Displacement Of Fracture Fragments Research Articles

Suture Bridge Technique with 5-Ethibond: A Promising Approach for Infrapatellar Pole Fracture Treatment.

Infrapatellar pole fractures are challenging injuries that require appropriate treatment to ensure optimal functional outcomes. This study aimed to introduce the application of the Suture Bridge technique using the 5-Ethibond for the treatment of infrapatellar patella fracture. Five cases of infrapatellar pole fracture that were treated at our institution between February 2020 and September 2021. The patients included one male and four females, with an average age of 66 years (range: 60-77 years). All patients were treated with the Suture Bridge technique using the 5-Ethibond to preserve the infrapatellar pole. The average operative time was 64 min (range: 50-80 min). The average blood loss during surgery was 51 mL (range: 40-60 mL). All cases demonstrated fracture healing at an average of 10 weeks (range 8-12) after surgery. The patients were followed up for an average period of 14.8 months (8-22). No wound infection or second displacement of fracture fragment was found. Full range of motion was restored in all patients within 12-14 weeks after surgery. None of the patients complained of anterior knee pain. Based on the findings of the study, it appears that the Suture Bridge technique using 5-Ethibond is a promising and viable option for the treatment of infrapatellar pole fractures.

Assessment of biomechanical properties of the new two-hole miniplate internal fixation for bony mallet finger treatment by finite element analysis

Surgery is highly recommended for a bony mallet finger when the fracture fragment involves greater than one-third of the articular surface. K-wire based and plated-based internal fixation are widely used for mallet fracture. However, the outcomes of different surgical treatment options make the treatment of the bony mallet finger controversial due to frequent complications. The two-hole miniplate is a new and promising plate-based internal fixation treatment for the bony mallet finger with low complication rates in recent years. The aim of this study was to evaluate the biomechanical parameters (von Mises stress, strain and deformation) of the two-hole miniplate fixation compared to the traditional K-wire-based fixation using finite element analysis (FEA). Further, the biomechanical parameters of each part of the two-hole miniplate internal fixation were also analyzed. The results indicated that the two-hole miniplate model had the minimum von Mises stress value and the displacement of fracture fragment was less than 30 µm. The two-hole miniplate had an apparent compression effect on the avulsion fracture and inhibited the fracture displacement. This study would provide further guidance for clinical application in using the two-hole miniplate internal fixation.

Management of Lingual Cortex Fracture of Mandible Using Lingual Arch Bar: A Finite Element Analysis of Reduction with a Pilot Clinical Trial.

Fractures of lingual cortex are frequently left untreated leading to poor resolution of patient's symptoms and function. Positioning an implant on same side of fracture would provide better reduction. The study aims at improving stability offered by Erich arch bar placed on lingual surface, by Finite element analysis (FEA) along with a pilot clinical trial. Two FEA models were generated from CT scan of an individual having lingual cortex fracture: control model with labial arch bar and study model with lingual arch bar. Parameters assessed: Stress distribution (Mpa) along lines of osteosynthesis; Separation of fracture fragments (mm) across fracture line. Associated, was a clinical trial of 5 patients, managed by placing lingual arch bar. Feasibility of arch bar, post-operative pain, radiographic inter-fragmentary gap and complications were assessed clinically. Lingual positioning of arch bar demonstrated less displacement (mm) of fracture fragments compared to labial placement (0.123 vs. 0.677) upon application of masticatory load. Insignificant lingual splay and lesser degree of stress distribution (Mpa) was observed (83.1 vs. 99.3) favoring placement of arch bar on lingual side. Clinical trial correlated with outcomes of FEA, resulting in improvement of patient's symptoms. FEA and supporting clinical trial provided an effective method of reduction for lingual cortical fracture.

