Low-profile Titanium Plate Research Articles

Advancements in Metacarpal Fracture Management: A Narrative Review of Rehabilitative Strategies.

Metacarpal fractures are prevalent injuries that can significantly impact hand functionality if not managed effectively. This narrative review examines recent advancements in treatment strategies, comparing conservative and surgical interventions, and evaluates the role of early mobilization and innovative rehabilitation techniques. We analyze evidence showing that surgical treatment with low-profile titanium plates provides superior stabilization, enabling earlier mobilization and better functional outcomes compared to conservative methods or K-wire fixation. Early mobilization, facilitated by metacarpal braces or controlled active exercises, enhances recovery and reduces the need for extended physical therapy. We also explore the integration of technology in rehabilitation, which has improved patient adherence and satisfaction. The review highlights the importance of personalized treatment plans and discusses the potential of novel rehabilitation approaches to optimize metacarpal fracture management. Future research should focus on refining these strategies and developing standardized protocols to enhance hand function and patient satisfaction.

Efficacy of spinal fusion in treatment of splintered fracture of the C6 vertebral body with spinal cord compression in an adolescent (case history)

Fractures and dislocation fractures of C5‑Th1 vertebrae account for about 70 % of all spinal injuries. The article describes a case history of the successful treatment of the fractured C6 vertebra by means of spinal fusion with an autogenous bone. The SCT (spiral computed tomography) and MRI (magnetic resonance imaging), performed for diagnostic purposes, showed a splintered fracture of the C6 vertebra with spinal cord compression and mild spinal cord swelling. The clinical picture indicated acute pain in the cervical spine, quadriplegia, and functional disorder of the pelvic organs caused by the severity and level of the injury. The patient underwent two simultaneous surgeries: during the first operation, a fragment of autologous bone from the left iliac wing was taken, and during the second surgery, spinal fusion of C5‑C7 with autologous bone and fixation with a titanium plate were performed. After the interventions, the follow-up SCT of the C-spine showed no signs of spinal cord compression, and the wedge-shaped deformation of the vertebral canal was remedied. No displacement of the vertebral bodies and changes in the height of the vertebrae and vertebral discs is present. After treatment, the patient will undergo long-term rehabilitation measures. The obtained result proves the efficacy of autobone spinal fusion with anterior low-profile titanium plate fixation with four screws. Due to correct and timely medical care provided to the patient, all of the treatment objectives (minimizing secondary injuries of the spinal cord and ensuring optimal conditions for recovery of neurons and axons in the area of disturbed blood supply, spine stabilization) were accomplished.

Topographical and Ultrastructural Evaluation of Titanium Plates Coated with PLGA, Chitosan, and/or Meropenem: An In Vitro Study.

The present investigation was undertaken to evaluate the topographical and ultrastructural architecture of titanium plates coated with polylactic co-glycolic acid (PLGA), chitosan (CH), and/or meropenem (MEM) with or without Staphylococcus aureus (SA) or Pseudomonas aeruginosa (PA) bacteria. Single-hole segments of 0.4 mm thick, low-profile titanium plates were spray coated using an airbrush with polymeric carriers (PLGA or CH) loaded with MEM, in addition to the negative control group (uncoated titanium plates). The coated plates and the negative control group were subjected to bacterial biofilms through a cultivation process while being slowly stirred at 20 rpm for 24 h. The samples were fixed and processed for scanning electron microscopic study at 5, 10, and 20 k magnification. The data were statistically analyzed to compare within and between the different materials. Coating titanium plates with PLGA or CH with MEM appeared to enhance bacterial inhibition over uncoated plates, hindering biofilm formation and preventing bacterial proliferation. In the staphylococcus aureus group, the highest bacterial count was observed in the uncoated plates, whereas the lowest count was detected in meropenem-PLGA, followed by PLGA, chitosan, meropenem, and meropenem-chitosan, respectively. On the other hand, the Pseudomonas aeruginosa group with the uncoated plates had the highest bacterial count, whereas the lowest bacterial count was found related to CH, followed by PLGA, MP, MC, and MEM, respectively.

