DCP Plate Research Articles

Aseptic Diaphyseal Pseudarthrosis of the Forearm Initially Treated with Target Plate: Risk Factors and Management

Aseptic diaphyseal pseudarthrosis of the forearm is a major complication. There are patient-related and treatment-related risk factors. The aim of our work is to evaluate the functional and radiological results of aseptic diaphyseal pseudarthrosis of the forearm initially treated with a screw plate. A series of 12 patients were collected in the Orthopedic and Traumatological Surgery Department A of IBN TOFAIL Hospital, retrospectively over a 5-year period. The most frequent site of these pseudarthroses was the ulna (5 cases), followed by both bones (4 cases) and finally the radius (3 cases). 50% of pseudarthroses were atrophic (12 cases). The use of a screw-plate stabilization technique combined with bone grafting and osteo-muscular decortication yielded satisfactory results in terms of bone consolidation and clinical outcome. Smoking is a major risk factor. Solid restraint is necessary to immobilize the fracture site and protect it from forces detrimental to consolidation. De-periostealization and muscular deinsertion are iatrogenic factors that favour the occurrence of pseudarthrosis. Solid DCP plate osteosynthesis combined with autograft after decortication of the fracture site is an important therapeutic weapon with good results.

Finite element analysis of intramedullary nailing and nail-plate combinations for treating unstable proximal tibial metaphyseal fractures.

The anatomy of the proximal tibia presents treatment challenges, and there is currently no widely accepted surgical fixation method for fractures in this region. The aim of this study is to evaluate the efficacy, benefits, and differences between intramedullary nailing (IMN) with a 4-hole Limited Contact Dynamic Compression Plate (LC-DCP) combination and IMN with an 8-hole LC-DCP combination in unstable fractures of the proximal metaphyseal region of the tibia. An oblique fracture was created in the metaphyseal region, forming a 30-degree angle in the sagittal plane in three tibial models. The fracture was designed to be 5 cm distal to the knee joint anteriorly and 8 cm distal to the knee joint posteriorly. One model was fixed with intramedullary nailing alone, while the others received additional fixation with either a 4-hole or an 8-hole plate in addition to the nail. Finite element analysis was performed using 3D computed tomography images of the models. Deformation, displacement, von Mises stress, and maximum principal strain values resulting from axial, lateral, coronal, and rotational forces applied to the models were analyzed. The model fixed with intramedullary nailing alone demonstrated greater maximum stress, maximum deformation, and displacement under all applied forces. In the model with nail and 8-hole plate, unlike the other models, the highest amount of stress in the nail was concentrated on the distal locking screw under axial force. We observed that the maximum principal strain in the tibia was higher in the models with combined nail and plate fixation than in the model with intramedullary nailing alone. The results of this study indicate that the combination treatment with an 8-hole DCP plate is biomechanically superior for treating unstable proximal tibial fractures with nails. Although the nail-plate combination requires an additional surgical incision and extra implants, it provides advantages in terms of stability and the sustainability of fracture reduction in unstable fractures.

428 Ulna Shortening Osteotomy Using a Dorsal DCP Plate Versus Volar Low-Profile Plate: Which Is Superior?

Abstract Aim There is limited literature comparing differing techniques and equipment used in ulna shortening osteotomy. This study reviewed operative outcomes of ulna osteotomies across one NHS Trust. Our aims were to compare outcomes of two different operative techniques: dorsal-approach DCP plates versus volar-approach low profile plates and to evaluate the impact of plate size on union rates. Method We performed a retrospective review of all patients undergoing an ulna shortening osteotomy between 2016–2021 at North West Anglia Foundation Trust. We reviewed patient demographics, surgical technique, plate size, complications, union rates and need for reoperation. Outcomes between two operative techniques were compared using Fisher's exact test. Results 32 patients were identified. 21 had a dorsally placed DCP plate using the Stanley jig, 11 had a volar low-profile plate using alternative systems. The majority of DCP plates were 6 or 7 holes. One 5-hole plate was used, resulting in the only case of non-union. Overall complication rate was 41%. 38% of patients with a dorsal plate had symptoms of plate irritation post-operatively. 5 needed removals, which was significantly greater than in the volar plate group (rate of 0%, p = 0.03). There were no cases of nerve damage and one case of CRPS in the volar low-profile plate group. Conclusions We found that a 5-hole DCP plate should be avoided and dorsally placed DCP plates led to more cases of plate irritation requiring removal. Overall, rates of union and improvements in function and pain scores were acceptable and comparable regardless of surgical technique used.

