Interfragmentary Screw Research Articles

Novel method for mandibular fracture reduction using inter-fragmentary screw - report of a surgical technique.

Novel method for mandibular fracture reduction using inter-fragmentary screw - report of a surgical technique.

Addition of an Oblique Interfragmentary Screw to T-plate Fixation Decreases Nonunion Rate in Trapeziometacarpal Arthrodesis.

Background: T-plate fixation is a popular method for trapeziometacarpal arthrodesis in patients with osteoarthritis. Previous studies report an 8% to 18% rate of symptomatic nonunion and a 26% rate of radiographic nonunion. In this study, we present our surgical technique of trapeziometacarpal arthrodesis using the addition of an oblique interfragmentary screw to T-plate fixation on the rate of symptomatic and radiographic nonunion. Methods: A retrospective review of all trapeziometacarpal arthrodeses for osteoarthritis was completed by a single surgeon between 2010 and 2018. Preoperative demographics, pain, and Eaton classification were included. The technique was identical in all surgical cases, using a T-plate and oblique interfragmentary screw across the arthrodesis site from the metacarpal to the trapezium. Postoperative nonunion rate and time to clinical healing (absence of pain) and radiographic union were reviewed. Results: A total of 22 trapeziometacarpal arthrodeses were performed on 17 patients using the above technique. The average age was 53 years, 71% were women, and 53% involved the dominant hand. Mean preoperative Eaton classification was 2.74 (±0.73). Mean time to clinical healing was 34 days (±12 days), and mean time to radiographic union was 55 days (±23 days). Mean follow-up was 9 months, and no patients were found to have symptomatic or radiographic nonunion. Hardware removal was required bilaterally in 1 patient after complete healing. Conclusions: The addition of an oblique interfragmentary screw to T-plate fixation is a novel technique in trapeziometacarpal arthrodesis, resulting in no symptomatic or radiographic nonunion.

Biomechanical analysis of four augmented fixations of plate osteosynthesis for comminuted mid-shaft clavicle fracture: A finite element approach.

Sufficient stabilization of comminuted mid-shaft clavicle fractures via plate fixation is difficult to achieve. Various augmentations, including interfragmentary screws and cerclage wiring, have been adopted to reinforce fixation stability. The present study aimed to assess the biomechanical stability of augmented plate fixations using the finite element method. First, a clavicle fracture model was created from CT data. Fixation was then induced using a locking compressive plate (LCP) with the following four augmentations: i) Double inner cerclage wirings (DICW), ii) double outer cerclage wirings (DOCW), iii) a single interfragmentary screw (SIS) and iv) double interfragmentary screws (DIS). Compressive and bending forces of 100 N were subsequently applied at the acromial region of the clavicle. The stress distribution, displacement and fracture micro-motions of the model were assessed and compared. The DOCW resulted in the highest stress exerted on the LCP, followed by SIS, DICW and DIS. For the clavicle fracture, DICW, DOCW and SIS resulted in high stress levels. However, DIS fixation alone resulted in levels of stress that were below the yield strength of cortical bone. Displacement analysis revealed that DOCW fixation resulted in the greatest degree of displacement and fracture micro-motions, followed by SIS, DICW and DIS. The results indicated that SIS, DIS and DOCW may be used as augmentations of LCP fixation for comminuted mid-shaft clavicle fractures. However, DIS was the recommended augmentation due to it exerting the lowest stress and the highest stability compared with the other fixations. The DICW may be used to aid fracture reduction and plate placement in surgery but should be avoided for permanent fixation.

Intramedullary Headless Screw Fixation for Metacarpal Fractures.

Multiple techniques have been proposed for metacarpal fracture fixation, including percutaneous Kirschner-wires, interfragmentary screws, plate and screw constructs, intramedullary (IM) nails, and cannulated IM headless screws. Each of these treatment options has its proposed advantages and disadvantages, and there remains no consensus on the optimal mode of treatment. We describe a technique of retrograde IM headless screw fixation for extra-articular metacarpal fractures.

Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint.