A prospective study to evaluate the functional outcome of metacarpal shaft fracture treated with mini plates

Background: Metacarpal fractures are among the most common fractures of the hand. They may lead to loss of function if treated improperly. These injuries can be treated conservatively. However, if significant shortening, rotational deformity and angulation occur, surgical treatment is required. Recent studies have shown good functional results with surgical treatment of metacarpal fractures using miniplates and screws as compared to the conservative treatment or K –wire fixation. Hence the study aims to assess the functional outcomes of patients with metacarpal fractures, who will be undergoing open reduction and fixation with low profile titanium plates in our department.Materials and Methods: Patients coming to the Department of Orthopaedic, at Sri Siddhartha MedicalCollege, Tumakuru with metacarpal shaft fractures who are treated with open reduction and internal fixation with mini-plate. All patients are operated in supine position and under infraclavicular block or general anesthesia. After the tourniquet is inflated, the forearm is placed in pronation, a dorsal longitudinal incision is made and the fracture is exposed with adequate soft tissue dissection. A low profile 2.0 mm titanium miniplate is applied with four screws, two on each side of the fracture. In oblique or spiral type of fractures, initially fixed with inter fragmentary screws and then by plate. Metacarpal alignment and angulation will be confirmed with fluoroscopy. The plate and screws was covered with periosteum and soft tissues.Results: The maximum subjects had injury on the right side (58.3%) and commones tbone to be involved was fracture of shaft of 5th metacarpal (37.5%). Transverse type (39.6%) was the commonest fracture pattern. Our study showed excellent functional outcome (54.2%) with lower complication rates and bone union was seen in minimum 6 weeks. Mean DASH score at 1 month (18.56), 3 month (11.56),6 months(3.02) with p value = 0.001.Conclusion: Plate and screw fixation is a good option for treating closed unstable metacarpal fractures, where other modalities of fixation are less effective. The rigid stable fixation provided by plating which withstands load without failure allowed early mobilization and achieved good functional results. Detailed clinical and radiological assessment of fracture, careful preoperative planning, meticulous dissection, precision in surgical technique (coverage of plate with soft tissue) and choosing the correct implant (low profile plate) are critical in achieving good results and minimizing the complication.

Point of Care Virtual Surgical Planning and Three-Dimensional Printing for Feminizing Foreheadplasty.

Point of Care Virtual Surgical Planning and Three-Dimensional Printing for Feminizing Foreheadplasty.

Surgical fixation of rib fractures: how I do it

Chest wall trauma is common worldwide. The majority of cases are a result of blunt mechanisms. Among these injuries, rib fractures are considered the most frequent type of clinically significant blunt thoracic trauma sequelae and are associated with considerable morbidity and mortality. Despite a large number of cases annually, there are no internationally recognized guidelines for rib fracture treatment yet. This controversy in treatment options can be attributed to the lack of high-level convincing clinical research that confirms the benefits of surgical treatment over conservative treatment measures. Over the last 100 years, rib fixation has been carried out infrequently using non-specific materials due to lack of specific rib fixation systems. However, a substantial advancement in materials (e.g., low profile titanium plates) and technologies (e.g., angle-stable locking screws) was achieved in the last decade. Despite these developments, so far no clinical study has proven the superiority of one system over another. In this article, we would like to share our experience in this field including indications for surgical rib fixation and how we perform such procedures.

Cranial flap fixation in sheep using a resorbable bone adhesive.

The authors' goal in this study was to investigate the use of a novel, bioresorbable, osteoconductive, wet-field mineral-organic bone adhesive composed of tetracalcium phosphate and phosphoserine (TTCP-PS) for cranial bone flap fixation and compare it with conventional low-profile titanium plates and self-drilling screws. An ovine craniotomy surgical model was used to evaluate the safety and efficacy of TTCP-PS over 2 years. Bilateral cranial defects were created in 41 sheep and were replaced in their original position. The gaps (kerfs) were completely filled with TTCP-PS (T1 group), half-filled with TTCP-PS (T2 group), or left empty and the flaps fixated by plates and screws as a control (C group). At 12 weeks, 1 year, and 2 years following surgery, the extent of bone healing, local tissue effects, and remodeling of the TTCP-PS were analyzed using macroscopic observations and histopathological and histomorphometric analyses. Flap fixation strength was evaluated by biomechanical testing at 12 weeks and 1 year postoperatively. No adverse local tissue effects were observed in any group. At 12 weeks, the bone flap fixation strengths in test group 1 (1689 ± 574 N) and test group 2 (1611 ± 501 N) were both statistically greater (p = 0.01) than that in the control group (663 ± 385 N). From 12 weeks to 1 year, the bone flap fixation strengths increased significantly (p < 0.05) for all groups. At 1 year, the flap fixation strength in test group 1 (3240 ± 423 N) and test group 2 (3212 ± 662 N) were both statistically greater (p = 0.04 and p = 0.02, respectively) than that in the control group (2418 ± 1463 N); however, there was no statistically significant difference in the strengths when comparing the test groups at both timepoints. Test group 1 had the best overall performance based on histomorphometric evaluation and biomechanical testing. At 2 years postoperatively, the kerfs filled with TTCP-PS had histological evidence of osteoconduction and replacement of TTCP-PS by bone with nearly complete osteointegration. TTCP-PS was demonstrated to be safe and effective for cranial flap fixation in an ovine model. In this study, the bioresorbable, osteoconductive bone adhesive appeared to have multiple advantages over standard plate-and-screw bone flap fixation, including biomechanical superiority, more complete and faster bony healing across the flap kerfs without fibrosis, and the minimization of bone flap and/or hardware migration and loosening. These properties of TTCP-PS may improve human cranial bone flap fixation and cranioplasty.

