Anterolateral Plating Research Articles

Anterolateral versus anteromedial plate osteosynthesis of midshaft humeral fractures; is there a difference in the rates of iatrogenic radial nerve palsy?

The anterolateral (AL) and anteromedial (AM) surfaces of the humerus are typically used for plate placement during plate osteosynthesis of midshaft humeral fractures via the anterolateral approach. The purpose of this study was to determine if a significant difference exists in the rates of iatrogenic radial nerve palsy (IRNP) following either AL or AM humeral fracture plating. The research question is stated as follows: is anteromedial plating of humeral fractures associated with lower rates of IRNP when compared with anterolateral plating? This multicenter prospective randomized study was undertaken following ethical review and approval with eligible patients who had midshaft humeral fractures or nonunions randomized into 2 groups, viz AL plate osteosynthesis group and AM plate osteosynthesis group. Following diagnostic and preoperative evaluation, patients had open plate osteosynthesis through the anterolateral approach with plate placement according to their study groups. Post-operatively, they were assessed for IRNP while obtained data was analyzed with SPSS version 23 and inter-group differences with P values less than 0.05 were considered statistically significant. Eighty-five eligible patients participated in the study with 43 patients in Group A (AL plate osteosynthesis group) and 42 patients in Group B (AM plate osteosynthesis group). The observed inter-group differences with regard to gender distribution, mean age and clinical diagnosis; acute fracture (AF) versus nonunion were not statistically significant. Furthermore, four (9.3%) patients amongst the 43 patients in Group A (AL plate osteosynthesis group) developed IRNP while two (4.8%) patients amongst the 42 patients in Group B (AM plate osteosynthesis group) had IRNP. The inter-group difference with regard to rates of IRNP was not statistically significant (P = 0.694). This study found that (in contrast to previous studies) there was no significant difference in the rates of IRNP following either open anterolateral or anteromedial plate osteosynthesis of midshaft humeral fractures through the anterolateral approach. Orthopaedic surgeons should therefore remain cautious when obtaining consent for surgery as well as when performing internal fixation of midshaft humeral fractures to limit medicolegal disputes that may arise from IRNP.

A Comparison of Anteromedial Plating Versus Anterolateral Plating for Humerus Shaft Fractures Using the Anterolateral Approach.

Background Plate osteosynthesis is the gold standard treatment for the management of humeral shaft fractures. In the present study, we performed plate osteosynthesis on the anteromedial and anterolateral surfaces using the anterolateral approach to compare the functional outcomes. Aims and objectives To study and compare the functional outcome, time to achieve union and associated complications of anteromedial and anterolateral plating in humerus shaft fracture by anterolateral approach. Methods This prospective, randomised control study was performed at Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India.This study had 46 patients in total, who were divided into two equal groups at random. All of the fractures in group A were treated using a limited contact dynamic compression plate (LCDCP) on the anterolateral surface using an anterolateral approach, while all of the fractures in group B were corrected using an anteromedial surface using an anterolateral approach using LCDCP. All the patients were followed for six months at regular intervals. At each follow-up, patients were assessed radiologically with X-rays and clinically by Rodriguez-Merchan criteria (RM criteria). Results and conclusions The union was achieved in the majority of the cases of the anteromedial plating group within 12 weeks (78.3%) with a mean union time of 11.7±1.5 weeks than the anterolateral group (56.5%) with a mean union time of 12.3±1.8 weeks. Based on functional assessment according to RM criteria, the excellent outcome was achieved in 69.6% and 65.2% of the anterolateral and anteromedial plating groups, respectively.There was no case of non-union and radial nerve palsy in anteromedial plating cases whereas in anterolateral cases one patient did not achieve union and two (8.7%) had radial nerve injury, which recovered completely by the end of the study.An anterolateral approach with anteromedial surface plating on the flat medial aspect of the humerus is a good technique for fixing humeral fractures.

Dynamic Compression Plating Versus Antegrade Intramedullary Nailing for the Treatment of OTA/AO 12-A Fractures: A Retrospective Cohort Study.