Novel screw-cable integrated system(SCIS) for minimally invasive treatment of patella transverse fractures: a finite element analysis

BackgroundThe most recommended method for treating transverse patella fractures is modified tension band wiring (MTBW). However, the optimal instrument for use with MTBW is still undetermined. Hence, we aimed to design a novel screw-cable integrated system (SCIS) and compare its biomechanical characteristics with Kirschner-wire, SCIS, and Cable-Pin systems in treating transverse patellar fracture.MethodsA finite-element (FE) model of transverse patella fracture was created. The fracture model was fixed with either K-wire, SCIS, or Cable-pin. Different tension force loading (400 N and 800 N), direction(0° and 45°), and screw or K-wire depth(5 mm and 10 mm) were set. The maximum displacement of the fragment and maximum gap opening were measured by using FE analysis.ResultsCompared with the K-wire and Cable-pin system, SCIS increased the stability of the fractured patella by reducing fragment displacement and gap opening. Under 400 N loading in the direction 45°, SCIS with screw placing at 5-mm depth reduced the maximum fragment displacement (0.43 mm) by 49.62% and 26%, respectively, compared with the K-wire (0.22 mm) and Cable-pin (0. 22 mm) group. Meanwhile, the gap opening in SCIS (0.05 mm) was reduced by 83% and 59.8% (0.05 to 0.18) compared with the K-wire (0.30 mm) and Cable-pin (0.18 mm) group.ConclusionSCIS demonstrated improved biomechanical stability for treating transverse patellar fractures compared to MTBW with Kirschner wire and the Cable-Pin system. Finite element analysis showed SCIS substantially reduced fracture fragment displacement and gap opening under various loading conditions.

Comparison between Novel Anatomical Locking Guide Plate and Conventional Locking Plate for Acetabular Fractures: A Finite Element Analysis.

The treatment of complex acetabular fractures remains a complicated clinical challenge. Our self-designed novel anatomical locking guide plate (NALGP) has previously shown promising potential in T-shaped acetabular fractures (TAF), but a direct comparison with conventional fixations is yet to be made. The TAF model was established based on a volunteer's computer tomography data and then fixed with double column locking plates (DLP), a posterior column locking plate with anterior column screws (LPACS), and our NALGP. Forces of 200 N, 400 N, and 600 N were then loaded on the model vertically downward, respectively. The stress distribution and peaks and maximum displacements at three sites were assessed. We found that the stress area of all three plates was mainly concentrated around the fracture line, while only the matching screws of the NALGP showed no obvious stress concentration points. In addition, the NALGP and DLP showed significantly less fracture fragment displacement than the LPACS at the three main fracture sites. The NALGP was found to have less displacement than DLP at the posterior column and ischiopubic branch sites, especially under the higher loading forces of 400 N and 600 N. The fixation stability of the NALGP for TAF was similar to that of DLP but better than that of LPACS. Moreover, the NALGP and its matching screws have a more reasonable stress distribution under different loads of force and the same strength as the LPACS.

Thickness of simple calcaneal tuberosity avulsion fractures influences the optimal fixation method employed.

This study aimed to establish the optimal fixation methods for calcaneal tuberosity avulsion fractures with different fragment thicknesses in a porcine model. A total of 36 porcine calcanea were sawed to create simple avulsion fractures with three different fragment thicknesses (5, 10, and 15 mm). They were randomly fixed with either two suture anchors or one headless screw. Load-to-failure and cyclic loading tension tests were performed for the biomechanical analysis. This biomechanical study predicts that headless screw fixation is a better option if fragment thickness is over 15 mm in terms of the comparable peak failure load to suture anchor fixation (headless screw: 432.55 N (SD 62.25); suture anchor: 446.58 N (SD 84.97)), and less fracture fragment displacement after cyclic loading (headless screw: 3.94 N (SD 1.76); suture anchor: 8.68 N (SD 1.84)). Given that the fragment thickness is less than 10 mm, suture anchor fixation is a safer option. Fracture fragment thickness helps in making the decision of either using headless screw or suture anchor fixation in treating calcaneal tuberosity avulsion fracture, based on the regression models of our study.

Finite element study of three novel internal fixation modes for bicondylar four-quadrant fractures of tibial plateau

