Anatomical Plate Research Articles

The Effectiveness of Three-Dimensional Osteosynthesis Plates versus Conventional Plates for the Treatment of Skeletal Fractures: A Systematic Review and Meta-Analysis.

To assess the difference between preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates for the treatment of skeletal fractures in terms of anatomical reduction, operation time, approach, patient outcomes, and complications. MEDLINE (1950 to February 2023), EMBASE (1966 to February 2023), and the Cochrane Central Register of Controlled Trials (inception to February 2023) databases were searched. Eligible studies were randomised clinical trials, prospective controlled clinical trials, and prospective and retrospective cohort studies (n ≥ 10). Inclusion criteria were studies reporting the outcomes of preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates after treating skeletal fractures. Outcome measures included anatomical reduction, stability, operation time, hospitalisation days, patients' outcomes, and complications. Two independent reviewers assessed the abstracts and analysed the complete texts and methodologies of the included studies. In total, 21 out of the 5181 primarily selected articles matched the inclusion criteria. A meta-analysis revealed a significant difference in operation time in favour of the preformed anatomical plates and patient-specific implants versus conventional plates. Significant differences in operation time were found for the orbital (95% CI: -50.70-7.49, p = 0.008), upper limb (95% CI: -17.91-6.13, p < 0.0001), and lower limb extremity groups (95% CI: -20.40-15.11, p < 0.00001). The mean difference in the rate of anatomical reduction in the lower limb extremity group (95% CI: 1.04-7.62, p = 0.04) was also in favour of using preformed anatomical plates and patient-specific implants versus conventional plates. This systematic review showed a significant mean difference in surgery time favouring the use of preformed anatomical plates and patient-specific implants for orbital, upper, and lower limb extremity fractures. Additionally, preformed anatomical plates and patient-specific implants in the lower limb group result in a significantly higher rate of anatomical reduction versus conventional flat plates.

Surgical management of distal humerus gunshot fractures: descriptive case series

PurposeThe purpose of this study was to report our 5 years surgical experience and the rate of neurovascular injury following gunshot fractures of the distal humerus in a in level-1 Trauma Centre in South Africa.MethodsA retrospective case series of 25 consecutive adult gunshot injuries to the distal humerus. Demographic and injury data were extracted from clinical case notes and electronic operative records. Imaging archives were used to classify fractures according to the AO/OTA classification.ResultsTwenty-five male patients, with mean age of 32-years-old, sustained gunshot injuries to the distal humerus. Eleven patients had multiple gunshots. Forty-four percent of patients underwent Computed Tomography Angiography (CTA), 20% had confirmed brachial artery injury. Limbs with vascular injury were salvaged with arterial repair and external fixation. Fractures were extra-articular in 20 cases (80%). Nineteen fractures were classified as highly comminuted. Nerve injuries occurred in 52% and were all managed expectantly. Only 32% of patients attended follow-up beyond 3 months.ConclusionsThese are rare challenging injuries with high rates of neurovascular damage. This demographic of patients is poorly compliant with follow up highlighting the need for high-quality early care. Brachial artery injury should be excluded with CTA and can be managed with arterial repair and external fixation. All fractures in this series were surgically managed with conventional anatomical plate and screw fixation techniques. For nerve injury, we advocate expectant management.Level of evidenceIV.

Implant Choice and Outcomes of the Sinus Tarsi Approach for Displaced Intra-articular Calcaneal Fractures.

Operative fixation of displaced intra-articular calcaneal fractures is considered the gold standard, for which multiple fixation methods are available. This study compares the (functional) outcome of screw fixation (SF), plate fixation (PF), and anatomical plate fixation (APF) via the sinus tarsi approach (STA). A total of 239 patients (265 fractured calcanei) who received surgical treatment of a displaced intra-articular calcaneal fracture via STA between 2011 and 2022 were included. Böhler angle (BA) measured immediately postoperatively (BA post-OR) and the decrease in BA at 1 year (∆BA) differed significantly in favor of PF/APF compared with SF (BA post-OR: SF vs PF P = .010 and SF vs APF P = .001; ∆BA: SF vs PF P = .032 and SF vs APF P = .042). Implant removal surgery was performed significantly less in the APF group as compared to the SF/PF groups (APF vs SF/PF; 9.9% vs 22.9%/23.7%, P = .015). Surgical site infections and secondary arthrodesis of the subtalar joint occurred equally in the 3 groups. Furthermore, the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index score, and EuroQOL-5D-index / visual analog scale score, did not differ notably between SF, PF, and APF. The results show that both PF and APF are favored over SF because of an improved correction of BA measured directly postoperatively, a lower secondary loss of BA and, for APF, a lower implant removal rate. There was no difference in the rate of surgical site infections, need for secondary arthrodesis, nor functional outcome scores between different implants using the STA. Level III, retrospective cohort study.

