Prominent Hardware Research Articles

Precontoured dynamic compression plate using patient-specific 3D-printed models in minimally invasive surgical technique for midshaft clavicle fractures.

This study introduced a novel approach for the treatment of midshaft clavicle fractures, utilizing patient-specific 3D-printed models for accurate preoperative contouring of dynamic compression plates (DCPs) and an alternative minimally invasive plate osteosynthesis (MIPO) technique with precontoured DCPs through small vertical separated incisions. Mirror image 3D clavicular models were reproduced from 40 patients with acute displaced midshaft clavicle fractures who underwent MIPO using precontoured DCPs inserted through small, vertical separated incisions. Exclusion criteria included patients with open fractures, pathological fractures, ipsilateral limb injury, skeletal immature patients, and those who had previous clavicle fractures or surgery. Postoperative evaluation was conducted using clinical and radiographic review. The Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were used for clinical evaluations, and the Patient and Observer Scar Assessment Scale was used to assess surgical scars. The average time to union of all fractures was 12.88weeks (range, 8-15) without loss of reduction. The patient-specific precontoured DCPs fitted well in all cases, with fracture consolidation and minimal three cortical sides connecting the fracture fragment. No hardware prominence and skin complications occurred, and clinical evaluation showed no existing difference compared with the contralateral sides. The average Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were 96.33 ± 3.66 and 93.26 ± 5.15, respectively. Two patients requested their implant removal, and scar qualities were satisfactory. Our study demonstrated that the use of a patient-specific precontoured DCP, in combination with 3D printing technology, provides accurate preoperative planning, effective fracture reduction, and improved postoperative outcomes in displaced midshaft clavicle fractures. The MIPO with a patient-specific precontoured DCP through separated vertical incisions along the Langer's lines appears to be a promising option, regarding appearance, avoiding associated complications, and obviating the need for reoperation. These results suggest that this technique has merit and can be a viable option for the treatment of midshaft clavicle fractures.

Volar plating of isolated ulna shaft fractures

Background: Dorsal plating for ulna shaft fracture is a common practice. But this is associated with hardware prominence on the dorsal subcutaneous border of ulna necessitating implant removal on later days. Volar surface of ulna is flat similar to radius volar surface with good muscle cover reducing the problem of hardware prominence. So, we wanted to study the outcome of volar plating of ulnar shaft fractures. Methods: Ten patients satisfying our inclusion criteria underwent volar plating using volar approach between FCU and ECU and 3.5 DCP was placed on flat volar surface of ulnar shaft under thick muscle cover of FCU and FDP. Results: Out of 10 patients, 7 were acute fractures, 2 were neglected non unions and 1was non-union with implant insitu. Bone graft was used in non-union cases. All fractures united at 6-9 month post op without any complications. Conclusions: Isolated ulnar shaft fractures are common orthopaedic injuries. Displaced fractures require stabilization with dynamic compression plate (DCP). Application of implant on its volar aspect in distal 2/3rd fractures is easy due to flat surface and avoids complications related to hard ware prominence and subsequent need for implant removal.

Modified unilateral iliac screw fixation with partial reduction in the treatment of high-grade spondylolisthesis at L5/S1 in adult patients: introduction of key technique, report of clinical outcomes and analysis of spinopelvic parameters

BackgroundManagement of high-grade spondylolisthesis (HGS) remains challenging. Spinopelvic fixation such as iliac screw (IS) was developed to deal with HGS. However concerns regarding constructs prominence and increased infection-related revision surgery have complicated it’s use. We aim to introduce the modified iliac screw (IS) technique in treating high-grade L5/S1 spondylolisthesis and it’s clinical and radiological outcomes.MethodsPatients with L5/S1 HGS who underwent modified IS fixation were enrolled. Pre- and postsurgical upright full spine radiographs were obtained to analyze sagittal imbalance, spinopelvic parameters, pelvic incidence-lumbar lordosis mismatch (PI-LL), slip percentage, slip angle (SA), and lumbosacral angle (LSA). Visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated pre- and postoperatively for clinical outcomes assessment. Estimated blood loss, operating time, perioperative complications and revision surgery were documented.ResultsFrom Jan 2018 to March 2020, 32 patients (15 males) with mean age of 58.66 ± 7.77 years were included. The mean follow-up period was 49 months. The mean operation duration was 171.67 ± 36.66 min. At the last follow-up: (1) the VAS and ODI score were significantly improved (p < 0.05), (2) PI increased by an average of 4.3°, the slip percent, SA and LSA were significantly improved (p < 0.05), (3) four patients (16.7%) with global sagittal imbalance recovered a good sagittal alignment, PI-LL within ± 10° was observed in all patients. One patient experienced wound infection. One patient underwent a revision surgery due to pseudoarthrosis at L5/S1.ConclusionThe modified IS technique is safe and effective in treating L5/S1 HGS. Sparing use of offset connector could reduce hardware prominence, leading to lower wound infection rate and less revision surgery. The long-term clinical affection of increased PI value is unknown.

