Conventional Plate Osteosynthesis Research Articles

3D printed plates based on generative design biomechanically outperform manual digital fitting and conventional systems printed in photopolymers in bridging mandibular bone defects of critical size in dogs.

Conventional plate osteosynthesis of critical-sized bone defects in canine mandibles can fail to restore former functionality and stability due to adaption limits. Three-dimensional (3D) printed patient-specific implants are becoming increasingly popular as these can be customized to avoid critical structures, achieve perfect alignment to individual bone contours, and may provide better stability. Using a 3D surface model for the mandible, four plate designs were created and evaluated for their properties to stabilize a defined 30 mm critical-size bone defect. Design-1 was manually designed, and further shape optimized using Autodesk ® Fusion 360 (ADF360) and finite element analysis (FE) to generate Design-2. Design-4 was created with the generative design (GD) function from ADF360 using preplaced screw terminals and loading conditions as boundaries. A 12-hole reconstruction titanium locking plate (LP) (2.4/3.0 mm) was also tested, which was scanned, converted to a STL file and 3D printed (Design-3). Each design was 3D printed from a photopolymer resin (VPW) and a photopolymer resin in combination with a thermoplastic elastomer (VPWT) and loaded in cantilever bending using a customized servo-hydraulic mechanical testing system; n = 5 repetitions each. No material defects pre- or post-failure testing were found in the printed mandibles and screws. Plate fractures were most often observed in similar locations, depending on the design. Design-4 has 2.8-3.6 times ultimate strength compared to other plates, even though only 40% more volume was used. Maximum load capacities did not differ significantly from those of the other three designs. All plate types, except D3, were 35% stronger when made of VPW, compared to VPWT. VPWT D3 plates were only 6% stronger. Generative design is faster and easier to handle than optimizing manually designed plates using FE to create customized implants with maximum load-bearing capacity and minimum material requirements. Although guidelines for selecting appropriate outcomes and subsequent refinements to the optimized design are still needed, this may represent a straightforward approach to implementing additive manufacturing in individualized surgical care. The aim of this work is to analyze different design techniques, which can later be used for the development of implants made of biocompatible materials.

Similar Clinical Outcome in Locking and Conventional Plate Osteosynthesis for the Treatment of AO 44-B2 Ankle Fractures.

Biomechanical studies have proved that locking plates have better primary stability besides versatility regarding fracture pattern while reducing bone contact and bridging the gap, whereas conventional nonlocking plates (plus lag screw) depend on bone-plate compression. The clinical benefit of locking plates over nonlocking plates remains unanswered, however. Therefore, this retrospective cohort study was set up to test the hypothesis that the use of locking plates for unstable ankle fractures will result in fewer re-displacements, superior bony healing, and functional and clinical outcomes better than observed in the nonlocking cohort. Bimalleolar ankle fractures (AO 44-B2) without syndesmotic injury treated with either a locking or a nonlocking plate were included. Groups were compared for complications, bone healing, secondary dislocation, progressions of osteoarthritis, and clinical outcome using patient-reported outcome measures. Data revealed no clinical outcome differences (Olerud-Molander Ankle Score: nonlocking 88.2 ± 14.4, locking 88.8 ± 12.3, P = .69, robust two 1-sided test for equality (RTOST): P = .03; American Orthopaedic Foot and Ankle Score: nonlocking 91.2 ± 12.9, locking 91.8 ± 11.3, P = .96, RTOST: P = .04). Nevertheless, a significant postoperative progression of osteoarthritis was detected in both groups (P = .04). This was independent of implant (P = .16). Although difference was not significant, locking plates were preferred in older (P = .78) and sicker patients (P = .63) and in cases with severer osteoarthritis (P = .16), and were associated with a higher complication rate (P = .42) and secondary dislocation (nonlocking 9.4%, locking 18.2%; P = .42). Re-displacement, however, was not a compelling reason for revision. The present study shows statistically significant equality of both types of implants. Contrary to our expectation, locking plates seemed to be associated with a higher risk for re-displacement. Overall, the use of either locking or nonlocking plates for unstable AO 44-B2 fractures is safe and successful despite significant progression of osteoarthritis. III, Retrospective observational cohort study.