A retrospective comparison of double-hooked locking plates versus non-locking plates in minimally invasive percutaneous plate osteosynthesis for the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures

BackgroundSurgical approach and fixation material are crucial in the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures. This study compared the efficacy of double-hooked locking plates and anatomic plates in minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures.MethodsClinical data were collected from 96 patients diagnosed with comminuted distal fibular fractures accompanied by tibial Pilon fractures who had undergone MIPPO. Patients in the study group (n = 48) received double-hooked locking plate fixations and the control group (n = 48) received anatomical plate fixations. The operating time, intraoperative bleeding, length of hospital stays, full weight-bearing time, fracture healing time and complication rates in the two groups were compared. The quality of fracture reduction was evaluated using the Burwell–Chamley imaging scoring system; the ankle function was assessed based on the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score.ResultsPatients in the study group had shorter operating time, less bleeding, significantly shorter hospital stays, and shorter time to full weight-bearing as well as fracture healing compared to the control group (P < 0.05). Additionally, the post-operative complication rates were significantly lower in the study group (6.16% vs. 22.92%) (P < 0.05), but there was no significant difference in the fracture reduction rate between the two groups (P > 0.05). Patients in the study group experienced better ankle recovery than those in the control group (93.75% vs. 75.00%) (P < 0.05).ConclusionDouble-hooked locking plates have advantages in the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures during MIPPO due to their shorter operating time and less intraoperative bleeding, as well as shorter hospital stays, full weight-bearing time and fracture healing time, fewer complications and better ankle recovery. Therefore, double-hooked locking plates are worthy of clinical application.

Some considerations before the clinical application of the novel anatomical plate for oblique lumbar interbody fusion.

Some considerations before the clinical application of the novel anatomical plate for oblique lumbar interbody fusion.

Clinical and Functional Outcomes of Anatomical Plating in Distal Humerus Fractures in Adults.

Background Overall, 2% of all adult fractures are attributed to fractures of the distal humerus, including both supracondylar and intercondylar fractures. According to recent studies, stable fixation with anatomical reduction of intra-articular fragments and early mobilization is required for best outcomes. This study included patients with distal end humerus fractures treated by open reduction and internal fixation (ORIF) with anatomical locking plates and evaluated their clinical outcomes. Methodology This prospective study was conducted at a medical college teaching hospital in southern Rajasthan, India. In total, 20 adult patients with distal end humerus fractures who presented to the orthopedic outpatient department or casualty were admitted. Patients were treated by ORIF with anatomical locking plates, followed up, and evaluated for clinical and functional outcomes. Results Using the Mayo Elbow Performance Score, out of 20 cases, excellent results were noted in five patients, good results in seven patients, fair results insix patients, and poor results in two patients. Conclusions Locking plates are reliable and effective management options for distal humerus fractures. As locking plates are strong and rigid, the period of immobilization can be decreased. Early mobilization helps in preventing joint stiffness and fixed deformity of the joint.

Finite element analysis of titanium anatomic plate and titanium reconstructive plate for treatment of extra-articular fractures of the scapula

