To compare implant failure rates, reoperations, and postoperative mobilization between lateral locked plate (LLP), retrograde intramedullary nail (rIMN), and nail-plate combination (NPC) constructs in treating distal femur fractures. Retrospective cohort study. Single level 1 trauma center. Adult patients treated operatively for distal femur fractures (OTA/AO 33A and 33C) from 2019 to 2024 were included. Patients were excluded if they sustained partial articular injuries, pathologic fractures, multifocal femoral injuries, or critical bone defects. Construct failure was the primary outcome, defined as displaced implant breakage, gross loss of fracture reduction, or any reoperation for nonunion. Secondary outcomes included all-cause reoperation, deep infection, death within 90 days, and mobilization status at the time of discharge. In total, 196 distal femur fractures in 188 patients were included. There were 83 fractures treated with NPC fixation (mean age 70 years, 24% men, BMI 31), 37 fractures treated with rIMN (mean age 55 years, 54% men, BMI 28), and 76 fractures treated with LLP (mean age 65 years, 29% men, BMI 32). Across the 3 treatment groups, patients with rIMN were younger ( P < 0.001) and had a higher proportion of men ( P = 0.004). Immediate weightbearing was allowed in 70% of NPC constructs, 32% of rIMN constructs, and 3% of LLP constructs, respectively ( P < 0.001). After controlling for age, BMI, and open fracture status, NPC was associated with a lower risk of construct failure, occurring in 1 of 83 (1.2%) cases, compared with LLP, which failed in 15 of 76 (19.7%) cases (hazard ratio 17.43 [95% confidence interval [CI], 2.23-136.10], P = 0.006). Although NPC had the lowest rate of failure among the 3 constructs, the difference between NPC and rIMN, which failed in 2 of 37 (5.4%) cases, was not statistically significant (hazard ratio 7.62 [95% CI, 0.66-88.24], P = 0.104). All-cause reoperation occurred in 7 (8.4%) patients in the NPC group, 4 (10.8%) patients in the rIMN group, and 18 (24.7%) patients in the LLP group. Deep infection occurred in 6 (7.2%) patients in the NPC group, 1 (2.7%) patient in the rIMN group, and 1 (1.3%) patient in the LLP group ( P = 0.085). There were no differences in estimated blood loss ( P = 0.137), or death ( P = 0.999) between groups. Geriatric patients (age ≥60 years) with NPC fixation were more likely to discharge within a higher mobilization strata relative to single implant constructs (OR 2.93, P = 0.049). NPC and rIMN demonstrated a lower hazard of construct failure and reoperation than LLP in the treatment of acute distal femur fractures. Although NPC had a higher number of deep infection cases, controlling for multiple comorbidities found no statistical difference in infection rates between NPC, LLP, and rIMN, but rather an increased risk of infection in smokers and patients with high BMI. NPC fixation was associated with improved postoperative mobilization in geriatric patients compared with single implant constructs. Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.