Primary stability of multi-hole cups compared to plate osteosynthesis in osteoporotic anterior column and posterior hemi-transverse acetabular fractures-A biomechanical comparison.

IntroductionAcetabular fractures pose high demands on the surgeon and in the case of osteosynthetic treatment, anatomical reconstruction has the highest priority to achieve a good outcome. However, especially in older patients with poor bone quality, even anatomical reconstruction is no guarantee for a good clinical outcome and may nevertheless end in early osteoarthritis. Primary arthroplasty therefore has an increasing importance in the treatment of these patients. The aim of this study was to biomechanically compare fracture gap displacement and failure load as an assessment measure of the primary stability of conventional plate osteosynthesis with the treatment using a sole multi-hole cup for acetabular fractures.MethodsSix hemi-pelvises each with anterior column and posterior hemi-transverse (ACPHT) fracture were treated with either plate osteosynthesis or a multi-hole cup. The tests were carried out in a standardised test set-up with cyclic loading in various stages between 150 N and 2500 N. The fracture gap displacement was recorded with optical 3D measuring and the failure load was determined after the cyclic measurement.ResultsWith increasing force, the fracture gap displacement increased in both procedures. In each group there was one treatment which failed at the cyclic loading test and a bone fragment was broken out. The primary stability in arthroplasty was comparable to that of the standard osteosynthesis.ConclusionsThe results found seem promising that the primary arthroplasty with a sole multi-hole cup and corresponding screw fixation achieves an initial stability comparable to osteosynthesis for typical ACPHT fractures. However, further clinical studies are needed to prove that the cups heal solidly into the bone.

One-year follow-up after treatment of proximal and/or middle one-third humeral shaft fractures with a helical plate: healing rates, complications and functional outcome measures

BackgroundConventional plate osteosynthesis is a valuable treatment option in displaced proximal and/or middle one-third humeral shaft fractures. Nonetheless, this procedure can be complicated by a radial nerve palsy. To date, many surgical techniques have been developed in an attempt to minimize this high-impact complication. A helical plate has the potential to avoid an iatrogenic radial nerve palsy due to its design. This article aims to evaluate safety and functional outcomes of patients treated with a helical plate compared to conventional plate osteosynthesis. In particular healing rates, complications and functional outcome measures.MethodsWe retrospectively included all patients with displaced proximal and/or middle one-third humeral shaft fractures who were treated with a helical plate from October 2016 until August 2018 at a single level-1 trauma center (AZ Groeninge, Kortrijk, Belgium). A self-molded long PHILOS plate (DePuy Synthes®) or a pre-contoured A.L.P.S proximal humeral plating system (Zimmer Biomet®) were used. Patient baseline characteristics and standard radiographs were obtained pre- and postoperatively. We retrospectively searched for complications. Patients were reassessed using the Disabilities of the Arm, Shoulder and Hand (DASH), Constant Murley (CMS) and EQ-5D-5L scores with a minimal follow-up of 1 year.ResultsThe humeral shaft fractures of all sixteen patients consolidated within 3 months and no iatrogenic radial nerve palsies were observed. One plate had to be removed after 1 year due to a late deep infection. With a minimum follow up of 1 year, the mean DASH score was 22 ± 19 and the mean normalized CMS was 80 ± 19.ConclusionOperative treatment of proximal and/or middle one-third humeral shaft fractures with a helical plate is a safe procedure with good to excellent shoulder function at one-year follow-up. Contrary to conventional plate osteosynthesis, a helical plate has the potential to completely avoid a radial nerve palsy, while maintaining similar healing rates and functional outcomes.Trial registrationRetrospective cohort study. B396201939564. Registered on 10 MAY 2019.