To compare the biomechanical differences among the three novel internal fixation modes in treatment of bicondylar four-quadrant fractures of the tibial plateau through finite-element technique, and find an internal fixation modes which was the most consistent with mechanical principles. Based on the CT image data of the tibial plateau of a healthy male volunteer, a bicondylar four-quadrant fracture model of the tibial plateau and three experimental internal fixation modes were established by using finite element analysis software. The anterolateral tibial plateaus of groups A, B, and C were fixed with inverted L-shaped anatomic locking plates. In group A, the anteromedial and posteromedial plateaus were longitudinally fixed with reconstruction plates, and the posterolateral plateau was obliquely fixed with reconstruction plate. In groups B and C, the medial proximal tibia was fixed with T-shaped plate, and the posteromedial plateau was longitudinally fixed with the reconstruction plate or posterolateral plateau was obliquely fixed with the reconstruction plate, respectively. An axial load of 1 200 N was applied to the tibial plateau (a simulation of a 60 kg adult walking with physiological gait), and the maximum displacement of fracture and maximum Von-Mises stress of the tibia, implants, and fracture line were calculated in 3 groups. Finite element analysis showed that the stress concentration area of tibia in each group was distributed at the intersection between the fracture line and screw thread, and the stress concentration area of the implant was distributed at the joint of screws and the fracture fragments. When axial load of 1 200 N was applied, the maximum displacement of fracture fragments in the 3 groups was similar, and group A had the largest displacement (0.74 mm) and group B had the smallest displacement (0.65 mm). The maximum Von-Mises stress of implant in group C was the smallest (95.49 MPa), while that in group B was the largest (177.96 MPa). The maximum Von-Mises stress of tibia in group C was the smallest (43.35 MPa), and that in group B was the largest (120.50 MPa). The maximum Von-Mises stress of fracture line in group A was the smallest (42.60 MPa), and that in group B was the largest (120.50 MPa). For the bicondylar four-quadrant fracture of the tibial plateau, a T-shaped plate fixed in medial tibial plateau has a stronger supporting effect than the use of two reconstruction plates fixed in the anteromedial and posteromedial plateaus, which should be served as the main plate. The reconstruction plate, which plays an auxiliary role, is easier to achieve anti-glide effect when it is longitudinally fixed in posteromedial plateau than obliquely fixed in posterolateral plateau, which contributes to the establishment of a more stable biomechanical structure.

A PROSPECTIVE INTERVENTIONAL STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF BI-PLANE DOUBLE SUPPORTED SCREW FIXATION IN FRACTURE NECK OF FEMUR

INTRODUCTION: The treatment of fracture neck femur varies according to the age of patient, the displacement of fracture fragments and the duration of the fracture. Various treatment options available for patients are cancellous screw xation, dynamic hip screw, femoral neck system, or arthroplasty in elderly. MATERIALS AND METHODS: This is a prospective study done at authors institutes between June 2020- June 2022. 32 patients aged between 18 to 65 years who sustained fracture neck femur were included in the study. 9 were males and 23 were females and they were operated by the biplane double supported screw xation method (BDSF TECHNIQUE) and were followed up for a period of one years. The nal Harris Hip Score at the last follow up was calculated, as well as Radiological union score for hip was calculated. RESULTS: Out of the 32 patients, the union was achieved in all the patients. The mean duration of union was 10 weeks. 2 patient had progressive femoral head resorption due to chondrolysis resulting in antalgic gait and unbearable pain and were planned for total hip arthroplasty. The mean harris hip score was 86.8. CONCLUSION: In young patients with fracture neck femur osteosynthesis plays an important role and is more efcient that the conventional inverted screw conguration. As well as more affordable than the costlier Femoral neck system. In older patients with osteoporosis and in those patients who can not afford arthroplasty or in those patients where arthroplasty is contraindicated, BDSF method is an alternate method for xing fracture neck femur.

GERIATRIC ANKLE TRAUMA: EXPERIENCE OF THE ACUTE HINDFOOT NAIL

Ankle fractures represent the third most common fragility fracture seen in elderly patients following hip and distal radius fractures. Non-operative management of these see complication rates as high as 70%. Open reduction and internal fixation (ORIF) has complication rates of up to 40%. With either option, patients tend to be managed with a non-weight bearing period of six weeks or longer. An alternative is the use of a tibiotalocalcaneal (TTC) nail. This provides a percutaneous treatment that enables the patient to mobilise immediately. This case-series explores the efficacy of this device in a broad population, including the highly comorbid and cognitively impaired.We reviewed patients treated with TTC nail for acute ankle fractures between 2019 and 2022. Baseline and surgical data were collected. Clinical records were reviewed to record any post-operative complication, and post-operative mobility status and domicile. 24 patients had their ankle fracture managed with TTC nailing. No intra-operative complications were noted. There were six (27%) post-operative complications; four patients had loosening of a distal locking screw, one significant wound infection necessitating exchange of nail, and one pressure area from an underlying displaced fracture fragment. All except three patients returned to their previous domicile. Just over two thirds of patients returned to their baseline level of mobility.This case-series is one of the largest and is also one of the first to include cognitively impaired patients. Our results are consistent with other case-series with a favourable complication rate when compared with ORIF in similar patient groups. The use of a TTC nail in the context of acute, geriatric ankle trauma is a simple and effective treatment modality. This series shows acceptable complication rates and the majority of patients are able to return to their baseline level of mobility and domicile.