BackgroundDue to the lack of postoperative reporting outcomes and bio-mechanical studies, an optimal management of scapular fractures has not been well-established in clinical treatment, even though there are many options available. This study aimed to compare the stability of the new titanium anatomic and traditional titanium reconstructive plates for extra-articular scapular fractures through finite element analysis.MethodsTwo models of scapular assembly were constructed, including one anatomic plate (AP model) and one reconstructive plate (RP model). After meshing, material parameter, and boundary condition settings, we applied four loading conditions to simulate forces acting on the scapula and osteosynthesis material. To evaluate the bio-mechanical properties, the equivalent von Mises stress, equivalent elastic strain, and total deformation were investigated.ResultThe stress and strain distribution of model AP has better performance than model RP, with more uniform and lower values. The maximum stress value of the scapula in model AP is smaller than that of the scapula in model RP (102.83 MPa vs. 166.71 MPa). The maximum stress of the anatomic plate is half that of the reconstructive plate (218.34 MPa vs. 416.01 MPa). The maximum strain of the scapula in model AP is smaller than that of the scapula in model RP (0.0071 vs. 0.0106). The maximum strain of the anatomic plate is half that of the reconstructive plate (0.0019 vs. 0.0037). The maximum displacement of each model is all at the acromion, with a similar value (2.2947 mm vs. 1.8308 mm).ConclusionsWith sufficient bio-mechanical stability, the anatomic plate to support scapular fracture fragments was superior to that of the reconstructive plate.

Treatment of bipolar clavicle injury with internal plating: a case series and literature review

BackgroundBipolar clavicle injury is a rare injury involving any combination of dislocation and/or fracture at both ends of the clavicle. Most reports of bipolar clavicle injury have been based on a single case, and treatment of this injury remains controversial. The present study was performed to evaluate the efficacy of surgical management with internal plating for bipolar clavicle injuries.MethodsWe performed internal plating to treat seven consecutive bipolar clavicle injuries with different injury patterns from May 2013 to June 2021. A clavicle hook plate was used for five sternoclavicular joint injuries (including a revision surgery) and three acromioclavicular joint dislocations, a T plate was used for one sternoclavicular joint injury, and an anatomic plate was used for one distal clavicle fracture. At follow-up, radiographs were assessed for bone alignment, joint congruity, fracture union or malunion, and implant failure or migration. Clinical evaluation included determination of the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant–Murley score; visual analog scale (VAS) score; and complications.ResultsThe patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1 ± 22.0 months, each fracture had solid bone union, and each dislocation showed no sign of recurrent instability. The mean shoulder forward flexion was 159.3° ± 7.9°, and the mean DASH score was 8.8 ± 5.1. The mean Constant–Murley score was 88.9 ± 7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0 ± 1.5, and the mean patient satisfaction score was 9.3 ± 0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfied with their treatment.ConclusionsIn the present study, internal plating for bipolar clavicle injury allowed early mobilization and resulted in good joint function. We recommend fixation of the more severely affected side first because the other side may be passively reduced and acquire stability once the more severely affected side has been fixed. Internal fixation of the other end may therefore be unnecessary unless residual instability exists.

Results of intra-articular distal humerus fracture treated with open reduction and internal fixation

Introduction: Distal humerus fractures are uncommon injuries that account for fewer than 2% of all adult fractures. The complex shape of the elbow joint, the adjacent neurovascular structures, and the soft-tissue envelope combine to make these fractures difficult to treat. The treatment usually consists of determining the injury mechanism and developing a treatment algorithm to regain full mobility of the joint. Materials and Methods: This is a prospective study of 20 cases of distal humerus intra-articular fracture treated by open reduction and internal fixation at our institute during 2017–2019. All the patients in this study were above 18 years of age. These patients were treated with open reduction and internal fixation either by paratricipital approach for fractures with minimal intra-articular comminution or by olecranon osteotomy approach for fractures with more intra-articular comminution. Results: In this study of 20 patients with distal humerus fracture treated with open reduction and internal fixation with ages ranging from 18–65 years, 13 (65%) were male patients and 7 (35%) were female patients. 12 (60%) patients had fracture on the left side, and 8 (40%) patients had fracture on the right side. 11 (55%) patients sustained fractures following the fall from height, and 9 (45%) patients had fracture due to a road traffic accident. Postoperatively, 2 (10%) patients had superficial infection; both patients recovered with antibiotics. In our study, 17 (85%) patients had excellent results, and 3 (15%) patients had a good result according to the Mayo Elbow Performance Score. Conclusion: Distal humerus intra-articular fractures require anatomical reduction of intra-articular components. Vigorous, active physiotherapy is a must for good results. Rigid internal fixation is best accomplished by low-profile anatomical plate fixation, which provides an optimal biomechanical stability; hence, early mobilization can be started, and a good functional outcome can be achieved with a low complication rate.