Evaluation of functional outcome of distal tibial fractures managed with locking compression plate using minimally invasive plate osteosynthesis (MIPPO) technique

Background: Treatment of distal tibial fracture is challenging, because of precarious blood supply leading to poor healing. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But this modalities doesnot give better functional outcome and had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To evaluate clinical, functional and radiological outcomes after minimally invasive plate osteosynthesis using distal tibial locking compression plates. Materials and Methods: In this study, 30 patients with distal third tibial extra articular Metaphyseo diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at Tripura Medical College, between August 2020 to July 2021. Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 6.27 days post- trauma, with an average operative time of 66.25 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 17.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 86.66% cases. Conclusion: It is concluded that locking plate fixation by minimally invasive percutaneous plate osteosynthesis technique (MIPPO), is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.

A prospective study on functional outcome of distal tibial fracture fixation with locking compression plate using minimally invasive percutaneous osteosynthesis technique

Introduction: Treatment of distal tibia fractures is challenging because of its subcutaneous location, poor vascularity and limited soft tissue envelope. Various modalities of surgical treatment such as Intramedullary nailing, Open reduction and internal fixation with conventional plate osteosynthesis and external fixation have reported good functional outcome but had high complication rate. The newer technique of distal tibia fracture fixation with Minimally invasive plate osteosynthesis (MIPO) using Locking compressing Plates (LCP) has emerged as an alternative treatment option because it involves less soft tissue handling, minimal periosteal stripping resulting in low infection rate, faster healing and it respects biology of distal tibia and also provides biomechanically stable construct.Aim: To assess the functional role of locking compression plates in treatment of distal tibial fractures using minimally invasive percutaneous osteosynthesis technique.Materials and Methods: In this study, 30 patients with distal 1/3rd tibia extra articular fractures (AO type 43A1, 43A2, 43A3) with or without associated fibula fractures were treated with LCPs using MIPO technique. The present prospective study was conducted in Department of Orthopaedics, Geetanjali medical college and hospital, Udaipur between January 2019- May 2020.Results: All fractures had excellent clinical and functional outcome, the fractures were stabilized by LCP using MIPO technique with an average operative time of 48.16 minutes. The age of the patients ranged from 20 to 76 years with the fracture being most common in the 3rd and 4th decade. Out of 30 patients, 21 (70%) patients were males and 9 (30%) patients were females showing male preponderance. Functional outcome evaluation was done using American Orthopaedic Foot and Ankle Society (AOFAS) score. At the end of this study, 21 (70%) patients had excellent outcome, 08 (26.66%) had good results, 01 (3.33%) had fair outcome and no patient had poor functional outcome. None of the cases had implant failure or any significant deformity.Conclusion: The present study shows that MIPO technique using LCP proves to be most effective and safer technique in the management of distal tibial fractures with or without intra-articular comminution by providing good fracture healing, enabling rapid functional recovery and avoiding major complications.

Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis

IntroductionIn fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone.Materials and methodsWe retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO.Results48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO.ConclusionThere is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.

“A prospective study of minimally invasive percutaneous plate osteosynthesis using LCP for surgical management of distal tibia fracture”

Background: Management of distal tibia fracture is challenging because of wound infections and poor wound healing due to precarious blood supply. Various methods of surgical treatment had been tried, such as closed intramedullary nailing, open reduction and internal fixation with conventional plate osteosynthesis and external fixation however most of them have a high complication rate than a good functional outcome. The newer technique of distal tibia fractures fixation using MIPPO involves less soft tissue handling and minimal periosteal stripping resulting in a lower infection rate and faster healing. Materials and Methods: In this study, 25 patients with distal tibia extra articular fractures and intra articular fractures with or without associated fibula fractures were treated with MIPPO using medial LCP. The present study was conducted in the department of Orthopaedics at a tertiary care hospital and followed up for a period of 2 years. Results: The mean follow up period ranged from 6 weeks to 2 years. All the fractures were united at an average of 16 weeks and mean AOFAS score at the end of 1 year was 85.64. There were two superficial wound infections which were treated with oral antibiotics and there was one deep infection and another with persistent ankle pain. Conclusion: Minimally invasive percutaneous plate osteosynthesis is a reliable method of fixation not only extra articular, but also intra articular fractures of distal tibia. MIPPO technique for the distal tibia fractures offers a biological advantage by preserving the blood supply and decreases chances of delayed or non-union. Patients treated by MIPPO technique have a much lesser rate of deep infection and excellent radiological union. MIPPO technique helps in initiating early mobilization and reduces the risk of ankle stiffness.

