Fracture Fixation Research Articles

Can the screw number in volar locking plate fixation for distal radius fractures predict the Patient-Rated Wrist Evaluation outcome?

Can the screw number in volar locking plate fixation for distal radius fractures predict the Patient-Rated Wrist Evaluation outcome?

Outcome of Locking Compression Plate (LCP) Fixation of Diaphyseal Radius-Ulna fracture in Patients of 50 Years and Above

A prospective, observational study was conducted at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, from January 2018 to December 2019, to evaluate the effectiveness of locking compression plate (LCP) fixation in treating diaphyseal forearm fractures. A total of 34 adults aged 50 and above, a population with a high prevalence of osteoporosis, were selected for this study. With an average follow-up period of 25.27±1.39 weeks, the study found that older age and delayed surgery correlated with poorer outcomes, while motor vehicle accidents accounted for 52.94% of the injuries. The average time to radiological union was 12.18±1.53 weeks, with one case of nonunion and a complication rate of 11.76%. At the final follow-up, the mean range of motion for flexion-extension and supination-pronation was 133.53°±5.44° and 124.41°±11.19°, respectively, and the mean Quick DASH score was 14.6%±7.14%. According to the Anderson criteria, 50% of cases were rated as excellent, 47.06% as good, and 2.94% as poor. The study concludes that LCP fixation is an effective treatment for diaphyseal forearm fractures in this age group, demonstrating favorable outcomes regarding union rates, pain management, and functional recovery, with meticulous surgical technique being key to optimal results. Mugda Med Coll J. 2024; 7(2): 95-101

Analysis of the short-term effect of three different level pedicle screws in the treatment of thoracolumbar type A fractures

ObjectiveThe effects of three short-segment vertebral fixation methods—short-segment fixation (4s group), short-segment fixation across the injured vertebra (6s group), and long-segment fixation (8s group)—on the surgical efficacy of patients with type A thoracolumbar fractures were compared to identify the optimal fixation method.MethodsData from 277 patients who underwent posterior pedicle screw fixation for thoracolumbar fractures between September 2018 and January 2023 were retrospectively analyzed. Surgery-related indicators, laboratory parameters, clinical functional measures (VAS and ODI), and postoperative imaging findings were compared among the three groups.ResultsBaseline data showed no significant differences among the three groups. The operation time in the 4s group (75.352 ± 15.458 min) and intraoperative blood loss (188.65 ± 42.728 ml) were significantly lower compared to the 8s group (operation time: 108.243 ± 19.529 min; intraoperative blood loss: 209.93 ± 50.542 ml), with statistically significant differences (p < 0.05). Postoperative hematocrit (33.277 ± 4.639) and albumin levels (34.971 ± 4.116) in the 6s group were significantly higher than those in the 8s group (hematocrit: 31.820 ± 4.323; albumin: 33.170 ± 3.553), with p < 0.05. Other outcome indicators did not show statistically significant differences (p > 0.05).ConclusionShort-segment fixation across the injured vertebra (6s) provides results comparable to short-segment fixation (4s) while causing less trauma. Furthermore, the 6s method demonstrates similar efficacy to long-segment fixation (8s) in maintaining long-term deformity correction. These findings offer valuable insights for clinicians in selecting surgical fixation methods, optimizing treatment strategies, and improving patient outcomes.

Comparison of Hemiarthroplasty, total hip arthroplasty, and internal fixation for hip fractures in patients over eighty years of age: factors affecting mortality: a nationwide cohort study of fifty three thousand, four hundred and ninety five patients from Türkiye