Enhanced piezoelectric and dielectric properties of AC poled sliver-mode Pb(In1/2Nb1/2)O3-Pb(Mg1/3Nb2/3)O3-PbTiO3 single crystals for ultrasonic abdomen probes

The effect of AC poling (ACP) on the piezoelectric and dielectric properties of diced sliver-mode vibrators (L13 × W0.15–0.30 × T0.51 mm3) was investigated for a convex abdomen ultrasound (US) probe that is made of a large Pb(In1/2Nb1/2)O3-Pb(Mg1/3Nb2/3)O3−0.3PbTiO3 (PIN-PMN-PT) single crystal (SC) plate (L13 × W60 × T0.51 mm3). The SC was manufactured by the continuous feeding Bridgman (CF-BM) method. The /ε 0 aging rate (AR) of both DCP and ACP large plate SCs were found to be within 1%/decade suggesting no obvious property degradation. After array dicing, a considerable decrease in electromechanical and dielectric properties was observed. After a post-dicing DCP, the diced DCP-DCP 0.15 mm wide SC slivers showed /ε 0 and electromechanical coupling factor (k′33) of 4300 and 89.1%, respectively. The diced ACP-DCP 0.15 mm wide SC slivers showed improved /ε 0 and k′33 of 5980 and 92.2%, respectively, which are considered useful in practical medical array transducer applications.

Functional outcome of operative management of humeral shaft fractures

Fractures of the humeral shaft are common, accounting for approximately 3% of all Orthopaedic injuries according to a study by World Health Organization [1], and result in a significant burden to society from lost productivity and income. These humeral shaft fractures have traditionally been regarded as benign, with high percentage of primary healing with conservative methods. However loss of reduction in the plaster cast invariably leads to malunion. Surgery is however indicated in some of these patients for optimum outcome. With improved implant design and surgical technique, operative management of humeral shaft fractures has increasingly become accepted [2, 3].Study Duration: 1st April 2018 to 1st April 2019Methods and Materials: Purposive sampling method was used to select 45 patients who sustained humeral shaft fractures requiring surgery. A thorough history and clinical examination was done. Age of the patient, etiology/cause of trauma, time and place of injury, occupation of the patient, associated injuries were recorded in a trauma sheet.Patients who presented to hospital immediately after injury and required surgery had careful pre- operative planning done. Blood investigations were taken and pre-operative review done by anaesthetist. Surgery was done under general anesthesia and prophylactic antibiotics were administered in all cases. Treatment consisted of a standard posterior triceps-splitting approach to the humerus. The radial nerve was identified and protected for the duration of the procedure. A dorsal 3.5mm or 4.5mm DCP plate was utilized. A minimum of eight cortices of fixation above and below the fracture site were obtained.Postoperatively, anteroposterior and lateral radiographs were done to assess alignment and reduction of fractures. X-rays were taken immediately post operatively, at 6 weeks and at 6 months. Assessment for pain at the fracture site and evidence of union were checked at 6 weeks, while functional outcome using ASES and Mayo Elbow Performance scores were done at 6 months.Results: 45 patients with humeral shaft fractures were managed operatively by plating. The mean age was 34.6 years. Men accounted for 68.9% (31 out of 45) of the cases. Of these 38 were right hand dominant while the rest were left handed. 26 patients had right humeral shaft fractures while 19 had the left humerus affected. Sixteen patients experienced shoulder pains while 19 were on pain medications. The median shoulder functionality scores in the different age groups ranged from 80 to 85 out of 100. The oldest age group (45 years and above) had lower scores with median score of 80 and range 48.3 to 85.The duration of healing was about 6 months.Conclusion and Recommendations: The results of this study indicate operative management of humeral shaft fractures results in good functional outcomes with little complications. Operative management by plating appears to be method of choice for internal fixation. All patients in this study were fixed by this method.

