Dynamic Compression Plate Fixation Research Articles

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

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

Single dorsal incision approach for plate fixation of radius ulna midshaft fracture; interesting case report

Radius and ulna shaft fractures, also known as both bone forearm fractures, are common fractures caused due to direct or indirect trauma. Open reduction and internal fixation with plating by two separate incisions is a standard and widely accepted mode of fixation. We report a case where we approached the fracture with a single dorsal incision. An eighty years old female had fractures of both radius and ulna shaft with Gustilo Anderson type two open injury. We managed the patient with single-stage debridement, open reduction, and dynamic compression plate (DCP) fixation of both bones with a single dorsal curvilinear incision and followed up postoperatively for one year. At the end of the last follow-up, the patient had no pain with a full range of movement. There were no wound-related issues. Radiologically complete union occurred without complications mentioned in the literature, such as synostosis.: We found that under specific circumstances such as open injury where two separate incisions for radius and ulna are inappropriate, a single dorsal curvilinear incision for radius and Ulna midshaft fractures is a safe and effective alternative method.

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.

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.

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.

Evaluation of post-operative complications, outcome, and long-term owner satisfaction of elbow arthrodesis (EA) in 22 dogs.

The objective of this study was to report post-operative complications and outcomes in canines undergoing elbow arthrodesis (EA) with fixation techniques including bone plate fixation with a non-locking dynamic compression plate (DCP), bone plate fixation with a locking plate (LCP), and external skeletal fixator (ESF). Medical records of twenty-two cases that underwent EA between January 2009-December 2019 from 8 referral hospitals including both private practice and academic institutions were reviewed. Post-operative complications were classified as either minor or major, surgical evaluations were performed 8 weeks post operatively, and a follow-up questionnaire was sent to owners. Of the total 22 cases that met inclusion criteria, a total of 19/22 cases had complications, 12 major and 7 minor. Complications reported in 8/9, 7/9, and 4/4, for the DCP, LCP, and ESF fixation groups, respectively. Mild to moderate mechanical lameness was identified at surgical evaluation in 16/22 cases. Complete radiographic bone healing was achieved after 9 weeks in 19/22 cases. Long term owner follow up was available in 14/22 cases. Owners reported a good to normal quality of life in 13/14 cases and poor in one case. The majority of owners (11/14) reported good to excellent satisfaction with the outcome irrespective of persistent lameness. This study demonstrates that successful EA can be achieved using a variety of fixation methods, but persistent lameness is expected and complication rate is high.

Lateral migration resistance of screw is essential in evaluating bone screw stability of plate fixation

Conventional evaluation of the stability of bone screws focuses on pullout strength, while neglecting lateral migration resistance. We measured pullout strength and lateral migration resistance of bone screws and determined how these characteristics relate to screw stability of locking plate (LP) and dynamic compression plate (DCP) fixation. Pullout strength and lateral migration resistance of individual bone screws with buttress, square, and triangular thread designs were evaluated in polyurethane foam blocks. The screw types with superior performance in each of these characteristics were selected. LP and DCP fixations were constructed using the selected screws and tested under cyclic craniocaudal and torsional loadings. Subsequently, the association between individual screws’ biomechanical characteristics and fixation stability when applied to plates was established. Screws with triangular threads had superior pullout strength, while screws with square threads demonstrated the highest lateral migration resistance; they were selected for LP and DCP fixations. LPs with square-threaded screws required a larger force and more cycles to trigger the same amount of displacement under both craniocaudal and torsional loadings. Screws with triangular and square threads showed no difference in DCP fixation stability under craniocaudal loading. However, under torsional loading, DCP fixation with triangular-threaded screws demonstrated superior fixation stability. Lateral migration resistance is the primary contributor to locking screw fixation stability when applied to an LP in resisting both craniocaudal and torsional loading. For compression screws applied to a DCP, lateral migration resistance and pullout strength work together to resist craniocaudal loading, while pullout strength is the primary contributor to the ability to resist torsional loading.

