Compression Plate Fixation Research Articles

Locking Compression Plate Fixation of Feline Acetabular Fractures: Application, Complications and Perioperative Outcome.

The aim of this study was to report the use, complications and perioperative outcome of locking compression plates (LCP) for acetabular fracture fixation in feline patients. Medical records were reviewed for cats presented with acetabular fractures between 2011 and 2019. Only cases that involved open reduction and internal fixation with at least one LCP and had a minimum of 5-week postoperative follow-up were included. Long-term follow-up was based on the Feline Musculoskeletal Pain Index. Fifteen cats with 15 acetabular fractures met the inclusion criteria. Locking compression plates were used as a sole method of fixation in 11/15 cases, while with other ancillary implants in 4/15 cases. There were two minor complications related to the LCP consisting of a single screw backing out. Two major perioperative complications not related to the locking implants were described and required further surgical treatment. At the last clinical follow-up (median 46 days: 38-88 days), function was described as full for 7/15 cats, and acceptable for 8/15 cats. The Feline Musculoskeletal Pain Index questionnaire was completed by 9/15 owners at a median of 2,332 days; all owners reported their cats had minimal impairment. Based on our results, LCP is a suitable implant for acetabular fracture fixation in cats, associated with a satisfactory outcome. Complications were similar to previously reported with other methods.

Repair of a Comminuted Femur Fracture in a Komodo Dragon (Varanus komodoensis) Using a Double Plating Technique

This report describes double locking compression plate fixation of a moderately comminuted mid-diaphyseal right femur fracture in a Komodo dragon (Varanus komodoensis). The animal was restrained for a routine examination, during which the dragon struggled to escape restraint. When returned to the exhibit, the dragon did not use the right pelvic limb to walk. A right-sided, closed, mid-diaphyseal comminuted (type C3) femur fracture was diagnosed using palpation and radiographs, and the animal was transported to a specialty clinic within a few hours for fracture repair. Two locking compression plates (LCPs) were applied in bridging fashion for fracture repair. Radiographs performed at the four-month post-operative recheck revealed a healed fracture with significant callus formation and stable implants. The dragon was transitioned from cage rest in a restricted space to his normal large exhibit after healing was confirmed, no lameness was observed, and normal limb use was noted. After almost three years, he is still ambulating normally and without lameness. This is the first report of successful femur fracture stabilization using bone plate fixation in a Komodo dragon.

Evaluation of locking compression plate fixation of the distal phalanx to the hoof wall as a potential therapy for laminitis.

Surgical stabilisation of the distal phalanx (DP) is a potential therapeutic strategy for severe acute laminitis. To evaluate the effects of locking compression plate (LCP) fixation of the DP to the dorsal hoof wall. Ex vivo and in vivo experiments. A T-shaped LCP was applied to one limb per pair in six pairs of cadaver forelimbs subjected to a combination of thermally induced lamellar failure and vertical load to simulate severe acute laminitis. Standard radiographic measurements were used to compare DP displacement. The LCP was then applied to one forefoot in 12 healthy Standardbred horses either standing (n=6) or under general anaesthesia (n=6). Lameness was evaluated daily, then horses were euthanised (day 8) and lamellar tissue analysed using light microscopy, histomorphometery and molecular markers of apoptosis. In the cadaver limb model, LCP fixation prevented the significant changes in hoof-distal phalanx distance, coronary extensor process distance and sole depth that characterised DP displacement in untreated limbs (p < 0.05). Application of the construct in vivo was well tolerated with minimal lameness (10/12 horses were sound at the trot on day 8); however, histology revealed dorsal lamellar pathology consistent with laminitis, but with extensive keratinocyte apoptosis. Adjacent to the LCP, caspase-3 positive cell counts were approximately 20-fold higher than control (p < 0.001). Pathology was evaluated at a single time point. Microvascular perfusion was not evaluated. Rigid fixation of the DP to the hoof capsule was achieved with the LCP construct in a cadaver limb laminitis model. In live horses, LCP fixation caused regional lamellar pathology with extensive apoptosis, likely due to disturbed lamellar microvascular perfusion and/or mechanostasis. Understanding these mechanisms is critical for refinement of the technique in order to avoid iatrogenic lamellar damage.