The outcome of minimally invasive distal tibia plating in a case of an extra articular distal tibia fracture

Background: Aim was to delineate the functional and radiological outcome of minimally invasive distal tibia plating in a case of extra-articular distal tibia fracture using contoured 4.5 DCP plate and long periosteal elevators. Methods: The study was conducted on patients who were diagnosed with extra-articular distal tibia fractures and underwent minimally invasive distal tibia plating in the Department of Orthopaedics, KEM hospital Parel Mumbai from March 2020 till June 2021. Participants were evaluated for functional outcome using the AOFAS score at minimum of 6 months postop, time to full radiological union and time to partial and full unaided weight-bearing was calculated based on follow up OPD visits at 6 weeks, 3 months, and 6 months. Results: Of the 30 participants involved in the study the average period of follow up was 8.47 months, the mean AOFAS score was 89.67, mean time to partial weight bearing was 6.13 weeks. And the mean time to full unaided weight bearing was 10.17 weeks, and the average time to complete radiological union was 17.03 weeks. One patient developed superficial wound complication which was managed with antibiotics and dressing. No patient developed deep infection osteomyelitis and non-union. Conclusions: minimal invasive plate osteosynthesis with contoured 4.5 dynamic compression plate can be successfully used for fixation of extra articular distal tibia fractures with minimal soft tissue compromise and wound complications and excellent results.

Functional outcome of locking anatomical plate in extra articular fractures of the distal humerus

<p class="abstract"><strong>Background:</strong> Extra articular distal humerus fractures are difficult to treat with conventional implants like intra medullary nail, 4.5 DCP and dual plate. The present study aims to study the functional outcome of the extra articular distal humerus plate (EADHP).</p><p class="abstract"><strong>Methods:</strong> 48 patients with displaced extra articular distal humerus fractures were included in the study. Inclusion criteria were age more than 18 years, closed fractures with or without radial nerve palsy and less than 3 weeks old trauma. Patients aged less than 18 years, those having open fractures, fractures more than 3 weeks old, non – unions and pathological fractures were excluded from the study. All patients were operated with EADHP. Clinically, the outcome was assessed by the disability of arm, shoulder and hand (DASH) score and elbow range of motion radiologically, union was evaluated on anteroposterior and lateral radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 48 patients, 12 had AO type 12 A1 fracture, 26 patients had type B1 fractures and remaining 10 had type C1 fractures. Mean DASH score at final follow up was 18.1; range being 12.6 to 35.7 points. The mean elbow range of motion was 0 to 130 degrees (range: 120 to 140 degrees). The mean duration for complete radiological fracture union was 14 weeks, range being 12 to 18 weeks.</p><p class="abstract"><strong>Conclusions:</strong> The extraarticular distal humerus plate is an ideal implant for the fixation of distal humerus fractures since it provides good stability of fracture and enables early return to function.</p>

O sistema convencional de placa e parafusos na osteotomia tibial alta em cunha de abertura medial é suficientemente estável? Um estudo retrospectivo

ObjectiveOpening‐wedge osteotomy of the proximal tibia is a widely performed procedure for treating medial gonarthrosis in active patients and in the presence of varus malalignment of the lower limb. The fixation method is controversial, and the use of conventional implants has been abandoned in favor of implants with more modern locking screws. The aim of the present clinical study was to assess the maintenance of the correction achieved in cases wherein fixation was performed using conventional implants. MethodsThis retrospective study included 51 patients who underwent opening‐wedge high tibial osteotomy wherein fixation was performed using conventional implants (4.5‐mm DCP plate and non‐locking screws). Radiological findings regarding patellar height, tibial slope, and varus correction postoperatively and after consolidation were analyzed to assess the maintenance of the correction achieved by osteotomy. ResultsThe mean loss of correction angle, calculated by the difference between the correction angle in the immediate postoperative period and that after consolidation, was 0.92°±0.9°. In addition, changes in patellar height determined by the Blackburne–Peel method and in the sagittal slope of the tibial plateau were not significant or clinically relevant. ConclusionsThe use of conventional plates and screws is viable in the fixation of opening‐wedge high tibial osteotomy because they provide enough stability to maintain the achieved correction until consolidation, without significant changes.