The purpose of this study was to investigate and compare the clinical and radiological results of ORIF with inter-fragment screw or buttress plate fixation of acute PIP joint fracture dorsal dislocation. Between January 2007 to December 2016, nineteen patients-14 men and 5 women with an average age of 40.9 (19 to 64) years-were included in this study; 9 patients underwent small sized interfragmentary screw fixation and 10 patients underwent small buttress plating. The average follow-up period was 45.1 (13 to 78) months. Clinical assessment included measurement of range of motion (ROM) of the proximal and distal interphalangeal joint (PIP, DIP), grip and pinch strength, and pain with use of the Visual Analog Scale (VAS). At the postoperative X-ray, articular step off, gap, and degree of dorsal subluxation was measured, and maintenance of the reduction, fracture union, and the presence of degenerative changes were assessed. All patients achieved solid unions without instability. The overall average range of motion of PIP joint were from 9° to 85° (10-83° in the screw group, 8-87° in the plate group without significant difference). However, the screw group (average: 53°) presented more flexion in the distal interphalangeal joint than the plate group (average: 34°). Plate fixation can cause limited DIP flexion. Six of the ten patients from the plate group, underwent implant removal and two of these patients required PIP joint arthrolysis due to the PIP flexion contracture of more than 30°. Three of the nine patients in screw group underwent implant removal and two of the three patients required PIP joint arthrolysis. Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favorable clinical and radiographic outcomes through stable fixation and early range of motion exercise. Screw fixation, if possible, is probably preferable to plate fixation because of better DIP joint ROM and lower incidence of hardware removal. If there is a need for plate fixation the use of a short plate is recommended to avoid joint stiffness.

Central metatarsal fractures: a review and current concepts.

Central metatarsal fractures (CMF) are common injuries. More frequently fractures are those of the fifth metatarsal, followed by CMF and therefore by the first metatarsal. Third metatarsal is injured most frequently than the others and up to 63% is associated with second or fourth metatarsal fractures and up to 28% with both. Anatomy and metatarsal kinematics merits attention due to its influence on function, injuries and treatment options. Diagnosis is based on the history of trauma and clinical examination, relating with instrumental exams. Fractures with less than 10° of angulation and 3-4 mm of translation in any plane are typically treated conservatively, while operative treatment is generally reserved for fractures out if these values. Intramedullary fixation with K-wires seem to be the most common and valid surgical treatment in simple fractures. Spiral fractures should be treated by interfragmentary screws, which positioning may result difficult due to the adjacent metatarsals. Therefore, an alternative approach is an osteosynthesis with a dorsal plate. Multiple metatarsal fractures often occur in the contiguous bones, so clinicians will also have to carefully inspect metatarsals and adjacent joints such as Lisfranc articulation. The clinical and functional outcomes are often influenced by the pattern of fractures and patient conditions and are reported in the literature up to 39% of poor results. (www.actabiomedica.it)

Patellar Fixation Following Fracture: A Retrospective Review of Outcomes Following Varying Surgical Interventions

Purpose: Patella fractures are a common injury in trauma patients and can be treated with a multitude of different fixation methods. With so many fixation techniques available, no current consensus exists on best practices for patients presenting with this injury. The purpose of this analysis is to review the multiple different patella fixation strategies and to evaluate the outcomes and complications associated with each. Methods: One hundred and fifteen patients who underwent patellar fracture fixation at an urban Level I-Trauma center were retrospectively reviewed. Operative treatment included open reduction and internal fixation with plate and screw devices, tension band wiring (TBW), cannulated screw tension band wiring (CS-TBW), isolated interfragmentary screw fixation, or partial patellectomy with soft tissue repair and tendon advancement. Patient demographics, fracture and injury characteristics, operative variables, radiographic information, and post-operative outcome measurements were recorded for each patient assessed in the study. Results: Results demonstrated that plating techniques had the highest overall rate of union. Furthermore, a significant decrease in implant removal with utilization of isolated suture/wire was appreciated compared to other fixation groups (p < 0.01). Conclusion: We conclude that plate utilization achieves high radiographic union compared with other fixation methods.