Fixation stability comparison of bone screws based on thread design: buttress thread, triangle thread, and square thread

BackgroundThe influence of thread profile on the fixation stability of bone screws remains unclear. This study aimed to compare the fixation stability of screws with different thread profiles under several loading conditions.MethodsBone screws that differed in thread profile (buttress, triangle, and square thread) only were made of stainless steel. Their fixation stabilities were evaluated individually by the axial pullout test and lateral migration test, besides, they were also evaluated in pairs together with a dynamic compression plate and a locking plate in polyurethane foam blocks under cyclic craniocaudal and torsional loadings.ResultsThe triangle-threaded and square-threaded screws had the highest pullout forces and lateral migration resistance. When being applied to a dynamic compression plate, higher forces and more cycles were required for both triangle- and square-threaded screws to reach the same displacement under cyclic craniocaudal loading. On the other hand, the triangle-threaded screws required a higher torque and more cycles to reach the same angular displacement under cyclic torsional loading. When being applied to a locking plate, the square-threaded screws needed higher load, torque, and more cycles to reach the same displacement under both cyclic craniocaudal and torsion loadings.ConclusionsThe triangle-threaded screws had superior pullout strength, while square-threaded screws demonstrated the highest lateral migration resistance. Moreover, dynamic compression plate fixation with triangle- and square-threaded screws achieved more favorable fixation stability under craniocaudal loading, while triangle-threaded screws demonstrated superior fixation stability under torsional loading. Locking plate fixation with a square-threaded screw achieved better fixation stability under both loading types.

Minimally invasive plate osteosynthesis via posterior approach for type B and C fractures of distal humeral shaft: surgical tactics and a clinical series.

The optimal technique and implant for fixation of multifragmentary fractures of the distal humeral shaft remain inconclusive. We describe the use of minimally invasive plate osteosynthesis (MIPO) via posterior approach and extra-articular distal humerus locking compression plate (LCP-EADH) fixation for 18 such fractures. All fractures were united with a mean union time of 17.6weeks (range 12-20). Transient radial nerve palsy was demonstrated in 2 patients. Six patients had 5° varus angulation and 1 had 5° valgus angulation. Triceps power was Grade 5 in all patients. The mean arc of elbow motion was 127.5 degrees (range 115-140). Six patients had an excellent MEP score and 12 had a good MEP score. As the results, posterior MIPO and LCP-EADH fixation could be an alternative for multifragmentary fractures of the distal humeral shaft, particularly for fractures with a very short distal fragment.

Open reduction and locked compression plate fixation, with or without allograft strut, for periprosthetic fractures in patients who had a well-fixed femoral stem: a retrospective study with an average 2-year follow-up

BackgroundThe use of cortical strut allograft has not been determined for Vancouver type B1 or C fracture. This study aimed to evaluate the short-term efficacy of locking compression plating with or without cortical strut allograft in managing these types of fractures.MethodsWe retrospectively assessed 32 patients (17 males, 15 females; 23–88 years, mean: 67.2 years) with Vancouver type B1 or C fractures. Seventeen patients (Group A; B1 fractures in 15 hips, C fractures in 2 hips) were treated with open reduction and internal fixation with locking compression plates (group A). The other 15 patients (Group B; B1 in 14 hips, C in 1 hip) were fixed by locking compression plating combined with cortical strut allografting (group B). The fracture healing rate, healing time, complications and function were compared between these two groups.ResultsThe mean follow-up time was 32.4 months (12 to 66), and the overall fracture union rate of the 32 patients was 96.9%. Group B had a higher fracture union rate than Group A, but the difference was not statistically significant. Group A had one case of nonunion of type B1 fracture and one case of malunion; the mean time to fracture healing was 5.3 months (3 to 9). In group B, all patients reached bony union without malunion, with a mean time of fracture healing of 5.1 months (3 to 8).ConclusionTreatment of Vancouver type B1 or C fractures by locking compression plating, with or without cortical strut allografting, resulted in similar union rates in these patients. This suggest that, the use of cortical strut allografting should be decided cautiously.

