Dynamic Compression Plate Research Articles

Fretting corrosion tests on orthopedic plates and screws made of ASTM F138 stainless steel

Introduction Although there has been significant progress in the design of implants for osteosynthesis, the occurrence of failures in these medical devices are still frequent. These implants are prone to suffer from fretting corrosion due to micromotion that takes place between the screw heads and plate holes. Consequently, fretting corrosion has been the subject of research in order to understand its influence on the structural integrity of osteosynthesis implants. The aim of this paper is to correlate the surface finish characteristics of bone plate-screw systems with fretting corrosion. Methods The surface finish (machined and polished) of five specimens taken from three commercial dynamic compression plates (DCP) were evaluated. For testing, the specimens were fixed with bone screws, immersed in a solution of 0.90% NaCl and subjected to a rocking motion with an amplitude of 1.70 mm and frequency of 1.0 Hz for 1.0 × 106 cycles, according to the ASTM F897 standard. Both, plate and screws were manufactured in Brazil with ASTM F138 stainless steel. Results Flaws on the hole countersink area and on the screw thread of some specimens were identified stereoscopically. At the end of the test all the specimens showed evidence of fretting corrosion with an average metal loss of 4.80 mg/million cycles. Conclusion An inadequate surface finish in some areas of the plates and screws may have favored the incidence of damage to the passive film, accelerating the fretting corrosion at the interfaces between the plate hole countersink and the screw head. Keywords Osteosynthesis, DCP, Bone plate, Screw, Fretting corrosion, Stainless steel.

Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle.

This review covers two conditions: acute clavicle fractures and non-union resulting from failed fracture healing. Clavicle (collarbone) fractures account for around 4% of all fractures. While treatment for these fractures is usually non-surgical, some types of clavicular fractures, as well as non-union of the middle third of the clavicle, are often treated surgically. This is an update of a Cochrane review first published in 2009. To evaluate the effects (benefits and harms) of different methods of surgical treatment for acute fracture or non-union of the middle third of the clavicle. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (27 June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 5), MEDLINE (1966 to June week 3 2014), EMBASE (1988 to 2014 week 25), LILACS (1982 to 27 June 2014), trial registries and reference lists of articles. We applied no language or publication restrictions. We considered randomised and quasi-randomised controlled trials evaluating any surgical intervention for treating people with fractures or non-union of the middle third of the clavicle. The primary outcomes were shoulder function or disability, pain and treatment failure (measured by the number of participants who had undergone or were being considered for a non-routine secondary surgical intervention for symptomatic non-union, malunion or other complications). Two review authors selected eligible trials, independently assessed risk of bias and cross-checked data. Where appropriate, we pooled results of comparable trials. We included seven trials in this review with 398 participants. Four trials were new in this update.The four new trials (160 participants) compared intramedullary fixation with open reduction and internal fixation with plate for treating acute middle third clavicle fractures in adults. Low quality evidence from the four trials indicated that intramedullary fixation did not result in a clinically important improvement in upper arm function (despite a statistically significant difference in its favour: standardised mean difference 0.45, 95% confidence interval (CI) 0.08 to 0.81; 120 participants, three trials) at long term follow-up of six months or more. Very low quality evidence indicated little difference between intramedullary fixation and plate fixation in pain (one trial), treatment failure resulting in non-routine surgery (2/68 with intramedullary fixation vs. 3/65 with plate fixation; risk ratio 0.69, 95% CI 0.16 to 2.97, four trials) or time to clinical fracture consolidation (three trials). There was very low quality evidence of a lower incidence of participants with adverse events (mainly infection, poor cosmetic result and symptomatic hardware) in the intramedullary fixation group (18/68 with intramedullary fixation vs. 27/65 with plate fixation; RR 0.64, 95% CI 0.39 to 1.03) but the CI of the pooled results also included the small possibility of a lower incidence in the plate fixation group. None of the four trials reported on quality of life or return to previous activities. Evidence is pending from two ongoing trials, with planned recruitment of 245 participants, testing this comparison.There was low or very low quality evidence from three small trials, each testing a different comparison. The three trials had design features that carried a high risk of bias, potentially limiting the reliability of their findings. Low-contact dynamic compression plates appeared to be associated with significantly better upper-limb function throughout the year following surgery, earlier fracture union and return to work, and a reduced incidence of implant-associated symptoms when compared with a standard dynamic compression plate in 36 adults with symptomatic non-union of the middle third of the clavicle. One quasi-randomised trial (69 participants) compared Knowles pin versus a plate for treating middle third clavicle fractures or non-union. Knowles pins appeared to be associated with lower pain levels and use of postoperative analgesics and a reduced incidence of implant-associated symptoms. One study (133 participants) found that a three-dimensional technique for fixation with a reconstruction plate was associated with a significantly lower incidence of symptomatic delayed union than a standard superior position surgical approach. Evidence is pending from two ongoing trials, with planned recruitment of 130 participants, comparing anterior versus superior plates for acute fractures. There is very limited and low quality evidence available from randomised controlled trials regarding the effectiveness of different methods of surgical fixation of fractures and non-union of the middle third of the clavicle. The evidence from four ongoing trials is likely to inform practice for the comparisons of intramedullary versus plate fixation and anterior versus superior plates for acute fractures in a future update. Further randomised trials are warranted, but in order to optimise research effort, these should be preceded by research that aims to identify priority questions.