"Fragment Width Ratio" as a Predictor of Nonunion for Femoral Shaft Fracture With Third Fragments.

Previous studies have reported that large fracture fragment with displacement might cause nonunion of femoral shaft fractures. We therefore intended to delineate significant risk factors for developing a nonunion predisposed by a major fracture fragment. We analyzed 61 patients who were operated on using interlocking nails for femoral shaft fractures from 2009 to 2018. We classified patients with modified Radiographic Union Scale for Tibia fractures scores of less than 11 or needing reoperations by 1 year postoperatively as nonunion. We thereafter measured parameters of the displaced fracture fragment and fracture site to identify the significant difference between the union and non-union groups. We also applied the receiver operating characteristic curve to demonstrate a threshold value for the fragment width (FW) ratio. Among 61 patients with complete follow-up, no significant difference was found regarding length, displacement, and angulation of fragments between patients with and without union. Except for higher mean FW (P=.03) and the FW ratio (P=.01) in patients with nonunion, the logistic regression analysis demonstrated that FW ratio significantly affected union (P=.018; odds ratio, 0.21; 95% CI, 0.001-0.522). Although a fracture fragment greater than 4 cm with displacement greater than 2 cm was reported to significantly cause nonunions, our study showed that an FW ratio greater than 0.55 instead of fragment size or displacement was predictive for the occurrence of nonunion adjoining to the fracture site. Fixation of the third fracture fragment should not be ignored for preventing a nonunion. More attention should be paid to achieve a better fixation for a major fracture fragment with an FW ratio greater than 0.55 to avoid the development of non-union following the use of interlocking nail for femoral shaft fracture. [Orthopedics. 2023;46(3):169-174.].

A rare case of lateral wall blow-in fracture of the orbit

Orbital blow-in fractures encompass a distinctive clinical entity that is characterized by displacement of fracture fragments into the orbital cavity with a consequent diminution in orbital volume. We report a case of a 30-year-old male who presented with outward protrusion of the left eye ball following trauma by bike handle. While fracture of the orbital roof has been documented as a common cause of blow-in fracture, in our case, a fracture of the lateral wall and floor of the orbit led to blow-in fracture. Repositioning of luxated globe was done even in the absence of visual prognosis in view of psychological benefit and prosthetic rehabilitation.

ОПЫТ ОПЕРАТИВНОГО ЛЕЧЕНИЯ ОТКРЫТОГО МНОГООСКОЛЬЧАТОГО ВНУТРИСУСТАВНОГО ЧРЕЗМЫЩЕЛКОВОГО ПЕРЕЛОМА ПЛЕЧА СО СМЕЩЕНИЕМ ОТЛОМКОВ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Complex intra-articular fractures require active patient management tactics and almost always the use of surgical treatment. For intra-articular fractures, it is extremely important to restore the normal anatomical structure, precise reposition and fixation of the fracture, without which it is impossible to restore the full function of the joint and limb. Surgical treatment should be carried out as early as possible in order to prevent the development of contractures. The purpose of this publication is to demonstrate the successful experience of treating a patient with an open comminuted intra-articular transcondylar fracture of humerus with displaced fracture fragments and the validity of the choice of an operative method of treatment of this pathology. Materials and methods : description of a clinical case and a brief analysis of the literature on this issue. Presented case of open reposition of a comminuted intra-articular transcondylar fracture of the shoulder and extra-cortical osteosynthesis with two reconstructive plates is successful. The effectiveness of treatment was evaluated based on the data of X-ray examination methods, as well as assessing the function of the limb and the amplitude of movement in the elbow joint. Results : performed open reposition of a comminuted intra-articular transcondylar fracture of shoulder and extra-cortical osteosynthesis with two reconstructive plates. Complete restoration of limb function and anatomical integrity of the distal metaepiphysis of the humerus has been achieved, the patient’s ability to work has been restored.

Conservative Treatment of Proximal Humerus Fractures: When, How, and What to Expect.