Abstract Purpose Hip fractures are a common cause of mortality in elderly patients. This study aimed to determine the predictive factors affecting mortality among patients over the age of 80 who underwent surgical treatment for hip fractures. Methods We searched the Turkish Ministry of Health’s e-health database to identify patients over 80 years old who had undergone surgery for proximal femoral fractures from 2016 to 2022. This process yielded 53,495 patients. Demographic data as well as comorbidities, blood transfusions, postoperative 90 days medical complications, and mortality was investigated. Multivariate logistic regression analysis was performed to identify risk factors for one year mortality in patients undergoing surgical treatment for proximal hip fractures. Results The mortality rate was 37.2% in the first year. The mean Charlson comorbidity index(CCI) was 6.8 (range: 4–22). In the postoperative period, 68.6% of the patients received blood transfusions. Logistic regression analysis identified significant predictors of one-year mortality in surgical patients, including male gender, increased age, higher CCI scores, AKI, PE, pneumonia, electrolyte imbalance, gastrointestinal bleeding, blood transfusion, and increased mortality risks with hemiarthroplasty and internal fixation compared to total hip arthroplasty. (p &lt; 0.001 for all). Conclusions This large cohort study demonstrated that the mortality rate is high and that the type of surgery, male gender, older age, blood transfusion requirements, and high CCI score are associated with mortality in patients over 80 years of age who have undergone surgery for hip fractures. Preoperative optimization and postoperative care are critical for these vulnerable elderly patients.

Medial buttress plate use in neck of femur fracture fixations: A systematic review.

Femoral neck fractures, particularly Pauwels type II and III, pose significant challenges due to their vertical instability and susceptibility to complications such as non-union and avascular necrosis (AVN). Medial buttress plates (MBPs) have emerged as a promising adjunct in fixation, offering biomechanical advantages by neutralizing shearing forces and enhancing stability. However, the clinical efficacy of MBPs across different fixation techniques, plate configurations, and positioning remains unclear. This study aimed to (1) analyse outcomes of femoral neck fracture fixations augmented with MBPs, focusing on Pauwels type 2 and 3 fractures, and (2) analyse the impact of plate size, positioning, and the use of MBPs in different fixation techniques. Systematic review; Level of evidence, 4. Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using PubMed, MEDLINE, EMBASE, and Cochrane databases. Studies published from 2010 onwards, focusing on MBPs in Pauwels type II and III femoral neck fractures, were included. Clinical outcomes and plate details were recorded. Data from 21 studies, including 11 derived from meta-analyses, encompassing 642 patients were analysed. MBP-augmented fixations demonstrated a non-union rate of 6 %, an AVN rate of 4 %, and an overall failure rate of 17.3 %. The mean time to union was 3.9 ± 1.2 months, and the average HHS was 89.5 ± 5.5 at the final follow-up. Multiple cannulated screws (MCS) combined with a MBP showed a lower failure rate (14.6 %) compared to dynamic hip screw combined with a MBP (26.8 %), though not statistically significant (p = 0.164). Medial or anteromedial plate positioning yielded better outcomes, while anterior placement was associated with high failure rates. No studies examined the outcomes of femoral neck system fixation combined with a MBP. MBPs are a valuable adjunct in managing Pauwels type II and III femoral neck fractures, providing favourable outcomes with low rates of failure and complications. The combination of MBPs with various fixation techniques has shown promising results, highlighting the potential for improved stability and outcomes. Further research is needed to optimize plate size, screw type, positioning, and the role of MBPs in augmenting fixation techniques for these challenging fractures.

Buried or exposed kirschner wires in paediatric upper extremity fracture fixation: A systematic review and meta-analysis of infection rates and complications.

Paediatric upper limb fractures are commonly treated with Kirschner (K) wire fixation, which can be buried or left exposed. Although both techniques are widely used, controversy remains regarding infection risk, complications, and other clinical outcomes between buried and exposed K-wires. This systematic review and meta-analysis aimed to compare infection rates and secondary outcomes between buried and exposed K-wires in paediatric upper limb fractures located distal to and including the elbow, and proximal to the carpus. A systematic review of the literature was conducted according to PRISMA guidelines, with searches performed across Medline, EMBASE, and the Cochrane Library up to July 2023. Studies were included if they directly compared buried and exposed K-wires in paediatric patients (under 18 years old) and reported on infection rates. Meta-analysis was conducted to compare overall infection rates. Pooled means were used to compare secondary outcomes. Bias was assessed using the ROBINS-I and RoB2 tools. Fifteen studies involving 1,854 participants were included. The meta-analysis showed that buried K-wires were associated with a significantly lower risk of overall postoperative infection compared to exposed K-wires (RR 0.33; 95 % CI 0.22 to 0.50; p< 0.001). The risk of deep infection requiring further surgery was 1.74 % in buried K-wires (95 % CI: 0.72 % to 2.75 %) and 2.07 % in exposed K-wires (95 % CI: 0.55 % to 3.59 %). Skin erosion was a common complication of buried K-wires, with a pooled mean rate of 13.0 %. Buried K-wires were associated with a higher likelihood of requiring removal in theatre (84.4 % vs. 4.2 %). Time to K-wire removal was longer in the buried group (10.9 weeks vs. 5.3 weeks). Re-operation and bone union failure rates were similar between groups. Our systematic review and meta-analysis suggest that, while buried K-wires are associated with lower overall infection rates, the risk of deep infection is comparable between buried and exposed K-wires. Buried K-wires show higher rates of skin erosion and increased need for removal in theatre. Given these findings, exposed K-wires offer a safe and more cost-effective option for paediatric upper limb fracture fixation. Further studies are needed to assess patient-reported outcomes and environmental impacts.