To compare lateral locked plating (LLP) to a combined treatment approach utilizing a retrograde intramedullary nail (rIMN) alongside a minimally invasive lateral locked periprosthetic plating system (PPS) (Smith & Nephew; Memphis, TN) in the management of Vancouver C periprosthetic femoral fractures. Retrospective chart review. Single, academic, Level-1 Trauma center. All adult patients who underwent fixation of a Vancouver C periprosthetic femur fracture (AO/OTA Type 32C [IVC/D]) with a rIMN and PPS (NP Group) or LLP (LLP group) between 2019 and 2025 with follow-up to union, reoperation, or a minimum of one year were included. Patients in the NP group were recommended to fully bear weight immediately while patients in the LLP group were recommended to remain non-weight bearing for 8 weeks. The primary outcome was fracture union. Secondary outcomes included implant failure, infection, and alignment immediately postoperatively and at final follow-up. Primary and secondary outcome measures were compared between the NP and LLP groups. A total of 52 patients were included. 31 in the NP group (68% female, mean age 79 years (range, 67 - 99)) and 21 in the LLP group (67% female, 69 years (range, 53 - 85)), (p = 0.54 for sex, p = 0.26 for age). In both groups, the lateral plate extended proximal to the hip prosthesis by at least 3 screw holes. There were no differences when comparing body mass index, diabetes, smoking status, mechanism of injury, or fracture classification between groups (p > 0.05). In the NP group the mean immediate aLDFA was 82 degrees range (79-87 degrees) compared to 80 degrees (range 79 - 87 degrees) at final follow-up (p = 0.37; 95% CI -5.08 to 12.9). In the LLP group the mean immediate aLDFA was 80 degrees (range, 63 - 87 degrees), compared to 82 degrees (range 69 - 87 degrees) at final follow-up (p = 0.43; 95% CI, -5.35 to 2.37). There was no difference in alignment both immediately postoperatively and at final follow-up between groups (p = 0.20 and 0.45, respectively). There were 2 reoperations (6%) in the NP group, both a removal of a loose interlocking screw. There were 3 reoperations (14%) in the LLP group, all nonunions without implant failure that were revised to nail-plate constructs and subsequently achieved union. There was no difference in reoperation between groups (p = 0.68). There were 0 nonunions in the NP group compared to 3 (14%) in the LLP group (p = 0.03). There were no cases of implant failure or infection. Retrograde nail/plate combination demonstrated a high union rate when treating Vancouver C periprosthetic femur fractures. When compared to lateral locked plating alone which does not facilitate immediate weight-bearing, this implant combination demonstrated lower rates of nonunion with the benefit of allowing immediate post-operative weight bearing. Level III.

Background. Proximal humerus fractures (PHFs) represent approximately 5% of all fractures, occurring predominantly in elderly patients with osteoporosis. Functional limitations and high complication rates are common results after PHFs treatment . The aim of this study was to compare the functional outcomes and complications between reverse total shoulder arthroplasty (rTSA) and locking plate (LP) fixation augmented with intramedullary fibular allograft (IFA) in patients older than 65 years with four-part PHFs. Methods. A retrospective comparative analysis was performed including 72 patients: 37 treated with rTSA and 35 with LP fixation augmented with IFA. Mean follow-up was 30 months for the rTSA and 31 months for the ORIF with LP and IFA group. Functional outcomes were assessed using the Constant-Murley score (CMS) (absolute and relative) and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Complication and revision rates were recorded. Results. The rTSA group demonstrated higher CMS (absolute 74.3 vs 60.3; relative 92.3 vs 79.5), while DASH scores were comparable (14.5 vs 15.8). Although clinically relevant the difference was not of statistical significance. In the LP fixation, avascular necrosis of the humeral head occurred in 34.3% and greater tuberosity necrosis in 17.1%. The rTSA group demonstrated fewer complications, while reoperation rates were similar between groups (8.1% vs 8.6%). Conclusion. RTSA demonstrated a trend toward better functional outcomes and lower complications compared with LP with IFA. The latter remains a viable reconstructive option providing medial calcar support when joint preservation is preferred. More patients with randomisation are needed to further confirm these results.

Locking plate fixation is widely used for the treatment of displaced proximal humerus fractures; however, robust long-term data regarding its function and late complications remain limited. We report 6-year clinical and radiographic outcomes of locking plate fixation, including data regarding the relationship between avascular necrosis (AVN), post-traumatic osteoarthritis (PTA), and shoulder function. Between 2017 and 2019, 31 consecutive patients (21 women, 10 men; mean age, 63 years) with displaced proximal humerus fractures underwent fixation with a locking plate. Follow-up data were obtained at 3, 12, and 72 months. The fractures were classified using the Neer classification system (9 patients with 2-part fractures, 16 with 3-part fractures, and 6 with 4-part fractures). Functional outcomes were assessed using the Constant score. Radiographs were evaluated for AVN (y/n) and PTA (y/n). Reoperations and complications were also recorded. At 72 months, the mean Constant score was 66.2, with no improvement beyond 12 months. AVN occurred in 19% of patients and PTA in 34% of patients. Despite marked radiographic changes, the patients with AVN showed better shoulder function than those with PTA (P < .05). Reoperations were required in 32% of patients at a mean of 11 months and were most commonly implant removal with or without arthrolysis. Long-term function after locking plate fixation is moderate and plateaus after one year. Although radiographically severe, AVN does not necessarily impair shoulder function. In contrast, PTA is associated with progressive functional decline. These findings emphasize the importance of differentiating between necrotic and degenerative radiographic sequelae and of carefully tailoring the indication for locking plate fixation, particularly in complex fracture patterns.

