Plate Fixation Research Articles

Outcome of Complex Coronal Shear Fractures of the Distal Humerus (Dubberley Type 3) Managed by the Transolecranon Approach.

Complex distal humerus coronal shear fractures are rare injuries. These fractures involve small articular fragments and are challenging to fix. Aprospective case series of 10 patients was done at a level 1 trauma centre between February 2017 and July 2021. Dubberley type 3 fractures were included in the study. All patients underwent ORIF using posterior approach with olecranon osteotomy by a single surgeon.Patients were followed up for a minimum of 12months postoperatively. The primary outcome measures were radiographic union and functional status of the limb (DASH score and MEPI score). All patients achieved radiographic union of fracture as well as the osteotomy. The mean DASH score as measured on the final follow-up was 12.6 ± 10.2 and the mean MEPI score was 90 ± 8.2. None of the cases needed reoperation. Consistently good functional outcomes can be obtained in complex coronal shear fractures by posterior approach with olecranon osteotomy. Dubberley type 3b patients should undergo additional plate fixation.

SOME CLINICAL CHARACTERISTICS OF ADULT PATIENTS TREATED BY OSTEOSYNTHESIS METHOD FOR THE PROXIMAL HUMERUS FRACTURE

Objectives: To describe some clinical characteristics of adult patients with closed proximal humerus fracture (PHF), treated by osteosynthesis method with locking plate. Subjects and methods: Adult patients who were closed PHF treated by open reduction and locking plate fixation at Military hospital 175. Report of a retrospective study conducted on 42 clinical cases. Results: The average age for both gender was 51.38 ± 14.63, the age group over 60 accounted for 26.19%. The ratio of female/male patients was 1.1/1, the difference was not statistically significant (p>0.05). The cause of injury due to traffic accidents (TA) accounted for the highest rate at 73.81%, due to daily life accidents (DLA) accounted for 21.43%, and due to work accidents (WA) accounted for 4.76%. Anatomical damage of PHF according to the classification of author Neer C.S. on X-ray, including groups III, IV, V, VI, 3-part fractures accounted for the highest proportion with 54.76%. Conclusion: The patients in the study group were mostly middle-aged from 18 to 60 years old. The main cause of TA was the age group from 18 to 60, which was the group with a large traffic demand (accounting for 80.64%), the majority of injuries had 3-4 broken parts (accounting for 61.29%), due to DLA, mainly in the group of people over 60 years old (accounting for 55.56%) with 3-4 broken parts accounting for 66.67%.

Evaluation and Management of Posterior Tibial Plateau Fractures.

Tibial plateau fractures are caused by high-energy or low-energy trauma and result in complex injuries that require careful management of both osseous injuries and associated soft tissues. The posterior aspect of the tibial plateau can be involved in a variety of fracture patterns, requiring systematic evaluation, imaging, and advanced surgical planning to address these complex injuries. Early classification systems failed to classify posterior plateau fractures; however, three-dimensional imaging and newer classification schemes, including the Quadrant System and 3D systems, have incorporated posterior column lesions. There has been a growing body of literature focused on fixation principles and plating options for posterior column fractures. Furthermore, there are multiple approaches for surgeons to choose between, including a direct posterior, posteromedial, posterolateral (including Lobenhoffer and lateral condyle osteotomy), and combined posterior approach. This article presents a guide for managing posterior tibial plateau fractures, including the initial evaluation and management, descriptions of the surgical approaches, principles of fixation, and the associated outcomes and complications.

3D-printed Multifunctional Guide Plate for Fenestration and Screws Drill in Proximal Femoral Benign Tumor.

The accurate fenestration, screw implantation and assisting stabilizing-plate placement in surgery of benign tumors in the proximal femur needs be defined easily. The aim of this study was to investigate the value of 3D printed multifunctional guides plate (3D-MGP) based on computer aided design. Between January 2020 and June 2022, 17 patients (nine females and eight males) with benign proximal femoral tumor had lesion curettage and allograft combined with internal plate fixation using 3D-MGP. In this study, the patients had CT scans and a technician reconstructed the 3D images of tumor and the femur, a doctor designed the location and margin of the fenestration and screws, and integrated different functions into MGP for benign proximal femoral lesions, which assisted in precise localization, fenestration and screw drilling. Musculoskeletal Tumor Society (MSTS) scoring was used to evaluate lower extremity function. Bone healing and the screws location was assessed with the radiographs. All patients underwent successful surgery with complete resection of the tumor and internal fixation with using the 3D-MGP. The mean follow-up was 16.4 months. The operative time was 126.47 ± 18.44 min, intraoperative bleeding was 198.23 ± 67.94 mL, intraoperative fluoroscopy was 6.47 ± 0.62, postoperative drainage was 223.82 ± 119.51 mL, and MSTS score was 27.29 ± 1.31 points. There were no unplanned fenestration and improper screw fixation. The 3D-MGP enabled personalized and accurate location of tumor, fenestration, screw placement and assisted stabilizing-plate placement for the treatment of benign tumor of the proximal femur. This technique has the potential to shorten operative times, decrease intraoperative bleeding, and reduce radiation exposure to patients.