Fractures of the humerus diaphysis are common and often result from motor vehicle accidents (MVAs). Treatment methods range from nonoperative approaches to various operative techniques, including antegrade intramedullary nailing (AIMN) and dynamic compression plate (DCP) fixation. This study aimed to compare the cost effectiveness and outcomes of plating and nailing for humerus diaphyseal fractures. A retrospective cohort study involving 59 cases of humerus diaphyseal OTA/AO 12-A fractures was conducted at King Saud Medical City (KSMC), a level I trauma center located in the center region in Riyadh, Saudi Arabia. Patients treated with AIMN, anterolateral plating, or posterior plating were included. Data on demographics, clinical parameters, radiographic healing, and costs were collected and analyzed. The average surgical duration was shorter in the AIMN group compared to the anterolateral and posterior plating groups but with no statistical significance (P > 0.05). The average length of stay (LOS) was shorter, and the change in hemoglobin levels was lower in the AIMN group when compared to other groups but without a statistically significant difference (P > 0.05). The average cost of AIMN was significantly higher than that of anterolateral and posterior plating groups (P < 0.0001). While both nailing and plating procedures are options for treating OTA/AO 12-A fractures, AIMN carries a higher overall procedural cost. The practice of drain placement in our study population is likely the cause of the increased LOS in the plating groups. Relative additional analgesic requirements were associated with AIMN. Surgeons should consider meticulous hemostasis to avoid drain placement, which can decrease LOS, thus possibly decreasing unnecessary treatment costs of humerus shaft fractures.

Anterior Tibial Artery Danger Zone During Anterolateral Plate Fixation of the Distal Tibia: A 3D CT Angiogram Modeling Study.

The objective of this study was to define the danger zone at which the anterior tibial artery (ATA) is at risk during anterolateral plating of the distal tibia using a novel 3D CTA modeling technique. We identified 116 patients (232 lower extremities) with lower extremity CTAs performed between 04/2020 and 04/2022. Those with lower extremity trauma, evidence of a previously healed tibia fracture, or poor visualization of the ATA were excluded. The remaining 150 lower extremities (92 patients) were modeled with an anterolateral distal tibia plate using Sectra IDS7 software. The distance of the ATA from bony landmarks was measured perpendicular to the level at which the vessel intersected the plate. The ATA intersected the plate at a mean distance of 10.5 cm (95% CI 10.2 - 10.9) proximally, and distally at a mean distance of 4.6 cm (95% CI 4.4 - 4.9) from the central tibial plafond. The ATA intersected with the plate as far distal as hole number 1 and as proximal as hole 14 of the plate. The greatest injury risk was associated with plate holes 3-8. In this region the artery was at risk in 46-99 percent of specimens. The ATA is at risk when percutaneously placing screws in an anterolateral distal tibia plate. The artery can be as close as 4.4 cm and as far as 10.9 cm proximal to the tibial plafond when crossing the plate, correlating to a risk of injury to the ATA at plate holes 1 through 14. Level IV, computed tomography angiography study.

Anterolateral and Medial Locking Compression Plates for the Management of Distal Tibial Fractures: A Comparative Prospective Study.

Open/close reduction (OR/CR) and internal fixation (IF) of displaced fractures of distal tibia with either a medial or anterolateral plate is a commonly performed procedure. Anterolateral plating avoids an incision along the medial subcutaneous border of tibia and has been shown to have reduced risk of wound complications. The aim of our study was to determine the functional outcome of these fractures treated with anterolateral and medial distal tibial locking compression plates. This was a prospective study that included 60 patients with distal tibial fractures (close or grade I open injury)divided into two groups with 30 patients in each where one group was treated with OR/CR and IF using an anterolateral distal tibial locking plate (Group A) and the other using a medial distal tibial locking plate (Group B). The duration of surgery and intraoperative blood loss and time to union were recorded for all the patients. Functional evaluation was done at one year in terms of pain, function and alignment using theAmerican Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and complications, if any, were noted. Both the groups were comparable in terms of age, gender, time of presentation, AO classification and presence of wound. The mean duration of surgery as well as the intraoperative blood loss were more in the anterolateral plate group than in the medial plate group, but the difference was statistically insignificant. Ten patients (33%) with medial plates had symptomatic hardware and 7 (23.3%) underwent removal while only 3 (10%) patients in the anterolateral plate group had similar complaints and none had to undergo removal. Two patients with anterolateral plate and one with medial plate had malunion. The mean time to fracture union as well as the rate of infection was less and the functional outcome at one year was better in the group treated with anterolateral plates as compared to the one with medial plates, but the difference again was not statistically significant for all the parameters. With reduced risk of soft tissue complications and by obviating the need for implant removal, anterolateral plates can prove to be a better alternative to the medial plates especially in elderly patients in the management of these fractures.