Acute Open Reduction and Internal Fixation versus Non-Operative Treatment of Scapular Spine Fractures after Reverse Shoulder Arthroplasty: A Propensity Score-Matched Study

Acute Open Reduction and Internal Fixation versus Non-Operative Treatment of Scapular Spine Fractures after Reverse Shoulder Arthroplasty: A Propensity Score-Matched Study

Late fracture-related infections in HIV-positive patients : a prospective cohort study.

HIV and musculoskeletal injuries both disproportionately affect individuals living in low- and middle-income countries (LMICs), leading to a significant number of fractures in HIV-positive patients. Despite this, little is known about the long-term outcomes for these patients. This prospective cohort study investigated whether HIV infection is associated with fracture-related infections (FRIs). All adult patients between September 2017 and December 2018 who received intramedullary nail fixation of lower limb fractures in two tertiary referral hospitals in Cape Town, South Africa, were deemed eligible. In total, 358 participants were recruited for this study, 33 of whom were lost to follow-up. Of the 325 participants, 37 (11.4%) developed a total of 39 FRIs over the study period; 25 were early FRIs (64.1%) and 14 were late FRIs (35.9%). Participants were followed up for a minimum of 24 months. Throughout follow-up, participants were monitored for FRIs. These were categorized as early FRIs (< 90 days) and late FRIs (> 90 days). Overall, 71 participants (21.8%) were HIV-positive and 254 participants were HIV-negative (78.2%). In the HIV-positive population, 15 participants (21.1%) suffered 16 FRIs: seven early FRIs (9.9%) and nine late FRIs (7.0%). In the HIV-negative population, 22 participants (8.7%) experienced 23 FRIs, 18 were early FRIs (7.1%), and five participants experienced late FRIs (2.0%). On univariate and multivariate regression, being HIV-positive increased a participant's likelihood of suffering late FRIs, and FRIs overall. HIV status made no significant difference to early FRI rates. Contrary to recent evidence, this study demonstrates an association between HIV and an increased risk of a patient developing late FRIs. However, there was no significant difference in early FRI rates.

The Use of External Beam Radiation Therapy for Heterotopic Ossification Prophylaxis After Surgical Fixation of Acetabular Fractures: A Randomized Controlled Trial.

To determine the effect of external beam radiation (XRT) on preventing severe heterotopic ossification (HO) after acetabular surgery. Randomized controlled trial. Two level I academic trauma centers. Patients with an acetabular fracture (OTA/AO type 62) surgically treated through a posterior or combined anterior and posterior approach. Radiographic HO was determined using Brooker Classification at the last follow-up. The primary outcome was severe HO (Brooker classes III-IV). The secondary outcome was any HO (Brooker classes I-IV). The incidence of radiographic HO was compared between patients who did and did not undergo postoperative XRT. The results were analyzed in both an intention-to-treat (randomized to XRT) and as-treated (received XRT) basis. Severe HO occurred in 3 of 54 (6%) patients randomized to XRT and 9 of 50 (18%) patients randomized to no XRT (odds ratio 0.24, 95% confidence interval, 0.05 to 0.94; P = 0.05). Any HO occurred in 10 (19%) patients assigned to XRT and 17 (34%) patients in the no XRT control group (odds ratio 0.39; 95% confidence interval, 0.13 to 1.05; P = 0.07). The findings of this dual-center randomized controlled trial suggest that XRT after acetabular surgery significantly reduced the odds of severe HO compared with patients who did not receive XRT. These results can help guide shared decision making between surgeons and patients regarding the use of XRT for HO prophylaxis. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Numerical comparison of the intramedullary nail for the fixation of different proximal femoral fractures