Conventional plate and screws in medial opening-wedge high tibial osteotomy: are they sufficiently stable? A retrospective study

ObjectiveOpening-wedge osteotomy of the proximal tibia is a widely performed procedure for treating medial gonarthrosis in active patients and in the presence of varus malalignment of the lower limb. The fixation method is controversial, and the use of conventional implants has been abandoned in favor of implants with more modern locking screws. The aim of the present clinical study was to assess the maintenance of the correction achieved in cases wherein fixation was performed using conventional implants. MethodsThis retrospective study included 51 patients who underwent opening-wedge high tibial osteotomy wherein fixation was performed using conventional implants (4.5-mm DCP plate and non-locking screws). Radiological findings regarding patellar height, tibial slope, and varus correction postoperatively and after consolidation were analyzed to assess the maintenance of the correction achieved by osteotomy. ResultsThe mean loss of correction angle, calculated by the difference between the correction angle in the immediate postoperative period and that after consolidation, was 0.92°±0.9°. In addition, changes in patellar height determined by the Blackburne–Peel method and in the sagittal slope of the tibial plateau were not significant or clinically relevant. ConclusionsThe use of conventional plates and screws is viable in the fixation of opening-wedge high tibial osteotomy because they provide enough stability to maintain the achieved correction until consolidation, without significant changes.

EPIDEMIOLOGY AND TREATMENT OF MONTEGGIA LESION IN ADULTS: SERIES OF 44 CASES.

ABSTRACTObjective: To analyze the epidemiology, treatment and outcome of a series of adult patients with Monteggia lesion treated in Uruguayan institutions. Methods: This is a retrospective article, we retrospectively identified from two Uruguayan institutions 44 adult patients with Monteggia lesion and analyzed their characteristics including Bado classification, associated injuries, treatment modality and outcome (Morrey score). Results: Using Bado classification, 23 cases (52%) were type II, 12 (27%) type I, seven (16%) type IV and two cases (5%) type III. Associated lesions were radial head fractures, found in 15 patients, coronoid ipsilateral fractures in seven patients, and neurological injuries in four. Radial head dislocation was reduced in 93% of the cases with closed maneuvers. Ulna fractures underwent open reduction and internal fixation in all 30 cases using 3.5 mm DCP plates. Complications after surgery occurred in 21 cases. Revision surgery was done in 15 cases. Outcomes after primary and revision surgery were good or excellent in 37 cases. Conclusions: In our series we observed that Monteggia lesion in adults is a serious injury with a high number of complications that often require revision surgeries. Level of Evidence IV, Retrospective Study, Case Series.

Osteosynthesis unilateral plural shaft fractures of bones of a hip and a leg at associate to a trauma of a stomach and retroperitoneum

The purpose of research — the comparative analysis of methods of an osteosynthesis, time of carrying out at patients with plural unilateral shaft fracture of the hip and leg associated with the trauma of the stomach and retro peritoneum. Methods. With 2006 on 2012 the author 93 patients with plural unilateral shaft fracture bones of the hip and leg associated with the trauma of the stomach and retro peritoneum were observed. Men — 79 (84,9%), women — 14 (15,1%). 76,3% of victims were able-bodied age (21–60 years). A principal cause of a trauma at 88 (94,6%) victims — road and transport incidents. Right-hand damage is marked at 51 (54,8%) victims, left-hand — at 42 (45,2%). The closed crises it is marked at 32 (34,4%) victims, crisis of a hip at 11 (11,8%), bones of a shin 21 (22,6%). Open crises it is marked at 61 (65,6%), from them a femur — at 19 (31,2%) victims, bones of a leg — at 42 (68,8%), were classified on scale Gustilo R. B., Anderson J. T. (1976). 36 patients were treated by a conservative method, 57 the operative osteosynthesis is made. Results. 6 patients it is made relaporotomy, at 4 patients because of early loading — a floor of a DCP plate on a hip which were it are removed, made reosteosynthesis by intramedullar nail and the frame apparatus, pin an osteomyelitis — 8 (5 hip, 3 leg), the delayed union of bones of a leg — 9, mixed contracture a knee joint — 12 (7 — operative, 5 — non-operative) patients. The remote results are appreciated on scale Jonner R., Wruhs O. (1983). At patients treated a skeletal extension method: excellent — 19, good — 9, satisfactory — 8 (an average estimation — 4,3). An operative osteosynthesis: excellent — 31, good — 7, satisfactory — 11, unsatisfactory — 8 (an average estimation — 4,1). Conclusions. Patients with plural unilateral shaft fracture bones of the of the bottom finitenesses, associated with the trauma of the stomach and retro peritoneum should be observed and treated in versatile hospitals or branches associated traumas, with the stipulated established posts. Where alongside with antishock treatment and surgical interventions, under vital indications, it is necessary to impose skeletal extension which is one of factors of antishock treatment and also an effective independent method of conservative treatment, and serves, necessarily, as preparation of the patient for the further operative osteosynthesis. From methods of an operative osteosynthesis a choice for metallic construction, allowing to receive a steady and stable osteosynthesis, early activity and development of movements in both segments from victims.