Functional and radiological outcome of distal tibia fractures managed with expert tibia nail: a prospective clinical study

Leg bone fractures come at the top because it is actively involved in locomotive system with distal tibia fractures having second highest incidence due to its subcutaneous location with very less muscle mass around it. Such fractures are mostly comminuted fractures with extensive soft tissue injuries. These are the fractures which extend within approximately 4 cm. from the tibial plafond. As these fractures occur in proximity of weight bearing surface of ankle joint, a slight maladjustment may lead to permanent disability. Non operative treatment/ open reduction and internal fixation with medial or anterolateral plating of these fractures is associated with multiple post-operative complications like infection, wound dehiscence and non-union. Operative treatment allows proper length and anatomical alignment of the limb, early mobilization and hence excellent final results. The present study of 25 cases was done to evaluate the clinical and radiological functional outcome of extra-articular AO type A simple and compound (Gustilo type I and type II) fractures of distal tibia managed with expert tibial nail and complications (post-operative) if any of patients of either sex, same demographic profile admitted through emergency in a tertiary institute of Punjab. Clinico-radiologically results were assessed using Johner and Wruh’s criteria. Authors got excellent results in 88%, good to fair in 08% of the cases. Expert tibia nail provides good mechanical and rotational stability due to multiple, multidirectional distal locking options available in distal tibia fractures.

“A STUDY OF FUNCTIONAL OUTCOME OF TIBIAL PLATEAU FRACTURE OPERATED BY PLATE OSTEOSYNTHESIS”

Background: Tremendous advance in mechanization and fastness of travel have been accompanied by steep increase in number and severity of fractures and those of tibial plateau are no exception. Knee being one of the major weight bearing joints of the body, fractures around it will be of paramount importance. Objective: 1. This study is to analyze the functional outcome of ORIF with plating with or without bone grafting in tibial plateau fractures in adults. 2. To study complication of operative management Methods: Conrmed cases of Tibial plateau fractures admitted in Department of Orthopaedics in Basaweshwara Teaching and General Hospital attached to Mahadevappa Rampure Medical College, Kalaburagi. The purpose of the study is to include with tibial plateau fractures diagnosed with history taking, Examination and investigations: knee X ray-AP and Lateral view. The need of operative intervention is assessed based on the Shatzker`s classication and intervention done by techniques like anterolateral plating bicondylar plating, posteromedial plating. Patients will be reviewed at 6 weeks, 3 months and 6 months interval and their assessment done by Rasmussens functional and radiological scoring. In our Results: series, majority of the patients were males, middle aged, with road trafc accident being the commonest mode of injury, Most of the cases were Type I fractures i.e., split fracture of lateral condyle according to Schatzker`s classication, Surgery was performed with in 6.48 average days, Union was noted clinically and radiologically and functional evaluation was done by Rasmussen functional and radiological score. Excellent results were present in 23 patients (76%), 4(20%) good and 1(4%) poor results. Achieving and maint Interpretation /Conclusion: aining anatomical reduction with plates with less soft tissue dissection helps in early mobilization and hence obtaining good functional and radiological outcomes of tibial plateau fractures early physiotherapy for rehabilitation

Investigating the effectiveness of anterolateral distal tibia plate in treating distal tibial fractures in adults: a prospective study

Background: “Pilon” fractures of the distal tibia are a term used usually by orthopaedic surgeons. High-energy trauma and related soft tissue injuries are the main causes. It might be challenging to treat distal one-third of tibial fractures that affect the articular process or not. The objective of this work is to analyze the result of the Anterolateral Distal Tibia Plate in distal tibial fracture treatment in adults. Methods: After receiving permission from the ethical committee, this prospective interventional analysis was conducted among 25 patients who satisfied the inclusion standards and were given anterolateral distal tibia plates. The scoring system created by “Ovadia and Beals” was used to evaluate patients at the conclusion of the follow-up period. Results: The participants in this research varied in age from 18 to 64, with a mean age of 36. 13 patients had a left tibia fracture and 12 patients had a right tibia distal end fracture. There were 4 open GA-I fractures and 21 closed GA-I fractures. 18 patients got fractures as a result of road traffic accidents (“high energy trauma”), and 7 patients sustained a fracture due to a fall (low energy trauma). The union of fracture occurred in 24(96%) patients and 1(4%) case showed delayed union. The average period of union was 18 weeks with the radiological signs of callus formation. 2 patients developed superficial and 1 patient developed deep infection. Conclusions: Distal end tibial fractures especially with intra-articular involvement may be effectively treated by anterolateral plating within a single stage, offers advantages such as adequate fracture exposure, soft tissue preservation, and reliable fracture healing.