Numerical comparison of the intramedullary nail for the fixation of different proximal femoral fractures

Is routine Gram-negative antibiotic coverage required for optimum antibiotic prophylaxis in open reduction and internal fixation of fractures? A multicenter analysis of bacteria pathogens in fracture-related infections.

Measures directed at infection prevention, particularly perioperative systemic antibiotic prophylaxis, have received widespread implementation and are considered a standard of care for patients undergoing operative management of fractures, especially with implant use. This study aimed to review the microbiology profile of patients with fracture-related infections (FRIs) in a sub-Saharan African country in order to establish the necessity or otherwise of Gram-negative cover in the selection of antibiotics for perioperative prophylaxis. This study retrospectively reviewed records of adult patients (aged 18years and above) diagnosed with FRI from January 2018 to December 2022 in ten tertiary hospitals in Nigeria. Data related to demographics, fracture and FRI classification as well as pathogenic bacteria were obtained while data were analyzed with SPSS version 23. Over the study period, 137 cases met the inclusion criteria and their data were obtained for analysis. Gram-positive and Gram-negative bacteria species accounted for 70 (51%) and 67 (49%), respectively, of the entire microorganisms identified by bacteriological culture. The most common organisms isolated from culture include Staphylococcus aureus (62, 45.3%), Escherichia coli (29, 21.2%), Klebsiella pneumonia (17, 12.4%) and Pseudomonas aeruginosa (11, 8.1%). The distribution of pathogenic bacteria isolated from positive cultures of infected closed and open fractures revealed a predominance of Gram-negative bacteria in closed fractures accounting for 45(55.6%) of the 81 organisms isolated; however, Gram-negative organisms accounted for only 22 (39.3%) of the 56 organisms isolated in open fractures (P = 0.061). The findings in this study suggest that Gram-negative cover may be necessary for optimal perioperative antibiotic coverage, particularly in the sub-Saharan Africa setting in patients undergoing internal fixation of fractures. We recommend that individual institutions should establish local prophylactic protocols that provide Gram-positive and Gram-negative pathogen coverage guided by local microbiological flora.

Clinical and Radiographic Outcomes of 1.5-mm Locking Plate Fixation for 30 Radial and Ulnar Fractures in Dogs.

This study aimed to report clinical and radiographic outcomes of dogs that underwent radial and ulnar fracture repair using 1.5-mm locking plate systems. Dogs that had radial and ulnar fractures repaired using 1.5-mm locking compression plate systems at four referral hospitals were retrospectively included. Signalment, body weight, fracture aetiology, fracture location and configuration, radius diameter, plate-bone ratio, repair method, clinical and radiographic outcomes, complications, and time to last follow-up were recorded. Thirty fractures in 28 dogs were included. Median body weight was 2.4 kg (range 1.3-5.5 kg). The mean length of the proximal segment relative to the total length of the radius was 67% (range 33-93%). The mean diameter of the radius at its isthmus was 4.9 mm (range 3.1-6.1 mm). The mean plate-bone ratio was 64% (range 48-89%). Radiographic union was documented in 29/30 fractures at a median of 8 weeks postoperatively. Of the cases with long-term follow-up available, 21/24 had a full function and 3/24 had an acceptable function. Five complications occurred, including infection (n = 2), screw migration (n = 1), bandage sores (n = 1), and peri-plate fracture (n = 1). In this population of miniature and toy-breed dogs, 1.5-mm locking plates provided effective fixation for radial and ulnar fractures. Despite complications in 5/30 fractures, radial union occurred in 29/30, and no dog had an unacceptable function at the last follow-up.