Comparison of the biomechanical behavior between commercial and 3D-printed patient-specific Ti6Al4V L-Shaped titanium plates following le fort i osteotomy using finite element analysis: A technical Note

ObjectiveTo evaluate and compare the biomechanical behavior of three-dimensionally (3D) printed patient-specific Ti6Al4V with commercially made titanium mini plates following Lefort-I osteotomy using finite element analysis. MethodsLe Fort I osteotomy was virtually simulated with a 5 mm maxillary advancement and mediolateral rotation in the coronal plane, resulting in a 3 mm gap on the left side's posterior. Two fixation methods were modeled using software to compare 3D-printed Ti6Al4V and commercial titanium mini plates, both featuring a 4-hole l-shape with thicknesses of 0.5 mm and 0.7 mm at the strategic piriform rim and zygomaticomaxillary buttress locations. Using ANSYS R19.2, finite element models were developed to assess the fixation plates and maxilla's stress, strain, and displacement responses under occlusal forces of 125, 250, and 500 N/mm². ResultsThis comparative analysis revealed slight variation in stress, strain, and displacement between the two models under varying loading conditions. Stress analysis indicated maximum stress concentrations at the vertical change in the left posterior area between maxillary segments, with the Ti6Al4V model exhibiting slightly higher stress values (187 MPa, 375 MPa, and 750 MPa) compared to the commercial titanium model (175 MPa, 351 MPa, and 702 MPa). Strain analysis showed that the commercial titanium model recorded higher strain values at the bending area of the l-shaped miniplate. Moreover, displacement analysis revealed a maximum of 3 mm in the left posterior maxilla, with the Ti6Al4V model demonstrating slightly lower displacement values under equivalent forces. ConclusionThe maximum stress, strain, and segment displacement of both fixation models were predominantly concentrated in the area of the gap between the maxillary segments. Notably, both fixation models exhibited remarkably close values, which can be attributed to the similar design of the fixation plates.

VARIABLE ANGLE LOCKING PLATE VERSUS MULTIPLE K WIRE FIXATION FOR INTRA-ARTICULAR DISTAL RADIUS FRACTURE: A PROSPECTIVE COMPARATIVE STUDY OF FUNCTIONAL OUTCOME IN ELDERLY

Distal radius fracture (DRF) is a common wrist injury and it accounts for about one-sixth of emergency department visits. In spite of availability of various treatment options, none is universally effective for comminuted intraarticular fracture, because of varied fractures patterns. Two commonly used surgical methods are multiple K-wire fixation and open reduction and internal fixation by variable angle locking plates. Objective of the study was to compare functional outcomes of variable angle locking plate and multiple K wire fixation for intra-articular distal radius fracture in elderly. Prospective observational study was conducted among the patients of distal radius fractures with age more than 50 years. Patients were divided in to two groups with 24 cases in each group. Group one included patients treated with variable angle locking plate and group two included patients treated with multiple K-wires. Post surgery patients were assessed at 6 weeks, 3, 6 and 12 months. Evaluation was done clinically, and the outcomes were assessed by using the Disabilities Arm, Shoulder and Hand (quickDASH) score (primary outcome), Patient-Rated Wrist Evaluation (PRWE) score, range of motion, grip strength and were compared between the groups. Patients treated with variable angle locking plate was found to have better functional outcome than those treated with multiple K-wire initially during the study, but later by the end of the study at 12 months, both groups were found to be having similar outcomes, with no significant difference between the groups. This signifies that among variable angle locking plate and multiple K-wire fixation, no single procedure is superior to the other in long term.