Tension band wiring of fracture distal end of clavicle: Favorable clinical outcome among the patients

Background: A fracture of the clavicle is common traumatic injury. It can be classified into middle third, medial third, and distal third fractures. Around 10–15% of clavicle fractures occur in the distal third. The ideal method of fixation in distal third clavicle fracture remains controversial till date. Aims and Objectives: The clinical outcome of the patients having fracture of the distal end clavicle using rigid fixation with tension band wiring (TBW) with Kirshner wires and SS wire to be assessed instead of other conventional procedures. Materials and Methods: Eight patients of Neer type II closed distal-third clavicle fracture of &lt;3 weeks of duration were included in our study. The fractures were reduced by open reduction and fixed with TBW with two K-wires and SS wire. Results: The mean average age of patients was 41.87 years. All fractures united clinically and radiologically. The mean average time of union was 12 weeks. There was two case of hardware prominence, no fracture related complications. One case of superficial infection was found in study. All of them regained near normal range of motion, and the mean average constant Murley score for distal clavicle fracture at the end of 1 year was 88. At the end of 1 year follow-up, all patients had reached their pre-injury performance levels. Conclusion: There was an encouraging result with TBW in distal third clavicle fracture in our study. This technique is simple with lesser need of expertise and is also cost effective.

Short-Term Outcomes of Jones-Specific Implant Versus Intramedullary Screw and Plate Fixation for Proximal Fifth Metatarsal Fractures

Although intramedullary screw fixation is commonly performed for proximal fifth metatarsal fractures, high rates of nonunion, refracture, and hardware prominence have been reported. The Jones Specific Implant (JSI) is a novel surgical implant which contours to the native curvature of the fifth metatarsal allowing for a more anatomic fixation. The purpose of this study was to compare short-term complication rates and outcomes of patients treated with the JSI to other fixation types such as plates and intramedullary screws. Electronic records were queried for adult patients with proximal fifth metatarsal fractures who underwent primary fixation from 2010 to 2021. All patients were treated by a foot and ankle fellowship-trained surgeon with intramedullary screws, plates, or JSI (Arthrex Inc., Naples, FL). Visual analog scale (VAS) and the American Orthopedic Foot and Ankle Score (AOFAS) were recorded and compared using univariate statistics. Eighty-five patients underwent fixation using intramedullary screw (n = 51, 60%), plate (n = 22, 25.9%), or JSI (n = 12, 14.1%) with a mean follow-up of 11.1 ± 14.6 months. The total cohort demonstrated a significant improvement in VAS pain (p < .0001) as well as AOFAS (p < .0001) scores. When comparing the cohort treated with JSI and the cohort treated with all other types of fixation, there were no significant differences in postoperative VAS or AOFAS scores. Only 3 complications, one with JSI (3.5%) required removal of the symptomatic hardware. The JSI is a novel treatment for proximal fifth metatarsal fractures, with similar early outcomes and complication rates when compared with intramedullary screw and plate fixation.