Comparative failure analysis of allograft constructs stabilized with compression plates utilizing unicortical versus bicortical screws with or without PMMA

Orthopaedic internal fixation is subject to high stress concentration around screw holes leading to screw loosening. We compared the screw pullout strength (n=8), and bending and torsional stiffness (n=6) for cadaveric (young adult donors age 45years or less) diaphyseal bone constructs with a gap and stabilized with Zimmer 4.5 narrow stainless steel dynamic compression plates with 4.5mm cortical stainless steel screws placed in a unicortical or bicortical manner with and without intramedullary PMMA. The pullout strength for unicortical fixation with PMMA (4.3±.6kN) was not significantly different with bicortical fixation with PMMA (5.3±1.5kN), n=8, P>.5; and for the group with bicortical fixation without PMMA (4.3±1.1kN), n=8, P>.5. The difference in bending stiffness for the group with two unicortical screws fixation with PMMA (324.1±59.7kN/m) was also not statistically significant when compared with the groups with four bicortical screws fixation without PMMA (278.7±89.6kN/m) and two bicortical screws fixation with PMMA (347.9±66.7kN/m), n=6, P>.1. The difference in torsional stiffness for the group with two unicortical screws fixation with PMMA (173±44Nm/deg) was not statistically significant when compared with the groups with four bicortical screws fixation without PMMA (190±22Nm/deg), two bicortical screws fixation with PMMA (179±36Nm/deg), and two bicortical screws fixation with PMMA (193±31Nm/deg), n=6, P>.5. The use of PMMA in allograft fixation appears to allow the use of fewer screws, and perhaps unicortical fixation without significant compromise of strength. Clinically, two unicortical screws with PMMA may replace the use of two bicortical screws without PMMA, or two bicortical screws with PMMA may replace four bicortical screws. The clinical relevance would be the ability to use fewer screws and reduce violation of the far cortex of the allograft.

A Neglected Unusual Galeazi Fracture Dislocation In 12 Years Child: Management

A galeazi fracture is defined as a fracture of the shaft of the radius with dislocation of the distal radioulnar joint (DRUJ). Isolated radial shaft fractures with or without DRUJ dislocation in children are unusual in clinical practice. If there is fracture the degree of angulation is measured and accordingly managed. A 12 years boy came to the casualty department of Community Based Medical College Hospital Bangladesh (CBMCH,B) with the history of fall from bicycle on out stretcher right hand 5 years back, diagnosed to have fracture shaft of right radius. X-ray examination revealed old fracture at the junction of the middle and lower third of right radial shaft with feature of nonunion with volar angulation 30° (180-1500) and interosseous angulation 150 (180-165°). Patients was operated by open reduction and internal fixation (ORIF) of the fracture using dynamic compression plate (DCP) and screws and we corrected the angulation to near normal status and also correction of DRUJ done to its near normal anatomy. Postoperatively wound healed well and patient achieved full range of motion by three weeks. Radiologically the fixation was satisfactory and at the 6 weeks fracture was united. In conclusion, an old unusual galeazzi fracture dislocation in a child below 14 years with volar / dorsal / interosseus angulation more than 150 and rotational angulation more than 30° must be managed surgically to get near normal anatomy of bone as well as near normal range of motion.
 CBMJ 2015 January: Vol. 04 No. 01 P: 41-44