A Study to Analyse Correlation of Plate Position With Flexor Pollicis Longus Tendon Attrition In Patients Managed With Volar Plating

Background: Purpose of this study was to study association of flexor pollicis longus tendon (FPL) attrition using Ultrasonography with plate position on radiographs in patients managed with volar locked compression plate fixation (LCP) in distal radius fractures. Methods: Status of flexor pollicis longus tendon was analysed by ultrasonography in patients who underwent volar locked compression plating a minimum of one year follow up. Soong’s criteria were used to assess the plate position and then correlated with the ultrasonography findings of flexor pollicis longus. Results: There were 45 patients included in our study, of which 28 belonged to Soong’s grade zero, 10 were grades one and 7 were grade two. Flexor pollicis longus attrition was noted in 5 cases with grade two plating. Conclusion: Amongst the cases with grade 2 of Soong’s criteria, attritional changes were seen in 72 percent of patients , which warrants a proper follow up to identify any impending signs of tendon rupture and to make early intervention to prevent rupture.

Prospective comparative study between antegrade interlocking undreamed nail versus compression plate fixation of acute closed humeral mid third shaft humerus in adults

Objective: To assess the functional outcome, time to union, shoulder pain, blood loss, operative time, iatrogenic radial nerve injury, hospitalization, and infection. Methodology: It is a prospective randomized study on 30 patients with mid-shaft humerus fracture according to AO classification (1.2A1, 2, 3 and 1,2B) with functioning radial nerve. They were randomly dividing into two groups. Group A were treated by a closed antegrade interlocking nail, and group B treated by open reduction and locked compression plate fixation. The follow-up was up to 6 months, including time to union, shoulder pain, intraoperative blood loss, operative time and iatrogenic radial nerve injury. Functional outcome was assessed by quick DASH score. Results: Road traffic accident was the main cause of trauma (70%). The average time to union were statistically not different in both groups. Quick DASH score was good in both groups and statistically not significant. Shoulder pain in group A was (40%), while none patient in group B (p&gt;0.017). The operative period time, mean hospital stays, and blood loss of group B were significantly higher than in group A Conclusion: Nailing is minimally invasive, has less infection rate, iatrogenic nerve injury, operative time, intraoperative blood loss, and hospitalization.

Nonunion of clavicle treated with precontoured locking compression plate fixation and bone grafting: A long-term outcome

Background: Plate fixation with bone grafting is the treatment of choice for nonunion of the clavicle and the use of precontoured locking compression plate (LCP) has been proposed to have an advantage of minimal hardware prominence and low rate of implant removal surgery. Materials and Methods: The retrospective analysis was performed to assess the long-term efficacy of precontoured LCP and bone grafting in nonunion of the clavicle. Fifteen patients who had undergone the surgery were assessed retrospectively in terms of clinical and radiological outcome for 4.1 years (range 2–7 years). The outcome was assessed using clinical and functional assessment by QuickDASH scoring and visual analog scale (VAS) system, radiological assessment in terms of union, time of return to previous activities, and any adverse results during the surgery or in the postoperative follow-up. Results: The radiological consolidation was achieved in all patients in a mean period of 18 weeks (range14–20 weeks). All patients returned to their previous activity level in a mean period of 5.9 months (range 2.5–9 months). There was a statistically significant improvement in QuickDASH and VAS scores (P < 0.05); however, one patient had symptomatic hardware prominence. Conclusion: The use of precontoured LCP in nonunion clavicle is a well-tolerated surgery giving promising results with most patients returning to previous activity level with the advantage of minimal hardware prominence and low rate of implant removal surgery.

Functional outcome of midshaft humerus fracture treated with minimally invasive anterior plate osteosynthesis

Introduction: Humeral shaft fractures make up approximately 1% of all fractures. Typically, they are the result of direct trauma. Though open reduction and plating technique of humerus shaft fracture is prevailing, Minimally invasive plate osteosynthesis technique also gives favorable outcome. This techniques are challenging and have the benefitof reducing soft- tissue damage.Materials and Methods: Twenty two patients with humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with locking compression plate fixation in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, and fracture union time were noted. The constant Murley score for shoulder and Mayo elbow performance score for elbow were used for assessing the shoulder and elbow function.Results: Of the twenty two patients in the study, 54.4% were males and 45.5% were females. The mean age was 45.8 years (range 21 to 85 years). 59.1% patients had the left side fractured. RTA was most common mode of injury. Mean surgical time in minutes was 71.36 mins. The mean fracture union time was 12.82 weeks. At the end of 1-year follow-up, mean constant score was 87.9 and mean Mayo score was 97. 20 patients had no post-op complications and 2 had delayed union.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique should be considered as an effective, cosmetically advanced surgical option. It is a safe and less time consuming method for simple types of humeral shaft fracture.