External Fixation and Adjuvant Pins Versus Volar Locking Plates in Unstable Distal Radius Fractures: A Randomized Controlled Study with a 10-Year Follow-Up.

To determine whether 6-12 weeks modified Radiographic Union Score for Tibial fractures (mRUST) scores after lateral locked plating (LLP) of distal femur fractures were associated with nonunion versus healing. Retrospective case-control study. Two Level 1 Trauma Centers. Included were adult patients with distal femur fractures (OTA/AO 33A/C) treated with LLP between 2006 and 2024 and with available postoperative radiographs between 6 and 12 weeks. Nonunion cases were defined as patients undergoing reoperation for nonunion after 12 weeks and were randomly matched 1:2 to controls, defined as those not undergoing reoperation for nonunion and with documented healing or an mRUST score of ≥12 at final follow-up. Total mRUST (scale: 4-16) and combined medial and posterior mRUST (scale: 2-8) scores were compared between nonunion cases and controls. Associations of mRUST scores with nonunion versus healing were estimated using logistic regression with adjustment for sampling distribution and time from surgery to mRUST assessment. Thirty distal femur nonunion cases and 60 controls were included (median ages 58 and 63 years; with 70% and 67% women, respectively). The median total mRUST score was 6 (interquartile range 6-7) for nonunion cases and 10 (interquartile range 8-11) for controls ( P < 0.001). Each 1-point increase in mRUST score was associated with a 57% reduction in odds of nonunion (odds ratio: 0.43, 95% confidence interval: 0.24-0.66; area under the curve 0.91). For the combined medial and posterior cortex scores, each 1-point increase was associated with a 70% reduction in odds of nonunion (odds ratio: 0.30, 95% confidence interval: 0.12-0.61; area under the curve 0.84). mRUST scores between 6 and 12 weeks demonstrated strong association with nonunion versus healing after LLP of distal femur fractures. This was consistent in analysis limited to medial and posterior cortices, although wide confidence intervals suggest imprecision in the effect estimate. Early mRUST assessment may serve as a helpful adjunct to support clinical decision making and patient counseling after LLP of distal femur fractures. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Biomechanical Analysis of Standard Locking Compression Plate versus Dual Minifragment Locking Plates in Ulna Shaft Fracture Fixation: A Human Cadaveric Study.

Distal radius fractures are extremely common, accounting for one-sixth of all fractures seen in the emergency department. Intra-articular fractures present a greater challenge due to joint involvement. These fractures occur more commonly in women than in men, increase in frequency with advancing age, and result from low-energy falls more often than from high-energy trauma. The work aims to evaluate the predictors of clinical and radiological outcomes of intra-articular distal radius fractures treated by open reduction and internal fixation using a volar locking plate. A total of 20 patients were included in this study, conducted between August 2024 and August 2025 at the Orthopedic Department, Omar Al-Mukhtar University. Patients aged between 40 and 65 years with intra-articular distal radius fractures were managed surgically using a volar locking plate. The majority of patients demonstrated good to excellent functional outcomes, with significant improvement in Mayo scores over a one–year follow-up period. Range of motion and grip strength improved with early return to activities of daily living. The majority of injuries were caused by falls, while a smaller proportion resulted from road traffic accidents. Among the 20 patients included in the study, the left distal radius was more commonly affected (55%) compared to the right side (45%). The study population consisted of 13 females (65%) and 7 males (35%), with a mean age of 50.35 years. The average time to fracture healing was 2.4 months, with most fractures healing within two months. Patients were followed up for a period of 6-12 months. Fixation of the distal radius fractures with a volar locked plate is very important for a good functional outcome and restoring the anatomical function of the joint. Radiographic alignment (including articular congruity) is a key determinant of outcome. Early motion and stable fixation help regain function and minimize stiffness.