Rigid Internal Fixation of Proximal Crescentic Metatarsal Osteotomy in Hallux Valgus Correction.

The purpose of this study was to evaluate outcomes utilizing a low-profile titanium plate and screw construct for rigid fixation of first ray proximal crescentic osteotomies in the treatment of hallux valgus. Forty-eight patients (53 feet) with mild to severe hallux valgus were prospectively enrolled and completed 12-month follow-up. All were treated with a proximal crescentic osteotomy, fixed with a low-profile titanium plate, distal soft tissue correction, with or without an Akin osteotomy. Recorded outcomes included change in first ray dorsiflexion angles, need for hardware removal, radiographic and clinical evaluation, pain, and American Orthopaedic Foot & Ankle Society (AOFAS) scores. All patients achieved radiographic union of their osteotomy. An Akin osteotomy was performed in 83% of patients. Seventeen feet (32%) had hardware removed. First ray dorsiflexion angles increased from a mean of 1.6 degrees preoperatively to 5.0 degrees postoperatively (P < .001). Dorsal malunion, defined as change in dorsiflexion angle greater than 1 standard deviation above the mean, occurred in 7 feet. The mean hallux valgus angle improved from 29 to 9 degrees (P < .001). The mean 1-2 intermetatarsal angle decreased from 14 to 6 degrees (P < .001). The first metatarsophalangeal joint range of motion decreased from 77 to 59 degrees (P < .001). The mean visual analog scale score improved from 4 to 0.7 (P < .0001). The mean AOFAS score improved from 55 to 89 points (P < .001). Proximal crescentic metatarsal osteotomy, fixed with a low-profile titanium plate and screw construct, with distal soft tissue repair, and Akin osteotomy as indicated, was a safe and reliable method for operative treatment of hallux valgus. Level IV, retrospective case series.

An Exploratory Study Using Semi-Tabular Plate in Zone II Flexor Tendon Repair.

This study evaluated the feasibility of using a low-profile titanium (Ti) plate implant, also known as the Ti-button, for Zone II flexor tendon repair. We hypothesize that the use of the Ti-button can distribute the tensile force on the digital flexor tendons to achieve better biomechanical performance. Twenty lacerated porcine flexor tendons were randomly divided into two groups and repaired using Ti-button or 6-strand modified Lim-Tsai technique. Ultimate tensile strength, load to 2 mm gap force, and mode of failure were recorded during a single cycle loading test. We also harvested twelve fingers with lacerated flexor digitorum profundus tendons from six fresh-frozen cadaver hands and repaired the tendons using either Ti-button method or modified Lim-Tsai technique. A custom-made bio-friction measurement jig was used to measure the gliding resistance and coefficient of friction of the tendon sheath interface at the A2 pulley. The ultimate tensile strength, load to 2 mm gap force, stiffness, and gliding resistance of the Ti-button repairs were 101.5 N, 25.7 N, 7.8 N/mm, and 2.2 N respectively. Ti-button repairs had significantly higher ultimate tensile strength and stiffness than the modified Lim-Tsai repair. However, Ti-button also increased the gliding resistance and coefficient of friction but there was no significant difference between the two repair techniques. Ti-button repair displayed comparable mechanical properties to the traditional repair in terms of 2-mm gap formation and gliding resistance, but with a stronger repair construct. Thus, this deepened our interest to further investigate the potential of using Ti-button implant in Zone II flexor tendon repair by studying both the mechanical and biochemical (tendon healing) properties in more in-depth.