The clinical frailty scale is associated with an increased risk of postoperative complications and the development of post-traumatic osteoarthritis in elderly patients with trimalleolar ankle fractures - a retrospective study

BackgroundThe Clinical Frailty Scale (CFS) is a tool to assess the overall health of older adults. There are few reports of CFS and prognosis of ankle fracture. The objective of this study was to determine the predictive power of the CFS for adverse clinical and radiographic outcomes after surgery in elderly patients with trimalleolar fractures.MethodAll patients aged 65 and older underwent open reduction and internal fixation for trimalleolar fractures between January 2015 to January 2023 were selected. Follow-up time was at least 1 year. Patients with post-traumatic osteoarthritis, bone tumors, bone infection, and other diseases before surgery were excluded. According to the CFS score, the patients were divided into three groups: not frail, vulnerable, and frail. Multivariate logistic regression analysis was used to evaluate the effect of the clinical frailty scale on postoperative complications.ResultExcluding 3 cases of death during the follow-up process, and 4 cases lost to follow-up, the study included a total of 146 patients, who were grouped based on their degree of frailty: the Healthy Group (CFS = 1–3, n = 69), the Vulnerable Group (CFS = 4, n = 50), and the Frail Group (CFS = 5–9, n = 47). In comparison with the not frail group, frail (CFS 5–9) emerged as an independent predictor of any complications (OR = 6.90, CI: 1.43–11.56, P = 0.009), adverse discharge destination (OR = 7.53, CI: 2.06–77.50, P = 0.006), and post-traumatic osteoarthritis (OR = 8.90, CI: 1.94–24.66, P = 0.003).ConclusionsThe frailty assessed by the CFS is associated with adverse discharge destination, any complications, and post-traumatic osteoarthritis in elderly patients undergoing open reduction and internal fixation for trimalleolar fractures.

Surgical Fixation of Thoracolumbar Fractures in Patients Older than 80 Years.

The global average life expectancy has been increasing steadily as the quality of healthcare continues to improve. However, there is a paucity of data looking at surgical fixation of thoracolumbar spine fractures in patients ≥80 years (super-elderly). Aim of this study is to look at whether there is higher rate of complications from surgical fixation of thoracolumbar fractures in this group of patients. We performed a retrospective study of patients who underwent surgical fixation of thoracolumbar spine fractures from 2019 to 2023. Patients were dichotomized into those who were 80 years old and above (super-elderly) and those younger than 80 years (control). Variables include sex, age, Charleston comorbidity index, presence of osteoporosis, length of hospital stay, complications, 6- and 12-months' implant status, and mortality. Incidence of revision surgery, rate of implant loosening, and mortality between the 2 groups were analyzed. Total of 108 patients were included, 43 patients in the super-elderly group and 65 in the control group. Despite the super-elderly having a higher rate of osteoporosis and higher proportion of patients with severe comorbidities (P < .0001), there was no significant difference in the rate of implant loosening at 12 months' follow-up (P = .467) or all-cause mortality (P = .158). There were no significant differences between the 2 groups regarding revision surgery (P = .923) needed either. The super-elderly had a higher incidence of osteoporosis and worse comorbidities, but there was no significant difference regarding implant complications, revision surgery required, or all-cause mortality. Hence, surgical fixation of thoracolumbar spine fractures in people older than 80 years should be considered despite their advanced age.

Food Insecurity Is Common in the Orthopaedic Trauma Population.