Transmalar Kirshner Wire Fixation Under Ultrasound Scanning is Useful for Unstable Zygomatic Arch Fracture Combined With Zygomatic Body Fracture.

Plate fixation to zygomatic arch fractures carries the risk of facial nerve palsy and scarring of the cheek; however, without plate fixation, bone deviation or displacement may reoccur after surgery. Furthermore, zygomatic arch fractures combined with zygomatic body fractures are more postoperatively unstable than single zygomatic arch fractures. Few reports have focused on this combined fracture type, and no consensus has been reached regarding treatment. Because plate fixation for slight deviation of the zygomatic body has little advantage for stabilization, the authors, usually opt for transmalar pinning alone instead of plate fixation at the hospital. This study is a retrospective case series of 7 patients, among 100 zygomatic fractures excluding isolated zygomatic arch fractures, treated using transmalar pinning under ultrasound scanning. The reduction was performed through the oral and temporal incision as a surgical procedure. Under ultrasound observation, a Kirshner wire was inserted into the zygomatic body from the unaffected side while maintaining the reduced position. The wire was removed at an outpatient visit 2 to 3 months following surgery. In all cases, the zygomatic body was of the laterally rotated type, and postoperative morphologic evaluation showed improvement without postoperative complications. Scores were higher in middle-aged and older than in young people. Correction of zygomatic rotation also scored higher than zygomatic arch morphology. Transmalar Kirshner wire fixation under ultrasound observation is a simple and minimally invasive method for zygomatic arch fractures, which avoids the possible complications related to plate fixation.

A case report: Posterior acetabular deficiency treated with femoral head autograft and hybrid total hip arthroplasty

As a choice for treating acetabular deficiencies, total hip arthroplasty (THA) is beset with many drawbacks, particularly in relation to untreated fractures and post-surgery complications. Furthermore, it is hard to ensure long-term fixation of the acetabular shell. In our case, a 52-year-old male manual laborer presented with complaints of a painful limp of the left lower limb with gross restriction of movements in the left hip joint. Previously, the patient had undergone open reduction and posterior acetabular wall plate fixation 2 years back and implant exit had been done 1 year before due to complaints of pain. We treated the patient with hybrid THA. To rectify the acetabular defect, we used a femoral head autograft, securing it with screws, and supporting it with a plate posteriorly. After 1 year, there was good graft consolidation sans acetabular component displacement as evidenced by radiography. A Harris hip score of 79.7 indicated good functionality. Therefore, hybrid THA with reconstruction is a good option for treating post-traumatic arthritis with acetabular wall deficiencies. Although the procedure is difficult to carry out, it yields better results in terms of lessened pain, enhanced stability, and better functionality.

Comparative Study of Calcaneal Fractures Treated with Percutaneous Screw Fixation and Plate Fixation

Comparative Study of Calcaneal Fractures Treated with Percutaneous Screw Fixation and Plate Fixation

Biomechanical analysis of plate versus K-wire fixation for metacarpal shaft fractures with wedge-shaped bone defects

BackgroundMetacarpal shaft fracture is a common type of hand fracture. Numerous studies have explored fixing transverse fractures in the midshaft of the metacarpal bone. However, this section of the metacarpal bone is often susceptible to high-energy injury, resulting in comminuted fracture or bone loss. In such cases, wedge-shaped bone defects can develop in the metacarpal shaft, increasing the difficulty of performing fracture fixation. Notably, the research on this type of fracture fixation is limited. This study compared the abilities of four fixation methods to fix metacarpal shaft fractures with wedge-shaped bone defects.MethodsIn total, 28 artificial metacarpal bones were used. To create wedge-shaped bone defects, an electric saw was used to create metacarpal shaft fractures at the midshaft of each bone. The artificial metacarpal bones were then divided into four groups for fixation. The bones in the first group were fixed with a dorsal locked plate (DP group), those in the second group were fixed with a volar locked plate (VP group), and those in the third group were fixed by combining dorsal and volar locked plates (DP + VP group), and those in the fourth group were fixed with two K-wires (2 K group). Cantilever bending tests were conducted using a material testing machine to measure yielding force and stiffness. The four groups’ fixation capabilities were then assessed through analysis of variance and Tukey’s test.ResultsThe DP + VP group (164.1±44.0 N) achieved a significantly higher yielding force relative to the 2 K group (50.7 ± 8.9 N); the DP group (13.6 ± 3.0 N) and VP group (12.3 ± 1.0 N) did not differ significantly in terms of yielding force, with both achieving lower yielding forces relative to the DP + VP group and 2 K group. The DP + VP group (19.8±6.3 N/mm) achieved the highest level of stiffness, and the other three groups did not differ significantly in terms of stiffness (2 K group, 5.4 ± 1.1 N/mm; DP group, 4.0 ± 0.9 N/mm; VP group, 3.9 ± 1.9 N/mm).ConclusionsThe fixation method involving the combined use of dorsal and volar locked plates (DP + VP group) resulted in optimal outcomes with respect to fixing metacarpal shaft fractures with volar wedge bone defects.