Schatzker II tibial plateau fractures: Anatomically precontoured locking compression plates seem to improve radiological and clinical outcomes

IntroductionThe design of anatomically precontoured locking compression plates (LCP) allows the placement of angular stable screws right underneath the reduced joint surface fragments. To date, there is a lack of evidence supporting the broad utilization of these implants in split depression fractures to the lateral tibial plateau. Thus, aim of the present matched pair retrospective cohort study was to investigate the radiological and clinical outcomes of anatomically precontoured LCP compared to conventional plate and screw osteosynthesis in Schatzker II fractures. Material and methodsThe institutional databank was searched for Schatzker II fractures from 2010 to 2016. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm LCP or conventional 4.5 mm l-shaped plates and screws were included. CT scans and radiographs were analyzed. Details of the operative procedures and secondary events were collected. A matched pair analyses was conducted in a best fit manner. The primary outcome parameter was the Rasmussen Radiological Score approximately one year postoperatively. Secondary outcome parameters were the medial proximal tibial angle (MPTA), the Rasmussen Clinical Score and the WOMAC Score after a follow up of at least three years. ResultsA total of 50 patients was included. Patient age, gender distribution, size and depression depth of the lateral joint surface fragments, frequency of utilizing bone grafts or substitutes and lateral meniscus repair as well as subsequent implant removal were comparable across the groups. Immediately postoperatively, the Rasmussen Radiological Score revealed no differences. After a mean of 64.2 weeks, the radiological outcome was significantly better in the LCP 3.5 group (RRS 8.2 vs. 6.3 points, p<0.001; MPTA 89.5 vs. 92.0°, p = 0.001). After a mean clinical follow-up of 4.5 years, the Rasmussen Clinical Score (22.9 vs. 27.8 points, p<0.001) and the WOMAC score (24.3 vs. 16.0 points, p = 0.04) revealed significantly impaired results in the conventional group. ConclusionAnatomically precontoured LCP prevent the subsidence of the reduced joint surface fragments more sufficiently and allow for improved patient outcomes compared to conventional plates and screws. The utilization of anatomically precontoured LCP should therefore closely be considered for internal fixation of any split depression fractures to the lateral tibial plateau.

Fixation of Distal Tibial Fractures by Intramedullary Nail with Multidirectional Distal Locking Screws

AbstractBackground: Fractures of the distal tibia involve the diaphyseo-metaphyseal area of the bone, and may be either extra-articular or intrarticular. Several methods have been described for the treatment of these fractures, including casting, external and internal fixation.Aim of Study: The aim of the work was to evaluate the results of fixation of distal tibial fractures by intramedullary nail with multidirectional distal locking screws (Expert tibial nail).Methods: This study included 21 patients with distal tibial fractures treated between October 2017 and October 2018 (including follow-up period) at Tanta University Hospital with intramedullary nail with multidirectional distal locking screws (Expert tibial nail). Clinical and radiological data were analyzed.Results: According to Tenny & Wiss scoring systems for distal tibial fractures the clinical results were graded as excellent in six patients (28.6%), good in nine patients (38.1 %), fair in four patients (19%) & poor in two patients (9.5%).The excellent and good results were considered as satisfactory results while the unsatisfactory included the fair and the poor results. Thus, satisfactory results were found in 15 patients (71.43%), and the unsatisfactory results were found in six patients (28.57%).Conclusion: Treatment of distal tibial fractures using intramedullary nail with multidirectional distal locking screws (Expert nail) is a safe and accepted method alternative to conventional nail and plating technique. It provides additional biomechanical stability than the conventional nails and plate osteosynthesis.