Risk factors for refracture after plate removal for midshaft clavicle fracture after bone union

BackgroundOpen reduction and internal fixation (ORIF) with plates and screws is one of the treatment options for clavicle fractures. However, an additional operation for implant removal after union of the fracture is commonly performed due to a high incidence of hardware irritation. Despite union of the fracture, a subsequent refracture might occur after removal of the implant which requires additional surgeries for fixation. This study aims to determine the risk factors associated with refracture of the clavicle after hardware removal.MethodsWe retrospectively reviewed the medical records of 278 patients that were diagnosed with a midshaft clavicle fracture (male 190; female 88) that had (1) undergone ORIF of the clavicle with plates and (2) received a second operation for removal of hardware after solid union of the fracture between 2010 and 2017. Their mean age was 40.1 ± 15.1 years, and mean interval from fixation to plate removal was 12.5 ± 7.5 months. The patients were then divided into two groups based on the presence of refracture (n = 20) or without refracture (n = 258). We analyzed patient demographics, interval between fixation and implant removal, fracture classification (AO/OTA, Robinson), fixation device, whether wires or interfragmentary screws were used, clavicular length, and bone diameter at the fracture site.ResultsThe overall refracture rate was 7.2%, and the mean interval between plate removal and refracture was 23.9 days. A multivariate analysis showed that female (adjusted odds ratio [aOR] 4.74; 95% CI 1.6–14.1) and body mass index [BMI] (for every 1-unit decrease, aOR 1.25; 95% CI 1.06–1.48) were risk factors for refracture. In women, BMI was the only risk factor. The optimal BMI cutoff value was 22.73. In a female patient with a lower BMI, the refracture rate was 29.8%.ConclusionsThere are no significant radiographic parameters associated with refracture. Routine plate removal in a female patient with a low BMI after bony union of a midshaft clavicle fracture is not recommended because of a high refracture rate.

Intra-Articular Osteotomy for Symptomatic Bennett Fracture Malunion.

Bennett's fractures are the most common fractures around the trapeziometacarpal joint but require specialized radiographs to be correctly diagnosed. If a fracture is missed at initial presentation, it may heal with an intra-articular gap, leading to joint incongruency and a painful trapeziometacarpal joint. We present a new technique to correct the intra-articular gap and restore joint congruency in the event of a symptomatic Bennett malunion with a gap of at least 2 mm. The joint is exposed through an anterolateral approach, and the malunion is marked with K-wires under fluoroscopic control. A closing wedge osteotomy with excision of the malunion site is then performed to restore joint congruency. The osteotomy is fixed with 3 interfragmentary screws, and the joint is immobilized for 2 weeks before passive mobilization is initiated. Hardware can be removed between 3 and 6 months postoperatively after consolidation of the osteotomy. We recommend this technique in active patients without trapeziometacarpal osteoarthritis who present with a painful Bennett malunion. Restoration of the joint congruency reduces pain and may prevent the development of posttraumatic osteoarthritis.

Bioabsorbable vs. titanium screws for first tarsometatarsal joint arthrodesis: An in-vitro study

BackgroundThe TMT-1 joint arthrodesis is a common repair for severe hallux valgus. Two crossing interfragmental screws, usually titanium or steel, and a locking plate or a plate with a compression screw are the most common fixation methods for first TMT joint arthrodesis. The qualities of an ideal fixation material include adequate strength and rigidity, biocompatibility, lack of interference with bone healing, lack of visibility and palpability, and a low risk of surgical removal. We sought to determine whether bioabsorbable cannulated screws would perform as well as titanium screws in anatomical models. MethodsIdentical anatomical TMT-1 arthrodesis was created with a saw by making a straight cut in 30 anatomical models (Sawbone®). The bioabsorbable and titanium screws were placed one at a time in exactly the same location in each model according to careful measurements. All 30 models were analyzed with a material testing machine (MTS Insight 30, Eden Prairie, USA). Each model was oriented 15° to the platform to simulate its position to the ground during mid-stance. ResultsIn the single-cycle load-to-failure test, the mean yield load was 61.4 N ± 5.7 N (range, 50.1 N–70.3 N) in the bioabsorbable screw group and 81.2 N ± 12 N (range, 61.7 N–113.4 N) in the titanium screw group (P < .001). The respective values for the stiffness of the fixation were 8.1 N/mm ± 0.8 N/mm (range, 6.7 N/mm to 9.1 N/mm) and 9.7 N/mm ± 1.8 N/mm (range, 6.9 N/mm to 12.6 N/mm) for the bioabsorbable and titanium groups (P = .004). The mean maximum failure loads in the bioabsorbable group were 85.1 N ± 8.5 N (range, 67.1 N–97.2 N) and in the titanium group 120.6 N ± 13.2 N (range, 96.7 N–136.7 N), respectively (P < .001). Analysis of the failure models shows bioabsorbable fixation failures caused by bending occur more often than in the titanium group. ConclusionIn biomechanical testing, titanium screws were stronger than bioabsorbable screws in the TMT-1 arthrodesis model tested, although bioabsorbable cannulated screws may be an alternative to titanium screws in the fixation Lapidus procedure.