Distal 3rd Diaphysial Fracture of Humerus Fixed with Dynamic Compression Plate Using Posterior Approach- The Assessment of the Outcome

Objectives: The effectiveness of open reduction and Dynamic Compression Plate (DCP) fixation with or without autogenous bone grafting using the posterior midline approach in the treatment of distal third diaphyseal humeral fractures was assessed.&#x0D; Methods: For humeral nonunion, comminuted fractures, or early failure of conservative therapies, 33 patients (24 men, 9 women; mean age 37 years; range 20 to 60 years) were operated on. The study was carried out at Dhaka Medical College Hospital (DMCH), Dhaka from July 2005 to December 2006.&#x0D; Results: After an average of 17 weeks, all of the patients had union (range 14 to 26 weeks).There was no deep infection, nonunion, malunion, implant failure, or nerve injury in any of the patients. In two cases, transient radial nerve palsy occurred. Minor infections were seen in four of the individuals. All of the patients were pain-free after surgery.The functional outcome was outstanding in all instances and good in 16 patients, yielding 87 % satisfying results. Functional outcomes increased considerably postoperatively compared to preoperatively (p&lt;0.001). In 20 individuals, the range of motion of the shoulders was great. The range of motion at the elbow was considerable in 21 patients and moderate in seven others. More than three-quarters of the patients (75.8%) experienced no problems. Four patients (12.1%) were infected, and two patients (6.1%) developed iatrogenic radial nerve palsy as a result of the surgery. One patient (3%) had a loose screw, while another (3%) needed blood transfusions owing to extensive bleeding at the donor graft site.&#x0D; Conclusion: In distal third humeral fractures, open reduction and posterior DCP fixing, with or without autogenous bone grafting, is a safe and effective treatment option, especially when there is no infection or bony or neurovascular damage. Very few study conducted on distal 3rd diaphysial fracture of humerus fixed with DCP using posterior approach, therefore this study conducted to know the assessment of the outcome.

RETROGRADE INTRAMEDULLARY SUPRACONDYLAR NAILING AND DISTAL FEMORAL LOCKING COMPRESSION PLATE IN THE MANAGEMENT OF DISTAL FEMUR FRACTURES – A COMPARATIVE STUDY

Objectives: The objective of the study is to assess the efficacy of retrograde intramedullary interlocking supracondylar nailing and distal femoral locking compression plate in the management of distal femur fractures. Methods: The present prospective study consists of a total of 36 cases with extra-articular supracondylar fractures of the femur between the age group of 21–70 years. Participants were randomly allocated to group 1 treated with distal femoral locking compression plate fixation and group 2 treated with retrograde intramedullary interlocking supracondylar nailing technique. Post-operatively, all the cases were followed up in regular intervals to assess the functional outcome using the American Knee Society score. Results: Road traffic accidents (80.56%) were the most common cause of injury. The average surgical duration (108 min and 90.14 min), duration of fracture union (12.48 weeks and 11.08 weeks), and blood loss (339.8 ml and 236.6 ml) was better in the nailing group than the plating group, respectively. The overall outcome was comparable between the two study groups. Conclusion: The supracondylar nailing technique has better functional outcomes in terms of less fracture union time, less operative duration, and minimal operative blood loss. Supracondylar nailing technique was effective and better in soft tissue damage control.

A Comparison of Trans-Articular Screw Versus Dorsal Bridge Plate Versus Compression Locking Plate Fixation in B2 Lis Franc Injuries: A 5-Year Experience in a Level 1 Trauma Center, in the United Kingdom