Rigid Internal Fixation of Proximal Crescentic Metatarsal Osteotomy in Hallux Valgus Correction

Category: Bunion Introduction/Purpose: Proximal first metatarsal crescentic osteotomies are an effective means for correction of moderate to severe hallux valgus deformities. The originally described fixation construct included an intramedullary screw and a Kirschner wire which crossed the joint and required removal at 6 weeks. Elevation malunion of the first ray was also frequently noted postoperatively. The purpose of this study was to evaluate the outcomes of utilizing a low-profile titanium plate and screw construct for rigid fixation of proximal crescentic osteotomies. Methods: There were 53 patients (60 feet, 7 bilateral) with hallux valgus deformities enrolled in the study. They were all treated operatively with a proximal crescentic osteotomy and distal soft tissue correction with or without an Akin osteotomy. The crescentic osteotomy was fixed with a low-profile titanium plate and screws. Postoperatively patients were assessed at 3 months, 6 months and 1 year. Outcomes assessed included the need for hardware removal, change in elevatus of the first ray, as well as pre- and post-op VAS pain scores, radiographic evaluation, AOFAS score, MTP joint range of motion, and complications. Results: Of the 60 hallux valgus cases enrolled, 56 have completed their final follow-up (93%). At 1 year 55/56 patients had achieved radiographic union of their osteotomy. Nine patients had their hardware removed (16%). Range of motion at the 1st MTP joint decreased from 76.5 to 59.6 degrees. Hallux valgus angle improved from a mean of 28.8 to 9.6 degrees. The mean 1-2 intermetatarsal angle decreased from 14.1 to 6.4 degrees. Elevatus of the first ray increased from a mean of 2.5 mm pre-op to 3.2 mm (&lt;1 mm) post-op. Mean VAS score improved from 4.43 to 0.68 (3.75 points). AOFAS score improved from 54.7 to 88.5 points. Complications included 4 superficial infections, 2 delayed wound healing cases and one DVT. Conclusion: Proximal crescentic metatarsal osteotomy with distal soft tissue repair is a safe and reliable method for operative treatment of hallux valgus. Utilization of a low-profile titanium plate and screw construct to rigidly fix the osteotomy yields a high rate of union and deformity correction with a low incidence of hardware removal and minimal increase in elevation of the first ray at final follow up.

A Biomechanical Comparison of Fifth Metatarsal Jones Fracture Fixation Methods

Background: Fifth metatarsal base fractures of the metaphyseal-diaphyseal watershed junction (Jones fracture) are commonly treated with surgical fixation in athletes. Intramedullary screw fixation remains the most utilized construct, although plantar-lateral plating is an alternative. Purpose/Hypothesis: The purpose was to compare the mechanical strength of fracture fixation between an intramedullary screw and plantar-lateral plating. The hypothesis was that plantar-lateral plate fixation would allow for more cycles and higher peak loads before failure, as well as less fracture gapping, than would an intramedullary screw in cadaveric foot specimens with simulated Jones fractures exposed to cantilever bending. Study Design: Controlled laboratory study. Methods: Twelve pairs of male cadaver feet were separated into 2 groups (plate or screw) to conduct contralateral comparative testing of 2 devices with equally numbered right and left feet. For each fifth metatarsal, an osteotomy with a microsagittal saw was created to simulate a Jones fracture. The plate group underwent fixation with a 3.0-mm 4-hole low-profile titanium plate placed plantar-laterally with 3 locking screws and 1 nonlocking screw. The screw group underwent fixation with a 40- or 45-mm × 5.5-mm partially threaded solid titanium intramedullary screw. After fixation, the metatarsals were excised for biomechanical testing. Cyclic cantilever failure testing was conducted with a gradient-cycle method. Sinusoidal loading forces were applied, increasing by 5.0-pound-force increments per 10 cycles, until each specimen experienced mechanical failure of implant or bone. Failure mode, number of cycles to failure, peak failure load, gap width at the last mutual prefailure loading, and video data were recorded. Paired 2-tailed t test (α = 0.05) was used to compare groups (P < .05 set for significance). Results: Failure mode in both groups occurred predominantly at the bone-implant interface. Plate fixation resulted in significantly higher mean ± SD values for cycles to failure (63.9 ± 27.0 vs 37.3 ± 36.9, P = .01) and peak failure load (159.2 ± 60.5 N vs 96.5 ± 45.8 N, P = .01), with a significantly lower mean gap width (0.0 ± 0.0 mm vs 3.2 ± 2.4 mm, P < .01). Conclusion: As compared with intramedullary screw fixation, plantar-lateral plating allowed for greater cycles to failure and peak load before failure, as well as less gap width, when applied to cadaver foot specimens with simulated Jones fractures exposed to cantilever bending in a load frame. Clinical Relevance: Early return to play among athletes before Jones fracture union is associated with increased risk of failure. This study introduces a plantar-lateral plating construct that performed more favorably than intramedullary screw fixation when applied to simulated Jones fractures in cadaveric foot specimens. Further clinical comparative studies are needed to assess the clinical use of this construct.