Outcome of distal tibia fractures managed with locking compression plate using MIPPO technique

Introduction: Treatment of distal tibial fracture with or without intra-articular involvement is challenging, for reasons like poor healing due to precarious blood supply. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But none of them have good functional outcome but had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To study the functional and radiological outcome of distal tibial fractures managed with MIPPO (minimally invasive percutaneous plate osteosynthesis), using locking plates and to look for complications in MIPPO. Materials and Methods: In this study, 55 patients with distal third tibial extra articular Metaphyseo-diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at a tertiary care hospital, between September 2014 to September 2018, followed up for a period of 1 year.Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 4.27 days post- trauma, with an average operative time of 76.5 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 19.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 88.5 % cases. Conclusion: From this study, it is concluded that Minimally invasive percutaneous plate osteosynthesis technique (MIPPO), using locking plate is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.

Operative Versorgung von Azetabulumfrakturen mit der neuen Azetabulumflügelplatte

Introduction: There have been significant increases in the number of acetabular fractures in elderly patients with primarily ventral pathology and medial protrusion of the femoral head. We have developed the "acetabulum wing plate", which is designed to facilitate repositioning, with its anatomically precontoured structure, and which offers full support of the quadrilateral surface, thus counteracting the force of the femoral head pushing inwards. Conventional plate osteosynthesis only provides insufficient support to the medial surface. After a successful series of biomechanical tests, we now report a clinical case series. Material and Methods: Between April 2012 and August 2013, a total of twelve patients underwent plate osteosynthesis using the precontoured plate described above. The patients (ten male, two female) were aged between 45 and 87 years, the average age being 62.5 years. We were able to perform all osteosynthesis with the modified Stoppa approach, in combination with the first window of the ilioinguinal approach (according to Letournel). In most patients, the plate was applied without complications, In some patients, it even supported repositioning. In six patients, the fractures were of the anterior collum and six fractures were fractures of both colla. The mean time span of follow-up was 13.1 months, the minimum being 4.5 and the maximum 23 months. Results: In most patients, the intra- and postoperative computed tomographic scans showed anatomically correct placement of the plate, thus confirming the correct repositioning of the bone. Routine follow-ups are part of the hospital's postsurgical care system for acetabular fractures; these revealed no secondary dislocation or loosening of the plate. The radiological examination showed consolidation of the fractures after a mean period of twelve weeks. A full year after the initial procedure, no implant-specific complications were observed. Revision surgery was necessary in one patient due to bleeding five days after surgery. In another patient, necrosis of the femoral head necessitated total hip replacement ten weeks after the first surgical intervention. In summary, the concept of the plate proved to be successful in its first case series. Summary: In spite of increasing surgical expertise and the refinements of standard approaches, there is a recognisable shift in acetabular fractures from mainly posterior fracture patterns to fractures of the anterior column. The new acetabulum wing plate takes these factors into account and is an implant designed to address the anterior aspects of the acetabulum. The outcome of the first application is promising and the acetabulum wing plate produces satisfactory results in our patients.

Minimally invasive distal radius plating: are outcomes better?

Recently, the technique of minimally invasive plate osteosynthesis (MIPO) can also be applied to volar locking plates in distal radius fractures. The advantages of MIPO are fracture healing, a quick return to activities of daily life, and cosmetics as a result of the preservation of the soft tissue compared with conventional plate osteosynthesis. The purpose of the present study was to test the hypothesis that using MIPO for distal radius fractures would achieve better radiologic, clinical, and cosmetic outcomes in volar locking plate fixation compared with conventional methods in consecutive patients performed by a single surgeon in one institution.

Minimally invasive plating for fresh displaced midshaft fractures of the clavicle.

The authors retrospectively reviewed 269 patients treated from September 2006 to August 2011 with the minimally invasive plate osteosynthesis (MIPO) technique using a universal reconstruction ribbon plate for fresh displaced midshaft fracture of the clavicle. Mean follow-up was 40.6 months. All had bony union (average healing time, 14.6 weeks). At 2-month postoperative follow-up, the mean Constant-Murley score was 92 points and the mean Disabilities of the Arm, Shoulder and Hand (DASH) score was 4.6 points. A total of 166 patients underwent hardware removal at an average of 15 months. A total of 258 patients were satisfied with the results of this surgery. This technique appears to be safe, simple, effective, and practical and to lead to rapid recovery, a high rate of union, a favorable cosmetic effect, and excellent function restoration. Thus, it can be considered an alternative to conventional plate osteosynthesis, intramedullary fixation, or non-operative treatment for fresh displaced midshaft clavicle fractures.