What to Expect? Use of Supplemental Fixation With a Concomitant Dorsal Spanning Plate for Complex Intraarticular Distal Radius Fractures.

The dorsal spanning plate (DSP) is a versatile implant suitable for bridging severely comminuted intraarticular distal radius fractures [AO (Arbeitsgemeinschaft für Osteosynthesefragen) 23-C.1-C.3]. It may be used alone or with supplemental fixation such as a volar locking plate (VLP) or fragment-specific fixation (FSF). Outcomes following DSP fixation with additional implants have not been specifically evaluated. We retrospectively reviewed consecutive patients who underwent internal fixation of a distal radius fracture by a single surgeon from 2017 to 2021. Patients were grouped according to implants used: DSP only, DSP + FSF, and DSP + VLP. Preoperative variables, treatment times, and wrist range of motion (ROM) were assessed. Functional wrist ROM was defined as minimum 80° combined flexion and extension. One hundred fifty-two patients underwent surgery for wrist fracture, 33 of them were treated with a DSP: 8 DSP only, 6 DSP + VLP, and 19 DSP + FSF. Falls from height greater than 10 ft accounted for 52% of injuries, most of which were treated with a DSP + FSF. Treatment times and ROM were similar between subgroups. Wrist ROM did not improve significantly beyond 4 weeks following DSP removal. Overall, DSP patients recovered a mean wrist ROM of 85° (range 0°-130°) within a median 26 weeks total treatment period (range 12-68 weeks). Regardless of the construct used, if the distal radius articular surface is well reduced and other principles of fracture fixation are applied, most patients treated with a DSP can expect to regain functional wrist ROM. Level IV-Retrospective review of prospectively collected data.

The Impact of a Computer-Based Interactive Informed Consent for Surgery on Decision Conflict

Informed consent for surgery can address the legal aspects of care while also being simple, informative, and empathic. We developed interactive informed consents and compared them with standard printed informed consents asking: (1) are there any factors associated with lower decision conflict or greater patient-rated clinician empathy including consent format? (2) Are there any factors associated with rating the consent process as informative, comfortable, and satisfying including consent format? Ninety-four adult patients accepted an offer of surgery from one of three hand surgeons to address one of six common hand surgery diagnoses: carpal tunnel release, cubital tunnel release, trigger finger release, plate and screw fixation of a distal radius fracture, removal of a benign mass, including a ganglion cyst, and Dupuytren contracture release. Fifty-three patients were randomized to complete an interactive consent, and 41, a standard written consent. Symptoms of anxiety, depression, and unhelpful thoughts were measured. Patients completed the Decision Conflict Scale and the Jefferson Scale of Patient's Perceptions of Physician Empathy and rated the consent as informative, comfortable, and satisfactory on a scale of 0-10. Greater decisional conflict was slightly associated with greater patient unhelpful thoughts about symptoms and was not associated with consent format. A higher rating of comfort with the consent process was slightly associated with patient choice to proceed with surgical treatment, but not with consent format. Accounting for potential confounding in multivariable analysis, a higher rating of the consent process as informative was slightly associated with patient preference for surgical over nonsurgical treatment, CONCLUSIONS: The observation that an interactive consent form was not related to decision conflict or other aspects of patient experience suggests that such tools may not have much weight relative to the interaction between patient and clinician. Efforts to improve informed consent may need to focus on the dialog between patient and surgeon rather than how information is presented.

Tension band versus locking plate fixation for patella fractures - a protocol of a randomised controlled trial.