This retrospective case series aimed to identify whether trans-articular screws, dorsal bridging plates or if a 4-corner compression plate offers better functional outcome after B2 Lis Franc injuries. Thirty-eight patients underwent surgical fixation for these injuries over 5 years in a Level 1 Trauma Centre. Patients were treated in 1 of 3 treatment arms: trans-articular screw, dorsal bridge plate, or 4-corner compression plate fixation. The primary outcome measures were the Manchester Oxford Foot and Ankle Questionnaire and the Euroqol- 5DL score and surgical results included postoperative complications and further surgery. Injury type, energy of mechanism, and open versus closed status were not significantly different within any fixation group. We achieved 94.7% (n = 36) good anatomical reduction. Finding significant improvement between plate fixation (both types) versus trans-articular screw groups treatment functional outcomes. A clinically crucial improvement in Manchester Oxford Foot & Ankle Questionnaire scores, and improved Euroqol- 5DL outcomes between 4-corner compression plate and trans-articular screw group. Overall, there was no significant difference in metalware failure, metalware removal and soft tissue complications. This study concludes that functional outcomes after Lis Franc fractures are not just dependent on the quality of anatomical reduction but are affected by fixation type. Further studies are required to provide qualitative analysis and assessment of dorsal bridge plate fixation versus 4-corner plate. Significantly, we have seen the 4-corner compression plate group reached the minimum clinically meaningful difference in the Manchester Oxford Foot and Ankle Questionnaire when compared to trans-articular screw fixation.

Comparing Single-locking and Double-locking Plate Fixation Methods in Patients With Proximal Tibial Fractures

Background: Proximal tibial fractures account for 1% of all fractures. Different treatments have been proposed for this fracture. Objectives: The present study aims to evaluate the clinical and radiological results of single-locking and double-locking plate fixation methods in patients with proximal tibial fractures. Methods: The present study was carried out on 40 patients with proximal tibial fractures referred to Imam Khomeini Hospital in Sari, Iran. They were divided into two groups of double-locking fixation with 3.5-mm Locking Compression Plate (LCP) and single-locking fixation with 4.5-mm LCP. They were followed up for at least 6 months after surgery. At the time of admission, they were assessed using Lysholm Knee Scoring Scale and Visual Analogue Scale. Radiographs were taken from all patients and the articular surface, and fracture healing,. Results: Of 40 patients, 17 and 23 were treated with 3.5-mm and 4.5-mm LCPs, respectively. The mean Lysholm score in the groups with 3.5-mm and 4.5-mm LCPs was 84±8.2 and 78.3±16.2, respectively. There was no statistically significant difference between the two groups (P&gt;0.5). Conclusion: The radiological and functional outcomes were almost the same for single-locking and double-locking plate fixation methods. Both methods can be used to treat the tibial plateau fracture. The treatment can be selected according to the surgeon and the patient’s request

Excellent clinical and radiological outcome following locking compression plate fixation of displaced medial clavicle fractures

BackgroundTreatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons. An increasing number of symptomatic non-unions following conservative treatment of displaced fractures led to the development of various surgical approaches. Aim of this study was to evaluate the clinical and radiological outcome following operative treatment of displaced medial end clavicle fractures.MethodsPatients who presented with a displaced fracture of the medial clavicle between September 2012 and December 2019 were retrospectively enrolled in this study. All patients were operatively treated with open reduction and internal fixation (ORIF) using an anatomically precontoured locking compression plate (LCP) originally designed for the lateral clavicle (Synthes®, Umkirch, Germany). Functional outcome was recorded using the American Shoulder and Elbow Surgeons (ASES) Score, the Munich Shoulder Questionnaire (MSQ), Shoulder Pain and Disability Index (SPADI) and Constant Score.ResultsOverall 18 patients with a mean age of 54.5 ± 23.5 years suffering from a displaced fracture of the medial clavicle were identified. The mean follow-up was 40.9 ± 26.2 months. The mean ASES accounted for 88.3 ± 20.8 points, the mean MSQ was 83.1 ± 21.7 points, the mean SPADI was 85.6 ± 22.5 and a mean normative age- and sex-specific Constant Score of 77.5 ± 19.1 points resulted. No minor or major complications were observed. Radiologic fracture consolidation was achieved in all patients after a mean of 6.4 months.ConclusionSurgical treatment of displaced medial clavicle fractures using an anatomically precontoured locking plate originally designed for the lateral clavicle led to very good to excellent clinical and functional results.Trial registrationNo: DRKS00024813, retrospectively registered 19.03.2021 (www.drks.de).