Functional outcome of column specific fixation in the management of complex tibial plateau fractures

Introduction: Complex tibial plateau fractures usually have complicated intra-articular fracture pattern, often associated with severe soft tissue injury and high risk of wound complications. Single or dual column plating fixation principle based upon conventional x-ray for such fractures may not address multiplanar comminution that often has posterior shearing or coronal fractures. Computed tomography based evaluation of such fractures and column specific approach allow direct fracture visualization and anatomic reduction that results in satisfactory outcome.&#x0D; Objectives: To assess the clinical and functional outcome and complications of complex tibial plateau fractures fixed with column specific fixation principle.&#x0D; Methodology: This prospective study was carried out from September 2019 to August 2021 in Orthopaedic department of Nobel Medical College, Biratnagar. Consecutive sampling was used among patient with complex tibial plateau fractures meeting the inclusion criteria. Among 30 patients, with closed and Gustilo grade I or II Schatzker type V-VI fractures or AO type-C injuries to the proximal tibia were operated on column specific approach and followed up for clinico-radiological evaluation.&#x0D; Results: In this study, most of the patients belonged to 31-40 years of age group with mean age of 40.47 years. Majority of patients were male( 76.7%). Fracture was highly associated with road traffic accident which accounted for 83%. Fourteen patients underwent anteromedial and anterolateral plating(46.67%), 10 patients underwent anterolateral and posteromedial plating(33.33%) and remaining 6 patients underwent triple column plating(20%). The Rasmussen’s functional score at final follow up was 27.17±2.793(range 21-30). 86.7% patients had acceptable clinical outcome. The mean Rasmussen’s radiological score at final follow up was 8.97±1.217(range 6-10). Thus 93.4% patients had acceptable radiological outcome.&#x0D; Conclusion: Column specific approach addresses all the fracture fragments of complex tibial plateau fractures to achieve acceptable clinical and radiological outcome.

OUTCOME OF ANTEROMEDIAL PLATING VERSES ANTEROLATERAL TECHNIQUE FOR FRACTURE OF MIDDLE 1/3RD OF THE HUMERUS

Background: Humerus shaft fracture accounts for 3-5% of all fractures commonly encountered by orthopedic surgeons. The application of plate for fracture of middle 1/3rd of Humerus is a gold standard in the presence of lot of intramedullary and extramedullary devices for these fractures.&#x0D; Objectives: To compare the outcome of anterolateral plating with the anteromedial plating for fracture of middle 1/3rd of the Humerus.&#x0D; Subjects and Methods: &#x0D; Study Design: Randomized control trial&#x0D; Study Setting: Department of orthopedic surgery services hospital Lahore&#x0D; Study Duration: Jan 2018 to Jan 2019&#x0D; Data collection and Analysis:&#x0D; Total number 60 patients with fracture of middle 1/3rd of shaft of the humerus were admitted through emergency department of this hospital. Subjects were randomly assigned into two equal groups. In Group A all fractures were fixed with DCP on the anterolateral surface of Humerus with anterolateral approach while in group B all 30 patients with fracture of shaft of Humerus were plated on the medial flat surface of Humerus by anterolateral technique. The radial nerve injury was also assessed in both of these groups post operatively. All these patients were followed for 6 months with weekly interval up to 03 weeks, then at 06 weeks, 03 months and thereafter at 06 months. At each follow up each patient was evaluated clinically and radiologically for fracture union range of motion at elbow and shoulder joint and post operative complications. Data was entered and analyzed in SPSS ver: 21.0. Mean and standard deviation was calculated for quantitative variables and frequency and percentages for qualitative variables. Independent t–test was applied for numerical outcome and chi-square test was used for proportions with p &lt; .05 as statistical significant.&#x0D; Results: Mean age 42.2 + 5.98 years. 66.6% of the fractures were as a result of RTA Mean duration of surgery in Group A (Anterolateral surface) was 60.25 + 7.56 and in Group B (Anteromedial surface) was 52.34 + 10.29. (p &lt; .001). Mean blood loss in group A was 110.17 + 12.36 and in Group B was 80.75 + 8.94 (p &lt; .000). No radial nerve injury in group B while 3 (10.0%) patients had iatrogenic radial nerve palsy in group A (p =.076).&#x0D; Conclusion: Anteromedial plating on the flat medial surface of Humerus is an excellent technique for fixation of fractures of middle 1/3rd of the Humerus as compared to anterolateral plating. It avoids the injury to the radial nerve.