Following surgical management of patella fractures, patients commonly report pain; difficulties with weight-bearing tasks such as walking, running and climbing stairs; and restrictions in quality of life. Recently, a locking plate system for surgical management of patella fractures has been introduced. To date, no studies have compared standard treatment with tension band wiring with locking plate fixation in a randomised study design. We aim to compare the one-year patient-reported Knee Injury and Osteoarthritis Outcome subscale scores (KOOS5-subscales) after standard care tension band fixation with locking plate fixation for patients with patella fractures. This is a multicentre randomised and prospective clinical trial. A total of 122 patients will be included in the study, and the primary outcome will be the KOOS subscales at 12 months after surgery. Findings from the present study are expected to advance our understanding of outcome following surgical treatment of patella fractures. This study is funded, in part, by the Novo Nordisk Foundation, Denmark. gov ID: NCT04891549.

Résultats à moyen terme des prothèses totales de coude dans le traitement des fractures gériatriques de l’humérus distal

Background: While double plate fixation is the gold standard treatment for distal humerus fractures in the general population, it is the source of many complications in the elderly. Total elbow arthroplasty (TEA) has been proposed as an alternative treatment, with satisfactory short-term functional outcomes. However, little is known about the longevity of the implant and the mid- and long-term complications of this procedure.Materials and methods: A total of 58 TEAs were performed in 57 patients with comminuted distal humerus fractures between September 2008 and September 2019. All patients were clinically (ranges of motion, Mayo Elbow Performance Score [MEPS] and Disabilities of the Arm, Shoulder and Hand [QuickDASH] functional scores) and radiographically assessed. The minimum follow-up was 2 years, and the mean follow-up was 4.7 years.Results: The overall complication rate was 20.7%, with ulnar nerve damage, complex regional pain syndrome, and severe stiffness being the main complications. The mean MEPS was 85.3, and the mean QuickDASH was 28.1. The mean flexion was 122°, and the mean extension was -23.5°. There were no prosthetic revisions. Of these patients, 17% had radiolucent lines, and 13% had bushing wear at the last follow-up.Discussion: TEA is an effective technique for treating comminuted distal humerus fractures in the geriatric population. The prosthesis's mid-term survivorship was highly satisfactory, with a complication rate that remained low and was generally lower than that of osteosynthesis, with identical functional outcomes. TEAs are indicated in elderly patients, for whom maintaining the fullest possible autonomy is paramount. Our findings suggest that TEAs have sufficient longevity to guarantee a functional, pain-free elbow with no need for reoperation.Level of evidence: IV; case series.

Biomechanical comparisons of F.E.R.I. techniques with different type of intramedullary screws fixation for Jones fractures.

Introduction: Jones fractures frequently fail to unite, and adequate fixation stability is crucial. This study aimed to elucidate the biomechanical stability of various intramedullary screw fixation constructs. Methods: Jones fracture model over the proximal 5th metatarsal of artificial bone was created in all specimens. Six groups were divided based on varied screw constructs with different screw lengths, either 30 or 40mm, including cannulated screws-C30 and C40 groups, one high-resistance suture combined with intramedullary cannulated screws (F.E.R.I. technique)-CF30 and CF40 groups, and second-generation headless compression screws (SG-HCS) -HL30 and HL40 groups. Mechanical testing was conducted sequentially, and the maximal force (N) and stiffness (N/mm) of all constructs were recorded. Results: The maximal force (N) at 1.0mm downward displacement in C30, C40, CF30, CF40, HL30, and HL40 groups were 0.56 ± 0.02, 0.49 ± 0.02, 0.65 ± 0.02, 0.49 ± 0.01, 0.68 ± 0.02, and 0.73 ± 0.02, respectively, and the stiffness (N/mm) in subgroups were 0.49 ± 0.01, 0.43 ± 0.01, 0.67 ± 0.01, 0.42 ± 0.01, 0.61 ± 0.01, and 0.58 ± 0.02, respectively. SG-HCS subgroups exhibited greater maximal force and stiffness than conventional cannulated screws. Screws of 30mm in length demonstrated better stability than all 40mm-length screws in each subgroup. In C30 fixation, the stiffness and maximum force endured increased by 1.16 and 1.12 times, respectively, compared with the C40 fixation method. There were no significant differences between CF30 and SG-HCS groups. Only the F.E.R.I technique combined with the 4.5mm cannulated screw of 30mm in length increased the biomechanical stability for Jones fractures. Discussion: These biomechanical findings help clinicians decide on better screw fixation options for greater stability in Jones fractures, especially when large-diameter screws are limited in use. However, this biomechanical testing of intramedullary screw fixation on Jones fracture model lacks clinical validation and no comparisons to extramedullary plate fixations. Moving forward, additional clinical and biomechanical research is necessary to validate our findings.