The key question to answer during the decision-making process for proximal humerus fractures (PHF) is whether the amount of displacement of a specific fracture pattern will be acceptable taking into account the anticipated demands on the patient. The aim of this review article was to provide some clarity regarding the features that contribute to poor clinical outcomes when PHF are treated non-operatively and to review the reported outcomes of conservative treatment. Conservative treatment for non-displaced or minimally displaced fractures leads to good outcomes in 80% to 90% of patients. However, with increasing fracture complexity and displacement, functional outcomes tend to diminish. In active patients with significant functional demands, the challenge is to predict which fractures will do poorly when treated non-operatively. A better understanding of fracture patterns and fragment displacement may improve treatment indications. To avoid complications related to conservative treatment, surgery should be considered (1) in fractures in which the humeral head is severely compromised (due to fracture-dislocation, severe impaction, or a split of the head itself), (2) in non-impacted fractures with gross instability between the humeral shaft and humeral head, and (3) in those cases in which displacement of the tuberosities or the final shape of the proximal humerus after healing will lead to symptomatic malunion.

Finite element comparative analysis of three different internal fixation methods in the treatment of Pauwels type III femoral neck fractures

BackgroundComparison of 4 cannulated lag screws (3 inverted triangular cannulated screws + anti-rotating screws;4 CLS), dynamic hip screws + derotational screws (DHS + DS), and femoral neck fixation system (FNS) in the treatment of Biomechanical properties of middle-aged Pauwels type III femoral neck fractures.MethodsThe femur CT data of a healthy young volunteer was selected and imported into Mimics software to construct a three-dimensional model of a normal femur. Pauwels type III femoral neck fractures were simulated according to the 70° fracture line. Use Geomagic and SolidWorks software to optimize and build CLS, DHS + DS, and FNS fracture internal fixation models. Finally, Ansys software was used to analyze the stress distribution, peak value, and maximum displacement of the proximal fracture fragment and internal fixation; the displacement distribution, and peak value of the fracture surface at the fracture end.Results① The stress peaks of the proximal fracture fragments in the three groups were concentrated near the femoral calcar. The peak stress of the FNS group was the largest, and the DHS + DS group was the smallest. ②The displacement of the fracture fragments was all located at the top of the femur. The peak displacement of the FNS group was the largest, and the DHS + DS group was the smallest. ③ The internal fixation stress of the three groups is concentrated in the middle part of the device. The stress distribution of the first two groups of models is more uniform than that of FNS. The peak stress of FNS is the largest and the CLS is the smallest. ④ The internal fixed displacements are all located at the top of the model. The peak displacement of the CLS is the largest, and the DHS + DS is the smallest. ⑤ The displacement of the fracture surface is in the upper part of the fractured end. The peak displacement of the FNS group was the largest, and the DHS + DS group was the smallest.ConclusionCompared with the other two internal fixation methods, dynamic hip screw + derotational screw (DHS + DS) showed good biomechanical stability. When Pauwels type III femoral neck fracture occurs in young adults, DHS + DS can be given priority as the preferred treatment for this type of fracture.

Open versus closed treatment for extracapsular fracture of the mandibular condyle.

Selection of treatment methods for mandibular condylar fractures remains controversial. In this study, we investigated treatment methods for condylar fractures to determine the indications for open or closed reduction. Patients and. Patients >12 years of age treated for mandibular condylar fractures with a follow-up period of ≥3 months were included in this study. The medical records of enrolled patients were reviewed for sex, age, fracture site, treatment method (open or closed reconstruction), postoperative intermaxillary fixation period, operation time, and complications. Radiological analysis of fracture fragment displacement and changes in ramal height difference was performed using computed tomography and panoramic radiography. A total of 198 patients was investigated, 48.0% (n=95) of whom underwent closed reduction and 52.0% (n=103) underwent open reduction. There was no significant correlation between reduction method and patient sex, age, or follow-up period. No statistically significant difference between the incidence of complications and treatment method was observed. None of the patients underwent open reduction of condylar head fracture. Binary logistic regression analysis showed that open reduction was significantly more frequent in patients with subcondylar fracture compared to in those with a fracture in the condylar head area. There was no statistically significant correlation between the groups and fracture fragment displacement. However, there was a significant difference between the treatment groups in amount of change in ramal height difference between the fractured and the nonfractured sides during treatment. No significant clinical differences were found between the open and closed reduction methods in patients with mandibular condylar fractures. According to fracture site, closed reduction was preferred for condyle head fractures. There was no significant relationship between fracture fragment displacement and treatment method.