Distal Ulna Fracture Fixation with the Specialized Threaded Pin

Distal ulna fractures can often be treated nonsurgically; however, many surgeons consider significant displacement or instability, especially following fixation of an associated distal radius fracture, an indication for surgical fixation because of potential problems associated with malunion of these fractures. Traditionally, these fractures have been addressed with plate fixation but hardware in this location is often prominent and associated with a high rate of symptomatic hardware and subsequent hardware removal. We proposed a method of intramedullary fixation using a specialized threaded pin. As this fixation is intramedullary, it avoids many of the problems associated with traditional surgical treatment methods for this fracture. We present a series of nine patients treated in this manner, all of whom had associated distal radius fractures. Preoperative and postoperative radiographs were reviewed, after which patients were contacted via phone. Patient-reported outcome measures, including QuickDASH and visual analog scale scores, were assessed. The average QuickDASH score was 13.6 (range, 0-100), with a median of 9.1. Three patients reported occasional ulnar-sided wrist pain, with an average visual analog scale score of 1.3 (range, 0-10) and a median of 0.5. All patients returned to all activities except one patient who could not resume playing musical instruments because of stiffness. No patient required removal of the threaded pin, but one patient underwent removal of the radial volar plate. No other patients underwent secondary procedures. Threaded pin fixation is a viable alternative to existing options for distal ulnar neck fractures and may have an advantage over plate fixation because of a lack of hardware prominence. Therapeutic IV.

Plate vs. intramedullary screw fixation of chevron olecranon osteotomies: a biomechanical study

Intra-articular distal humerus fractures frequently require olecranon osteotomies for adequate exposure, but fixation of olecranon osteotomies is associated with high rates of hardware-related complications requiring subsequent reoperation for removal. Intramedullary screw fixation is an attractive option to attempt to minimize hardware prominence. The purpose of this biomechanical study is to directly compare intramedullary screw fixation (IMSF) with plate fixation (PF) of chevron olecranon osteotomies. It was hypothesized that PF would be biomechanically superior to IMSF. Chevron olecranon osteotomies of 12 matched pairs of fresh-frozen human cadaveric elbows were repaired with either precontoured proximal ulna locking plates or cannulated screws with a washer. Displacement and amplitude of displacement at the dorsal and medial aspects of the osteotomies under cyclic loading conditions were measured. Finally, the specimens were loaded to failure. The IMSF group had significantly greater medial displacement (P=.034) and dorsal amplitude (P=.029) than the PF group. Medial displacement was negatively correlated with bone mineral density in the IMSF group (r=-0.66, P=.035) but not in the PF group (r=.160, P=.64). Mean load to failure between groups, however, was not statistically significant (P=.183). While there was no statistically significant difference in the load to failure between the two groups, IMSF repair resulted in significantly greater displacement of the medial osteotomy site during cyclic loading and greater amplitude of displacement dorsally with loading force. Decreased bone mineral density was associated with an increased displacement of the medial repair site. These results suggest that IMSF of olecranon osteotomies may result in increased fracture site displacement when compared to PF; this displacement may be greater in patients with poor bone quality.

Treatment of a comminuted patella fracture with a patella rim plate- a case report.

Patella fractures with comminution present a difficult challenge to the orthopedic surgeon. The use of a rim plate technique as a novel low profile method for the surgical management of comminuted patellar fractures provides the ability to minimize soft tissue irritation, hardware prominence, stable construct, and preservation of the patella in cases of comminution while achieving post operative goals of attainment of knee range of motion and ambulatory function.

Comparative study of functional outcome of distal one-third shaft tibia fractures treated with tip locking tibia nailing versus precontoured anatomical locking plate

Background: The distal 1/3rd shaft tibia extra-articular fractures are treated with both tip locking intra-medullary nailing (TLIMN) and precontoured anatomical locking plates (PCALP). The aim of this study was to compare the results of TLIMN and PCALP in distal tibia fractures and to determine dominant strategies. The complications and functional outcome in both groups were compared. Methods: Forty patients with distal 1/3rd shaft tibia were randomly assigned to TLIMN (group 1) and PCALP group (group 2). The functional outcomes were evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score. Complications like infection, delayed union, non-union, malunion, hardware prominence and secondary interventions were compared. Results: The average union time was 15.05±3.33 weeks in group 1 and 13.4±2.46 weeks in group 2 (p=0.045). The mean AOFAS score at 1 year follow up was 89.8±6.13 in group 1 and 89.1±6.15 in group 2 (p=0.262). Five patients in group 1 and one in group 2 had mal-alignment. Deep infection was present in one and superficial infection was present in two cases in group 2. Four patients in group 1 developed anterior knee pain and five patients in group 2 had hardware prominence. Conclusions: We conclude that tip locking intra-medullary nail is a reliable and satisfactory method for treatment of fractures of distal 1/3rd shaft tibia AO type 42A, 42B and 42C fractures with good functional outcomes and high union rates with comparatively low complications. Prevalence of malunion was higher in TLIMN group and hardware prominence was more prevalent in PCALP group. Implant removal are more in PCALP group mostly due to implant irritation.