Stacked-Blade, Single-Cut, Ulnar-Shortening Osteotomy

The authors reviewed a 10-year consecutive series of ulnar-shortening osteotomies using a freehand, single oblique cut with 2 or 3 stacked saw blades. Twenty-one patients (23 wrists) with chronic ulnar impaction syndrome (mean age, 45 years; range, 16 to 73 years) demonstrated an average preoperative ulnar variance of +2.1 mm (range, 0.0 to 4.0 mm). An oblique osteotomy was performed in the distal one-third of the ulnar diaphysis at an estimated 45° or 60° angle, relative to the ulnar axis, and was fixed with a 7-hole, 2.7- or 3.5-mm dynamic compression plate placed dorsally. Using a previously described formula, the authors estimated ulnar shortening on the basis of intraoperative measurement of kerf width and osteotomy angle as 3.3 mm (range, 2.3 to 4.7 mm). The actual measured average radiographic change in ulnar variance (preoperative to postoperative) was 2.8 mm (average 18% variance from intraoperative estimate). Final ulnar variance averaged -0.6 mm (range, -2.0 to 1.0 mm). Radiographic union occurred in all 23 (100%) osteotomies. Ten (43%) wrists required hardware removal for pain; 2 additional patients were symptomatic but declined removal. Ulnar-sided wrist pain was relieved in 22 wrists. This technique is simple, effective, and inexpensive. It can also be translated for use in shortening osteotomies for other long bones, although larger or smaller saw blades may be necessary for larger or smaller bones to achieve the desired amount of shortening. The authors' results also show it to be reasonably predictable, although the intraoperative use of a sterile goniometer for cut placement is recommended.

Screw insertion in osteoporotic bone: turn-of-the-nut and torque-based techniques provide similar resistance to bone plate slippage.

To measure the resistance to plate slippage provided by a screw inserted to various torsional and rotational endpoints. A 7-hole, 3.5-mm narrow dynamic compression plate was affixed to an osteoporotic humeral shafts using screws inserted: (1) to 90 degrees after plate contact, (2) to 180 degrees after plate contact, (3) by the 1.4-N·m torque limit method, and (4) by the "2-fingers tight" method. The resistance of the plate to sliding against the bone was measured using a materials testing machine. We checked for an effect of screw insertion method on bone-plate slippage with a general linearized latent and mixed model, controlling for bone mineral density, sex, and specimen clustering. Significance was set at P < 0.05. The force required to slip the plate for 180 degrees of screw rotation was not significantly greater than that of the other insertion groups. Inserting screws 180 degrees after seating can be expected to yield plate contact to bone similar to that of the "2-fingers tight" standard.

Patient-related factors influencing ulnar-shortening osteotomy outcomes using the trimed dynamic compression plate.

Ulnocarpal impingement can be surgically managed with various shortening osteotomy techniques. The purpose of this study was to retrospectively examine the outcomes of the ulnar-shortening osteotomy technique using the Trimed dynamic compression plate (Valencia, California) and to determine whether results vary among patient-related factors, including smoking status, occupation, preoperative diagnosis, and workers' compensation status. Twenty-seven patients (28 wrists) operated by a single surgeon underwent ulnar shortening over a 4-year span. Radiographic analysis was obtained preoperatively and at an average 24-month follow-up. A subset of 12 patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) inventory; the Patient-Rated Wrist Evaluation (PRWE); and the visual analog scale for pain and underwent clinical evaluation for range of motion and strength. Ulnar variance improved in all cases between pre- and postoperative imaging (P<.05). Grip strength and range of motion were found to be 79% and 90% of the contralateral extremity, respectively. Among the examined patient-related factors, patients involved in a workers' compensation claim demonstrated significantly different DASH (average, 56.8 claim vs 26.8 no claim; P=.037) and PRWE (average, 66.0 claim vs 32.8 no claim; P=.008) scores while also showing a trend toward nonunion (3/10 claim vs 1/18 no claim; P=.105). Results of ulnar-shortening osteotomy using the Trimed system at 2-year follow-up show consistent objective improvements in radiographic ulnar variance. Workers' compensation claims may negatively influence outcomes of ulnar shortening, and this factor should be considered in preoperative patient selection and counseling.

