Neutralization Plate Research Articles

Cementless Long-Stem Reverse Total Shoulder Arthroplasty as Primary Treatment for Metadiaphyseal Humeral Shaft Fractures.

The use of cementless diaphysis-fitting stems has been shown to be an effective treatment option for cases of metadiaphyseal humeral fracture. Complex metadiaphyseal fractures are those that extend below the surgical neck into the diaphysis, which can compromise the metaphyseal fixation of typical arthroplasty designs. The presently described surgical technique circumvents the potential risks associated with the use of cement while also permitting the treatment of common concomitant pathologies, such as arthritis and rotator cuff tendinopathy. Evidence supports the efficacy of this technique, showcasing consistent rates of healing, pain relief, and functional recovery, as well as acceptable complication rates compared with alternative surgical options. The surgical procedure is performed with the patient in a modified beach chair position. A deltopectoral approach is utilized in order to expose the humerus and glenoid. In cases in which the tuberosity is fractured, it is carefully tagged for subsequent repair. The metadiaphyseal extension of the fracture is exposed, and reduction is performed with cerclage cable augmentation as needed. When direct reduction proves challenging, the humeral prosthesis is utilized to aid in reduction. Full-length humeral radiographs and a humeral sounder are utilized to guide the placement of a trial prosthesis, ensuring that the stem spans 2 canal diameters past the fracture and restores the appropriate humeral length. The medullary stem is utilized as support for fracture fragment reduction, with use of a combination of bone stitching and cerclage cables as required. Fractures with compromised proximal humeral bone stock can be further augmented with extramedullary strut allografts and cerclage cables. The allograft strut fixation acts as a neutralization plate to maintain rotational control. The joint is reduced, and fixation of the subscapularis and tuberosity is achieved with use of a transosseous suture technique. This technique combines the use of arthroplasty as well as standard osteosynthesis principles to treat complex metadiaphyseal humerus fractures. Nonoperative treatment may be indicated in a primary setting and represents a multifactorial patient-specific decision. Other surgical options include open reduction with internal fixation with plates or an intramedullary humeral nail, and cemented long-stem arthroplasty. If the fracture is too distal and the surgeon is unable to achieve a length of 2 canal diameters for distal fixation, alternative treatment strategies such as cementation may be required. This procedure is most often performed in elderly patients with osteoporosis, who often also have comminuted fracture patterns and conditions such as glenohumeral arthritis or chronic rotator cuff pathology1,5,6,13,15. Whereas open reduction and internal fixation (ORIF) can be effective in younger patients, it poses higher risks of complications in patients with osteoporosis1,3,9,14-16. Neither ORIF nor intramedullary nailing addresses concurrent pathologies. Another alternative technique involves the use of a cemented stem; however, a cementless approach eliminates theoretical risks of cement use, allows easier revisions, and achieves comparable outcomes9,16,20. In summary, cementless long-stem RTSA offers consistent healing rates, satisfactory outcomes, and favorable results. Cementless long-stem reverse total shoulder arthroplasty (RTSA) is a viable alternative for elderly patients with metadiaphyseal proximal humeral fractures. This technique shows consistent healing rates, pain relief, shoulder function restoration, and an acceptable complication rate. In a study of 14 patients who underwent cementless long-stem RTSA from September 2017 to August 2020, all patients showed improved outcomes and radiographic evidence of union at an average of 13 months postoperatively. Minor complications have been reported, such as transient neuropathy, tuberosity nonunion, and humeral stress shielding. This technique is optimal for elderly patients with osteoporotic bone, comminuted fractures, glenohumeral arthritis, and/or rotator cuff pathology.Long comminuted fractures require bridging fixation, spanning 2 canal diameters beyond the fracture site.Patients with compromised proximal humeral bone stock may require allograft strut augmentation.The surgical principle integrates standard arthroplasty for joint length restoration, a relative fracture stability concept by spanning complex fracture segments, and an absolute stability concept by direct fragment alignment. RTSA = reverse total shoulder arthroplastyIMN = intramedullary nailORIF = open reduction and internal fixationAVN = avascular necrosisAP = anteroposteriorCT = computed topographyTSA = total shoulder arthroplastyXR = plain radiographsFU = follow-upSST = simple shoulder testASES = American Shoulder and Elbow SurgeonsDASH = Disabilities of the Arm, Shoulder and HandPROM = patient-reported outcome measuresROM = range of motion.