A New Optimal Method for the Secure Design of Combinational Circuits against Hardware Trojans Using Interference Logic Locking

Effective resistance to intellectual property theft, reverse engineering, and hardware Trojan insertion in integrated circuit supply chains is increasingly essential, for which many solutions have been proposed. Accordingly, strong attacks are also designed in this field. One way to achieve the above goal is obfuscation. The hardware obfuscation method hides the primary function of the circuit and the normal Netlist from the attacker by adding several key gates in the original Netlist. The functionality circuit is correct only if the correct key is applied; otherwise, the circuit is obfuscated. In recent years, various obfuscation methods have been proposed. One is logic locking, the most prominent hardware protection technique since it can protect against untrusted items. Logic locking induces functional and structural changes to a design even before the layout generation. We secured the circuit against hardware Trojan insertion with a secure logic locking method based on the insertion of key gates in interference mode. We call our proposed method Secure Interference Logic Locking, SILL. SILL is based on minimum controllability in paths with maximum fan-out. In this method, we have reduced the number of key gates required for circuit obfuscation and created the maximum Hamming distance between normal and obscure outputs. In addition, the key gates are added to the circuit’s complete interference, and the AES algorithm is used to generate the key. Our proposed method, SILL, was simulated in the Vivado simulation environment; the algorithms used in this method were prepared in VHDL language and designed to allow parallel execution, then applied on the original Netlist of the ISCAS85 benchmark circuits. By analyzing and comparing the results of this simulation to recent works, the amount of hardware consumption has decreased (about 5% space consumption and about a 0.15-nanosecond time delay). Then, the SAT attack algorithm was tested on ISCAS85 benchmark circuits that were obfuscated with SILL. The execution time of the attack in the second attempt was 0.24 nanoseconds longer compared to similar recent works, and it timed out in the fourth attempt. The resistance of our proposed method, having less hardware overhead and higher speed is more effective against SAT attacks than the existing conventional methods.

TWO-HOLE DYNAMIC HIP SCREW (DHS) FIXATION OF GARDEN I AND II NECK OF FEMUR FRACTURES: RADIOLOGICAL OUTCOMES AND PREDICTIVE FACTORS OF AVASCULAR NECROSIS

The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole DHS in Garden I and II neck of femur fractures in patients more than 60 years with a minimum follow up of one year.We retrospectively reviewed 51 consecutive patients aged more than 60 years who underwent DHS fixation for Garden I and II fractures. Demographics, fracture classification, time to surgery, pre-operative AMTS, preoperative posterior tilt angle, quality of reduction, pre and post-operative haemoglobin(hb), creatinine and comorbidities were analysed for correlation with AVN using Chi-Square test, Independent Sample and paired t test.There were 40 (78.4%) females and the mean age of the cohort was 77 years. 28 and 23 were Garden I and II NOF fractures respectively. Union was observed in all our patients except one(kappa =1). 12/51(23.5%) developed AVN of the femoral head. Statistically significant higher incidence of AVN was noted in patients with a pre-op tilt angle &gt; 200 (p = 0.006). The mean drop in Hb was higher in patients who developed AVN (21.5 g/L) versus the non-AVN group (15.9 g/L) (p = 0.001). There was no difference in AVN rates with respect to laterality, mean time to surgery, pre-op AMTS and Charlson comorbidity index. 4/52 (7.6%) had re-operations (one hardware prominence, two conversions to arthroplasty, one fixation failure during the immediate post-op period). The 30-day and one year mortality rates were 1.9 % and 11.7 % respectively.2-hole DHS fixation in undisplaced NOF fractures has excellent union rates. A pre-operative posterior tilt angle of &gt;200 and a greater difference in pre and post operative haemoglobin were found to correlate positively with the progression to AVN . No correlation was observed between AVN and time to surgery, laterality, quality of reduction and comorbidities.