Biomechanical properties of a novel fixation system for intra-articular distal humerus fractures: a finite element analysis

BackgroundThe traditional strategy for fixing intra-articular distal humerus fractures is double plating placed in an orthogonal configuration, based on posterior approach. With a combined medial and lateral approach, a novel configuration of plating (combined anteromedial and anterolateral plating) has been used. In this study, we investigated the biomechanical properties of the novel plating by comparing it with some traditional strategies.MethodsBased on the 3D morphology of a healthy subject’s humerus, models of three types of intra-articular distal humeral fractures were established using a variety of different internal fixation methods: (a) treatment of a simple intra-articular fracture of the distal humerus with the novel double plate and a traditional orthogonal plate; (b) treatment of a comminuted fracture of the lower distal humerus with the novel double plate, a traditional orthogonal plate and a traditional orthogonal plate combined with distally extended tension screws; (c) treatment of a coronal shear fracture of the distal humerus with the novel double plate, a traditional orthogonal plate and the intra-articular placement of three screws. The material properties of all plates and screws were isotropic and linearly elastic. The Poisson ratio of the implant and bone was 0.3, and the elastic modulus of the implant was 114,000 MPa. The axial loading is 200 N, the bending loading is 30 N and varus rotation is 7.5 Nm in the longitudinal direction.ResultsA simple model of intra-articular fracture of the distal humerus (AO C1 type) was established. Under all experimental conditions, the novel double plate showed greater stiffness than the orthogonal double plate. The axial straightening, bending compression and varus torsion increased by 18.00%, 16.00% and 44.00%, respectively. In the model of comminuted fracture of the lower distal humerus, the novel double plate showed the best stiffness under three experimental conditions (163.93 N/mm, 37.97 N/mm, 2697.84 N mm/°), and the stiffness of the traditional orthogonal plate combined with the distally extended tension screws was similar to that of the traditional orthogonal plate (121.21 N/mm, 32.61 N/mm, 1968.50 N mm/°). In the model of coronal shear fracture of the distal humerus, the novel double plate showed the best stiffness under all test conditions (194.17 N/mm, 38.46 N/mm, 2929.69 N mm/°), followed by the traditional plate (153.85 N/mm, 33.33 N/mm, 2650.18 N mm/°), while the stiffness of the three screws was the smallest (115.61 N/mm, 28.30 N/mm, 2180.23 N mm/°).ConclusionsIn terms of biomechanics, compared with other internal fixation methods, the novel combined anteromedial and anterolateral anatomical locking double-plate showed less stress, less displacement and greater stiffness. The novel double-plate method can be used to treat not only simple intra-articular fractures of the humerus but also complex comminuted fractures of the lower distal humerus and coronal shear fractures of the distal humerus, with a better effect than current traditional internal fixation methods.

Functional and clinical outcome of MIPPO anterolateral plating for proximal tibia fracture both proximal one third and coronal intrarticular fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;The proximal tibial fractures are one of the commonest intraarticular fractures. Generally these injuries fall into two broad categories, high energy fractures and low energy fractures. The tibial plateau fractures are mostly due to high velocity road traffic accidents and fall from height, where fractures result from direct axial compression, usually with a valgus (more common) or varus moment and indirect shear forces.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a prospective study and includes operations by MIPPO technique that were undertaken between January 2020 till June 2021 in RNT government hospital; Udaipur. The total number of cases studied were 25 with the youngest being 25 years old and oldest 70 years old. Intraoperative complications were noted. Functional outcome was assessed using Modified Rasmussen’s Criteria.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients with fracture in our study occurred between the age of 25 to 70 years with maximum incidence involving the productive age group of 21-30 years (90%). Majority of the patients was males- 90%.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;From the minimally invasive percutaneous plate osteosynthesis of proximal tibial fracture there is an increase in the complexity of proximal tibial fractures with increasing road traffic accident. As most of the patients sustained these fractures belong to physically highly active and productive age group, they need optimal treatment to get back to their previous work capacity and avoid long term complications like osteoarthritis. We treated all fractures in our study with MIPPO technique and found rapid healing by secondary fracture union and hence achieving strong bone union across the fracture site due to inherent benefits of less tissue damage and minimal disturbance of fracture site biology. We operated 20 proximal tibial fractures with MIPPO technique and observed rapid healing and good functional recovery.&lt;/p&gt;