Non-locked and locked small fragment straight plates have a similar behavior in buttressing the posteromedial shear tibial plateau fragment: a biomechanical analysis of three different fixations

PurposeThe aim of this study is to compare the biomechanical behavior of three different fixation constructions currently used for buttressing the posteromedial shearing tibial plateau fragment. Our hypothesis is that non-locked implants provide sufficient comparable stability in posteromedial tibial plateau fractures as locked implants.MethodsFifteen left synthetic tibiae from a single manufacturing batch were used to create a posteromedial shear tibial plateau fracture. The fracture was buttressed with three different posteriorly placed five-hole straight small-fragment plate. Five models were fixed with a one-third tubular plate (TTP), five models with a dynamic compression plate (DCP), and five models with a locking compression plate (LCP). All groups were tested to vertical subsidence (Stage 1). In the same experiment (Stage 2), TTP and DCP groups were tested until catastrophic failure. Force versus displacement curves were obtained in the two stages of the experiment.ResultsStage 1 – There was no significant difference in stiffness (p = 0.89), subsidence up to 2 mm (p = 0.38), and energy (p = 0.36) among the three fixation constructions. Stage 2 – Yield load revealed significantly less yield strength for the TTP group as compared with the DCP group (p = 0.048). However, there was no significant difference in maximum load to failure among the TTP and DCP fixation constructions (p = 0.16).ConclusionPlacement of either a locked or non-locked small fragment straight plate to buttress the posteromedial shear tibial plateau fragment has a similar biomechanical behavior. When the implant is positioned to buttress the shearing fragment it maximizes biomechanical stiffness.

A clinical study of anterior bridge plating for humerus shaft fractures by minimal invasive technique

Introduction: Diaphyseal fractures of humerus treated with bridge plating are showing superior results in view of post-operative pain and union time. In our study we have evaluated the clinical, radiological, and functional outcome of such fractures in 15 patients, all of them 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 gold standard, this technique also gives good outcome.Materials and Methods: Fifteen patients with humerus shaft fractures were managed by anterior bridge plating using Minimum invasive osteosynthesis technique between Jan 2017 and Jan 2018 were included in this study. All cases were managed with closed reduction and 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 scores were used for assessing the shoulder and elbow function. Results: Out of the fifteen patients in the study, eleven were males and four were females. The mean age was 40.2 years (range 25 to 60 years). Ten out of fifteen patients (66.67%) had the dominant side fractured. Mean surgical time in minutes was 90min (range: 60–120 minutes). The mean fracture union time was 10.6 weeks (range: 10–18 weeks). However Shoulder function was excellent to good in 13 cases (86.6%), fair in 1 case (6.67%) & poor 1 case (6.67%) on the UCLA score. Conclusion: In our study, small incision percutaneous anterior bridge technique for fracture shaft humerus results in good functional outcomes. It is based on relative stability which provides healing, and subsequent formation of the bone callus, and reduces the possibility of infection and non-union.it requires experience and a good assistance.

Early Results of Bridge Plating of Humerus Diaphyseal Fractures by MIPO Technique

Anterior bridge plating with minimally invasive technique in humeral shaft fractures is reported as an acceptable, less traumatic and reproducible procedure by several authors. We have evaluated the clini-cal, radiological, and functional outcome of such fractures in eleven patients, all of which were managed with dynamic compression plates over an average follow-up period of 22 months. Forty patients with humerus shaft fractures managed by anterior bridge plating using the MIPO technique between 2014 and 2016 were included in this series. All cases were treated with closed reduction and 10-12 hole 4.5mm dynamic compression plate fixation over anterolateral aspect in bridging mode using the MIPO technique. The UCLA shoulder and Mayo elbow performance scores were used for assessing shoulder and elbow function. Of the forty patients followed up for a minimum of 18 months in the study, 26 were males and 14 were females. The mean age was 34.3 years (range 20 to 53 years). 24 out of the forty patients (60%) had the dominant side fractured. The mean surgical time was 72.5 minutes (range: 45-100 minutes) and mean radiation exposure was 160 seconds (range: 100-220 seconds). The mean radiological fracture union time was 13 weeks (range: 8-18 weeks). Shoulder function based on the UCLA score was excellent to good in 33 cases (82.5%), fair in 6 cases (15%) and one patient (2.5%) developed infection for which the plate was removed prematurely at the 4th month and the wound was meticulously debrided and then managed conservatively. Road traffic accident (RTA) was the most common mode of injury, found in 27 cases; 12 patients sustained blunt trauma due to a fall; one patient sustained an injury following a direct blow by stick. 1. The mini-incision anterior bridge technique for humeral shaft fractures gives good functional results and should be considered an effective, cosmetically advanced surgical option in the treatment of humeral shaft fractures. 2. The mini-incision anterior bridge technique is a safe and less method for simple types of humeral shaft fractures when the surgeon is experienced in the technique.