Stable fixation of the greater trochanter during hip arthroplasty for unstable osteoporotic intertrochanteric fractures remains a significant challenge. Conventional techniques depend on securing the bone-implant interface, which is particularly compromised in osteoporotic bone. Here, we propose a novel conceptual approach that establishes a direct mechanical bridge from the abductor tendon to the prosthesis, thereby reducing reliance on the fragile bone-implant interface. In this two-stage translational study, we progressed from biomechanical validation to clinical application. First, using a decalcified caprine femoral model simulating osteoporosis, three fixation constructs were compared: locking plate (LP), suture-augmented locking plate (LPSA), and Kirschner-wire tension band (KWTB). Ultimate load and construct stability were evaluated. Biomechanical testing confirmed the principle of suture-mediated load sharing and highlighted the intrinsic weakness of screw fixation in osteoporotic bone. Guided by these results, we designed a novel femoral prosthesis that eliminates screw fixation, employs sutures as the primary load-bearing element, and incorporates integrated suture anchor tunnels. This prosthesis was then assessed in a retrospective series of 15 consecutive elderly patients with osteoporotic intertrochanteric fractures. Clinical outcomes were evaluated using the Harris Hip Score (HHS). Biomechanically, the LPSA construct sustained a significantly higher ultimate load than the LP construct in decalcified bone (P < 0.001) and exhibited a greater load at 2-mm displacement than the KWTB construct (P < 0.001). Clinically, all patients achieved fracture union without prosthesis-related complications. The mean HHS at final follow-up was 88.27 ± 6.60, and 80% of patients regained independent ambulation. A prosthesis-anchored, suture-mediated "tendon-to-prosthesis" load pathway provides reliable stabilization of the greater trochanter in osteoporotic bone. Biomechanical validation and favorable early clinical outcomes support the potential of this novel fixation strategy.

Locking plate constructs are integral to modern fracture fixation, particularly in osteoporotic bone. Carbon-fibre reinforced polyetheretherketone (CFR-PEEK) plates offer a stiffness profile closer to cortical bone than titanium, potentially improving the mechanical environment for healing. However, the optimal insertion torque for locking screws in CFR-PEEK plates is unclear. This study investigated the influence of insertion torque on construct performance in CFR-PEEK plates compared to titanium alloy (Ti-6Al-4V) plates. Locking screws (3.5mm, Ti-6Al-4V) were inserted into Ti-6Al-4V and CFR-PEEK plates at six torque levels (0.5-3.0Nm). Construct strength was assessed via axial push-out and cantilever bending tests. Video analysis was used to correlate insertion torque with screw rotation. Additional testing was performed on two-screw CFR-PEEK constructs at three torque levels (0.5, 1.5, 2.5Nm). Insertion torque was linearly related to screw rotation within the tested range (0.5-3.0Nm). In CFR-PEEK single screw constructs, higher torque (≥2Nm) improved push-out strength (p<0.05), while 1.5Nm yielded the highest cantilever strength (p<0.05). Ti-6Al-4V constructs showed a similar trend. In two-screw CFR-PEEK constructs, no significant differences were found in performance across torques for either push-out or cantilever testing (p>0.5). Beyond an initial threshold (∼0.5Nm), increased insertion torque did not consistently enhance construct performance. These findings indicate that moderate torques (∼1.5Nm) optimise performance while reducing the risk of implant damage, support the mechanical reliability of CFR-PEEK plates.

IntroductionLocking screws typically provide more stable fixation than conventional cortical screws. However, the rigid connection between the locking screw head and plate hole can cause stress concentrations and lead to early failure under cyclic loading. This study aimed to compare the mechanical stability of a continuous (headless) locking screw with standard locking screws and cortical screws, either in a standard (flush with the bone) or in far cortical locking constructs, using biomechanical testing and finite element analysis (FEA).MethodsThe Trident Distal Radial Locking Plate (A-Plus Biotechnology Co., Ltd., Taiwan) was used to repair a simulated distal radial diaphysis fracture and was secured to the bone using different screw types. The fracture gap was bridged with the plate placed flush with the bone and with the plate offset from the bone surface by 4 mm (far cortical locking (FCL)). The constructs were subjected to static compression and cyclic axial loading tests to assess construct stiffness and yield load, as well as endurance and failure mechanisms under cyclic loading, while FEA was used to evaluate the von Mises stress distribution on the plates and screws.ResultsThe Group 3a (flush with bone, continuous locking screws) had a significantly higher yield load than Groups 2b (FCL with locking screws) and 3b (FCL with continuous locking screws) (p < 0.05). In addition, Group 1 (flush with bone, cortical screws) was found to be significantly stiffer than Groups 2b and 3b (p < 0.01). For the dynamic testing, Group 3a showed intermediate endurance and failed predominantly by screw pull-out, whereas Groups 1 and 2 primarily failed by plate deformation. The FEA results showed stress concentrations at the screw neck of the standard locking screws and around the threaded regions of the continuous locking screws.ConclusionContinuous locking screws placed flush with the bone had the greatest fixation strength of all configurations tested. However, using continuous locking screws in an FCL configuration may redirect stress to the threaded region of the screw neck, potentially increasing the risk of failure.