Application of elastic intramedullary nail in the treatment of both ulna and radius fractures in children

To compare the efficacies of internal fixation by elastic intramedullary nail versus conventional plate osteosynthesis in the treatment of both radius and ulna fractures in children. A total of 84 cases were randomly divided into control and experimental groups at our department from July 2007 to 2013. The control group underwent conventional plating while the experimental group received elastic intramedullary nail. Preoperative preparations and postoperative rehabilitation protocols were similar. The operative outcomes were evaluated from pain score at Day 3 post-operation, radiology and forearm curative function, local wound healing after 2, 4, 8 weeks, 3, 6 months and 1 year. Local wound healing time, radiology and forearm curative function had statistical significance between two groups (P < 0.05). And the pain score had significant difference (P < 0.01) . Elastic intramedullary nail has multiple advantages of mini-invasiveness, quicker healing and excellent function recovery in the treatment of both ulna and radius fractures in children.

Clinical study of the pronator quadratus muscle: anatomical features and feasibility of pronator-sparing surgery.

BackgroundNo clinical data for the relationship of pronator quadratus (PQ) muscle to distal radius had been reported. The aim of this study was to investigate the anatomical features of the PQ muscle related to plate osteosynthesis for distal radius fractures in clinical cases. The feasibility of PQ muscle sparing surgery was investigated as well.MethodsFifty two distal radius fractures (23-A2) were enclosed in this study. The whole width of the muscle and the distance from the distal edge of the muscle to the joint surface of the distal radius were measured. The distance from the fracture site of the radius to the joint surface was measured as well.ResultsThe average width of the pronator quadratus muscle was 37.6 mm. The average distance from the pronator quadratus muscle to the lunate fossa surface was 12.2 mm, and the average distance from the pronator quadratus muscle to the scaphoid fossa surface was 13.6 mm. The average distance from the lunate fossa of the distal radius to the fracture site was 12.2 mm (range, 7.3-17 mm), and the scaphoid fossa of the distal radius to the fracture site was 13.2 mm (range, 9.4-18.8 mm).ConclusionsThis PQ muscle sparing surgery is feasible and can be performed without difficulty. The data might provide a useful basis for the preservation of pronator quadratus muscle applied to a functionally reduced fracture regarding the potential efficacy of conventional volar plate osteosynthesis.

Complication rates and outcomes stratified by treatment modalities in proximal humeral fractures: a systematic literature review from 1970–2009

BackgroundThe optimal treatment of complex, displaced proximal humeral fractures is controversial. A systematic literature review of the time period from 1970 to 2009 was conducted. The purpose was to evaluate the clinical success and complications of the available treatment modalities to determine specific treatment recommendations for the different fracture patterns.MethodsThe databases (PubMed/EMBASE) were searched for the time period (01/1970–09/2009). Study quality, treatment modalities, classification, outcome scores and complications of 200 publications including 9377 patients were analyzed. Interventions were compared by analysis of variance with subsequent Tukey’s-test. Complication rates among methods were compared by using Pearson’s-chi-square-test and pairwise comparisons using Fisher’s-two-tailed-exact-test.ResultsHemiarthroplasty, angle-stable plate and non-operative treatment were used for 63% of the follow-up-patients. For 3- and 4-part fractures, patients with hemiarthroplasty [3-Part: 56.4 (lower/upper 95% confidence interval (CI): 43.3-68.7); 4-Part: 49.4 (CI: 42.2-56.7)] received a lower score than different surgical head-preserving methods such as ORIF [3-Part: 82.4 (CI: 76.6-86.9); 4-Part: 83.0 (CI:78.7-86.6)], intramedullary nailing [3-Part: 79.1 (CI:74.0-83.4)] or angle-stable plates [4-Part: 66.4 (CI: 59.7-72.4)].The overall complication rate was 56%. The most common complications were fracture-displacement, malunion, humeral head necrosis and malreduction. The highest complication rates were documented for conventional plate and hemiarthroplasty and for AO-C, AO-A, for 3- and 4-part fractures. Only 25% of the data were reported with detailed classification results and the corresponding outcome scores.DiscussionDespite the large amount of patients included, it is difficult to determine adequate recommendations for the treatment of proximal humeral fractures because a relevant lack of follow-up data impaired subsequent analysis. For displaced 3- and 4-part fractures head-preserving therapy received better outcome scores than hemiarthroplasty. However, a higher number of complications occurred in more complex fractures and when hemiarthroplasty or conventional plate osteosynthesis was performed. Thus, when informing the patient for consent, both the clinical results and the possibly expected complications with a chosen treatment modality should be addressed.