Lateral distal tibial locking compression plate fixation through single lateral incision technique is biologically superior and mechanically equivalent alternative to medial plate fixation for lower third tibia-fibula fractures

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; A number of surgical options for management of distal tibia fractures makes scenario confusing and available techniques are associated with complications. Recently lateral plating of tibia has shown good promise. To compare results between medial and lateral distal tibial locking compression plate for treatment of distal third tibia fractures&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective clinical study was carried out among 24 patients presenting with distal third tibia fractures. Patients were randomized into two groups of 12 each. One group was allocated into medial distal tibial LCP and second group was allocated into lateral distal tibial LCP. In first group, approach taken was medial or anteromedial while in second group, approach taken was lateral. Follow up was done for six months after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 10 cases in medical group and eight cases in lateral group which had fracture due to road traffic accidents. All cases in medical group had concomitant fibula fracture while such cases were 10 in lateral group. One case in each group developed infection after surgery. There was one case of superficial skin dehiscence and one case of hardware problem in medial group compared to none in lateral group. Two cases from medial group required removal of implant compared to none from medial group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Lateral distal tibial LCP seems to provide biological advantage than medial distal tibial LCP without difference in biomechanical properties of implants. Single lateral incision technique is an ingenious, biologically sound, and cosmetically superior for fixation of both lower third tibia &amp;amp; fibula fractures together.&lt;/p&gt;

Good to Excellent Functional Outcome and High Return to Sports Rate after Operative Treatment of Unstable Lateral Clavicle Fractures: Comparison of Two Coracoclavicular Button Fixation Techniques.

Purpose: Operative therapy for unstable lateral clavicle fractures is necessary to reduce the risk of bony non-union. Irritation and restriction during sportive activities due to the implanted materials are a common reason for impaired function and implant removal. The aim of this study was to gain information on functional outcome and time until return to sport (RTS) after surgical treatment of unstable lateral clavicle fractures, comparing two coracoclavicular button techniques. Methods: A retrospective chart review of patients who were consecutively treated for unstable lateral clavicle fractures at our level one trauma center from 2014 to 2018 was conducted. Two different surgical techniques were evaluated and compared. Group 1 was treated using a locking compression plate and knotted DogBone™ Button, while group 2 received an LCP and knotless DogBone™ Button. Functional outcome (ASES (American Shoulder and Elbow Score), Constant-Score, DASH (Disability of Arm, Shoulder and Hand), MSQ (Munich Shoulder Questionnaire) and SPADI (Shoulder Pain and Disability Index) and time until RTS were investigated and compared between both groups, 1 year postoperatively. Results: A total of 56 patients (n = 35 group 1, n = 21 group 2) with a mean age of 45.1 ± 14.6 years met the inclusion criteria. Functional outcome reached good to excellent results (ASES 94.7 ± 9.8, Constant Score 85.1 ± 8.1, DASH 5.5 ± 8.4, MSQ 90.9 ± 7.2, SPADI 96.1 ± 5.7). Implant removal rates were higher in group 1 (48.3% vs. 35.3%) yet without statistical significance (p = 0.122). All patients returned to sports postoperatively with a mean time period until return to sport of 4.6 (3–9) months. Conclusion: Locking compression plating and coracoclavicular fixation using a knotless Dogbone™ technique provides good to excellent functional outcomes, a high and fast rate of return to sport and lower irritation rates compared to the knotted DogBone™ technique.

Anterior bridge plating with mini incision MIPO technique for type a humerus diaphyseal fractures

Introduction: Anterior bridge plating with minimally invasive technique for type A shaft humeral fractures is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in twenty patients, all of which were managed with dynamic compression plate over an average follow- up period of 12 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome.Materials and Methods: Twenty patients with type a humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with closed reduction and 10-12 whole 4.5mm dynamic compression plate fixation over anterior aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function.Results: Of the Twenty patients in the study, ten were males and ten were females. The mean age was 34.3 years (range 18 to 85 years) twelve out of twenty patients (60%) had the dominant side fractured. Mean surgical time in minutes was 88.98 (range: 50 to 150 minutes). The mean fracture union (radiological) time was 14.3 weeks (range: 10–16 weeks) and clinical union time was 10.4 week. However Shoulder function was excellent in 20 cases (100%) on the UCLA score.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique for type A fracture shaft humerus gives good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of type A humeral shaft fractures. It is a safe and less time consuming method for type a humeral shaft fractures when the surgeon is experienced in the technique.