Postoperative Displacement of the Dorsal Ulnar Fragment After Volar Locking Plate Fixation: Risk Factors and Clinical Prediction Tool.

BackgroundMagnesium degradation-induced variable fixation plates (MVFPs) offer different fixation modes during fracture healing, but their biomechanical reliability is not well established.Materials and MethodsCT images of femurs from volunteers were used to build a model, and Abaqus software simulated deformation, stress, and relative displacement under various stress conditions. Mechanical tests including vertical loading, four-point bending, torsion, and fatigue were conducted using femur simulation models and suitable magnesium shims were screened.ResultsFinite element analysis showed that under 700N vertical loading, MVFP exhibited 83%–116% of the total deformation, 88%–120% of the maximum stress, and 86%–121% of the average relative displacement compared to locking plate (LP). Under 250N four-point bending, these were 76%–186%, 73%–183%, and 61%–170%, respectively. Under 10Nm torsional moment, they were 102%–109%, 114%–118% (for implants), and 110%–113%, respectively. In vitro biomechanical tests showed that MVFP had greater total and relative displacements but lower axial, four-point bending, and torsional stiffness (81.5%, 68.5%, and 63.9% of LP, respectively). Fatigue testing indicated both LP and MVFP samples endured 100,000 cycles of 700N vertical load without failure. The MVFP with a 0.5 mm shim exhibited superior stiffness and offered greater space for elastic deformation compared to the 1 mm shim.ConclusionAlthough MVFP’s stiffness slightly decreases compared to LP after shim degradation, it improves interfragmentary micromotion and reduces stress shielding while maintaining good fatigue resistance. MVFP with 0.5 mm axial micromotion shows promise for further development and clinical application.

Comparison of locking plate alone and locking plate combined with 3D printed polymethylmethacrylate augmentation in treating proximal humerus fractures in elderly.

Introduction Distal femur fractures are associated with significant morbidity, particularly in elderly patients, and achieving stable fixation that permits early mobilization remains challenging. The nail-plate construct (NPC) combines the biomechanical advantages of intramedullary nailing and lateral locking plate fixation and may provide improved stability and functional outcomes. Methods This prospective observational study evaluated adult patients with acute distal femur fractures treated using an NPC at a tertiary care center. Thirty-two patients were included and subgrouped based on age (<65 years and ≥65 years). Radiological union and malunion at one-year follow-up were the primary outcomes. Secondary outcomes included postoperative mobilization, length of hospital stay, complications, and patient-reported outcomes measured using the EuroQol five-dimension five-level (EQ-5D-5L) questionnaire. Results The median age of the cohort was 70.5 years (range: 30-91), with the majority aged ≥65 years. Low-energy mechanisms accounted for 28 (87.5%) of fractures, and 30 (93.8%) were closed injuries. At one-year follow-up, radiographic union was achieved in all patients, with no cases of malunion or implant failure. Early postoperative mobilisation was feasible across age groups. The mean EQ-5D-5L index value demonstrated favourable functional recovery, with most patients reporting no or only slight problems with mobility, self-care, and usual activities. Postoperative complications occurred predominantly in the elderly subgroup, with a small proportion requiring reoperation. Conclusion NPC fixation for acute distal femur fractures resulted in excellent radiological union, early mobilization, and favorable patient-reported outcomes at one year. This technique appears to provide stable fixation that supports early rehabilitation, particularly in elderly patients. Larger comparative studies with longer follow-up are required to further define its role relative to isolated fixation methods.