Proximal tibia MIPO locking plate-prospective study of functional outcome for AO/OTA type 41-B, C fracture

Objective: The aim of our study was to evaluate the functional outcome using the HSS knee scoring system and complications of tibia plateau fractures in the Indian population treated with the Locking Anterolateral plate with the MIPO technique. Method: A prospective study was carried out in our institute at Kolhapur. A total number of 57 patients with tibia plateau fracture (AO/OTA type 41-B, C) were studied between March 2019 and Jan 2021. All were treated with an anterolateral locking plate via anterolateral approach and MIPO technique. A mean follow-up of 12 months was carried out, and evaluation was done with the help of the HSS (Hospital for special surgery) Knee scoring system. Result: The mean radiological union time was 16 weeks. The outcome was measured using HSS knee scoring. The average follow up period was 12 months with good patient satisfaction. A total of 11 patients out of 57 reported complications like Non-union (2%), Delayed union (7%), Infection (5.20%) and hardware irritation (5.20%). No case of peripheral neuropathies reported in any of the patients. Conclusion: Locking anterolateral plating via the MIPO technique is a good treatment option showing good clinical outcome in the treatment of tibia plateau fracture (AO/OTA type 41-B, C). It offers a more stable fixation and good functional recovery after the surgery.

Risk factors for infection in fixation of distal tibia fractures

BackgroundThe aim of this study is to evaluate risk factors for infection as well as infection rates after open reduction and internal fixation for distal tibia fractures with a distal tibia locking plate and/or isolated screws. MethodsThis is a retrospective and descriptive study based on 55 patients treated in our Major Trauma Centre from January 2009 to December 2016. All patients were classified by age, sex, open or closed fracture, injury mechanism, comorbidities, fixation and time from injury to surgery. 22 extraarticular fractures AO/OTA 43-A and 33 intraarticular (14 cases 43-B and 19 43-C) were recorded. High energy trauma was related in 27 patients, while open fractures were observed in 10 patients. Splint until surgery was applied routinely while temporary external fixation (EF) was performed in 21 patients (7 extraarticular and 14 intraarticular). Patients were treated by 5 different consultant surgeons performing isolated screws (SC) in 20% of the surgeries, antero-medial locking distal tibia plate (AM) and anterolateral (AL) were used in 47% and 33% of the patients respectively. After assessing normality and homogeneity of the subgroups, statistical contrast tests were performed. ResultsInfection rate was 31.5%, mainly caused by S. aureus. We obtained a statistically significant correlation between greater age and infection rate. In the same way, a positive statistical trend between infection and AL plating was found. The use of EF followed by ORIF was not observed as a risk factor for infection compared with splint followed by internal fixation, however, the group of patients in which a splint was used, a positive relationship was found between the infection rate and shorter time until the definitive fixation. No statistically significant associations were found between extra/intraarticular fracture pattern, use of corticosteroids or open fractures and infection rate. ConclusionGreater age was a predisposing factor for infection. The use of external fixation before definitive ORIF seems to be a safe procedure regarding risk infection, and if an external fixation is not used, we recommend longer waiting time until definitive ORIF. Screw fixation or antero-medial plates, if allowed by fracture pattern, can be an option to avoid infection.