A retrospective cohort analysis of failure and potential causes after osteosynthesis of femoral fractures with VA-LCP Condylar plate 4.5/5.0, Depuy Synthes

BackgroundSince 2014, the VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, has been the preferred implant for these injuries at our institution, however, speculations have been made whether it is more prone to failure compared to other implants. Thus, the aim of the study was to describe the cohort treated with the VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, at our department from 2014 to 2020, including the number of failures. Secondary, whether specific outcome measures were significantly overrepresented in the failure group. MethodsPatients were identified through the hospital database, and demographic data was extracted from patient files. X-rays were evaluated for injury type, osteosynthesis characteristics, and whether the construct failed during follow-up. Thanks to the national patient record database a minimum of patients was lost to follow-up. ResultsAfter exclusion 159 patients (165 osteosyntheses, descriptive part) and 108 patients (112 osteosyntheses, subgroup analysis) were eligible for inclusion. The VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes, was used for most AO-type fractures and inserted as both neutralization, buttress, and bridging plates. Overall failure was seen in 8 % of osteosyntheses. Significantly more failures were seen in patients with increased Body Mass Index (BMI) (24 vs. 32, p = 0,046) and those treated for a periprosthetic fractures (41 % vs. 89 %, p = 0,005). We did not see an association between failure and plate length, bridge span, screw density or the degree of medial support. ConclusionThe VA-LCP Condylar Plate 4.5/5.0, Depuy Synthes is a versatile plate with failure rates comparable to previously reported studies. This study confirmed that elevated BMI may be a risk factor for failure, while other previously reported risk factors were not associated with failure in this study.

Comparative study of locking neutralization plate construct versus tension band wiring with a cannulated screw for patella fractures: experimental and finite element analysis

Transverse patella fractures, accounting for approximately 1% of Orthopedic injuries, pose intricate challenges due to their vital role in knee mechanics. This study aimed to compare the biomechanical performance of a construct, integrating cannulated screws and an anterior locking neutralization plate, with the conventional tension band wiring technique for treating these fractures. Experimental testing and Finite Element Analysis were employed to evaluate the constructs and gain profound insights into their mechanical behavior. Sixteen cadaveric knees were prepared, and transverse patella fractures were induced at the midpoints using a saw. The plate construct and tension band wire fixation were randomly assigned to the specimens. A cyclic test evaluated the implants' durability and stability, simulating knee movement during extension and flexion. Tensile testing assessed the implants' maximum failure force after cyclic testing, while Finite Element Analysis provided detailed insights into stress distribution and deformation patterns. Statistical analysis was exclusively performed for the experimental data. Results showed the plate enhanced stability with significantly lower deformation (0.09 ± 0.12 mm) compared to wire fixation (0.77 ± 0.54 mm) after 500 cycles (p = 0.004). In tensile testing, the construct also demonstrated higher failure resistance (1359 ± 21.53 N) than wire fixation (780.1 ± 22.62N) (p = 0.007). Finite Element Analysis highlighted distinct stress patterns, validating the construct's superiority. This research presents a promising treatment approach for transverse patella fractures with potential clinical impact and future research prospects. This study presents a promising advancement in addressing the intricate challenges of transverse patella fractures, with implications for refining clinical practice. The construct's improved stability and resistance to failure offer potential benefits in postoperative management and patient outcomes.

Adjunct neutralization plating in patella fracture fixation: a technical trick-Erratum.

Adjunct neutralization plating in patella fracture fixation: a technical trick-Erratum.

Comparing the torsional resistance of different fixation techniques for spiral metacarpal fractures.

This study aimed to compare the torsional resistance of three fixation techniques for spiral metacarpal fractures: screw-only fixation, screw plus neutralization plate fixation, and a locking plate construct. A spiral fracture was created on 18 cadaveric metacarpal bones by applying an axial and torsional loading force using an Instron 3343 mechanical tester. The failure strength was defined as the native torque strength. The fractures were divided into three groups and fixed using each of the three techniques. The repaired bones were loaded to failure to determine the post-repair strength. The neutralization plate group conferred a post-repair torque (278.6 Nmm) that was similar to the native torque (292 Nmm) with a diminution of only 4.5% and appeared to provide the best resistance to torsion.

Does Screw Order Matter? A Technique Tip to Prevent Loss of Fracture Reduction during Surgical Fixation of Lateral Malleolus Fractures.

When obtaining surgical fixation of lateral malleolus fractures, a cortical lag screw is commonly used to obtain anatomic reduction. Subsequently, a neutralization plate is applied. Slight loss of fracture reduction after plate placement occasionally occurs. Although this is frequently attributed to poor bone quality or suboptimal initial lag screw fixation, a frequently overlooked factor is screw order when applying the neutralization plate. The purpose of this technique tip is to highlight the biomechanical rationale behind this loss of reduction and advocate a specific screw order for lateral malleolus fixation.