First metatarsophalangeal fusion using joint specific dorsal plate with interfragmentary screw augmentation: Clinical and radiological outcomes

BackgroundThis study reports the outcome of a plating system for arthrodesis of the first metatarsophalangeal joint (1st MTPJ) that incorporates a lag compression screw within a low profile titanium plate with a predetermined contour. This is the first report of the outcomes of this implant from a non-affiliated centre. Patient and methodsThis is a prospective cohort study of 40 consecutive primary 1st MTPJ arthrodesis procedures. The mean age of the cohort was 56 years (range, 20–74 years). The diagnosis was hallux rigidus in 31 patients and inflammatory arthropathy in 7 patients. ResultsAll patients achieved clinical union at 6 weeks and radiological union was confirmed on plain radiographs between 6–16 weeks. One case of hardware removal was reported. ConclusionThe cohort achieved consistently satisfactory results with a reliable and reproducible MTPJ position and a 100% union rate. There was a low rate of hardware removal. Level of evidenceLevel IV evidence. Prospective cohort study.

The oblique fracture of the manubrium sterni caused by a seatbelt--a rare injury? Treatment options based on the experiences gained in a level I trauma centre.

Sternal fractures are rare with 3-8 % out of the total number of trauma cases mostly caused by direct impact to the anterior chest wall. Most cases described are due to motor vehicle crash either caused by direct impact to the steering wheel or by the seat belt. Fractures mainly occur to the sternal body. Only rarely are cases of manubrium fractures described in literature, for example, in relationship with a direct impact to the shoulder which caused an oblique fracture near to the sternoclavicular joint. Three patients with profoundly dislocated oblique manubrium fracture were admitted to our Level I Trauma Center in 2012 and 2013. Those patients suffered from instability of the upper sternum and the shoulder girdle. Between January 2012 and October 2013, a total of 538 trauma patients were admitted to the emergency room and received whole body CT-scan. They were analysed retrospectively for sternal fractures. In cases of instability and dislocation, fracture stabilisation was performed by anterior plating through a medial approach using low profile titanium plates (MatrixRib®). Seventy-nine (14.7 %) patients showed sternal fracture, out of which 13 (2.4 %) patients showed a fracture of manubrium, ten caused by seatbelt. In three cases stabilization was performed. Follow up showed sufficient consolidation without complications. A total of 16.5 % of sternal fractures were localized at the manubrium, mostly caused by seat belt. Fractures without significant dislocation seemed to be stable and healed well under conservative treatment. Dislocation in this region leads to unstable shoulder girdle. Anterior plating provides sufficient stabilisation and allowed consolidation.

Is an implant removal after dorsal plating of distal radius fracture always needed?

The purpose of this study was to evaluate the need for an implant removal and the frequency of hardware related complications in a group of distal radius fractures treated with dorsal double plating. This retrospective study analyzed data from 37 patients in whom distal radius fracture surgery was performed through single dorsal approach with two low profile titanium plates during a period of 5 years. Objective and subjective parameters were evaluated, focusing on detection of potentially harmful complications and the need of hardware removal during the follow up at least 12 months after the surgery. 37 patients with distal radius fracture treated by dorsal double plating were included in this study. 19 patients had their implant removed and 18 patients had their implant retained. There was no statistical difference between these groups in respect to age, fracture type, incidence of associated wrist injury, hand dominance, gender and Mayo wrist score. Only subjective parameters including the average value of the Quick Disabilities of Arm, Hand, and Shoulder Questionnaire and the Visual Analogue Scale were higher in the group of patient requiring implant removal with a statistically significant difference. Our results suggested that only symptomatic hardware should be removed. A decreased range of motion and extensor tendon problems are the most frequent complication, that necessitate plate removal. The main indicator of implant related soft tissue problems was the dorsal wrist pain syndrome (Tab. 1, Fig. 3, Ref. 36). Text in PDF www.elis.sk.