Comminuted patellar fractures: The role of biplanar fixed angle plate constructs

BackgroundComminuted patellar fractures represent a challenging clinical problem. Treatment aims to restore the integrity of the extensor mechanism and the congruity of patellofemoral joint. Controversy exists regarding the ideal fixation method. Metallic constructs aiming to convert pulling forces on the anterior aspect of the patella into compression forces across the fracture site are the standard of care. More recently, low profile plates have been described in the management of comminuted patellar fractures. The aims of this study were to (1) develop a novel unstable patellar fracture model and (2) to compare biomechanically three different constructs for fixation comminuted patellar fractures. We hypothesized that an orthogonal biplanar disposition of the screws within an anteriorly placed locking plate provides the best biomechanical properties in the management of comminuted fractures.MethodsSix-part complex AO 34–C3 patella fractures were simulated in 18 human cadaveric knees by means of osteotomies including comminution around the distal patellar pole. The specimens were randomly assigned to 3 fixation techniques (n ​= ​6) for either anterior plating, antero-lateral plating, or tension band wiring (TBW). Biomechanical testing was performed over 5000 cycles in active extension and passive flexion, followed by ultimate destructive quasi-static testing. Interfragmentary movements were captured by means of optical motion tracking.ResultsDisplacement between the proximal and distal medial patella fragments was lower after anterior plating compared to both antero-lateral plating (P ​= ​0.084) and TBW (P ​< ​0.001). Moreover, displacement between the proximal and distal lateral fragments was significantly lower after anterior plating compared to both other techniques (P ​≤ ​0.032). In addition, it was significantly lower for antero-lateral plating versus TBW (P ​< ​0.001). Rotation around the medio-lateral axis between the proximal and distal medial fragments was significantly lower after anterior plating compared to TBW (P ​= ​0.017).ConclusionsAnterior mesh plating with biplanar placement of locking screws provides superior stability for fixation of comminuted patellar fractures when compared to both antero-lateral mesh plating and TBW. The latter is associated with considerably inferior performance.

Anteromedial Surface Plating for Midshaft Fracture Humerus Through an Anterolateral Approach - A Better Option than Anterolateral Plating.

Introduction:Osteosynthesis by plate fixation of humeral shaft fractures as a gold standard for fracture fixation has been proven beyond doubt. However, during conventional anterolateral plating Radial nerve injury may occur which can be avoided by applying plate on the medial flat surface. The aim of this study was to evaluate the results of application of plate on the flat medial surface of humerus rather than the conventional anterolateral surface.Materials and Methods:This study was conducted between Oct 2010 to Dec 2015. One-hundred-fifty fracture shafts of the humerus were treated with the anteromedial plating through the anterolateral approach.Results:One-hundred-fifty patients with a fracture shaft of the humerus were treated with anteromedial plating. Twenty were female (mean ±SD,28 years±4.5) and 130 were male (mean ± SD, 38 years±5.6). One hundred and forty-eight out of 150 (98.6%) patients achieved union at 12 months. Two of three patients developed a superficial infection, both of which were treated successfully by antibiotics and one developed a deep infection, which was treated by wound debridement, prolonged antibiotics with the removal of the plate and subsequently by delayed plating and bone grafting.Conclusion:In the present study, we applied plate on the anteromedial flat surface of humerus using the anterolateral approach. It is an easier and quicker fixation as compared to anterolateral plating because later involved much more dissection than a medial application of the plate and this application of plate on a medial flat surface, does not required Radial nerve exposure and palsy post-operatively. The significant improvement in elbow flexion without brachialis dissection is also a potential benefit of this approach. Based on our results, we recommend the application of an anteromedial plate for treatment of midshaft fractures humerus.

Metaphyseal callus formation in pilon fractures is associated with loss of alignment: Is stiffer better?

To assess the relationship between metaphyseal callus formation and preservation of distal tibial alignment in pilon fractures treated with internal plate fixation. Retrospective Review SETTING: Academic Level I Trauma Center PATIENTS: Forty-two patients with AO/OTA type C2 or C3 pilon fractures treated with plate fixation. Internal fixation with anterolateral plating, medial plating, or both. Modified Radiographic Union Score in Tibial fracture (mRUST) scores were determined from six-month radiographs. Change in lateral and anterior distal tibial angles (LDTA and ADTA) at six months post-operatively. High callus formation (mRUST ≥ 11 at six months) was associated with a greater loss of coronal reduction as measured by LDTA compared to low callus formation (mRUST < 11): 3.8vs 2.1° (p=.019), with no difference in ADTA change between groups. In a multivariable logistic regression controlling for age, smoking, obesity, and open fracture, higher mRUST scores were a predictor of coronal reduction loss of five or more degrees (OR 1.71, p=.039). Dual column plating did not independently predict maintenance of alignment. Recent literature has popularized dual column fixation for pilon fractures, but it remains unknown whether increased metaphyseal stiffness enhances or impairs healing. In this series, decreased metaphyseal callus formation was associated with maintained coronal alignment, suggesting that a stiffer mechanical environment may be preferable to prevent short term reduction loss in these complex injuries. III.

Fixation of Posterior Tibial Plateau Fracture with Additional Posterior Plating Improves Early Rehabilitation and Patient Satisfaction.