Low-Profile Dual Small Plate Fixation Is Biomechanically Similar to Larger Superior or Anteroinferior Single Plate Fixation of Midshaft Clavicle Fractures

Background: Limited biomechanical data exist for dual small plate fixation of midshaft clavicle fractures, and no prior study has concurrently compared dual small plating to larger superior or anteroinferior single plate and screw constructs. Purpose: To biomechanically compare dual small orthogonal plating, superior plating, and anteroinferior plating of midshaft clavicle fractures by use of a cadaveric model. Study Design: Descriptive laboratory study. Methods: The study used 18 cadaveric clavicle specimens (9 pairs total), and 3 plating techniques were studied: anteroinferior, superior, and dual. The dual plating technique used smaller diameter plates and screws (1.6-mm thickness) than the other, single plate techniques (3.3-mm thickness). Each of the 9 clavicle pairs was randomly assigned a combination of 2 plating techniques, and randomization was used to determine which techniques were used for the right and left specimens. Clavicles were plated and then osteotomized to create an inferior butterfly fracture model, which was then fixed with a single interfragmentary screw. Clavicle specimens were then potted for mechanical testing. Initial bending, axial, and torsional stiffness of each construct was determined through use of a randomized nondestructive cyclic testing protocol followed by load to failure. Results: No significant differences were found in cyclical axial (P = .667) or torsional (P = .526) stiffness between plating groups. Anteroinferior plating demonstrated significantly higher cyclical bending stiffness than superior plating (P = .005). No significant difference was found in bending stiffness between dual plating and either anteroinferior (P = .129) or superior plating (P = .067). No significant difference was noted in load to failure among plating methods (P = .353). Conclusion: Dual plating with a smaller plate-screw construct is biomechanically similar to superior and anteroinferior single plate fixation that uses larger plate-screw constructs. No significant differences were found between dual plating and either superior or anteroinferior single plating in axial, bending, or torsional stiffness or in bending load to failure. Dual small plating is a viable option for fixing midshaft clavicle fractures and may be a useful low-profile technique that avoids a larger and more prominent plate-screw construct. Clinical Relevance: Plate prominence and hardware irritation are commonly reported complaints and reasons for revision surgery after plate fixation of midshaft clavicle fractures. Dual small plate fixation has been used to improve cosmetic acceptability, minimize hardware irritation, and decrease reoperation rate. Biomechanically, dual small plate fixation performed similarly to larger single plate fixation in this cadaveric model of butterfly fracture.

Carpometacarpal 4/5 Fracture Dislocations: Fracture Morphology and Surgical Treatment

We conducted a retrospective review of six patients with carpometacarpal (CMC) ⅘ fracture-dislocations managed with ORIF by a single surgeon between October 2006 and August 2017. An open, dorsal approach to the hamate was used with a combination of interfragmentary screw fixation and Kirschner wire reduction in the CMC joints. At a mean of 96 days follow-up (range: 31–265), all patients had recovered wrist motion, excellent grip strength, and complete resolution of pain. There were no complications or reoperations during the postoperative period. Radiographic review showed restoration of anatomy and well-maintained congruity of the CMC joints. Our study has shown favorable outcomes after open reduction and internal fixation of the hamate body fracture with interfragmentary screws, when combined with stabilization of the CMC dislocation with percutaneous Kirschner wires. Fracture morphology does not appear to guide choice for specific hardware (size screw, headed/headless) or use of a washer. This is a level IV, therapeutic study.