Introduction: Humeral shaft nonunion remains a significant clinical challenge, particularly after failed fixation attempts. Recent biomechanical and clinical studies suggest that double plate fixation may offer superior mechanical stability in revision surgery. Moreover, addressing underlying metabolic and nutritional deficiencies may enhance bone healing in complex nonunion cases. Methods: We present a focused technical case series of 3 patients with hypertrophic humeral shaft nonunions (AO 1.2.A.3) who had undergone at least 2 prior failed surgeries. All patients presented with painless progressive deformity and functional limitation. Comprehensive metabolic evaluation revealed previously undiagnosed vitamin D deficiency, hypoalbuminemia, and hypothyroidism. All cases were managed with open resection of the nonunion site, autologous iliac crest bone grafting, and double locked plate fixation (anterior 10-hole LCP and lateral 5-hole LCP, in either parallel or orthogonal configuration). A tailored metabolic correction protocol was implemented preoperatively and postoperatively. Results: All 3 patients achieved radiographic union within 8 weeks. Functional outcomes improved progressively, with DASH scores decreasing from a mean of 45.0 to 5.0, and Constant and MEPS scores reaching &gt;90 by 12 months. No complications or reoperations were recorded. All patients returned to unrestricted manual labor. Conclusion: Double plate fixation, combined with metabolic and nutritional optimization, is a safe and effective strategy for complex humeral shaft nonunion with prior failed fixation. A multidisciplinary approach that integrates biomechanical stability with systemic metabolic correction may accelerate healing and improve long-term functional outcomes. Level of Evidence: Level IV.

Purpose: Radiation exposure from intraoperative fluoroscopy is routinely encountered in orthopedic procedures, especially during distal radius fracture fixation. Prolonged exposure to high-dose radiation is a known risk factor for genetic mutations. This study presents a simple, alternative mechanical targeting device using a plummet that functions as a laser aimer. Methods: A prospective randomized controlled trial was conducted at a single institution involving 42 consecutive patients who underwent locked plate fixation for distal radius fractures and were randomized into two groups. One group underwent fluoroscopic imaging using a plummet as the aiming device, whereas the other group underwent imaging without an aimer. The radiation exposure time, dose, and fluoroscopy accuracy were recorded and analyzed. Results: A total of 42 patients were enrolled, with 21 assigned to the Plummet group and 21 to the Control group. Demographic data and fracture patterns were comparable between the groups. Compared to the Control group, the Plummet group required significantly fewer fluoroscopic images (8.38 vs. 21.86) and demonstrated a higher accuracy of fluoroscopy (99.21% vs. 67.53%). Radiation exposure was also lower in the Plummet group (3.78 vs. 9.98 µSv), with a shorter ionizing radiation exposure time (0.05 vs. 0.13 min). Operative time was also reduced in the Plummet group (51.52 vs. 60.81 min). Conclusions: Compared to the conventional method, the use of a plummet as an aiming device significantly reduced the number of fluoroscopic images, radiation exposure, and operative time, while improving the accuracy of fluoroscopy.

Background: This study aimed to investigate whether the use of artificial bone substitutes during volar locking plate (VLP) fixation for intra-articular comminuted distal radius fractures in elderly women improves radiographic and clinical outcomes. Methods: A retrospective study was conducted on female patients aged ≥65 years with intra-articular comminuted distal radius fractures (AO/OTA types B3, C2 and C3) treated with VLPs between 2018 and 2022. Patients were categorised into groups based on the use of β-tricalcium phosphate (β-TCP) as a bone substitute. A propensity score (PS) matched comparison utilising inverse probability of treatment weight was conducted comparing patients receiving standard versus β-TCP augmentation during fixation. Clinical and radiographic outcomes were evaluated. The screw-joint surface distance was assessed as a radiographic parameter indicative of optimal distal screw positioning adjacent to the subchondral bone. Results: The mean follow-up period was 9.9 months (range: 6-35 months). After PS matching, each group included 35 patients with comparable baseline characteristics. The screw-joint surface distance was significantly lower in the bone substitute group, indicating closer distal screw placement. However, at final follow-up, no significant differences were observed between the groups in radiographic or clinical outcomes. These results were consistent in inverse probability of treatment weighting (IPTW)-adjusted regression analysis. Conclusions: Closer placement of screws near the joint was observed in the bone substitute group, possibly reflecting improved intraoperative stability, but was not significantly associated with the prevention of postoperative correction loss or other clinical outcomes. Since clinical outcomes were similarly good regardless of its usage, artificial bone substitute may not be necessary for low-energy comminuted intra-articular fractures in elderly women. Further studies are warranted to determine its potential benefit in cases involving severe metaphyseal voids or joint instability. Level of Evidence: Level III (Therapeutic).