Subgroups and differences of fixation in 3-part proximal humerus fractures.

This study aimed to determine the morphological differences of three-part proximal humerus fractures, the group in which plate screw fixation is most frequently used, and to evaluate the functional and radiological results of the methods applied for different subgroups. Twenty-nine patients (6 males and 23 females) with three-part proximal humerus fractures were in the study, with an average age of 64. The patients were in three groups according to their fracture types. Group 1 included eight patients with valgus impaction fracture. Group 2 included eleven patients with easily achieved stability after reduction. Group 3 consisted of ten patients with procurvatum varus angulation, a significant displacement between fragments, and in whom medial cortical continuity was not maintained without fixation. All patients underwent surgery with a minimally invasive deltoid split approach method and locked ana-tomic plate screw osteosynthesis. In group 1 patients, the space in the area where valgization is present in the head was filled with cortico-cancellous allografts. No grafting or metaphyseal compression took place in Group 2 patients. In group 3 patients, the metaphyseal compression technique was applied to the bone defect area. Cephalodiaphyseal angles (CDA) were measured at the postoperative and final follow-up. The constant Murley score made the functional evaluation. The patients were followed for an average of 27.6 months, and the union was present in all patients for an average of 3.6 months. Early screw migration was present in three patients, and late screw migration was in one patient. There were twenty-four excellent and 5 good results. CDA decreased from 139.42° to 136.13°. A statistically significant difference was present between the values of Groups 2 and 3 in the final control CDA of the groups. In this study, the functional scores of grafting stable valgus-impacted fractures and metaphyseal compression of unstable fractures with insufficient medial support were as good as stable 3-part fractures. Considering neer type 3 fractures should be evaluated with their subgroups, and fixation and stability-enhancing solutions specific to the groups are essential.

Correlation of the radial inclination angle in the distal part of the radius with the volar cortical angle and age-related changes of these angles

Background/Aim. The radial inclination (RI) and volar cortical (VC) angle values used in the treatment of radial distal end fractures may vary depending on factors such as the age and gender of the patient. That raises the question of the compatibility of the standard anatomical plates, which are frequently used in the surgical treatment of these fractures. The aim of the study was to evaluate the VC and RI angles depending on the age and gender of subjects and determine the correlation between these two angles. Methods. A total of 121 individuals (59 females and 62 males) aged 10?65 years were included in the study. The individuals were divided into two groups: a group of 60 adolescents (31 females, 29 males) 10?20 years old and a group of 61 adults (28 females, 33 males) aged 20?65 years. The subjects were also evaluated between themselves, independently, within each age group. Radiographic images were evaluated by using the 3.0.1.55 version of the KarPacsViewer application. Measurement points were determined, and angles between these points were measured. Statistical analyses were made using the SPSS 15.0 program. Results. When the correlation for 121 individuals was assessed independently of their gender, no statistically significant relationship was found between the RI angle and age (p = 0.616; r = -0.046). A statistically negative (or opposite) relationship was found between the VC angle and age (p &lt; 0.001; r = -0.396). When women and men were compared in terms of the RI and VC angles, no statistically significant difference was found (p = 0.958, p = 0.165, respectively). The VC angle decreased as the age increased in females (p = 0.004; r = -0.365), while both the RI and VC angles decreased with increasing age in males (p = 0.032, r = -0.273; p &lt; 0.0001, r = -0.445, respectively). Conclusion. Our findings regarding the RI and VC angles offer an advantage in terms of determining which plate designs are most appropriate for planning surgical procedures and treatment processes.