Outcomes of distal femoral fractures treated with minimally invasive plate osteosynthesis versus open reduction internal fixation with combined locking plate and interfragmentary screws

PurposeFractures of the distal femur remain challenging to treat, and numerous fixation methods are designed to promote stability and fracture healing. Locking plate constructs have recently become the mainstream fixation method, but debate exists on whether to use locking plates alone or to augment them with interfragmentary screws. This article compares outcomes of distal femur fractures treated with a single locking plate alone versus those treated with a locking plate and interfragmentary screws. MethodsWe retrospectively reviewed 57 patients treated for distal femur fractures from 2010 to 2013. Patients were divided into two groups: Those treated with a locking plate alone utilizing the minimally invasive plate osteosynthesis (MIPO) technique and those treated with combination of a locking plate and interfragmentary screws using an open technique. Postoperative outcomes were obtained via a manual chart review. Fracture healing and callus indices were evaluated from radiographs. Results9 patients required revision surgery in the locking plate alone group (6 for persistent nonunion and 3 for varus deformity). Only two patients in the combination group required revisions (both for nonunion). Average time to full weight bearing was 19.54 weeks in the locking plate group versus 14.57 weeks in the combination group (p = 0.004). At the time of full weight bearing, frontal (1.15 versus 1.11, p = 0.004) and sagittal (1.22 versus 1.15, P = 0.008) callus indices were both significantly greater in the locking plate group. ConclusionsIn this study, the combination of a locking plate and interfragmentary screws achieved suitable stability and a faster time to full weight bearing than using a locking plate alone. Surgeons should consider combining a locking plate with interfragmentary screws as an effective method for fixation of distal femur fractures, particularly in cases when plate fixation alone fails to provide adequate fracture stability.

Primary ilizarov external fixation in open grade III type C distal femur fractures: Our experience

IntroductionOpen comminuted distal femur fractures are notorious for septic or aseptic non-union. The recommended fixed angle distal femur locking plate in such situations can lead to a septic non-union due to its extensive approach and further periosteal stripping. Supracondylar nails, though have a minimally invasive approach, are not suitable for type C2 and C3 (AO/ASIF) fractures. A monolateral fixator as damage control followed by plating may be recommended. But if wound healing is delayed it results in difficult articular reduction, poor alignment and a stiff knee. We therefore used ilizarov circular external fixators (ICEF) for such open fractures (type C1, C2 and C3) and analysed its radiological and functional outcomes. Materials and methods25 male patients, with a mean age of 31.04 ± 6.62 years (range, 22–44 years), with open grade III type C distal femoral fractures were treated with ICEF. There were 7 fractures of type C1and C3 each, 11 were of type C2. Articular reduction and compression was achieved with inter-fragmentary screws through minimal open technique by extending the open wound and then stabilising the fracture with ICEF. The main outcomes evaluated were union, range of motion, final shortening, Knee Society scoring and ASAMI scoring system for radiological and functional outcomes. ResultsThe mean follow-up period was 19.12 ± 1.14 months. All fractures except two united at a mean period of 30 ± 3.02 weeks, without the need of bone grafts. The bony assessment (according to ASAMI score) was excellent in 8 cases (33.33%), good in 9 cases (37.5%) and fair in 5 cases (20.83%), while there were 2 poor clinical end results. The functional results were excellent in 6 cases (25%), good in 9 cases (37.5%) fair in 6 cases (25%) poor in 3 cases (12.5%). The complications included shortening, extension lag and pin tract infections. ConclusionWith the encouraging results, the use of ICEF with minimal internal fixation in grade III open comminuted distal femur fractures as a primary definitive treatment is a valuable alternative.

Surgical treatment of acetabulum posterior wall fractures: Comparison between undercountering and marginal impaction reconstruction method with odd methods