The Bridging Infix: a modified, minimally invasive subcutaneous anterior pelvic fixation technique

Various methods for anterior pelvic ring fixation have been described in the literature, each with specific advantages and disadvantages. We describe a modified minimally invasive subcutaneous technique for anterior fixation: the Bridging Infix. It combines the benefits of internal plate fixation with external fixator principles. We merged and modified features of the existing INFIX and Pelvic Bridge techniques during the design. Similar to these techniques, we use plate-rods typically used during occipitocervical fusions. The design changes allow for less discomfort due to prominent hardware in thin patients and eliminate the need for an intact medial pubic rami for fixation. There is also no risk of bladder injury due to accidental screw perforation through the pubic rami. The Bridging Infix is ideal for patients who are physiologically too frail for extensive open reduction and plate osteosynthesis, such as elderly patients with pelvic fragility fractures who are failing to mobilise due to pain. It can also be used for patients in whom external fixators may be impractical or poorly tolerated, such as obese patients or those with increased nursing demands. This technique does not provide adequate posterior pelvic ring stability, thus it requires an intact posterior tension band or the addition of separate posterior fixation. Patients can commence in-bed mobilisation the same day as the procedure, with weight-bearing as tolerated allowed for most cases, and toe-touching reserved for highly unstable injury patterns only. The implants are not routinely removed unless requested by the patient, especially in the elderly to avoid additional anaesthetic exposure. Potential complaints include lateral thigh pain, due to lateral femoral nerve compression, and mechanical discomfort during exercise activities. Level of evidence: Level 5

Early Complications of Modified Tension-Band Wiring (MTBW) in the Treatment of Close Patellar Fractures

Introduction: Patella fracture account for 1 Percent of all skeletal fracture, Patella fractures are problematic because the loss of the extensor mechanism of the knee, loss of articular congruity and stiffness of the knee joint. The surgical goals are anatomic reconstruction of the articular surface and stable fixation to allow early motion. Modified tension band wiring MTBW (MTBW) is the procedure of choice for patellar fracture these days because of the dramatic decrease in post-operative complications with this procedure.The complications noted in the early post-operative period are infection,loss of reduction, prominence of hardware, and knee stiffness. Objective: To determine the frequency of early post-operative complications following modified tension band wiring MTBW for closed patellar fractures. Methods: This study was conducted in the department of orthopedic surgery, Lady Reading Hospital, Peshawar from June 2010-september 2011. Through a descriptive cross sectional study, a total of hundred patients of closed patellar fractures were selected in a consecutive manner from the OPD and ER department. All patients were subjected to modified tension band wiring MTBW under G/A by an expert orthopedic surgeon and data was also collected at 1st week, 1st month, 3 months and 6 months regarding early post-operative complications like loss of reduction, infection, prominence of hardware and stiffness. Results: Total patients were hundred. There were 60 (60 Percent) males and 40 (40 Percent) were females. Mean age of the patients was 43.82 years + 14.3SD years (range 20-85 years). 74 (74 Percent) were presented with history of road traffic accident. Overall complication rate by the end of 6 months was a total of 25 Percent with of 21 Percent patients with infection, 11 Percent had developed stiffness, 6 Percent with hardware prominence and only 4 Percent with loss of reduction. Conclusion: The frequency of early post-operative complication following modified tension band wiring MTBW for closed patellar fractures was higher than previously reported and further research work should be carried out to identify the factors responsible for it. Keywords: Developed Stiffness, Closed Fracture Patella, Modified Tension Band Wiring MTBW, Early Post-Operative Complications, Hardware Prominence,

Styloid Ulna Window Approach for Repair of Avulsed Foveal Attachment of Triangular Fibrocartilage Complex

To describe a surgical approach for open repair of the triangular fibrocartilage complex foveal avulsion via ulnar styloid osteotomy, and to assess its clinical results. We reviewed 12 patients with distal radioulnar joint (DRUJ) instability due to isolated foveal avulsion of DRUJ ligaments. Wrist arthroscopy was conducted for all patients to exclude the presence of concomitant tear of the superficial part of the triangular fibrocartilage complex and to corroborate the diagnosis with a positive hook test. Through an ulnar approach between flexor and extensor carpi ulnaris, an ulnar styloid osteotomy was performed under image intensifier control just ulnar to the fovea of the head of the ulna. The avulsed foveal attachment was anchored through transosseous sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed by means of screws or tension band wires. Outcome measures included clinical assessment of pain (visual analog scale), grip strength, DRUJ instability, range of motion of the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine union of the ulnar styloid osteotomy, DRUJ subluxation, and any hardware-related problems. Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity, visual analog scale, and modified Mayo wrist score improved, while grip strength and range of motion remained unchanged. One patient had prominent hardware necessitating removal after union of the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal cutaneous branch of the ulnar nerve. Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex using an ulnar styloid osteotomy is an alternative to either open or arthroscopic repair approaches. Therapeutic IV.