Results of surgical treatment in metacarpal shaft fractures using low profile mini plates.

Metacarpal fractures are among the most common fractures of the hand. They may lead to loss of function if treated improperly. These injuries can be treated conservatively. However, if significant shortening, rotational deformity and angulation occur, surgical treatment is required. In this article, results of metacarpal fractures treated with open reduction and internal fixation with mini plates were presented. We retrospectively reviewed the clinical and radiologic records of twenty-nine consecutive patients with 37 metacarpal fractures treated by open reduction and internal fixation with low profile mini plate fixation between 2006 and 2013. Surgical treatment with dorsal approach was planned for cases with unacceptable shortening, rotational deformity, and angulation. Early active motion was begun in all cases postoperatively. Patients were permitted to use their hands in daily activities four weeks after surgery. For objective assessment, total range of joint motion was measured. Rotational deformity of the fingers was assessed. Grip strength and quick DASH scores were compared with the uninjured side. Metacarpal shortening was evaluated radiologically, and angulation was measured. Mean age was 35.1 years (19-61 years) and mean follow-up period was 32 months (6-39 months). While mean operation time was 8.48 days (2-23 days), mean shortening was 7.58 (2-30) mm. In cases with radiologically documented union, mean angulation in the posteroanterior plane was 8.13 (0-42) degrees preoperatively and 3.55 (0-28) degrees postoperatively. In lateral X-rays, mean angulation was 8.22 (0-39) degrees preoperatively and 3.66 (0-28) degrees postoperatively. Mean quick DASH score was 3.6 (0-11.4). Mean grip strength measurements by Jamar hand dynamometer were 41.05 (±8.3) kg for fractured hands, 44.7 (±9) kg for normal hands. No significant relationship was found between normal hand and fracture hand by Mann-Whitney U test. As in general fracture treatment principles, goals in metacarpal fracture treatment are obtaining an anatomical and stable reduction, fracture union and beginning early movement to avoid loss of function. Open reduction and low profile titanium plate application in metacarpal fractures is the choice of treatment in suitable cases as it meets the above mentioned treatment principles.

Hardware-Related Complications After Dorsal Plating for Displaced Distal Radius Fractures

There has been a trend away from dorsal fixation of distal radius fractures secondary to a historically higher complication rate. However, the literature on low-profile dorsal plates and titanium implants for the treatment of these fractures is limited. The goal of the current study was to evaluate hardware-related complications and removal rates after open reduction and internal fixation of unstable, displaced distal radius fractures using a dorsal approach with a low-profile titanium plate. A single surgeon treated 125 patients with isolated, unstable, dorsally displaced distal radius fractures by open reduction and internal fixation using a low-profile titanium dorsal plating system. A total of 110 patients were followed for a minimum of 1 year, and mean follow-up was 27 months (range, 12-74). Outcomes were assessed radiographically and clinically. Satisfactory alignment was achieved in all cases, and no fracture went on to nonunion. Nine patients (8%) required removal of hardware at an average of 12 months (range, 6-34). Six patients (5%) had evidence of extensor tenosynovitis intraoperatively, but no extensor tendon ruptures were identified. Overall, using the Gartland and Werley score, results were excellent in 82 patients, good in 22 patients, fair in 5 patients, and poor in 1 patient. Six complications accounted for the fair and poor results. The average Disabilities of the Arm, Shoulder and Hand (DASH) score at latest follow-up was 6 (range, 0-25). This series showed that the technique of dorsal plating with a low-profile titanium plate is safe and effective.

Surgical fixation of sternal fractures: locked plate fixation by low-profile titanium plates—surgical safety through depth limited drilling

Operative treatment of sternal fractures has become a matter of increasing interest. Anterior plating seems to be the most appropriate method for fixing sternal fractures. However, there are several concerns in relation to the operative procedure such as severe injuries to mediastinal organs, patient comfort and proper stabilisation, for example. This paper describes a safe method of anterior sternal plating using locked plate fixation with limited depth drilling. Ten patients with sternal fractures were included in this cohort study and were treated by anterior plating using one or two plates in parallel through a median approach to the sternum. Follow up was performed after six weeks, 12 weeks and six months. Follow up revealed no serious complications. One patient suffered from postoperative wound seroma. No problems were caused by the plates. Sternal plating using low profile locked titanium plates seems to be a safe and stable method with a high level of patient comfort.