Functional outcome of closed diaphyseal fractures of both bone forearm in adults treated by small dynamic compression plate fixation in radius &amp; intramedullary nail fixation in ulna

Introduction: Both bone forearrn fractures represent approximately 10-14% of all fractures.It is advocated that these type of fracture should be treated surgically, Fixation of fracture is done by either plate or nail or both. Aims and objectives: To study and evaluate functional outcome by GE (Grace & Eversmann Rating) rating & Anderson et al. score in closed diaphyseal fractures of both bone forearm in adults treated by SDCP (Small Dynamic Compression Plate) in radius & intramedullary nail in ulna. Method and Materials: Present study included 60 patients aged 18-45yrs having fracture both bone forearm admitted in OPD and emergency at MBGH Udaipur from 1stjanuary 2017 to 31stjuly 2018 & divided in 4 groups on the basis of location of fracture site of both bones, A (both upper third), B (Both Middle Third), C (both lower third) & D (Both At Different Site). All patients were operated with intramedullary Talwalkar’s square nail in ulna & SDCP in radius. Functional outcome using GE rating and Anderson et al. score and complications were observed with 9 months clinic radiological follow up. Result: Maximum no. of patients were in group B which is 36(60%). Mean union time for was minimum for B (15.41 Wks.), maximum in A (20wks) with overall 16.25wks. Average roation arc was 140.51 (90.32% of the reference mean). In GE patients showing excellent result were overall 56.6%& maximum 70% in D, while unacceptable in 6.67%. In Anderson et al. score patients showing excellent result were 63.33% overall with maximum 80% in D, while failure in 5%. Conclusion: Fracture union time was minimum in group-B & maximum in group A(because of prolong immobilization and delayed physiotherapy).Both scoring system showed best results with variable site involvement (D) because of better stability, early mobilization & good rotation arc. Considering GE & Andrson et al. scores with overall union rates & rotation arc, SDCP in radius and square nail in ulna is a good fixation modality for fracture forearms especially I n group D.

A clinical study of minimal invasive anterior bridge plating for humerus shaft fractures

Introduction: In humeral shaft fractures management anterior bridge plating is reported as an acceptable less traumatic and reproducible procedure by several authors. Our study done to evaluated the clinical, radiological, and functional outcome of such fractures in 10 patients, all of which were managed with dynamic compression plate over an average follow up period of 16 months. Though open reduction and plating technique of humerus shaft fracture is gold standard, this technique also gives good outcome. Materials and Methods: Ten patients with humerus shaft fractures were managed by anterior bridge plating using Minimum invasive osteosynthesis technique between Jan 2016 and April 2017 were included in this study. All cases were treated with closed reduction and 4.5mm dynamic compression plate fixation over anterolateral aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, 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: Out of the ten patients in the study, seven were males and three were females. The mean age was 38 years (range 24 to 60 years). seven out of ten patients (70%) had the dominant side fractured. Mean surgical time in minutes was 80min (range: 60–100 minutes) and mean radiation exposure, in terms of one sec for each c-arm exposure was 88 seconds (range: 60–140 seconds).The mean fracture union (radiological) time was 11.6 weeks (range: 10–18 weeks). However Shoulder function was excellent to good in 9 cases (90%) and fair in 1 case (10%) on the UCLA score. Conclusion: There is high rate of union and excellent functional outcomes by this procedure. Minimal incision with this anterior bridge technique for fracture shaft humerus results in good functional outcomes and should be considered as an effective surgical option in the treatment of humeral shaft fractures. It is a safe and less time consuming method for simple types of humeral shaft fractures when the surgeon is experienced in the technique.

