar plating: A prospective and comparative study.

Volar locking plates, used in distal radius fracture (DRF), present a risk of injuring extensor tendons with screws penetrating the dorsal cortex of the radius. Actually, even when aiming to use maximum-length unicortical locking screws, some still could be bicortical. We hypothesize the use of only short unicortical screws would allow a proper stabilization of the radial epiphysis without the risk of dorsal cortex penetration. A prospective monocentric non-randomized study was conducted. Patients with DRF (excepted for partial dorsal joint fractures) were treated in group A with short locking epiphyseal screws (16mm for females, 18mm for males) and in group B with full-length unicortical locking screws. Ultrasound was done 3months postoperatively to evaluate the number and length of prominent dorsal screws. X-rays were performed after 6weeks to assess stability according to volar tilt and radial inclination variations. There were 37 patients in group A and 39 in group B with 148 and 156 epiphyseal screws, respectively. In group A, there were 0% of dorsal penetrating screws against 6.5% (10 screws from 8 patients) in group B (p < 0.05). There was no significant difference for the stability between the groups: mean volar tilt variation ( - 0.6° vs. - 0.7°) and mean radial inclination variation ( - 0.4° vs. - 0.4°). For a same stability with volar locking plates for DRF, short epiphyseal locking screws should be preferred to full-length unicortical screws in order to prevent extensor tendon injuries. Based on 75% of distal radial average anteroposterior width for each sex, screw lengths of 16mm for females and 18mm for males seem to be the length to use. LEVEL OF EVIDENCE 2: Prospective, Comparisons made, non-randomized.

Dissimilar joining mechanism, microstructure and properties of Ni to 316 stainless steel via Ni-Al thermal explosion reaction

Abstract To meet the requirements of energy-efficiency and high quality joining in the emerging industries field, a novel thermal explosion (TE) joining method was developed. The dissimilar Ni/316SS joint was first obtained by the TE reaction technology. The Ni-Al mixed powder was selected as TE reaction system, and the reaction product was used as interlayer. The effect of temperature (800, 850 and 900 °C), hold time (5, 10, 15 and 20 min) and joining pressure (0, 10, 20 and 30 MPa) on interfacial microstructure, diffusion behavior and mechanical properties of Ni/316SS joint were investigated. The maximum combustion temperature of Ni-Al interlayer during heating process was 1655 °C and a significant exothermic phenomenon was lasted for 2 s. 316SS(Al), Fe2Al5(Ni, Cr) and serration-like Ni5Al3 and Ni3Al were detected at the interface containing a reaction layer because of element diffusion. The maximum shear strength of the Ni/316SS joint was 65.2 MPa, and the failure is characterized by typical brittleness fracture. The fracture mode is the combination of partial spalling and fracture of the interlayer. The post heat-treatment assisted TE joining technique significantly shortened the bonding process of the dissimilar Ni/316SS joint at moderate temperatures, realizing the low energy and efficient joining between Ni and 316SS.

Clinical Outcome of Percutaneous IntramedullaryFixationfor Midshaft ClavicularFractures Using Elastic Stable Nails.

This study investigated the clinical outcomes of fixation of displaced middle-third clavicular fractures using percutaneous elastic stable intramedullary nails. This study included sixty patients with a mean age of 26.40 ± 8.91 years (16-53 years) presented with a displaced middle third fracture of the clavicle. According to the Robinson classification, 48 cases (80%) were type 2B1, 9 cases (15%) type 2B2 and 3 case (5%) 2A1. All cases were treated by elastic intramedullary nails and followed up for at least 12 months. At the end of the twelve months' follow-up period, the mean Constant Shoulder score was 95.70 ± 13.55, ranging from 48 to 100. 54 patients (90%) had excellent results, 3 patients (5%) had an adequate result and 3 patients (5%) had a poor result. There was a statistically significant relationship between the final score and age and associated medical conditions. 1. Elastic Stable Intramedullary Nailing is an image-dependent procedure indicated best for young medically free athletes with simple 2-part middle third clavicle fracture. 2. Hammering is not recommended to avoid dorsolateral cortex perforation. 3. The most common complication is medial skin irritation because of the subcutaneous position of the clavicle as well as the sharp end of the cut nail.

Current Controversies in the Treatment of Geriatric Proximal Humeral Fractures.

Multiple studies comparing nonoperative and operative treatment for displaced proximal humeral fractures in the geriatric population have demonstrated minimal differences in functional outcomes. Factors such as surgeon experience as well as the quality and maintenance of the reduction may influence operative outcomes, and their impact on these findings merits further investigation. In the treatment of 2 and 3-part fractures involving the surgical neck, intramedullary nailing has demonstrated functional outcomes that are comparable with those of open reduction and internal fixation (ORIF). In the geriatric population, reverse total shoulder arthroplasty has demonstrated improved functional outcomes, with a decreased rate of reoperation, compared with hemiarthroplasty. Tuberosity repair has been shown to improve functional outcomes and range of motion after both procedures and should be performed at the time of arthroplasty. Several authors have demonstrated the negative effect of osteopenia on outcomes after ORIF of proximal humeral fractures. Augmentative procedures, including cortical strut augmentation, are being investigated to address this issue; their role in the treatment of these fractures is unclear at this time.