Clinical Outcomes of Fifth Metatarsal Fractures using Jones Fracture-Specific Screw vs Intramedullary Fixation

Category: Midfoot/Forefoot Introduction/Purpose: Fractures of the proximal fifth metatarsal (Jones fractures) are common foot injuries in both athlete and nonathlete populations, given repetitive loading of the lateral column during gait. Intramedullary screw fixation is the current most common surgical management for Jones fractures, but high rates of nonunion and refracture as well as hardware prominence are reported with existing implant options for this fracture pattern. The Jones bolt is a novel surgical treatment for Jones fractures which aims for more anatomic fixation of this injury. The purpose of this study was to compare the Jones bolt to intramedullary screw fixation with regard to complication rates and patient reported outcomes. Methods: A retrospective single-surgeon case series was approved by our institutional review board. A sample of both athletes as well as nonathletes with proximal fifth metatarsal fractures treated with either intramedullary screw fixation or the Jones bolt was collected. Demographic data, patient reported outcomes, and complication rates were analyzed. Results: Patients reported significant improvements in both visual analog scale (VAS) and the American Orthopaedic Foot &amp; Ankle Society (AOFAS) scores following operative fixation of Jones fractures (Table 1). The average VAS score improved from 5.4+-2.6 preoperatively to 1.4+-1.7 postoperatively (p&lt;0.0001). The average AOFAS score improved from 59.0+-13.2 preoperatively to 186.0+-11.2 postoperatively (p&lt;0.0001). There was no difference in final postoperative VAS (1.4 vs. 1.4; p=0.9702) or AOFAS (87.7 vs 85.7; p=0.4262) or overall change of VAS (3.8 vs. 3.5; p=0.8219) or AOFAS (20.5 vs. 25.0; p=0.6613) for Jones bolt versus all other types of fixation. Conclusion: The Jones bolt is a novel treatment for proximal fifth metatarsal fractures, with noninferior outcome scores and complication rates when compared with intramedullary screw fixation. Long-term follow-up and larger sample sizes are indicated to assess for superiority of the Jones bolt.

Biomechanical comparison of continuous compression implants versus tension band fixation for transverse olecranon fractures

PurposeTension band wiring (TBW) is considered the ‘gold standard’ for fixation of transverse olecranon fractures (OTA/AO 2U1B1d). However, this approach requires a large exposure, can be technically demanding and operator-dependent, and is associated with hardware prominence. Continuous compression implants (CCI) may address these limitations. To the authors' knowledge, a comparison between TBW and CCI has not been performed. Therefore, this study was designed to compare biomechanical properties of CCI to TBW for 2U1B1d olecranon fractures using human cadaver elbows. MethodsA transverse olecranon fracture was simulated in eight matched pairs of cadaveric elbows. Matched pairs were used for comparison of TBW and CCI. Cyclic loading was performed at both 10 N and 500 N, with gap formation and load to failure recorded. Results: No significant difference in gap formation at 10 N (p > 0.3) or 500 N (p = 0.6), or load-to-failure (p=.00.41), was observed between the two groups. DiscussionCCI fixation requires a smaller incision, is easy to perform, and involves low-profile implant that may reduce morbidity. Based on biomechanical properties that match the gold standard, continuous compression nitinol implants are an appropriate option for fixation of transverse olecranon fractures with potential advantages over tension band wiring.

OCR Oriented Reading System for Blind People

The current engendering of the digital phones has prominent hardware endowment and a speedier operation that is robust and ample to evolve applications that facilitate the user to be a part of and act with the Universe at their own convenience. this method is an OCR scanning system that uses a camera application present in your smartphone consolidated with Optical Character Recognition (OCR). OCR may well be a mechanism that converts pictures of manuscripts or printed content into machine-encoded text. During this system, the application will scan and convert the content that is written in English (West Germanic language) accent into a speech format. By victimization of the Text to Speech Module speech output is generated. The seek of coming up with the type of voice/speech is to give out datum that is bestowed in the given image to the visually impaired people.