First Metatarsophalangeal Joint Arthrodesis With Complete Resection of the Subchondral Bone Plate

First metatarsophalangeal arthrodesis is associated with high union rates but there is a wide range of union incidence reported. Whether the subchondral plate is completely resected, is not reported by individual studies and without meticulous care, there is often residual subchondral plate. The primary aim was to report our union rate following first metatarsophalangeal arthrodesis with complete resection of the subchondral plate, locking plate fixation and immediate protected weight bearing. A retrospective case study of 2 surgeons was performed from August 2016 to June 2023. Our study was unique in that all patients had complete resection of the subchondral plate to trabecular bone. One hundred seventeen feet were identified for analysis, in 112 patients following exclusion criteria. Patients were excluded if they had less than 3 months follow-up, revisional surgery or charcot. Demographic data and indications for the procedure were reported. A single construct locking plate with an interfragmentary compression screw through the plate was used in 37 feet and a locking plate with separate interfragmentary compression screw was used in 80 feet. We reported a nonunion incidence of 0.9% (n = 1) with a delayed union incidence of 0.9% (n = 1) and a broken hardware incidence of 0.9% (n = 1). Complete resection of subchondral plate with early weight bearing and locking plate fixation had a high union rate for first metatarsophalangeal arthrodesis. Our results compare favorably with union rates in the literature, where there is often residual subchondral plate.

Salvage fixation of proximal tibia non-union and mal-union with 95° angled blade plates

Introduction: Proximal tibia non-unions and mal-unions can present particular challenges in their management because of a short proximal segment, excessive misalignment and soft tissue compromise. Available options in the management should consider the biomechanical demand of that anatomical location. The aim of this study was to determine the long-term functional outcomes of patients treated with open reduction and internal fixation with 95° angled blade plate (ABP). Materials and methods: Total of twenty nine patients with a proximal tibial non-union and mal-unions were retrospectively treated between September 2016 and March 2022. Eighteen (62%) were non-unions, and eleven (38%) were mal-unions. The male were 21 (72%) and female were 8 (18%); Right tibia in 16 patients, and left tibia in 13 patients. Among the non-unions twelve were originally closed fractures, and six were open fractures. While among the eleven mal-unions, Eight were varus deformity and three were valgus deformity. All cases were treated with a consistent approach of debridement, deformity correction, angled blade plate fixation, and with or without bone grafting. Only 5 patients who presented with non-union had bone graft. Results: All the twenty nine patients’ fixations healed within an average of 30 weeks, and alignment was within 5° of anatomic in all cases after follow up for a median 3.2 years (range 1.8 to 6.6). The average duration of union after surgery was 4.5 month (range 3 to 7.5 month). The outcome were 23 (79%) excellent; 4 (14%) good; 1 (3.5%) fair, and 1 (3.5%) poor result based clinical and radiological evaluations of pain, range of knee motion, limb length, fracture healing and overall satisfaction with daily living activities. Conclusions: For clinical and biomechanical consideration, 95° ABP could be a very suitable implant in the management of metaphyseal non-union and mal-unions of the proximal tibia with high success rate.

A comparison of clinical outcomes between narrow and broad dynamic compression plate for femur fractures

Purpose: To review the short term performance 4.5/5.0mm Wise-Lock Narrow Dynamic Compression Plate with LC under cuts and 4.5/5.0mm Wise-Lock Broad Dynamic Compression Plate with LC under cuts for femur fractures in terms of postoperative complications and failure rates. Methods: The total number of 46 patients, 24 to 55 years’ age group, who underwent internal fixation with wise-lock narrow and broad dynamic compression plate for femur fractures were reviewed. These implants were manufactured at Auxein Medical Private Limited Sonipat (India). The wise-lock narrow dynamic compression plates were implanted to 24 patients (18 Male and 05 Female) and broad dynamic compression plates were implanted to 22 patients (15 Male and 08 Female). These plates were made up of SS 316L and Ti6Al4V alloy respectively. Clinical and radiological follow-ups were conducted at the end of 30 days, 90 days, 180 days, 270 days and 365 days after surgery to examine the bone union, non-union & other related complications. During the one year of follow-up by the surgeon the patient's health status was analysed by the American society of anesthesiologists grade and the visual analogue score (VAS) was also determined. Results: Patients were followed up for one year. Out of 24 patients who were treated with wise-lock narrow dynamic compression plate, stainless steel, 04 patients (03 males & 01 female) were faced the complications of pain. However, out of 22 patients who were treated with broad dynamic compression plate, titanium, 02 patients (02 males) developed complications of pain. No biomechanical issue related to screw loosening, corrosion, bending, or other factors was not detected in 46 patients. Conclusions: Femur plate fixation is feasible for the treatment of femur fracture. The clinical outcomes and prognosis of patients are dependent on the accuracy of intraoperative reduction and surgical expertise.