A prospective comparative study of surgical management verses conservative management of clavicle fracture

Background: Fracture of the clavicle accounts for 5 to 10% of all fractures and almost half of the shoulder girdle injuries and70- 80% of clavicular fractures are mid clavicular fractures. Most clavicular fractures are benign. Non operative treatment has been a mainstay of a modality of treatment, and irrespective of the type of fracture and amount of comminution, all these fractures were treated non-operatively. Different surgical methods for clavicle midshaft fractures have been described and these are locking compression plate fixation, intramedullary K-wires, Steinmann pin fixation, and intramedullary nailing with TENS. Therefore in this study we have compared the functional outcome of displaced clavicle fractures treated by non-surgical management with that of surgical management by TENS and by open reduction and internal fixation with clavicular locking compression plate. Methodology: 30 Patients of age above 18 years having closed clavicular fracture who are admitted in DR. B.R. Ambedkar Medical College and Hospital, meeting the inclusion criteria are taken for study after obtaining their written informed consent. Patients were followed up for a period of 6 months at 1,6 and 24 weeks after surgery. In total 15 patients were operated and 15 patients were treated conservatively. Outcome was analysed in terms of radiological union and functional outcome of the patient. Results: Among 30 patients with clavicle fractures, majority of the injury occurred in male patients- 21 cases (70%), whereas a total of 9 cases (30%) were seen in females. The functional outcome at the end of 6 months in 15 conservatively managed cases showed, 2 cases (13.3%) with excellent outcome, 3 cases (20%) had good outcome, 8 cases (53.3%) had fair and 2 cases (13.3%) had poor outcome. While in surgically managed 15 cases, the functional outcome at the end of 6months showed a total of 11(73.3%) cases with excellent outcome, 2 cases (13.3%) had good outcome, 1 cases (6.6%) had a fair, and 1case (6.67%) had poor outcome. At the end of 6 months, functional outcome of both the groups were compared and in our study operative group had fewer complications, early bony union and better functional outcome as compared to the conservative group. Conclusion: This study concludes that irrespective of surgical modalities of management used, surgically treated cases have better functional outcome, fewer complications, early bony union and better overall patient satisfaction.

Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach.

To summarize the surgical technique and clinical effects of the extended anterolateral approach for the treatment of Schatzker type II and Schatzker type V/VI involving the posterolateral column tibial plateau.From January 2015 through December 2018, 28 patients with tibial plateau fractures involving the posterolateral column were included in the study. Among them, 16 patients were Schatzker type II treated using an extended anterolateral approach with lateral tibial locking compression plate fixation. Twelve patients were Schatzker type V or VI treated using an extended anterolateral combined with a medial approach using lateral tibial locking compression plate plus medial locking compression plate fixation. All cases were followed up for 15 to 31 months, with an average follow-up of 22.5 ± 3.7 months. During the follow-up, the tibial plateau angle (TPA), lateral posterior angle (PA) and Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation; the Hospital for Special Knee Surgery score and the range of motion were used to evaluate knee function. Additionally, the Lachman and knee Valgus (Varus) stress tests were used to evaluate anteroposterior and lateral stability of the knee.All fractures healed. At the 12-month follow-up, the Schatzker type II group revealed a mean TPA of 86.38 ± 3.92°, a mean PA of 7.43 ± 2.68°, and a mean Rasmussen radiological score of 16.00 ± 2.06 points. The Schatzker type V/VI group showed a mean TPA of 84.91 ± 3.51°, a mean PA of 9.68 ± 4.01°, and a mean Rasmussen radiological score of 15.33 ± 2.99 points. During the 1-year follow-up, when the postoperative PA was re-measured, the TPA and Rasmussen score of the 2 groups did not change significantly (P > .05). At the last follow-up, the Schatzker type II group showed a knee flexion angle of 110° to 135° and a mean HHS score of 88.37 ± 10.01 points. The Schatzker type V/VI group revealed a knee flexion angle of 100° to 130° and a mean HHS score of 82.17 ± 10.76 points. Additionally, up to the last follow-up, the Lachman and knee Valgus (Varus) stress test results of the 2 groups were negative. No complications were found.The extended anterolateral approach is a good choice to treat tibial plateau fractures involving the posterolateral column.