Osteosynthesis of the Radius and Ulna in a Brown Hare Lepus Europeus

Six months old brown hare was presented at the Surgery Clinic for evaluation of a right forelimb third grade lameness. Full physical examination, blood samples for complete blood count, and serum biochemistry were performed. Radiographic examination from anteroposterior and lateral views confirmed a old, closed, complete, non-comminuted, transverse fracture in the middle part of right radius and ulna. Fracture repair in the brown hare is a similar to those in cats and dogs. Stabilization of fractures with bone plates and screws are the most popular methods of fracture fixation. Osteosynthesis was performed by 2.0, 8-hole stainless steel Synthes dynamic compression plate, DCP (Synthes Holding AG, 4500 Solothurn, Switzerland) placed on radius in neutral position to achieve anatomical repositioning of fragments and to restore normal biological function of the limb. Surgical procedure was performed within 45 minutes in order to reduce residence in a hospital environment, which hares generally find stressful. The fracture was assessed as clinically stable in the 5th day postoperatively and the animal was weightbearing on it's forelimb. Osteosynthesis of hare radius using DCP plate 2.0 is a good method of fixation and healing fractures. After performing full clinical examination and bloodwork, controled and modulated anaesthesia and analgesia, it is possible to perform osteosynthesis with excellent outcome and also a good way to preserve fragile wildlife.

Internal Fixation of Cervical Fractures in Three Horses.

To describe the surgical treatment outcome of cervical fractures in 3 horses. Case report. Three client-owned horses with cervical vertebral fractures. Three horses were refered for neck stiffness, pain, and ataxia after a cervical trauma because of a fall. Radiographic examination showed an oblique displaced fracture of the caudal aspect of the body of the second cervical vertebra (C2) in horse 1, an oblique displaced fracture of the caudal aspect of C4 involving the disc between C4 and C5 in horse 2, and a displaced transverse fracture of the body of the axis (C2) extending to the lateral arches and involving the vertebral canal in horse 3. In horse 1, the fracture was reduced and stabilized using a 14-hole narrow DCP plate, applied ventrally, and fixed with cancellous screws. A cervical fusion was performed. In horses 2 and 3, fracture fixation was performed using a 5-hole narrow LCP and 5 mm locking screws. All horses showed improvement and returned to full activity. The fracture healed in all horses. Internal fixation of cervical fracture in these horses was associated with minimal complications, and was associated with healing and a highly functional outcome in all horses. The LCP was preferred and would be recommended for ventral stabilization of selected cases of vertebral fractures.

Is arthrodesis still a good indication for non-inflammatory arthrosis of the wrist?

ObjectiveThe aim of this study was to objectively and subjectively evaluate wrist function after total arthrodesis, among patients with sequelae of non-inflammatory arthritis who were treated with rigid internal fixation using a DCP plate. MethodsThirty-two patients with sequelae of non-inflammatory degenerative arthritis were treated using total arthrodesis of the wrist. Of these, two patients were treated with Kirschner wires and four discontinued the treatment, thus leaving 26 patients. The indication for arthrodesis of the wrist was the presence of intracarpal pathological conditions: eight wrists presented sequelae from fractures of the distal radius; 13 had sequelae from fractures of the scaphoid; and five had sequelae from Kienbock's disease. The cases were evaluated using the visual analogue scale (VAS), the muscle strength test, the Jebsen–Taylor functional test and the Buck-Gramcko test. ResultsIt was observed that there were no significant differences at the level of 5%, in the variables of grip strength, VAS, Jebsen–Taylor functional test or Buck-Gramcko/Lohmann test, between the pathological conditions. ConclusionTotal arthrodesis of the wrist using a plate in the dorsal region was shown to be a safe and efficient technique for patients with different types of pathological arthrosis of the wrist, since it did not cause any important functional incapacity and brought great pain relief.