English

AIMS AND OBJECTIVES: To study the fractures, mechanism of injury, union rates and functional results of humeral shaft fractures treated with open reduction and internal fixation with dynamic compression plate. RESULTS: In present study, 25 patients of diaphyseal fractures of humerus, surgically managed by dynamic compression plate & screws, between October 2012 to September 2014 in government general hospital attached to kurnool medical college were included. The average age of the patient is 38.9 years, road traffic accidents being the most common mode of accident with 72%, middle third fractures were commonest with 80%, transverse fractures were the commonest with 52%, anterolateral approach was used in 88%, union achieved in 88% with mean time for union 15.56 weeks, iatrogenic radial nerve palsy in 4%, postoperative infection in 4%, full range of movements in 80%, with 8% nonunion. CONCLUSION: By the analysis of the data collected in the present study, dynamic compression plate & screws remains the implant of choice in the management of diaphyseal fractures of humerus.

Contact Analysis for Coupling of Plates and Screws in Fracture Fixation of Cortical Bone

Internal fixation is a common treatment for bone fracture. Bone fracture occurs due to different reasons such as motor vehicle accidents, falling,...etc. The treatment is performed by fixing plate and screws to the fracture site. Lack of stability of the implants (plates and screws) may lead to delay in healing or failure of treatment. Micro-motion between the implant and the bone may cause formation of fibrous tissue around the screw which will lead to implant loosening. On the other hands, firm fixing of the conventional implants (Dynamic Compression Plates) may lead to delay resorption and delay in healing. Recently, Locked Compression Plates were introduced to get over the shortcomings of the existing Dynamic Plates. In Locked Plates the hole and screw head were threaded to provide more stability and reduce contact with the bone surface. In this communication we conducted computational analysis to compare the stability of both sets of implants. Results have revealed that Locked Plates provide more stable fixation and resistance to micro-motion. However, stress shielding might occur which will delay healing. Future designs of the Locked Plates can focus on improving stability and reducing damage to blood supply which will shorten the Short Research Article Gailani et al.; AIR, 4(2): 94-101, 2015; Article no.AIR.2015.065 95 healing period. Computational analysis (finite element analysis) can be effectively used to guide these future designs.

Comparative study of functional outcome of Dynamic compression plating with Intramedullary Interlocking nailing in close fracture shaft of humerus in adults

Background and objective: To compare the results of dynamic compression plating and intramedullary interlocking nailing in treatment of closed fracture shaft humerus in adults with reference to study Functional outcome, Rate of healing, Complications between two groups. Methods: 48 adult patients with closed fracture shaft humerus were randomly assigned in to two groups after informed consent. Both groups were investigated in usual manner. Group A (ILN group) with 25 patients were treated with intramedullary interlocking nailing and group B (DCP group) with 23 patients were treated with Dynamic compression plating. The patients were followed up every four weeks till radiological union was seen. Disabilities of Arm, Shoulder and Hand (DASH) Questionnaire was used for functional outcome measurement. Results: Time taken for radiological healing is more in DCP group but it was statistically not significant. According to DASH score functional outcome assessment more excellent result found in DCP group than ILN group. Postoperative complication rate is higher in ILN group which was statistically significant. Conclusion: Both dynamic compression plating and interlocking nailing are good with respect to union of the fracture but with respect to the functional outcome and rate of complications, we are of the opinion that dynamic compression plating offers better result than interlocking nailing. Key words: Humerus shaft fracture, interlocking nailing, dynamic compression plating, DASH Score

Comparative Study of Interlock Nailing Versus Dynamic Compression Plating in Fractures of Tibia – A Study of Sixty Cases