BackgroundModern treatment principles for posterior wall fractures have become widespread in the last decade in many countries by means of international or local courses. The purpose of this study was to compare the clinical and radiologic outcomes of acetabulum posterior wall fractures using unconventional methods of fixation, including plates placed in unusual directions, or, in the case of reoperation, only interfragmentary screws. In addition, we examined acetabulum posterior wall fractures treated by open reduction and internal fixation with standard undercountered plates from ischion to iliac bone in latter cases. MethodsTwenty-one patients who had open reduction and internal fixation of an unstable unilateral fracture of the posterior wall of the acetabulum between 2009 and 2013 were included. Group 1 was composed of 10 former patients who were treated with unconventional methods that included a compression technique with a direct plate or solely screw fixation. Group 2 was composed of latter 11 patients who were treated with standard surgery that included undercountered plates oriented from the ischial tuberosity to the iliac bone proximally and reconstruction of marginal impaction if necessary. The functional outcome was evaluated with the use of the clinical grading system adopted by Merle d'Aubigné and Postel. The Kellgren–Lawrence radiologic criteria were used for the radiologic assessments. The reduction of the fracture, posterior dislocation, marginal impaction, mean fracture particle amount, trochanteric osteotomy and avascular necrosis were compared between the two groups and examined with the Mann–Whitney U test. ResultsIn Groups 1 and 2, the median score of the modified Merle d'Aubigné and Postel clinical scoring system was 16 (8–18) and 18 (14–18), respectively. The clinical scores between the two groups were statistically significant (p < 0.01). When two groups were compared using the Kellgren–Lawrence radiographic criteria for the development of osteoarthritis, the median value in Groups 1 and 2 was 3 (0–4) and 1 (0–3), respectively (p < 0.01). ConclusionsThis study displays the evolution of the surgical treatment of acetabular fractures of the posterior wall in our clinic. The older methods failed in terms of exposure, diagnosis of fracture anatomy and fixation techniques. Patients treated after the surgeons took courses in this field showed evidence of superior clinical and radiological scores. We attribute these benefits to exposure, definition and treatment of marginal impaction and fixation principles.

The Use of a Triplanar Metatarsal Rotational Osteotomy to Correct Hallux Valgus Deformities.

Proximal rotational metatarsal osteotomy (PROMO) is a technique that allows the surgeon to correct the varus and pronation of the first metatarsal that is observed in most patients with hallux valgus deformity. Persistent metatarsal pronation is a recognized recurrence factor for operatively treated hallux valgus. The indication for this technique is a mild-moderate hallux valgus deformity (i.e., intermetatarsal angle <18° and hallux valgus angle <40°) in which pronation is present. (Note that according to the literature, 10% to 20% of patients do not have pronation.) The PROMO is performed via a single proximal oblique metatarsal incision. Following completion of the osteotomy, the distal metatarsal segment is supinated (external rotation), correcting pronation and varus deviation, which is achieved as a result of the oblique nature of the osteotomy (i.e., rotation through an oblique plane). Step 1: Preoperative planning: measure the intermetatarsal angle and the metatarsal rotation. For the latter, use the published classification (mild, moderate, severe). With both values, use the table included in the PROMO tray to know which osteotomy angulation should be used. Step 2: medial foot incision. Step 3: drive the guidewire 1 cm distal to the tarsometatarsal joint. Step 4: Under fluoroscopy, ensure that the wire is parallel to the sole of the foot and perpendicular to the metatarsal. Step 5: use the positioning jig to drive a Kirschner wire with the chosen pronation correction. Step 6: slide the osteotomy jig with the previously chosen osteotomy angulation. Step 7: perform the osteotomy. Step 8: use the rotation jig with the desired pronation correction. Step 9: derotate and correct the metatarsal deformity, leaving both wires parallel to each other. Step 10: perform osteotomy transient fixation with 2 Kirschner wires. Step 11: apply a medial locking plate and an interfragmentary screw at the osteotomy site. The expected outcome is complete correction of the first metatarsal varus and pronation.

Stable Fixation and Immediate Weight-Bearing After Combined Retrograde Intramedullary Nailing and Open Reduction Internal Fixation of Noncomminuted Distal Interprosthetic Femur Fractures.

With an aging population, treatment of interprosthetic femur fractures continues to pose a challenge to the orthopaedic surgeon. Retrograde intramedullary nailing combined with open reduction internal fixation using a tissue-preserving plating technique was used in our series of 9 patients with noncomminuted, distal femur fractures. No interfragmentary screws, cables, cerclage wires, or supplemental bone grafts of any type were used. Each patient initiated weight-bearing as tolerated after operative intervention. Every fracture healed at an average of 20 weeks (range 18-24 weeks). Use of a lateral locking plate combined with a retrograde intramedullary nailing enables immediate postoperative weight-bearing and stable fixation for patients with interprosthetic femur fractures.