Food insecurity is the condition of limited access to healthy and safe food. Malnutrition resulting from food insecurity is a concern particularly in the surgical population due to the association with impaired healing. This aim of this study was to report the incidence and risk factors for food insecurity in the orthopaedic trauma population. Orthopaedic trauma centers at three distinct regions of the United States enrolled patients who had undergone extremity or pelvis fracture fixation within the previous 6 months. Participants completed the United States Department of Agriculture Household Food Insecurity Survey, and food insecurity was defined as a score ≥3. In addition, participants recorded patient demographics and injury/treatment/household characteristics and completed information about diet quality. Diet quality was compared between households with and without food insecurity using chi-square or Fisher exact tests. Logistic regression was used to create a multivariable model of factors associated with greater odds of food insecurity. Food insecurity was documented in 11.5% (81/703) of households. Households with food insecurity were less likely to report daily consumption of fruit, vegetables, and protein-rich foods. We found a greater odds of food insecurity among households with a yearly income of <$50,000 (odds ratio = 4.30 [95% confidence interval = 2.07 to 8.92], P < 0.001), tobacco use (2.33 [1.26 to 4.28], P = 0.007), Medicaid or no insurance (2.34 [1.19 to 4.62], P = 0.014), and Hispanic or Latino ethnicity (4.55 [1.69 to 12.24], P = 0.003), for each 10-year decrease in age (1.19 [1.00 to 1.40], P = 0.045), multiple surgically treated fractures (2.41 [1.08 to 5.35], P = 0.031), and for each additional 15 minutes of travel time to the nearest grocery store (2.12 [1.37 to 3.26], P < 0.001). Food insecurity is common in the orthopaedic trauma population, and households with food insecurity are more likely to have low diet quality. Nutrition supplementation during the healing phase after trauma and referral to nutrition assistance programs has the potential to mitigate malnutrition and prevent negative outcomes resulting from food insecurity.

Unraveling of cannulated screw threads during fixation of medial epicondyle humerus fractures in adolescents: short communication.

Cannulated screws have significant advantages, including ease of insertion and increased accuracy, during fracture fixation. Unraveling of screw threads is an uncommon complication related to cannulated screws. This single-institution case series aims to highlight four cases of unraveling of cannulated screw threads during the fixation of medial epicondyle humerus fractures in adolescents. All four cases involved the use of 4.0 or 4.5 mm partially threaded cannulated screws from the same manufacturer. This phenomenon was replicated in two cadaveric humeri. The higher density of bone on the lateral aspect of the medial column of the distal humerus would likely contribute to this complication. Modifying the surgical technique to include predrilling prior to screw placement can potentially avoid this complication.

Optimising Treatment Strategies: Labial versus Labio-inferior Plating Using Three-dimensional Miniplates for Mandibular Symphysis and Parasymphysis Fractures

Abstract Introduction: Many advanced techniques and materials have been introduced in recent years with the advent of new design technology for treating mandibular symphysis and parasymphysis fractures. This study was conducted to evaluate the post-operative stability of mandibular symphysis and parasymphysis fractures when treated with three-dimensional (3D) miniplates positioned labio-inferiorly and labially. Materials and Methods: We piloted a prospective clinical study among 12 subjects of both genders with mandibular symphysis and parasymphysis fractures. We compared the 3D miniplates positioned labio-inferiorly and labially, dividing the subjects into two equal groups. The clinical parameters were evaluated both clinically and radiologically. Results: Enhanced rigidity was observed in both the superior and inferior borders of the mandible with labio-inferior plating in the current investigation. When subjected to masticatory forces, labio-inferior plating demonstrated superior rigidity compared to labial plating. In addition, the labio-inferior plate is equally effective as the 3D plate in addressing symphysis and parasymphysis fractures. Conclusion: This study compared labial and labio-inferior 3D miniplates for the fixation of mandibular symphyseal and parasymphyseal fractures. While the statistical results were not significant, the authors found labio-inferior miniplates particularly useful in treating comminuted fractures and fractures with open wounds. Therefore, we recommend the use of labio-inferior plates for comminuted mandibular symphyseal and parasymphyseal fractures, as well as for fractures associated with open wounds.

Osteochondral Fractures in Adolescents With First-time Patellar Dislocation: Three-dimensional Characterization and Association With Radiographic Features.