Low-profile Titanium Plate Construct for Early Weightbearing with First Metatarsophalangeal Joint Arthrodesis

First metatarsophalangeal joint arthrodesis is a useful procedure for various first ray pathologic entities. Multiple constructs for fixation have provided successful fusion. A retrospective study of 21 feet (18 patients) was performed after first metatarsophalangeal joint fusion using crossed Kirschner wires or compression fixation with cannulated screws followed by the application of a 2-hole low-profile partially locking titanium plate. The median age was 59 (range 41 to 76) years, and we had 4 smokers and 3 patients with diabetes in our series. Postoperatively, a compression dressing with a posterior splint was applied. The patients then transitioned to a controlled ankle motion walker, and all patients reported full weightbearing by 2 weeks postoperatively. The mean follow-up duration was 11.43 (range 6 to 27) months. The overall primary fusion rate was 95.24% (20 of 21). Two nonunions occurred; one was asymptomatic and successfully consolidated at 12 months. The second nonunion required revisional surgery with an autogenous bone graft to heal successfully. This patient was noncompliant with the postoperative regimen and had a 48-pack year history of tobacco usage. Our results have shown early weightbearing after first metatarsophalangeal joint arthrodesis can be successfully initiated with splintage or lag screw fixation and a 2-hole, low-profile, partially locking titanium plate.

Outcomes of Unstable Extraarticular Metacarpal Fractures Treated with Low Profile Titanium Plate System

Purpose: The purpose of this study was to evaluate clinical results for open reduction and internal fixation of unstable extraarticular metacarpal fractures using low profile titanium plates. Methods: Sixty-two consecutive patients (76 metacarpals) with unstable extraarticular metacarpal fractures who prospectively underwent internal fixation with plating were enrolled. Minimum follow-up was 1 year. There were 48 males and 14 females; average age was 39 years (range, 15-71 years). The location of the fractures was shaft in 65 metacarpals and the type was transverse in 22 cases, oblique in 46 cases, and communited in 8 cases. Of the 62 patients, 11 were open; 9 of these had additional soft tissue injury. The surgical outcome was assessed by clinical and radiographic outcomes and complications. Results: Bone union was successfully achieved in all patients on the average period of 6.4 weeks. The final range of total active motion was excellent for 64 cases, good for 6 cases, fair for 5 cases, and poor for 1 case. Postoperative complications occurred in 9 patients (15 metacarpals). Statistical analysis revealed that patient age, occupation, multiple metacarpal fractures, and soft tissue injury were significantly correlated with incidence of complications at last follow-up. Conclusion: Low profile titanium plating showed the low complication rate and good results in treating unstable extraarticular metacarpal fractures.

Complex Primary Arthrodesis of the First Metatarsophalangeal Joint After Bone Loss

Complications associated with a failed Keller procedure or joint replacement include bone loss and shortening of the first ray. We treated failed Keller resection arthroplasty and joint replacement arthroplasty cases with metatarsophalangeal joint arthrodesis, using an interpositional tricortical autograft from the iliac crest and a low-profile titanium plate. This was a retrospective case note review of the patients treated by four consultant surgeons in a university teaching hospital. A Keller procedure was considered to have failed when patients presented with a short, painful great toe with valgus cock-up deformity. Prosthetic joint replacements were considered to have failed based on the clinico-radiological loosening with associated pain. Metatarsophalangeal joint arthrodesis was carried out using an interpositional tricortical bone autograft and a titanium plate. Patients were assessed for resolution of pain, clinical and radiological evidence of fusion and complications. Ten operated feet in nine female patients, with a mean age of 55.9 (range, 37.8 to 80.2) years were followed for a mean of 12.6 (range, 6 to 26) months. Six patients presented with failed prosthetic joint replacements and four with failed Keller arthroplasty. Full clinicoradiological union was achieved in nine of the ten patients as judged by an independent consultant musculo-skeletal radiologist. Four patients needed removal of implants, one for infection, two for prominent hardware and one for implant failure. Eight of the ten patients were satisfied with the relief of pain. Failed arthroplasty or Keller procedure is a difficult problem to manage. We recommend complex primary arthrodesis with an interpositional iliac crest autograft and a low profile plate as a salvage procedure.