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; Subtrochanteric femoral fractures are unstable injuries characterized by high mechanical stress, cortical bone predominance and an increased risk of fixation failure. Optimal implant selection remains controversial, particularly for unstable fracture patterns. This study aimed to compare the outcomes of proximal femoral nailing and locking plate fixation in the management of closed subtrochanteric femoral fractures. &amp;lt;i&amp;gt;Methods:&amp;lt;/i&amp;gt; This comparative study was conducted at the Department of Orthopaedics, President Abdul Hamid Medical College Hospital, Kishoreganj, Bangladesh, from January to December 2025. Fifty adult patients with closed subtrochanteric femoral fractures were divided into two groups: proximal femoral nailing (PFN, n=25) and proximal femoral locking plate fixation (PFLP, n=25). Intraoperative parameters, postoperative recovery, radiological union, functional outcomes using the Harris Hip Score and complications were evaluated. Statistical analysis was performed using SPSS version 25.0, with significance set at p&amp;lt;0.05. &amp;lt;i&amp;gt;Results:&amp;lt;/i&amp;gt; The mean operative time was significantly shorter in the proximal femoral nailing group (85.4 ± 12.5 min) than in the locking plate group (110.6 ± 15.3 min). Intraoperative blood loss was lower with nailing (180 ± 40 mL vs. 270 ± 60 mL). Time to partial weight bearing (4.8 ± 1.2 vs. 6.2 ± 1.6 weeks) and radiological union (17.6 ± 3.1 vs. 20.8 ± 3.7 weeks) were significantly earlier with nailing. Mean Harris Hip Score was higher following nailing (83.5 ± 6.4 vs 77.2 ± 7.8). &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; Proximal femoral nailing provides superior operative efficiency, faster recovery and improved functional outcomes compared with proximal femoral locking plate fixation.

BackgroundVolar locking plate fixation has become the preferred operative treatment for unstable distal radius fractures because it allows stable fixation and early mobilization. However, long-term clinical outcomes and early complications in Asian populations treated in routine practice remain less well documented.MethodsThis retrospective cohort study included 40 consecutive adult patients with unstable distal radius fractures treated with volar locking plates by a single hand and wrist surgeon at a university hospital between January 2012 and December 2021. Patients met predefined radiographic criteria for instability and were followed for at least two years. Radiographic parameters (radial inclination, palmar tilt, and ulnar variance) were assessed preoperatively, immediately after surgery, at three months, and at ≥2 years. Wrist range of motion, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), and pain visual analog scale (VAS) scores were recorded preoperatively, at two weeks, three months, and at ≥2 years. Early complications within three months (carpal tunnel syndrome, median nerve palmar branch injury, and extensor pollicis longus rupture) were retrieved from medical records. Paired t-tests were used to compare changes over time.ResultsA total of 40 patients were included (mean age, 55.4 years), of whom 26 (65.0%) were women. Radiographic alignment improved after fixation and was maintained at ≥2 years. Patient-reported outcomes (QuickDASH and PRWE), pain, range of motion, and grip strength improved progressively, with minimal disability and pain at long-term follow-up. Early symptoms consistent with carpal tunnel syndrome occurred in seven (17.5%) patients; no median nerve palmar branch injury, extensor pollicis longus rupture, or flexor pollicis longus rupture was identified.ConclusionsIn this single-surgeon retrospective cohort with a minimum two-year follow-up, volar locking plate fixation for unstable distal radius fractures achieved durable restoration of radiographic alignment and progressive improvement in wrist-related pain and function. Patient-reported outcomes, range of motion, and grip strength improved over time, and major complications were uncommon; early symptoms consistent with carpal tunnel syndrome occurred in seven (17.5%) patients, and no extensor pollicis longus or flexor pollicis longus rupture was identified. Overall, these findings support volar locking plate fixation as a reliable treatment option for unstable distal radius fractures in routine clinical practice.