Artrodese ainda é uma boa indicação na artrose não inflamatória do punho?

ObjectiveThe aim of this study was to objectively and subjectively evaluate wrist function after total arthrodesis, among patients with sequelae of non‐inflammatory arthritis who were treated with rigid internal fixation using a DCP plate. MethodsThirty‐two patients with sequelae of non‐inflammatory degenerative arthritis were treated using total arthrodesis of the wrist. Of these, two patients were treated with Kirschner wires and four discontinued the treatment, thus leaving 26 patients. The indication for arthrodesis of the wrist was the presence of intracarpal pathological conditions: eight wrists presented sequelae from fractures of the distal radius; 13 had sequelae from fractures of the scaphoid; and five had sequelae from Kienbock's disease. The cases were evaluated using the visual analogue scale (VAS), the muscle strength test, the Jebsen‐Taylor functional test and the Buck‐Gramcko test. ResultsIt was observed that there were no significant differences at the level of 5%, in the variables of grip strength, VAS, Jebsen‐Taylor functional test or Buck‐Gramcko/Lohmann test, between the pathological conditions. ConclusionTotal arthrodesis of the wrist using a plate in the dorsal region was shown to be a safe and efficient technique for patients with different types of pathological arthrosis of the wrist, since it did not cause any important functional incapacity and brought great pain relief.

The Comparison of Results of Treatment of Midshaft Clavicle Fracture between Operative Treatment with Plate and Non-Operative Treatment.

Clavicle fractures are common and usually heal without complications. In this study, we evaluated the outcomes of non-operative versus operative management of displaced fractures. In a prospective clinical trial study, sixty-five patients with displaced clavicle mid-shaft fractures were non-randomly divided in two treatment groups. The first group underwent non-operative treatment with figure of 8 bandage (30 patients), and the other underwent operative treatment with plate fixation (35 patients). Figure of 8 bandage and 3.5 millimeter DCP plate with at least six cortical screws were used in non-operative and operative groups respectively. We followed up all patients at weeks 2, 6 and 12, and at month sixth. In addition to clinical examination and x-ray evaluation, we assessed satisfaction, DASH and Constant Shoulder Score for each individual. The average durations of union were 19.3 and 24.4 weeks in operative and non-operative groups respectively (P=0.006). Satisfaction with operative treatment was 74.3% and with non-operative treatment was 66.7%, showing no significant difference (P=0.500). The non-union rate was 5.7% in the operative group and 13.3% in the non-operative group (P=0.518). A significant difference between the two groups in terms of DASH and Constant Shoulder Scores after the six-month follow-up was not found (P=0.352). According to our results, we recommend operative treatment in mid-shaft clavicle fractures only when there is a definitive indication.

Non Union of Fracture Neck of Femur for Intertrochanteric Osteotomy

BACKGROUND: Femoral neck fracture is a difficult problem in adult patients and without proper treatment leads to high functional impairment and frequent complications. OBJECTIVE: The aim of this study was to see the functional outcome in patients with non union of fracture neck of femur treated with intertrochanteric osteotomy. MATERIAL AND METHODS: All 14 cases operated and non operated (neglected) fracture neck of femur were enrolled for the study 2003 to 2009 in National Medical College, Birganj and Janaki Medical College, Janakpur. Patients were treated conservatively and in some patients failure of fixation was used to evaluate the functional outcome. RESULTS: There were 14 patients with average age of 30 years with age range 14-50 years. 8 patients were male and six were female. 10 patients were previously treated conservatively and 4 patients presented with failure of fixation. Average duration of fracture was 7 months (2 months -3 years with pauwel angle of 32.8. CONCLUSION: Neglected neck of femur fracture should be treated by three cancellous screw fixation with molded and angled narrow DCP plate, valgus osteotomy and autogenous bone grafting round the fracture to achieve a high rate of patient satisfaction and satisfactory functional outcome. DOI: http://dx.doi.org/10.3126/jucms.v1i3.8762 Journal of Universal College of Medical Sciences Vol.1(3) 2013: 33-36