A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st Century.

Background:Rarely, closed reduction cannot be achieved in patients with acute shoulder dislocation, necessitating open management. A paucity of literature exists regarding these cases.Purpose:To perform a systematic review on the mechanism, management, and outcome data of acute irreducible shoulder dislocations.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE between 2000 and 2020. Inclusion criteria were as follows: human participants, acute irreducible shoulder dislocation requiring open management, English language, and publication within the past 20 years. We excluded basic science articles, technique articles, reviews, editorials, and studies of chronic shoulder dislocations or dislocations with ipsilateral humeral shaft fractures.Results:Twelve articles fit the inclusion criteria and were considered for review. All studies were single case reports (level 4 evidence). Ten of the 12 studies were of male patients. The direction of dislocation included 7 anterior/anteroinferior, 2 posterior, 1 inferior, 1 bilateral inferior, and 1 superolateral. Most dislocations were irreducible owing to a mechanical block to reduction. The most common type of block was an incarcerated long head of the biceps tendon, followed by interposition of 1 of the rotator cuff tendons. The axillary and musculocutaneous nerves, displaced fracture fragments, and Hill-Sachs and bony Bankart lesions were other causes of blocks to reduction. Eleven patients were treated with open surgery, while 1 patient was treated arthroscopically. Procedures performed were dependent on concurrent pathology. Final follow-up ranged from 6 weeks to 2 years, with no repeat dislocation episodes reported. Complications after open reduction included 1 case of brachial plexopathy (posterior cord) and 1 case of musculocutaneous nerve palsy.Conclusion:There is a paucity of literature on the management of irreducible acute shoulder dislocations. The most common irreducible dislocation found in this systematic review was anterior with a mechanical block attributed to interposition of the long head of the biceps tendon. When patients were treated with an open or arthroscopic procedure, recurrence was low, with none reporting recurrent dislocation in limited follow-up.

A Novel Anatomical Locking Guide Plate for Treating Acetabular Transverse Posterior Wall Fracture: A Finite Element Analysis Study.

ObjectiveTo improve the treatment of the acetabular transverse posterior wall fracture (ATPWF), a novel anatomical locking guidance plate (NALGP) was designed and compared with traditional fixations using finite element analysis.MethodsThe ATPWF model was constructed using the three‐dimensional finite element model of the half pelvis via the Mimics software and three internal devices were used to fix this model: the posterior‐column locking plate with anterior‐column screws (PCLP), double‐column locking plates (DCLP), and NALGP. Next, mesh division was conducted by solid 187 tetrahedral elements in the workbench software. After defining the boundary condition and material properties, each assembly model was loaded in an increasing manner with a downward vertical force of 200, 400, and 600 N, respectively. The loading force was directed at 45 degrees upward in the coronal plane and 25 degrees backward in the sagittal plane. Finally, the stress distribution and stress peak of plates and screws were measured and evaluated, and the displacement of fracture fragments under different loading force was assessed among the three groups.ResultsFor stress distribution, it was found that the stress mainly acted on the posterior‐column plate, especially concentrated at the middle and lower section of the plate in all three groups after fixation on the ATPWF. In addition, most stresses of screws appeared on the lag screws instead of the common screws. The common screws in the NALGP group experienced larger stresses under all loading force, while those in the DCLP group withstood less stresses compared to those in the PCLP group. For the displacement of fracture fragments, the NALGP group were found to have less fracture fragment displacements than the PCLP group, but had comparable results to DCLP at both the transverse fracture and the posterior wall fracture sites.ConclusionThe newly‐designed fixation device showed superiorities on fracture stabilization over PCLP, but had comparable stability to DCLP. This suggests that the DCLP might be unnecessary for treating ATPWF in some instances because it might cause bigger surgical trauma and blood loss.

Lateral locking plate plus antero-posterior lag screws techniques for the management of posterolateral tibial plateau fracture: preliminary clinical results and biomechanical study.