Background: In modern era high speed vehicular traffic accidents fractures of the tibial shaft are common injuries among the long bones and mainly affect young adults, i.e. individuals at their peak of physical and work capacity. The present study was a comparative study between interlock nailing and Dynamic compression plating (DCP) in the treatment of fractures of tibia. The purpose of the study was to determine the outcome and comparing the two different modalities of the treatment. Material methods: The Study includes sixty consecutive patients with fracture tibia [ closed and open Gustio & Anderson grade 1 only] treated with Dynamic compression platting and interlock nailing 30 in each group and were assessed clinically and radiologically and followed up to three years. Results: 90% patients had good to excellent results with 10% having fair results and no poor results. In DCP group there were 10 excellent, 15 good and 5 fair results whereas in interlock nailing group 15 patients had excellent, 14 patients had good results and 1 patient showed fair result. Conclusion: We conclude that DCP is a better mode of fixation for proximal and distal tibial facture and interlock nailing is ideal implant in diaphysial and segmental fractures. Key words: Fracture, Tibia, Interlock nail, DCP, Implants, Diaphysial fracture. Mesh Terms: Adult, Fracture fixation, Age, Male female, Infection

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

Surgical treatment of acute displaced midshaft clavicular fractures with plates

Background Plate fixation of acute displaced midshaft clavicular fractures has been shown to decrease nonunion, symptomatic malunion, and residual shoulder disability compared with nonoperative treatment. Materials and methods Our study included 16 patients with acute displaced midshaft clavicular fractures who were treated with open reduction, and internal fixation with 3.5 mm reconstruction plates in 14 patients and small dynamic compression plates (DCP) in two patients. Results Our series included 16 patients, all the fractures achieved union with no complications. Conclusion Plate fixation of displaced clavicle fractures is a safe procedure resulting in excellent functional outcomes, with an early return to the normal activities.

English

BACKGROUND: Diaphyseal fracture of the Humerus is a common fracture in the upper limb. Various treatment modalities like P.O.P, Plate and nail are used in the treatment. Limited Contact Dynamic compression plate has been promoted by some as a better plate than the Dynamic Compression Plate. The aim of our study is to find the difference between the mean duration of union between the DCP and the LCDCP in diaphyseal fractures of the Humerus and to find the difference in the functional outcome as measured by the DASH questionnaire. MATERIALS AND METHODS: From October 2004 and December 2005, thirty patients with Diaphyseal fractures of the humerus were treated with compression plating by compression plating using Dynamic Compression Plate or Limited Contact Dynamic Compression Plate. The time taken for radiological union in the two groups was noted and the difference in the time between the two groups was calculated. After radiological union occurred, the functional outcome was assessed by the Disabilities of Hand, Shoulder and Elbow (DASH) Questionnaire. RESULTS: There was no statistically significant difference in the two groups with respect to age, sex, mode of injury, side of injury and AO type. The average time taken for union in the DCP group was 16.53 weeks and in the LCDCP group it was 15.86 groups. The average time for union in all the thirty patients was 16.2 weeks. The functional outcome was excellent in 17 patients (8 in the DCP group and 9 in the LCDCP group) and good in 13 patients (7 in the DCP group and 6 in the LCDCP group). CONCLUSION: Since we found no statistically significant difference in the time taken for union and the functional outcome between the two groups, we conclude that the theoretical advantage of the LCDCP does not translate into clinical advantage when used in Diaphyseal fractures of the humerus.

Ilizarov external fixation versus plate osteosynthesis in the management of extra-articular fractures of the distal tibia.

The purpose of this study was to evaluate the outcome of Ilizarov external fixation (IE) versus dynamic compression plate (PO) in the management of extra-articular distal tibial fractures. Between 2010 and 2011, extra-articular distal tibial fractures in 40 consecutive patients met the inclusion criteria. They were classified according to AO classification fracture type A (A1, A2, and A3). In a randomized method, two equal groups were managed using either IE or PO. PO was performed using open reduction and internal fixation (ORIF) and DCP through anterolateral approach. IE was done using Ilizarov frame. For the PO group, non-weight bearing ambulation was permitted on the second postoperative day but partial weight bearing was permitted according to the progression in union criteria clinically and radiologically. For the IE group, weight bearing started as tolerated from the first postoperative day. Physiotherapy and pin-site care was performed by the patient themselves. Modified Mazur ankle score was applied to IE (excellent 10, good 10) and in PO (excellent 2, good 8, poor 6). Data were statically analysed using (Mann-Whitney test). The rate of healing in the IE group (average 130) was higher than the PO (average 196.5); plus, there were no cases of delayed union or nonunion in the IE group (p value 0.003). It was found that IE compared with PO provides provision of immediate weight bearing as tolerated following postoperative recovery, irrespective of radiological or clinical healing with no infection, deformity or non-union.