Pronator quadratus preserving versus pronator quadratus dissecting approaches in volar plate fixation of distal radius fractures: a systematic review of comparative studies.

To compare pronator quadratus preserving (PQ-P) approaches with PQ dissecting (PQ-D) approaches in volar plate fixation of distal radius fractures (DRFs). Three databases were searched on March 10th, 2024. The authors adhered to the PRISMA and R-AMSTAR guidelines and Cochrane Handbook for Systematic Reviews. Data on demographics, fracture classifications, patient reported outcome measures (PROMs), range of motion, radiographic parameters, and complications were extracted. Thirteen studies with a total of 1007 fractures were included. Two of three studies reported lower DASH scores in the PQ-P group between 6 weeks and 3 months postoperative, however no studies reported lower scores in the PQ-P group after 3 months. Three of three studies reported significantly lower VAS scores at 6 weeks postoperative, however no studies reported significant differences after 6 months. Only one of six studies reported significantly greater flexion, extension, and pronation in the PQ-P group. One of four studies reported greater radial deviation in the PQ-P group, while there were no differences in supination or ulnar deviation. One of ten and one of six studies reported greater volar tilt and ulnar variance or radial length, respectively, in the PQ-P group. There is not sufficient evidence supporting the utility of PQ-P approaches over conventional PQ-D approaches for volar plate fixation of DRFs, especially at long-term follow-ups (3+ months). There may be short term benefits with PQ-P approaches, specifically with regards to PROMs in the short-term (< 6weeks), however there is limited high-quality evidence supporting these findings. Level III.

Comparative study of minimally invasive titanium elastic nail and steel plate on the treatment of fracture of tibiofibular fracture in adults

To compare the clinical outcomes of using elastic intramedullary nail and plate to fix fibular fracture. The 60 patients with tibiofibular fractures admitted from January 2015 to December 2022 were divided into two groups:intramedullary nail group and plate group, 30 cases each, intramedullary nail group was treated with elastic intramedullary nail fixation group, plate group was treated with steel plate and screw fixation group. Intramedullary nail group, there were 18 males and 12 females, aged from 22 to 75 years old with an average of (39.4±9.8) years old, including 24 cases of traffic accidents injury, 6 cases of falling injury, 23 cases of closed fractures, 7 cases of open fractures. Steel plate group, there were 15 males and 15 females, aged from 24 to 78 years old with an average of (38.6±10.2) years old. The 22 cases were injured by traffic accident, 8 cases were injured by falling. The 24 cases were closed fractures and 6 cases were open fractures. The operation time, intraoperative bleeding, American Orthopedic Foot and Ankle Society (AOFAS) ankle and hind foot scores, clinical healing time of fibula and the incidence of wound complications were compared between the two groups. The patients in both groups were followed up for 6 to 21 months, with an average of (14.0±2.8) months. Compared with plate group, intramedullary nail group had shorter operative time, less bleeding, shorter clinical healing time of fibula, and lower infection rate of incision, and the difference was statistically significant (P<0.05). There were 2 cases of delayed healing in intramedullary nail group, 1 case of nonunion in plate group, and 2 cases of delayed healing in plate group, and there was no statistically significant difference between the two groups (P>0.05). In the last follow-up, according to the AOFAS scoring standard, the ankle function in intramedullary nail group was excellent in 17 cases, good in 12 cases, fair in 1 case, with an average of (88.33±4.57) points, while in plate group, excellent in 16 cases, good in 10 cases, fair in 4 cases, with an average of (87.00±4.14) points;There was no statistical difference between the two groups (P>0.05). Elastic intramedullary nail has the advantages of short operation time, less intraoperative bleeding, short fracture healing time and less incision complications in the treatment of fibular fracture, which is worthy of clinical application.