Consequences of osteochondral fractures associated with patellar dislocation can be severe for younger patients. Precise 3-dimensional characterization of fracture location, size, frequency, and radiographic associations remain undefined in this population. (1) To define the topographic characteristics of osteochondral fractures in pediatric and adolescent patients with first-time patellar dislocations and (2) to determine the relationship between these characteristics and radiographic and patient factors. Cross-sectional study; Level of evidence, 3. A retrospective observational study was conducted between 2015 and 2023 of consecutive patients aged <18 years undergoing surgical intervention for displaced osteochondral fractures in the setting of first-time patellar dislocation. Three-dimensional location and relative injury frequency were quantified with heat map analysis. Subgroup analysis of intraoperative osteochondral fracture size and location was conducted using chi-square testing and an independent t test at an alpha of .05. The study cohort included 82 knees (80 patients) with first-time patellar dislocation and osteochondral fracture. A total of 97 osteochondral fractures were identified, with the lateral femur as the most common fracture site at 55% (n = 53), as compared with 43% (n = 42) for the patella and 2% (n = 2) for the lateral trochlea. Patellar osteochondral fractures were significantly larger than femoral lesions (mean ± SD, 258 ± 168 mm2 vs 126 ± 109 mm2; P < .001) and more amenable to fixation than femoral osteochondral fractures (fixation, 57.1% [n = 24] vs 15.1% [n = 8]; P < .001). Patellar and femoral osteochondral fractures were >100 mm2 in 78.6% (n = 33) and 32.1% (n = 17) of lesions, respectively. Patellar mean fracture size was significantly larger in the group with a tibial tubercle-trochlear groove distance <20 mm (P = .018). The mean osteochondral fracture size of the lateral femoral condyle was significantly larger in the open physis group as compared with the closed physis group (P = .027). We found that the most common site for osteochondral fracture was the femur, although patellar osteochondral fractures were significantly larger. Factors that affect anatomic structure and ligamentous laxity appear to contribute to patterns of osteochondral fractures.

Finite element modeling of clavicle fracture fixations: a systematic scoping review.

Finite element analysis has become indispensable for biomechanical research on clavicle fractures. This review summarized evidence regarding configurations and applications of finite element analysis in clavicle fracture fixation. Seventeen articles involving 22 clavicles were synthesized from CINAHL, Embase, IEEE Xplore, PubMed, Scopus, and Web of Science databases. Most studies investigated midshaft transverse closed fractures by reconstructing intact models from CT scans and simulating fractures through gap creation. Common loading schemes included axial compression, distal torsion, and inferior bending. The primary objective was comparing different implant designs/placements on construct stiffness, von Mises stress, and fracture site micro-motion. Our review suggested a preference for plate fixation, particularly with anterior placement, for midshaft transverse fractures. However, limited fracture types studied constrain comprehensive recommendations. Additionally, the review highlighted discrepancies between finite element and clinical studies, emphasizing the need for improved modeling of physiological conditions. Future research should focus on developing a comprehensive database of finite element models to test various implant options and placements under common loading schemes, bridging the gap between biomechanical simulations and clinical outcomes.

Advancements in Surface Modification of NiTi Alloys for Orthopedic Implants: Focus on Low-Temperature Glow Discharge Plasma Oxidation Techniques

Nickel–titanium (NiTi) shape memory alloys are promising materials for orthopedic implants due to their unique mechanical properties, including superelasticity and shape memory effect. However, the high nickel content in NiTi alloys raises concerns about biocompatibility and potential cytotoxic effects. This review focuses on the recent advancements in surface modification techniques aimed at enhancing the properties of NiTi alloys for biomedical applications, with particular emphasis on low-temperature glow discharge plasma oxidation methods. The review explores various surface engineering strategies, including oxidation, nitriding, ion implantation, laser treatments, and the deposition of protective coatings. Among these, low-temperature plasma oxidation stands out for its ability to produce uniform, nanocrystalline layers of titanium dioxide (TiO2), titanium nitride (TiN), and nitrogen-doped TiO2 layers, significantly enhancing corrosion resistance, reducing nickel ion release, and promoting osseointegration. Plasma-assisted oxynitriding processes enable the creation of multifunctional coatings with improved mechanical and biological properties. The applications of modified NiTi alloys in orthopedic implants, including spinal fixation devices, joint prostheses, and fracture fixation systems, are also discussed. Despite these promising advancements, challenges remain in achieving large-scale reproducibility, controlling process parameters, and reducing production costs. Future research directions include integrating bioactive and antibacterial coatings, enhancing surface structuring for controlled biological responses, and expanding clinical validation. Addressing these challenges can unlock the full potential of surface-modified NiTi alloys in advanced orthopedic applications for safer, longer-lasting, and more effective medical implants.