Reasons why dynamic compression plates are inferior to locking plates in osteoporotic bone: a finite element explanation

While locking plate fixation is becoming increasingly popular for complex and osteoporotic fractures, for many indications compression plating remains the standard choice. This study compares the mechanical behaviour of the more recent locking compression plate (LCP) device, with the traditional dynamic compression plates (DCPs) in bone of varying quality using finite element modelling. The bone properties considered include orthotropy, inhomogeneity, cortical thinning and periosteal apposition associated with osteoporosis. The effect of preloads induced by compression plating was included in the models. Two different fracture scenarios were modelled: one with complete reduction and one with a fracture gap. The results show that the preload arising in DCPs results in large principal strains in the bone all around the perimeter of the screw hole, whereas for LCPs large principal strains occur primarily on the side of the screw proximal to the load. The strains within the bone produced by the two screw types are similar in healthy bone with a reduced fracture gap; however, the DCP produces much larger strains in osteoporotic bone. In the presence of a fracture gap, the DCP results in a considerably larger region with high tensile strains and a slightly smaller region with high compressive strains. These findings provide a biomechanical basis for the reported improved performance of locking plates in poorer bone quality.

Reconstruction of the distal radius with non-vascularised fibular graft after resection of giant cell tumour of bone.

To evaluate outcomes of wide resection and reconstruction of the distal radius with non-vascularised autogenous fibular grafts for giant cell tumour (GCT) of bone. Medical records of 7 men and 5 women aged 22 to 47 (mean, 31) years who underwent wide resection of the distal radius and reconstruction with non-vascularised autogenous fibular grafts for GCT of bone were reviewed. The mean length of the resected radius was 9 (range, 7-11) cm. The ipsilateral proximal fibula with a small portion of attached ligament was harvested. The articular surface of the graft was fixed to the scapholunate articular surface by Kirschner wires, and the ligament of the fibular head was sutured to the carpal ligaments. The graft was fixed to the proximal radius with a small dynamic compression plate. Iliac cancellous bone graft was added. Pain, instability, and functional status were assessed. Wrist joint movements were measured using a goniometer. The grip strength was measured. The operated and contralateral sides were compared. The mean follow-up was 24 (range, 20-27) months. All patients achieved radiological union after a mean of 16 (range, 14-20) weeks. The mean active range of movement in the operated wrists was 32º dorsiflexion, 38º palmar flexion, 15º radial deviations, 12º ulnar deviations, 50º supination, and 60º pronation. Compared with the contralateral wrists, the operated wrists regained 60% of the function, with satisfactory grip strength, and normal finger and thumb movements and hand sensation. No patient had recurrence after 2 years. Two patients had minor dorsal subluxation, which was resolved with a wrist brace. Three patients had superficial infection, which was resolved with intravenous antibiotics and dressings. Two patients had peroneal nerve palsy, which recovered completely in 12 weeks. Non-vascularised fibular grafts for reconstruction of the distal radius after resection of a GCT of bone achieved good cosmetic and functional outcomes.

Internal fixation of shaft humerus fractures by dynamic compression plate or interlocking intramedullary nail: a prospective, randomised study.

Compare the results of internal fixation of shaft of humerus fractures using dynamic compression plating (DCP) or antegrade interlocking intramedullary nail (IMN). Fifty patients with diaphyseal fracture of the shaft of the humerus and fulfilling the inclusion criterion were randomly assigned to one of the two groups. Twenty-five patients were managed with closed antegrade interlocking intramedullary nail, and 25 underwent open reduction and internal fixation using dynamic compression plating. The mean age of patients with IMN fixation was 37.28 years (SD 12.26) and 37.72 years (SD 12.70) for those who underwent plating. Road traffic accident was the most common mode of injury in both groups. There was a statistically significant difference between the two groups with respect to duration of hospital stay, operative time and blood loss. There was no significant difference between the two groups in terms of union or complications. The functional assessment at the end of 1 year between the two groups did not show any significant difference in outcome. Antegrade interlocking IMN and DCP fixation are comparable when managing diaphyseal shaft of humerus fractures with respect to union rates and complications. Although shoulder related complications are more in the IMN group, however, it is associated with shorter hospital stay, lesser operative time and less blood loss. This makes interlocking IMN an effective option in managing these fractures.