Comparative study of bridging Tricoticocancellous bone graft post medullary canal recanalization versus classical bone graft without opening medullary canal both procedures were used dynamic compression plate fixation in treatment of non-uniting fracture shaft humerus

Background: Nonunion of a Humerus shaft fracture after conservative treatments or repeatedly failed surgical attempts bone healing a difficult therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. We evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from June 2004 to December 2009 in Sulaimani Teaching Hospital, for healing of Nonunion fracture humerus. Aim of study: The lack of mechanical stability due to a flail arm functionally affected that interference with personal hygiene, dressing, and daily activities. The goal of surgery is to achieve a stable rigid fixation on healed nonunion fracture humerus, plus early mobilization. Methods: We evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from June 2004 to December 2009 in Sulaimani Teaching Hospital, for healing of nonunion humerus .44 patients randomly collected, classified into two groups. Group A, 22 patients were treated by recanalization opening the medullary canal with bridging Tricoticocancellous bone graft. Group B 22 patients were treated by bone graft alone without opening the medullary canal. Both groups were using compression plate Fixation in treatment of Non-uniting fracture shaft humerus. Results: In group a, 22 patients age range 22-60 years (mean age 41years). There were 16 males and 6 females. Four patients had open fractures; (one due to explosion of a truck tire, second due to machine injury, and two dues to road traffic accidents). 8 patients had treated conservatively, 14 patients had previous surgical treatment in the form of open reduction and internal fixation using plates and screws, intramedullary nails of different types. 12 patients autogenous ICBG were used previously at least once time together with internal fixation. The mean duration of nonunion was 4 years between 2- 6 years. Group B, the mean age between 25-64 years (mean age 44.5 years). There were 18 males and 4 females' patients. Two patients had open fractures. 10 patients had treated conservatively, 12 patients had previous surgical treatment in the form of open reduction and internal fixation using plates and screws, intramedullary nails of different types. 10 patients autogenous ICBG were used previously at least once time together with internal fixation. The mean duration of nonunion was 4.5 year between 3- 6 years. We detected improvements in our study for both bone healing index results and functional index outcome. The bone results were evaluated by the union rate, angular deformity, and limb shortening. The functional outcomes were evaluated for pain, function, movement, muscle power, and patients satisfaction. Conclusion: We confirm that recanalization opening medullary canal plus three Tricoticocancellous bone graft are superior in healing of Non-uniting fracture humerus than without recanalization non-opening medullary canal. However, we used dynamic compression plating in both techniques.

Evaluation of treatment of diaphyseal fracture of humerus: Dynamic compression plate versus interlocking nail: A prospective randomized controlled study

Fracture shaft of the humerus is a common injury in orthopaedic practice. Conservative management with plaster gives good result but this method cannot be applied in situations which necessitates internal fixation. There always a question arises which kind of implant to be used for surgical intervention. A prospective comparative study for the management of acute diphyseal humeral shaft fractures with dynamic compression plate and antegrade interlocking nail fixation was undertaken over a period of three years. In each category Twenty five patients had undergone above implant fixation after considering the inclusion and exclusion criteria. Rate and time of union, functional scoring criteria (ASES) and complication rate were used for postoperative assessment with an average follow-up period of one year. A higher rate of union with excellent to good functional outcome was seen with the plating group in our series.

Comparative study of functional outcome of dynamic compression plating and interlocking intramedullary nailing for fructure shaft of humerus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fracture of the diaphysis of humerus and its complications are a major cause of morbidity in trauma patients. Fracture of the humeral shaft account for 20% of humeral fractures &amp;amp; about 3% of all fractures. There is a debate between the choices of operation in humeral shaft fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A comparative study of management of acute humeral shaft fractures treated by Dynamic Compression Plate (DCP) and Intra Medullary Interlocking Nail (IMILN) fixation over a period of one half years. 18 patients of IMILN and 20 patients of DCP were included after considering inclusion and exclusion criteria. Functional scoring criteria were used for postoperative assessment &amp;amp; the average follow up period was one year.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A high rate of excellent &amp;amp; good results &amp;amp; a tendency for early union was seen with the plating group than nailing group.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Plating shows better results than nailing.