The relationship between surgical treatment results of AO type-C radius distal end fractures in adults and patient age

Aim: To evaluate the results of the locking anatomic plate fixation method with volar intervention according to age groups in the surgical treatment of unstable radius distal end fractures involving the joint. Materials and Methods: In this study, 72 adult patients with distal radius fractures who were treated with open reduction and locked volar plate fixation due to radius distal end fracture in group C according to AO classification between August 2010 and August 2018 were evaluated retrospectively. All our patients were evaluated for a post-op range of motion. We divided the age ranges into four groups: Group 1 for ages 17-30, Group 2 for ages 30-45, Group 3 for ages 45-60, and Group 4 for ages over 60. Results: The mean values of joint range of motion and grip strength in all our patients were; flexion 70.95° (Group 1 76.87°, Group 2 74.00°, Group 3 66.96°, and Group 4 64.16°), extension 67.38° (Group 1 71.87°, Group 2 68.33°, Group 3 61.15° and, Group 4 61.16°), radial deviation 27.02° (Group 1 32.50°, Group 2 29.67°, Group 3 23,08° and, Group 4 21.67°), ulnar deviation 32.86° (Group 1 38.75°, Group 2 36.33°, Group 3 28.46°, and Group 4 25.83°), supination 77.74° (Group 1 85.0°, Group 2 79.67°, Group 3 74.62°, and Group 70.0°), pronation 82.50° (Group 1 85.62°, Group 2 84.33°, Group 3 82.69°, and Group 4 73.33°). Analysis of the data revealed a negative correlation between patient age and post-operative joint range of motion. Our findings indicate a statistically significant difference in joint range of motion among Group 4, Group 1, and Group 2 patients. Conclusion: Volar locking plate surgery in AO type C radius distal fractures is suitable for all age groups thanks to rigid fixation and early mobilization.

Application of a new universal locking anatomical plate in treatment of tibial plateau posterolateral column fractures

To investigate the effectiveness of a new tibial plateau posterolateral column universal locking anatomical plate (hereinafter referred to as "new universal locking anatomical plate") in the treatment of tibial plateau posterolateral column fractures. Between October 2020 and December 2021, 14 patients with tibial plateau posterolateral column fracture were treated with a new universal locking anatomical plate. There were 7 males and 7 females with an average age of 59 years ranging from 29 to 75 years. There were 5 cases on the left side and 9 cases on the right side. The causes of injury included falling from height in 5 cases, traffic accident in 7 cases, and other injuries in 2 cases. The time from injury to operation ranged from 3 to 10 days, with an average of 6 days. According to Schatzker classification, there were 4 cases of type Ⅱ, 8 cases of type Ⅴ, and 2 cases of type Ⅵ. All fractures involved the posterolateral tibial plateau. Three column classification: two columns (anterolateral column+posterior column) in 4 cases, three columns in 10 cases. The operation time, intraoperative blood loss, fracture healing, and complications were recorded. The reduction of tibial plateau fracture was evaluated by Rasmussen radiographic score, and the recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score. All 14 cases completed the operation successfully. The operation time was 95-180 minutes, with an average of 154 minutes, and the intraoperative blood loss was 100-480 mL, with an average of 260 mL. All patients were followed up 6-19 months, with an average of 12.5 months. All fractures healed, and the healing time was 15-24 weeks, with an average of 18.7 weeks. During the follow-up, there was 1 case of common peroneal nerve palsy and 1 case of traumatic osteoarthritis. There was no other complication such as vascular injury, incision infection, deep venous thrombosis of lower limbs, heterotopic ossification, bone nonunion, and failure of internal fixation. The reduction of tibial plateau fractures was good immediately after operation, and the Rasmussen radiological score was 10-18, with an average of 15.7; 3 cases were excellent, 10 cases were good, and 1 case was fair, with an excellent and good rate of 92.9%. The scores and grades of HSS at 3 months after operation and at last follow-up significantly improved when compared with those before operation ( P<0.05). There was no significant difference between 3 months after operation and last follow-up ( P>0.05). For the fractures involving the posterolateral column of the tibial plateau, the new universal locking anatomical plate can provide strong fixation, satisfactory postoperative fracture reduction, and good recovery of knee function.

Axial and Rotational Malreduction (Golf Club Deformity) in Distal Femur Fractures.