Removal of forearm plate leads to a high risk of refracture: decision regarding implant removal after fixation of the forearm and analysis of risk factors of refracture.

Plate fixation is the gold standard for the treatment of forearm fractures at present, and whether or not to remove the implant after bone union remains controversial. This study demonstrated some cases of refracture in adult forearm fractures after bone union and discussed the risk factors for decision-making regarding implant removal. We reviewed patients with forearm diaphyseal fractures (including the radius, ulna, or both bones) who received open reduction and internal fixation (ORIF) from January 2008 to May 2011 in our institute. Fracture type was classified according to the AO/OTA system. All patients were fixed with a 3.5-mm dynamic compression plate. The patients were divided into two main groups: group A received implant removal after bone union, and group B retained the implant. There were 122 patients (170 bones) included in this study (40 females and 82 males). In group A, 7/51 patients (8/62 bones; 12.9 %) had refracture. As classified by the AO/OTA classification, one patient was classified as type A1, one patient as type A2, two patients as type A3, and three patients as type B3. All patients suffered refracture without high-energy trauma. In group B, the refracture rate was 2.77 %, and all were caused by high-energy trauma. Patients with refracture had a shorter time interval between ORIF and implant removal. The possible risk factors of refracture in this study included a wedge bone defect on plain film, implant removal performed after less than 18 months, and AO/OTA type B fracture. The incidence of refracture was significantly lower in the group that retained the implant. Routine implant removal after bone union in adult forearm fractures is not recommended due to the higher refracture rate.

Arthroscopically Assisted Shoulder Arthrodesis: Is It an Effective Technique?

The purpose of this study was to compare clinical and radiographic outcomes of open and mini-open arthroscopic arthrodesis. Twelve patients underwent arthroscopically assisted glenohumeral arthrodesis over a 5-year period; none were lost to follow-up. Surgery was performed with the patient in the lateral decubitus position, with the arm positioned in 30° each of flexion, internal rotation, and abduction. The articular cartilage was arthroscopically removed from the humerus and glenoid, creating flat opposing surfaces. One to 2 Kirschner wires were inserted percutaneously through the deltoid and across the glenohumeral joint in the center of the articulation; screws were then inserted arthroscopically. The glenohumeral joint was accessed through a mini-open posterior approach beneath the deltoid and was then reassessed before cannulated screws were tightened completely to compress the joint. Two dynamic compression plates were applied to the posterior glenohumeral joint to neutralize rotatory forces. Each patient was immobilized for 6weeks. Follow-up radiographic imaging was performed at 2, 6, 12, and 24months after surgery. These patients were then compared with a similar group who underwent a classic open approach. Success of arthrodesis was determined by bone growth across the glenohumeral joint as visualized on axillary radiographs. At 2-year follow-up, complete fusion was achieved in 12 (100%) arthroscopically treated patients, with 2 patients (17%) having early bone grafting (within 6weeks) through a percutaneous approach. Four patients in the classic open approach group ("open group") required additional grafting. Two patients in the group undergoing arthroscopic surgery ("arthroscopic group") had solid fusion but persisting infection from previously failed operations. Comparison of the 2 groups showed no difference in patient satisfaction or infection rates (2 in each group, all of whom had active infection at the time of the index surgery). One patient in the open group sustained a humeral shaft fracture 5years after arthrodesis, which required additional surgery. No patient who underwent an arthroscopic procedure required additional surgery other than the 2 early bone grafts. Arthroscopically assisted mini-open glenohumeral arthrodesis provides results that are at least equal to those of open arthrodesis, with a much less invasive approach. Success and complication rates are the same as for the completely open procedure. Level IV, therapeutic case series.