Stability of Locking Plate and Compression Screws for Lapidus Arthrodesis: A Biomechanical Comparison of Plate Position

Lapidus (first tarsometatarsal joint) arthrodesis is an established and widely used procedure for the management of moderate to severe hallux valgus, especially in cases involving hypermobility of the first tarsometatarsal joint. Multiple fixation methods are available, and several previous investigations have studied the relative strengths of these methods, including dorsomedial and plantar plating comparisons. However, these studies compared plates of varying designs and mechanical properties and used varying modes of compression and interfragmentary screw techniques. The present study mechanically investigated the resulting motion, stiffness, and strength of identical locking plate constructs fixed at various anatomic positions around the first tarsometatarsal joint. In a bench-top study, fourth-generation composite bones were divided into 3 fixation groups, each having identical interfragmentary screw applications, and randomized to 1 of 3 plate positions: dorsal, medial, or plantar. The plates applied in each case were identical locking plates, precontoured to fit the anatomy. Each construct was experimentally tested using a cantilever bending approach. The outcomes obtained were stiffness, yield force, displacement at yield, ultimate force, and displacement at ultimate force. The plantar plate position showed superior initial stiffness and force to ultimate failure. The plantar and medial plate positions exhibited superior force to yield. The medial plate position was superior regarding displacement tolerated before the yield point and catastrophic failure. The dorsal plate position was not superior for any outcome measured. Plantar and medial plating each offered biomechanical benefits. Clinical studies using similarly matched constructs are required to show whether these findings translate into improved clinical outcomes.

Complications following comminuted femoral shaft fractures treated with interlocking nail with or without inter fragmentary screw fixation for butterfly fragment: case series

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; This case series is to highlight the complications following interfragmentary compression screw fixation for butterfly fragment while treating femoral shaft fractures with interlocking nail.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Twelve cases have been included in this study conducted in institute of orthopaedics and traumatology, MMC &amp;amp; RGGGH, Chennai. All patients had shaft of femur fracture with butterfly fragment for which open reduction and interlocking nailing done. For 6 patients we applied interfragmentary screws for the butterfly fragment and in rest of the patients (6) patients we left the butterfly fragment in situ without disturbing the soft tissue attachment and bone grafting for the bone gap where ever necessary. We followed up the patient at 3 weeks, 6 weeks and 12 weeks, 6 months and 12 months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the six patients fixed with inter fragmentary screws had wound infection and went for infected nonunion for which appropriate management was done including revision nailing or LRS application. Union was achieved in 12 to 16 months after various surgical interventions. Remaining six patients in whom interfragmentary screws were not applied and primary bone grafting when and where necessary was done, showed radiological union by three months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Blood supply to large butterfly fragment is the main key for the healing process not the near normal anatomical reduction using interfragmentary screw for the butterfly fragment. Relative stability is enough for fracture union. In bone defects arising out of comminution primary bone grafting is essential for the bone healing. &lt;/p&gt;

First Metatarsophalangeal Joint Arthrodesis in Hallux Valgus Versus Hallux Rigidus Using Cup and Cone Preparation Compression Screw and Dorsal Plate Fixation.

Various techniques have been described for first metatarsophalangeal (MTP) joint arthrodesis. The purpose of this study was to determine if cup and cone preparation by a single surgeon with an interfragmentary screw and dorsal plate fixation provides a comparable union rate in hallux valgus versus hallux rigidus. Our study included all patients who underwent first MTP joint fusions using cup and cone preparation with an interfragmentary compression screw and dorsal plate fixation from 2010 to 2015. We compared union rates in 65 patients with hallux rigidus with 47 who had hallux valgus. One of 65 hallux rigidus cases developed non-union and underwent revision surgery. One of 47 patients in the hallux valgus group developed a painless non-union. All other patients achieved union based on post operative radiographs. Our rate of painful non-union was 1.5% for hallux rigidus and 0% for hallux valgus, which is lower than recent published literature of 7% for hallux valgus and 3.7% for hallux rigidus. We found no difference between the two groups suggesting this method may provide stronger fixation and may be preferable when dealing with hallux valgus. First metatarsophalangeal joint fusion in patients with severe hallux valgus and hallux rigidus, using spherical reamers, compression screw and dorsal plate fixation is equally successful at achieving clinical and radiographic fusion in both hallux valgus and hallux rigidus.