To describe malreduction of supracondylar distal femur fractures stabilized with lateral femoral locking plates and determine whether a mismatch in axial lateral distal femur anatomy and lateral distal femoral plate design contributes to supracondylar distal femoral fracture malreduction. OTA/AO 33A were simulated in 7 cadaver femurs and fixed with a lateral distal locking femoral plate placed flush to the lateral femoral condyle (group 1). In group 2, the anterior flange of the plate was externally rotated 10 degrees in relation to the lateral condyle. A motion capture system measured translation and rotation of the articular segment as shaft screws were applied, reducing plate to femoral diaphysis. Articular segment movement was compared between groups using paired Student t test, P &lt; 0.05. A large database of 3D scans of 800 femurs was used to define the relationship of the lateral femoral condyle to the lateral cortical surface of the human femur. Malreduction was observed with anatomic plate application results from medial translation (17 mm) and external rotation (12.2 degrees) (group 1). Modifying plate geometry to match lateral femur anatomy (group 2) improved medial translation by 46% and external rotation by 80%. An analysis of the shape of the 800 distal femurs showed that the average posterior anterior inclination is 16.5 degrees. Anatomic application of distal femoral plates results in significant malreduction. Modifying the plate design to accommodate 10 degrees slope of lateral distal femur results in partial correction of deformity. Future studies should investigate other means of correcting the malalignment, especially considering the 16.5-degree posterior anterior inclination of the condyle.

Novel slide compression anatomic plates of the femoral neck for treating unstable femoral neck fracture: A biomechanical study.

To compare the biomechanical stability of slide compression anatomic plates of the femoral neck, cannulated compression screws and dynamic hip screws with derotation screws for stabilizing unstable femoral neck fractures (Pauwels angle = 70°).Pauwels III femoral neck fractures were created on 45 Sawbones femurs and randomly assigned to three implant groups (1:1:1). The biomechanical stability of all Sawbones in each treatment group was evaluated with three tests. First, in the static loading test, the load-displacement curve, vertical stiffness (load/vertical displacement [N/mm]) and 5 mm failure load were recorded. Second, in the incremental cyclic loading test (700, 1000, and 1400 N), the cyclic-displacement curve and the displacement of the fragments were recorded. Third, in the torsion test, the torsional rigidity, maximum torque, and torsional angle corresponding to the maximum torque were recorded.The static compression test showed that slide compression anatomic place-femoral neck (SCAP-FN) had the largest vertical stiffness (275 ± 11 N/mm, p < 0.01) and 5 mm failure load (1232 ± 156, p < 0.01). The cyclic loading test showed that SCAP-FN had the lowest change in displacement after 30000 cycles of loading. The torsional stiffness and the maximum torque followed the order SCAP-FN > dynamic hip screw systems (DHS) + derotational screw (DS) > CCS, and the torsional angle corresponding to the maximum torque followed the order SCAP-FN < DHS + DS < CCS.The SCAP-FN construct provides stiffness and stability compared with other standard fixation techniques (3CS and DHS + DS). The fixation strategy of SCAP-FN might be sufficient for clinical use, indicating studies in the human body are warranted.

Design and topographic evaluation of a canine humeral anatomic plating system (CHAPS) for humeral condylar fracture repair in spaniels.

To design a precontoured plating system for humeral condylar fracture repair in spaniels with humeral intracondylar fissure (HIF) and quantify accuracy of fit of the system on 3D printed bone models. Experimental on 3D printed models. The plating system was based on morphometric data obtained from CT. Plates were applied to models and impression material was measured under the plates at points of interest to define plate bone gap (PBG). Data on locking screw interference on plate application were also obtained. Eleven elbows models were plated. Statistical analysis to assess for any difference in PBG measurements between left and right humuri revealed two loci (3 and 17) under the lateral plate and two loci (3 and 17) under the medial plate. On cumulate portion analysis, 67% of lateral plate loci and 80% of medial plate loci had a PBG of ≤2 mm respectively. An incidence of 2.1% (3/143) screw interference occurred. Design of a contoured plating system for application to humeral models from spaniels with HIF and its application with objective measurement of PBG is described. The majority of the loci measured under both lateral and medial plates had a BPG of ≤2 mm and the incidence of locking screw interference on plate application was low. This novel system may have application for the stabilization of humeral condylar fractures in spaniels avoiding the need for plate contouring and minimizing the incidence of locking screw interference.

Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Accuracy of Reduction and Early Functional Outcomes With a Minimum of 1-Year Follow-Up.