Quantifying osteosynthesis plate prominence – mathematical definitions and case study on a clavicle plate

Hardware prominence remains a clinical challenge in focus for implant design in subcutaneous plate applications. Existing evaluation of hardware prominence relies on plate-to-bone distance at a single point or on average. A reproducible measure for plate prominence remains undefined. This study mathematically defines the plate prominence linked to the cross-sectional area change due to the plate presence on the bone. Two anatomical plate designs were fitted to 100 clavicles, and afterwards plate prominence parameters were evaluated and compared. This methodology enables the quantification of hardware prominence for different plate designs to inform the development of implants targeting low prominence.

Hemiarthroplasty for the treatment of distal humerus fractures: long-term clinical results.

Total elbow arthroplasty is a treatment for unreconstructable distal humerus fractures; implant longevity remains a concern, especially in younger patients. However, distal humeral hemiarthroplasty (DHH) offers an alternative with potential long-term advantages. This is a retrospective study of 10 patients who underwent DHH for distal humerus fractures over a 4-year period (2008-2012) by a single surgeon. Patients underwent testing of range of motion, Mayo Elbow Performance Scores (MEPS), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), visual analog scale (VAS), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test, Charlson Comorbidity Index (CCI), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores. Average patient age at surgery was 71.9 years (range 56-81 years); average follow-up was 115.2 months (range 96-144 months). Patients maintained improvements in MEPS (mean 88, range 75-100) and DASH scores (mean 37.1, range 11.21-55.09), along with no statistically significant decrease in range of motion or scores in comparison to either short- or midterm results. Mean VAS score was 2.2 (range 0-7), SANE 69 (range 55-85), ASES 76.66 (range 51.67-100), and CCI 4.3 (range 1-7). Participants had an average flexion of 126° (range: 90°-140°), extension of 36° (range: 30°-45°), supination of 66° (range: 60°-70°), and pronation of 64° (range: 45°-80°). No elbow dislocations, subluxations, or heterotopic ossification were observed. Complications included 1 fracture and 1 complaint of prominent hardware. Four patients were deceased, and 1 patient was lost to follow-up. This long-term review suggests that DHH may be an effective treatment for certain distal humerus fractures. The data suggest that elbow range of motion and functional use are maintained from comparison with short- and midterm studies, with no appreciable change in radiographic cartilage wear along the radius or ulna.

A new all-suture tension band tape fixation technique for simple olecranon fractures versus conventional tension band wire fixation: a comparative biomechanics study.

Simple transverse or short oblique olecranon fractures without articular comminution are classified as Mayo type IIA fractures and are typically treated with a tension band wire construct. Because of the high reoperation rates, frequently because of prominent hardware, all-suture tension band constructs have been introduced. It was the purpose to compare the biomechanical performance of conventional tension band wire fixation with a new all-suture tension band tape fixation for simple olecranon fractures. Mayo type IIA olecranon fractures were created in 20 cadaveric elbows from 10 donors. One elbow of each donor was randomly assigned to the tension band wire technique (group TBW) or tension band tape (Arthrex, 1.3-mm SutureTape) technique (group TBT). Both groups were cyclically loaded with 500 N over 500 cycles, after which a uniaxial displacement was performed to evaluate load to failure. Data were analyzed for gap formation after cyclic loading, construct stiffness, and ultimate load to failure, where failure was defined as fracture gap formation greater than 4.0 mm. There was no significant difference in gap formation after 500 cycles between the TBW (1.8 mm±1.3 mm) and the TBT (1.9 mm±1.1 mm) groups (P=.854). The TBT showed a tendency toward greater construct stiffness compared with the TBW construct (mean difference: 142 N/mm; P=.053). Ultimate load to failure was not significantly different comparing both groups (TBW: 1138 N±286 N vs. TBT: 1126 N±272 N; P=.928). In both groups, all repairs failed because of >4.0-mm gap formation at the fracture site and none because of tension band construct breakage. Our study shows that the TBT technique produces equivalent or superior biomechanical performance to the TBW for simple olecranon fractures. The TBT approach reduces the risk of hardware prominence and as a result mitigates against the need for hardware removal. The TBT technique offers a clinically viable alternative to TBW.