Treatment of the humeral shaft fractures - minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace: study protocol for a randomised controlled trial

BackgroundHumeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Non-operative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Surgical treatment is reserved for specific conditions. Modern concepts of internal fixation of long bone shaft fractures advocate relative stabilisation techniques with no harm to fracture zone. Recently described, minimally invasive bridge plate osteosynthesis has been shown to be a secure technique with good results for treating humeral shaft fractures. There is no good quality evidence advocating which method is more effective. This randomised controlled trial will be performed to investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison with conservative treatment with functional brace.Methods/DesignThis randomised clinical trial aims to include 110 patients with humeral shaft fractures who will be allocated after randomisation to one of the two groups: bridge plate or functional brace. Surgical treatment will be performed according to technique described by Livani and Belangero using a narrow DCP plate. Non-operative management will consist of a functional brace for 6 weeks or until fracture consolidation. All patients will be included in the same rehabilitation program and will be followed up for 1 year after intervention. The primary outcome will be the DASH score after 6 months of intervention. As secondary outcomes, we will assess SF-36 questionnaire, treatment complications, Constant score, pain (Visual Analogue Scale) and radiographs.DiscussionAccording to current evidence shown in a recent systematic review, this study is one of the first randomised controlled trials designed to compare two methods to treat humeral shaft fractures (functional brace and bridge plate surgery).Trial registrationCurrent Controlled Trials: ISRCTN24835397

A finite element analysis of bone plates available for prophylactic internal fixation of the radial osteocutaneous donor site using the sheep tibia model

IntroductionThe strengthening effect of prophylactic internal fixation (PIF) with a bone plate at the radial osteocutaneous flap donor site has previously been demonstrated using the sheep tibia model of the human radius. This study investigated whether a finite element (FE) model could accurately represent this biomechanical model and whether stress or strain based failure criteria are most appropriate. MethodsAn FE model of an osteotomised sheep tibia bone was strengthened using 4 types of plates with unilocking or bicortical screw fixation. Torsion and 4-point bending simulations were performed. The maximum von Mises stresses and strain failure criteria were studied. ResultsThe strengthening effects when applying stress failure criteria [factor 1.76–4.57 bending and 1.33–1.80 torsion] were comparable to the sheep biomechanical model [factor 1.73–2.43 bending and 1.54–2.63 torsion]. The strongest construct was the straight 3.5mm stainless steel unilocking plate. Applying strain criteria the strongest construct was the straight 3.5mm stainless DCP plate with bicortical screw fixation. ConclusionsThe FE model was validated by comparison with the sheep tibia model. The complex biomechanics at the bone-screw interface require further investigation. This FE modelling technique may be applied to a model of the human radius and other sites.

Avaliação ultrassonométrica da osteossíntese de compressão axial: estudo experimental

OBJECTIVE: To measure the ultrasound propagation velocity (UV) through a tibial transverse osteotomy in sheep, before and after the fixation with a DCP plate. MATERIAL AND METHODS: Ten assemblies of a DCP plate with the diaphyseal segment of tibiae, in which a transverse osteotomy was made, were used. Both coronal and sagittal transverse and the axial UV were measured, first with the intact bone assembled with the plate and then with the uncompressed and compressed osteotomy; statistical comparisons were made at the 1% (p<0.01) level of significance. RESULTS: Compared with the intact bone assembly, axial UV significantly decreased with the addition of the osteotomy and significantly increased with compression, presenting the same behavior for the other modalities, although not significantly. DISCUSSION AND CONCLUSION: In accordance with the literature data on the ultrasonometric evaluation of fracture healing, underwater UV measurement was able to demonstrate the efficiency of DCP plate fixation. The authors conclude that the method has a potential for clinical application in the postoperative follow-up of DCP plate osteosinthesis, with a capability to demonstrate when it becomes ineffective. Laboratory investigation.