To evaluate the results of a new plate system using anterior approaches in the management of acetabular fractures. Retrospective case-note review. Pelvic and acetabular tertiary center. A consecutive series of acetabular fractures treated using only anterior approach and anatomical plates, at one tertiary specialist unit, were reviewed. The fracture patterns, incisions used, intraoperative and postoperative complications, reduction achieved (measured on postoperative radiographs and computed tomography scans), and early postoperative results (minimum 1-year follow-up) were recorded. Postoperative reduction (measured by postoperative plain radiographs and computed tomography). Thirty-three patients (mean age, 57 years) underwent reconstruction with the anatomical plates using anterior approaches. Associated both columns and anterior column posterior hemitransverse represented most of the patients (85%). The fracture pattern was complex with quadrilateral plate involvement in 79% of cases. Overall, anatomic reduction was seen in 82% on plain radiographs and CT scan evaluation. Increasing age was a statistically significant variable in obtaining anatomical reduction with an age cutoff value of 70 years ( P 0.012). Associated both column fractures were associated with a lower incidence of anatomical reduction ( P = 0.038). Complication rates were comparable with the literature. 22 patients (71%) were symptom free, with 20 patients (62.5%) having excellent radiographic outcomes at the latest follow-up. The results suggested that using approach-specific instruments and anatomical plates through anterior approaches in a specialized unit led to anatomical reconstruction in 82% with patients demonstrating satisfactory early radiological and functional outcomes at 1 year. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Les formes du visible

In his latest book, Descola analyzes more than 150 graphic works from all over the world, among which are animal statuettes of the Koryaks, a people of the Kamchatka region of Russia. Those figurines always represent animals lying in wait, ready to jump or already running. Such representations, the anthropologist argues, incline us to pay attention to what motivates and what troubles the animals: “All those animals that we see undertaking an action manifestly intentional or properly responding to unexpected events cannot but impose on the observers of their image the idea that they are moved by aims, that they have an interiority just like humans.” This type of animal figuration is especially common in peoples that in Descola's previous book, Beyond Nature and Culture, he referred to as “animist.”In that book, published in 2005, he described the animist ontology and three other modes of paying attention to continuities and differences between humans and animals: naturalism, analogism, and totemism. At the time, he focused exclusively on the description of those ontologies, as opposed to any study of their evolution. He begins his study of the genesis of ontologies in Les formes du visible by suggesting that each type of graphic work induces a different way of paying attention to psychological and physical continuities and differences. For instance, in contrast to a Koryak statuette, an anatomical plate (to use a simple example not covered in the book) depicts only the body of a dead and dissected specimen. By referring simultaneously to an anatomical description of the human body and to that of another mammal, we tend to see how similar our bodies are. Whereas the animist ontology emphasizes the psychological continuity of humans and animals, the naturalist ontology insists instead on their physical continuity. By producing and using repeatedly some kinds of graphic works, each society comes to favor one or another ontology, one or another way of paying attention to the world. (Descola never says so in these words, but what he seems to mean by ontologies are modes of attention).Descola's questions in this new book are engaging: What do images make us pay attention to? What modes of attention do images stimulate? Each case study selected by the author is, moreover, fascinating in itself: an Amerindian mask, an Aboriginal painting on a piece of bark, a sixteenth-century Mongolian drawing of an elephant. The answers offered for the questions asked are unfortunately always already canvassed by the theory of the four ontologies. In previous work, Descola built that theory based on discursive and ethnographic material; sometimes we are left with the impression that images (as opposed to spoken words) do not make any significant difference, since they did not motivate him to modify in any way his theory in his new book.In addition, Descola's framework brings him to focus only on a particular aspect of what images induce in our modes of attention: in his thinking, ontologies are defined solely by the way we notice (or do not notice) differences and continuities between beings on two levels, physical and psychological, which respectively he terms the exteriority and the interiority of beings. By combining these two pairs of opposing features (continuity/difference, interiority/exteriority), he constitutes his four ontologies. But depictions can produce more fine-grained ontologies by making us pay attention to, say, the separation or the blending of bodies, the stability or fluidity of souls, the equality or inequality of power between beings. Moment by moment, while reading Descola, we find ourselves tied to his four ontologies and indeed find it almost impossible to imagine ontologies other than the four he has set out. In a structuralist vein, he even presents that number as a necessary, logical, and cognitive limit to the construction of ontologies. Nevertheless, by opening the analysis of the modes of attention to more than just the double pair of features picked out by the anthropologist, we could well unearth more diversified ontologies, induced by images (and by other cultural and technical particulars). We could detect, in other words, more than four modes of paying attention to our environment and to our companion beings.