To date, there is no consensus on the optimal surgical strategy for the treatment of posterolateral tibial plateau fracture (PLF). This study introduced a novel, simple technique for treating PLF with a lateral locking plate plus antero-posterior lag screws (LPpLS). We conducted a retrospective case series of 42 patients (Female/Male 19/23) with PLF treated with LPpLS between 1 July 2016 and 30 June 2019. Several pre- and postoperative outcomes were recorded, including operative time, intraoperative blood loss, CT findings, HSS, and ROM. For biomechanical studies, seventy synthetic tibiae with a simulated posterolateral split fracture were divided into seven groups. The biomechanical evaluation included displacement measurement at axial compression and fatigue testing. Forty-two eligible patients were followed up for an average of 18months (range 14-21months). Postoperative radiographs and CT showed good positioning of plates and screws, no fracture fragment loss, and normalarticularsurfaces in all 42 cases. The biomechanical study showed that the axial stiffness of LPpLS was in the same fashion as the posterior buttress plate and better than the other fixation methods (P < 0.05). Additionally, the LPpLS group had a smaller displacement of fracture fragments along the X-axis (medial to lateral direction) than the BP group (P < 0.01). The LPpLS technique could implement good reconstruction of the PLF, showing satisfactory therapeutic effect. The biomechanical evaluation demonstrated that the LPpLS had better stability in three-dimensional directions for PLF than other fixation strategies.

Conservative treatment for brachial plexus injury after a displaced clavicle fracture: a case report and literature review

BackgroundA brachial plexus injury is a rare complication of clavicle fractures. Previous case reports only examined the surgical outcomes of brachial plexus injuries that occurred after a clavicle fracture and did not report on the outcomes of conservative treatment. In this report, we present the prognosis of a patient with an acute displaced clavicle fracture accompanied by a brachial plexus injury that was conservatively treated.Case presentationA 51-year-old man with a middle-third clavicle fracture due to a direct trauma after falling down the stairs. A brachial plexus injury experienced symptoms, including numbness occurred in the affected upper extremity, at 1 day after the injury. The patient’s motor power in the elbow, wrist, and hand decreased at 3 days after the injury. Magnetic resonance imaging (MRI) showed no loss of continuity in the brachial plexus, but showed nerve compression by displaced fracture fragments. Electromyography revealed brachial plexopathy. Conservative treatment, including a shoulder sling, was performed with satisfactory outcomes; the patient reported a 70% improvement at 6 months after the injury.ConclusionsA brachial plexus injury is a rare complication of clavicle fractures that can cause serious dysfunction of the upper extremities affected by the injury. Conservative treatment may be considered for acute nerve compression by displaced fracture fragments rather than extensive callus or granulation tissue formation to achieve a satisfactory recovery in young patients. MRI should typically be performed before making a treatment decision to examine the brachial plexus for any discontinuity or kinking.

Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series.

Establishing fracture union of low and comminuted intercondylar fractures of the humerus is inherently challenging. The purposes of the present study were to investigate the biomechanical effectiveness of pin & plate (PP) fixation compared to other dual-plating techniques by finite element analysis, and to present a technical description as well as retrospectively review the outcomes of PP fixation in such difficult fractures. Low-level intercondylar fracture 3D models of the humerus were virtually stabilized with three fixations on lateral side including PP, lateral pre-contoured locking compression plate (L-LCP), and variable angle lateral pre-contoured locking plate (VA-L-LCP) whereas medial pre-contoured locking compression plate (M-LCP) on medial side. Loading conditions under consideration were axial compression, internal rotation, posterior bending, and valgus rotation. Regarding the clinical series, eight patients with intra-articular and comminuted fractures of the distal humerus (6 intercondylar fractures, 1 fracture-subluxation, and 1 isolated lateral condylar fracture) were operated by isolated PP fixation or combinations of PP and the other standard implants. Data were collected on fracture union, perioperative complications, and objective clinical outcomes. Biomechanical results revealed the most instability of the fracture occurring under posterior bending. PP fixation presented comparable fracture stability and fragment displacement compared to other dual-plating fixations, except stress on the Kirschner wire under internal rotation which was higher than other fixations. Regarding the clinical series, fracture union was achieved in all cases with an average union time of 17weeks (range 12-20). All except one patient had good-to-excellent MEPS results with an average Disabilities of the Arm, Shoulder, and Hand (DASH) score of 14.6 (range 0-45) and an average arc of elbow motion of 107.5 degrees (range 60-140). By the biomechanical performance, PP fixation is a reliable technique for fixation of low intercondylar fractures of the humerus. Supported by the clinical outcomes, the present technique could be an alternative for this particular fracture especially when severe comminution prevents the use of the standard dual plating technique.