Comparison of Treatment with Titanium Elastic Nail Versus AO – Dynamic Compression Plate for Femoral Shaft Fractures in Children

&lt;p&gt;&lt;strong&gt;Abstract&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Femur fractures are among the commonest pediatric injuries. Until recent past, traction and hip spica were the standard treatment for all femoral shaft fractures which required long duration of hospitalization. The management of femoral shaft fractures in children above the age of six years has evolved more towards operative approaches in the last two decades to minimize the post plaster complications i.e. decrease in incidence of malunion, short hospital stay, better nursing care and early ambulation. Recently, a variety of therapeutic alternatives such as intramedullary nailing and dynamic compression plating have become available to decrease impairment, increase convenience and decrease cost of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the results of fracture shaft of femur in children (6 to 12 years of age) treated with Titanium Elastic Nail vs. AO – Dynamic Compression Plate fixation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective, comparative and interventional study was carried out in the department of orthopedic surgery, PGMI Lahore General Hospital, Lahore. A total of 64 patients were enrolled in this study and randomly divided into 2 groups of 32 patients each. In Group-A patients were treated with Titanium Elastic Nail and in Group – B patients were treated with AO – Dynamic Compression Plate fixation. Sample selection was done by using a pre-defined inclusion and exclusion criteria. Variables of interest were duration of operation, Infection, Limb Length discrepancy, Angulation, Time of union and implant failure. Patients were followed up from 2nd week till 24th week respectively. SPSS was used for data entry and analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Age range of patients was 6 – 12 years. Male patients were 51 and 13 patients were female. Eleven patients had Proximal 1/3, 45 mid shaft fracture and 8 distal 1/3 fracture. Mean operative time for DCP was 53.28 minutes and for elastic intramedullary nailing was 29.91 minutes. None of the patients in both treatment groups had limb length discrepancy. Infection and implant failure rate were the same in both treatment groups. Union was rapid till 8th week in Group-A patients after 8th week both treatment groups had equal union rate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Union was achieved in all cases in both groups. Angulation, Infection and implant failure was not seen in any of the patients in both treatment gro-ups. An earlier union of bone was earlier in Group-A (Elastic Intramedullay Nail) patients as compared to Group-B (DCP).&lt;/p&gt;&lt;strong&gt;Key Words: &lt;/strong&gt;AO – DCP, Titanium Elastic Nail, Pediatric Mid Shaft Femur, Infection, Union.

Retrospective analysis of factors associated with outcome of proximal interphalangeal joint arthrodesis in 82 horses including Warmblood and Thoroughbred sport horses and Quarter Horses (1992-2014).

Outcomes associated with arthrodesis of the proximal interphalangeal (PIP) joint in Quarter Horses used for Western performance activities are well documented but little is known regarding outcomes for other types of horses. To identify factors associated with outcomes, including breed and activity, after arthrodesis of the PIP joint in Warmbloods, Thoroughbreds and Quarter Horses. Retrospective case series. Surgical case records of 82 Quarter Horses principally engaged in Western performance and Thoroughbred or Warmblood breeds principally engaged in showing, showjumping and dressage, with arthrodesis of the PIP joint were reviewed. Arthrodesis was performed with either 3 transarticular cortex bone screws placed in lag fashion, a dynamic compression plate (DCP) with 2 transarticular cortex bone screws placed in lag fashion, or a locking compression plate (LCP) with 2 transarticular cortex bone screws placed in lag fashion. Demographic data, clinical presentation, radiographic findings, surgical technique, post operative treatment and complications were recorded. Long-term follow-up was obtained for all 82 horses. Osteoarthritis of the PIP joint was the most common presenting condition requiring arthrodesis, which was performed with either the 3 screw technique (n = 41), DCP fixation (n = 22), or LCP fixation (n = 19). Post operatively, 23/31 (74%) Warmbloods/Thoroughbreds and 44/51 (87%) Quarter Horses achieved successful outcomes. Thirteen of 23 (57%) Warmbloods/Thoroughbreds and 24 of 38 (63%) Quarter Horses, used for athletic performance, returned to successful competition. Within this subgroup of horses engaged in high-level activity, regardless of breed type, horses undergoing hindlimb arthrodesis were significantly more likely to return to successful competition (73%; 33/45) than those with forelimb arthrodesis (25%; 4/16, P = 0.002). Arthrodesis of the PIP joint in Warmbloods/Thoroughbreds and Quarter Horses results in a favourable outcome for return to their intended use and athletic competition.