Mono- versus polyaxial locking plates

Conventional plate osteosynthesis is undergoing a period of transition. The concept of locking plate osteosynthesis is of special importance. Monoaxial locking plate osteosynthesis has shown promising results (rapid bone healing via callus, minimal soft tissue irritation, advantageous in osteoporosis). Some implants allow for polyaxial locking. The first results of comparative studies concerning biomechanics and clinical outcome of mono- versus polyaxial locking plates are presented.

Clinical Results of Volar Locking Plate for Distal Radius Fractures: Conventional versus Minimally Invasive Plate Osteosynthesis

The purpose of this study was to compare the postoperative radiologic and clinical outcomes of conventional plate osteosynthesis (C) with minimally invasive plate osteosynthesis (M) using a transverse skin incision without cutting the pronator quadratus muscle for distal radius fractures. Retrospective consecutive cohort with prospective data collection. One community teaching hospital. Surgical treatment was performed by a single surgeon. Sixty-six patients (C group, 36; M group, 30) underwent open reduction and internal fixation of dorsally displaced distal radius fractures with the volar locking plating system from June 2006 to August 2008. Their mean age was 63.5 years and the mean follow-up period was 22.7 months. Radiologic parameters (volar tilt, radial inclination, ulnar variance), range of motion, grip strength, and Disability of the Arm, Shoulder, and Hand score were evaluated at each examination. The visual analog scale of wrist pain and evaluations of cosmetic problems were assessed at the final follow-up. The groups did not differ significantly in all main outcomes. In the M group, the mean values of the Disability of the Arm, Shoulder, and Hand score at 2 weeks postoperatively (P = 0.06) and visual analog scale (P = 0.07) were lower and the mean value of the patient's satisfaction score of cosmetic problems (P = 0.08) was higher than those in the C group, but no statistically significant differences were apparent in these values. No significant differences were found between the minimally invasive plate osteosynthesis and conventional plating for distal radius fractures based on the data from postoperative radiologic and clinical outcomes.

Prospective Evaluation of Minimally Invasive Plate Osteosynthesis in 36 Nonarticular Tibial Fractures in Dogs and Cats

To evaluate the clinical outcome of minimally invasive plate osteosynthesis (MIPO) for nonarticular tibial fractures stabilized using bone plates with or without an intramedullary rod (IMR). Prospective study. Dogs (n=28) and 8 cats. After closed reduction, fracture fixation was achieved using an epiperiosteal plate inserted percutaneously through epiphyseal small incisions. In some fractures, an IMR was inserted via medial parapatellar arthrotomy. Radiographs were recommended every 3 weeks until clinical union. Postoperative tibial length and alignment were compared with contralateral measurements (P<.05). Time to clinical union and complications were recorded. An IMR was used in 30.5% of the cases. Repaired tibiae were 1% shorter than contralateral tibiae (P<.05). Frontal and sagittal alignment were similar between repaired and contralateral tibiae (P>.05). Six dogs were lost for follow-up; owners indicated normal function. In 30 cases for which bone healing was documented, mean±SD healing time was 45±20.8 days; however, when considering the 23 cases, which completed preestablished scheduled follow-ups, healing time was 36±11.6 days. Minor complications occurred in 4 cases (11%). One major complication (3%) consisting of a plate fracture was successfully revised using MIPO with a larger plate. Consistent restoration of alignment was accomplished using MIPO techniques. Furthermore, MIPO appeared to yield faster healing times and lower complication rates than those reported with conventional plate osteosynthesis.