Introduction:Posterior tibial plateau fractures (PTPF) are difficult to manage because of options of multiple approaches, paucity of implants, and lack of ideal construct for fixation. We investigated the benefits of using posterior approach and buttress plate for fixation of the posterior tibial condylar fractures in terms of the fracture healing rate, clinico-radiological, perioperative morbidity, and patient-related outcomes and compared them in those who achieved acceptable reduction without posterior stabilization.Patients and Methods:Seventy two patients with posterior tibial plateau fractures were prospectively followed after random allocation into two Groups A and B. Thirty eight patients of Group A (dual plating) were managed with stabilization of posterior fragment with Lobenhoffer approach in addition to anterolateral plating. Thirty four patients of Group B (single plate) were managed with isolated anterolateral plating after reducing the PTPF. Twelve patients lost to follow-up and sixty patients were available (thirty in either group) for final assessment. Followup was done by clinical examination, radiographs and computed tomography scan, fracture union, articular continuity, and deformities around the knee. Subjective outcome assessment was done with the International Knee Documentation Committee (IKDC) 2000 and Knee Society Score (KSS).Results:At 1-year followup, the two groups did not differ in time of fracture union. IKDC and KSS were significantly better in dual-plating group (P < 0.001). Mean operative time and blood loss were more in dual-plating group (A). The mean hospital stay and complications did not show significant differences.Conclusion:Addition of posterior approach for stabilization of the posterior fragment in posterior tibial plateau fractures achieves early and improved knee functions, good range of movements, minimal deformities, and pain scores by the time fracture unites. However, peri-operative morbidity, Extra implant costs and increased operative time are its disadvantages.

Biomechanical analysis of a novel plating for intra-articular distal humerus fractures: combined anteromedial and anterolateral plating

PurposeThe traditional strategy for fixing intra-articular distal humerus fractures is double plating placed in an orthogonal or parallel configuration, based on posterior approach. With a combined medial and lateral approach, a novel configuration of plating (combined anteromedial and anterolateral plating) has been used. In this study, we investigated the biomechanical properties of the novel plating by comparing it with orthogonal plating.MethodsBased on the 3D morphology of a healthy subject’s humerus, the models of simple intra-articular distal humerus fractures were simulated. Two configurations of plating were applied to fix the models: the novel plating (with one plate anteromedially and the other anterolaterally on distal humerus), and orthogonal plating. Stresses, displacement, and stiffness were simulated and calculated under the conditions of axial compression, rotation torsion, bending torsion, and valgus torsion by using finite element analysis.ResultsIn all the conditions, the maximal von Mises stresses of the novel plating are similar to those of orthogonal plating, and the patterns of stress distribution are similar between these two configurations. However, the impact of high stresses was weaker on the novel plating. The maximal displacement of the novel plating is smaller than that of orthogonal plating. The stiffness of the novel plating is superior to that of orthogonal plating, with the improvements of 19.4%, 122.7%, 25.0%, and 54.2% in axial compression, rotation torsion, bending torsion, and valgus torsion, respectively.ConclusionsThe novel plating is stronger than orthogonal plating without increasing stress magnitude when fixing simple intra-articular distal humerus fractures, which makes it a feasible alternative. Further biomechanical and clinical studies are needed for a decisive conclusion.

Minimally Invasive Osteosynthesis of Distal Tibia Fractures using Anterolateral Locking Plate.

Introduction: Plating in distal tibia fractures are associated with higher rate of soft tissue complications. As adequate soft tissue cover is available over anterolateral surface of the tibia, use of anterolateral plate fixation in distal tibia fractures has increased. The purpose of our research is to evaluate the outcomes of anterolateral locking plate fixation in distal tibia fractures using ORIF.Materials and Methods: A retrospective analysis of 25 patients, who had distal tibia fractures and underwent open reduction and anterolateral plating. Bone and soft tissue healing and complications encountered were analysed.Result: Full weight bearing was allowed at an average of 5.4 months (range: 3-12 months) after seeing radiological union. We have observed superficial wound infection in four cases. Two cases had marginal necrosis, two cases had sensory disturbance over dorsolateral aspect of foot and two cases had delayed non-union. Mean length of surgical incision was 9cm (range: 5-12 cm).Conclusion: Open reduction internal fixation of distal tibia fractures with anterolateral plating is a reliable way of fracture fixation and stabilisation with proper surgical technique and aseptic precautions.