Anterior Bridge Plating with Mini Incision MIPO Technique for Humerus Diaphyseal Fractures

Introduction: Anterior bridge plating with minimally invasive technique in 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 eleven patients, all of which were managed with dynamic compression plate over an average follow-up period of 22 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome. Materials and Methods: Eleven patients with humerus shaft fractures were managed by anterior bridge plating using MIPO technique between Jan 2013 and April 2015 were included in this series. All cases were treated with closed reduction and 10-12 hole 4.5mm dynamic compression plate fixation over anterolateral aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, 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 Eleven patients in the study, eight were males and three were females. The mean age was 34.3 years (range 20 to 53 years). Eight out of eleven patients (72.7%) had the dominant side fractured. Mean surgical time in minutes was 79.5 (range: 60–100 minutes) and mean radiation exposure, in terms of one sec for each c-arm exposure was 95 seconds (range: 70–160 seconds).The mean fracture union (radiological) time was 13.7 weeks (range: 10–18 weeks). One patient (9.1%) develops infection for which premature plate removal and debridement was done at 5 months and managed then conservatively. However Shoulder function was excellent to good in 9 cases (81.8%) and fair in 1 case (9.1%) on the UCLA score. Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique

Locking plate and screw fixation after tibial plateau leveling osteotomy reduces postoperative infection rate in dogs over 50 kg.

To assess the influence of locking plate and screw implants on postoperative infection rate in dogs >50 kg undergoing tibial plateau leveling osteotomy (TPLO). Retrospective case series. Dogs >50 kg (n = 208) that had TPLO. Medical records (January 2003-September 2011) were reviewed for dogs that had TPLO. Type of implant used (locking plate and screw fixation [LP] and dynamic compression plate and screw fixation [NLP]), use of postoperative antibiotics and presence of postoperative infection were recorded. Multivariate analysis was performed. Forty dogs (21.3%) had clinical signs compatible with postoperative infection. A positive microbiology swab was available in 16/40 cases (40%). Administration of postoperative antibiotics was associated with a lower incidence of infection (P = .006) and the use of NLP was associated with a higher incidence of infection (P = .01). Use of LP construct and postoperative antibiotic therapy significantly decreased infection rate in dogs >50 kg that have TPLO.

Plate fixation for management of plantar instability of the distal tarsus/proximal metatarsus in 5 horses

To report plate fixation for management of traumatic injuries resulting in plantar instability of the proximal intertarsal (PIT) and tarsometatarsal (TMT) joints. Case series. Medical records (October 1988 to August 2007) of horses that had internal fixation of the distal aspect of the tarsus were reviewed. Horses that had a broad dynamic compression plate (DCP) or broad locking compression plate (LCP) applied on the plantar-lateral aspect of the tarsus extending from the proximal calcaneus to the proximal one third of the metatarsus were included. Signalment, clinical signs, radiographic findings, time to surgery, implant type, postoperative management and complications were recorded. Long-term (>1 year) outcome was obtained for 4 horses. Five horses were treated, 4 had DCP fixation and 1 had LCP fixation. Subluxation of the proximal intertarsal joint was treated in 3 horses and 2 horses had fractures of the distal tarsal bones or proximal aspect of the metatarsus. Perioperative complications included peroneus tertius rupture (2 horses) and postoperative infection.(1) Four horses were discharged and 1 year after surgery were considered sound at pasture; 3 horses were sound enough for limited riding. Plate fixation provides adequate strength and stability for successful management of injuries that result in plantar instability of the tarsus and proximal metatarsus.