Comparison of short-term effectiveness of metal screws and absorbable screws in repair of distal tibiofibular syndesmosis

To compare the short-term effectiveness of repairing distal tibiofibular syndesmosis with metal screws and absorbable screws. A retrospective analysis was performed on the clinical data of 63 patients with ankle fracture combined with injury of the distal tibiofibular syndesmosis admitted between January 2017 and January 2020. Among them, 31 patients were treated with absorbable screw fixation of the distal tibiofibular syndesmosis (research group) and 32 patients were treated with metal screw fixation of the distal tibiofibular syndesmosis (control group). There was no significant difference in gender, age, cause of injury, surgical side, time from injury to operation, fracture type, preoperative visual analogue scale (VAS) score, and American Orthopaedic Foot & Ankle Society (AOFAS) score between the two groups ( P>0.05). The operation time and fracture healing time were recorded and compared between the two groups. X-ray film was taken to evaluate the effect of ankle joint reduction and fixation. Olerud-Molander ankle fracture efficacy score (short for OM score), AOFAS score, and VAS score were used to evaluate the effectiveness. There was no significant difference in operation time between the two groups ( t=-0.683, P=0.497). In the control group, 1 case of delayed healing and 1 case of poor healing occurred in the lateral incision after operation, which healed after dressing change; the rest of the patients had primary healing of the incision. Patients in both groups were followed up 12-24 months, with an average of 13.8 months. In the control group, 1 patient with fracture of pronation and external rotation walked with full weight bearing after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks after operation, the anatomical plate of the lateral malleolus was broken, and the lateral malleolus was fixed again and recovered after 5 months; 1 patient had mild ankle pain after operation, and the pain disappeared after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks. No complication such as nerve and blood vessel injury occurred in all patients. There was no significant difference in fracture healing time between the two groups ( t=-1.128, P=0.264). The AOFAS and VAS scores significantly improved in both groups at 12 months after operation ( P<0.05). There was no significant difference between the two groups in the OM scores, and the difference of AOFAS and VAS scores between before and after operation ( P>0.05). Using absorbable screws to repair the distal tibiofibular syndesmosis can effectively restore the ankle acupoint structure, prevent ankle instability, and restore good ankle function. There is no significant difference in effectiveness between absorbable screws and metal screws, and there is no need for secondary operation to remove screws.

Comparison of Anatomical Conformity between TomoFix Anatomical Plate and TomoFix Conventional Plate in Open-Wedge High Tibial Osteotomy.

Background and Objectives: The TomoFix anatomical plate was developed to improve plate position, proximal screw direction, and post-correction tibial contouring. The purpose of this study was to compare postoperative configurations between the TomoFix anatomical plate and the TomoFix conventional plate. It was hypothesized that the new modified plate provides a better fixative coaptation than the conventional plate. Materials and Methods: A total of 116 cases (112 patients) were enrolled in this study from March 2015 to February 2021. Among them, 63 patients underwent surgery using the TomoFix conventional plate, and 53 underwent surgery using the TomoFix anatomical plate. The radiographic outcomes, including the hip–knee–ankle (HKA) angle, medial proximal tibial angle (MPTA), tibial slope, plate angle, proximal screw angles, and plate-to-cortex distance at #1 hole (just below the osteotomy site) were compared between the two groups. Results: Patients with the TomoFix anatomical plate showed similar results in terms of the pre- and postoperative HKA angle, MPTA, and tibial slope. The TomoFix anatomical group showed a significantly greater plate angle (39.2° ± 8.1° vs. 31.7° ± 7.0°, p < 0.001) and less screw angles, indicating that the TomoFix anatomical plates allowed a more posterior plate position than the conventional plate. The plate-to-cortex distance was significantly less in the TomoFix anatomical group than in the TomoFix conventional group (p < 0.001). Conclusion: The TomoFix anatomical plate showed a more posteromedial plating position, better proximal screw direction to the lateral hinge, and improved post-correction tibial contour compared to the TomoFix conventional plate.