Casimir effect associated with fractional laplacian and fractal dimensions

Casimir effect predicts that two parallel flat neutral plates are attracted to each other due to quantum fluctuations of the electromagnetic field. In this communication, we study Casimir effect based on two different approaches: the first one is correlated to fractional Laplacian by means of fractional derivatives operators whereas the second one is associated to fractal dimensions. It was observed that, in both approaches, the Casmir zero-point energy of the fields is affected by the fractional order parameter and the numerical value of the fractal dimensions. The first model requires the use of the Hurwitz zeta function and no regularization technique is strongly required. Nevertheless, the second model necessitates the use of the regularization technique augmented by the Lifshitz fixed point and Schwinger proper-time representation mainly when a particular eigenvalue problem is used. • 1-Casimir effect has been studied based on fractional Laplacian and fractal dimensions. • 2-Casmir zero-point energy is affected by the fractional order parameter and fractal dimensions. • 3-The fractional model requires the use of the Hurwitz zeta function without the need of the regularization technique. • 4-The fractal model requires the use of regularization technique and the Lifshitz fixed point approach.

Adjunct neutralization plating in patella fracture fixation: a technical trick.

Patella fracture outcomes are positive overall; however, in some cases, traditional fixation methods result in complications, including loss of fixation and irritable hardware requiring removal. We present a technique of plate fixation that we believe has the potential to improve stability and is less offensive in more comminuted fracture patterns. Improved stability should allow unfettered advancement of rehabilitation without concern for loss of fixation. Lower profile fixation offers a potential for diminishing the presence of irritating hardware requiring removal. We present our technique for using plate fixation to augment more complex patella fracture patterns.

The correlation between acromial osteolysis and acromion types in the treatment of acromioclavicular joint dislocation with hook plate.

This study aimed to radiologically evaluate the effect of hook plates used in the treatment of acromioclavicular joint (ACJ) dislocations on the development of subacromial osteolysis (SAO) according to acromion types. A total of 43 patients with mean age of 38.5 (19-77) years who were diagnosed with AC dislocation and applied neutral clavicular hook plate between 2013 and 2020 were retrospectively evaluated. Acromion types were determined by measuring acromion slope angle on lateral shoulder radiography and 3-dimensional (D)-CT of the patients. Presence of SAO was classified according to the severity of erosion in the subacromial region (grade I: minimal osteolysis, grade II: subacromial erosion <2 mm, grade III: subacromial erosion >2 mm, grade IV: cut-through of the acromion) on postoperative 3D - CT and correlation with acromion types was analyzed. Incidence of SAO was significantly higher among type 1 acromion compared to type 2 and type 3 acromion (P = .003). While osteolysis was observed in 21 patients, no osteolysis was observed in 22 patients. Osteolysis occurred in all patients with type 1 acromion, 7 patients with type 2 acromion, and 5 patients with type 3 acromion. Since the hook tip in the sagittal plane passes posterior to the center of the acromion and the concavity of the subacromial surface is inadequate in the type 1 acromion, we believe that the increased pressure applied by the hook tip on the subacromial cartilage increases the risk of SAO. We predict that the use of hook plates with an angle of 15-20 degrees, similar to the patient's AC angle, rather than neutral hook plate, will reduce the risk of osteolysis in patients with type 1 acromion.

A Review of the Effects of Plate Configurations and Electrolyte Strength on Production of Brown Gas Using Dry Cell Oxyhydrogen Generator

The production of brown gas (HHO gas) performance depends on the attribute of the oxyhydrogen generator. However, it is found that the main issue in the production of brown gas is the complexity of the oxyhydrogen generator system, electrolysis efficiency and safety. Therefore, this paper presents a review of the factors that affect the production of brown including the types of electrode materials, plate configurations, types of electrolytes, and the concentration of electrolytes. Furthermore, this study is also conducted to find out what are the suitable condition for each parameter stated in the research when using a dry cell oxyhydrogen generator in the production of brown gas. Therefore, it is found that by increasing the number of neutral plates and electrodes, the production of brown gas increases. Besides, the ideal plate orientation is the vertical position, and the suitable gap distance between each plate is 2 to 3 mm. Furthermore, the larger the cross-sectional area of plate, the higher the production of the brown gas. Not to mention, the ideal electrolyte that boosts the production of the brown gas is potassium hydroxide (KOH). In addition, dry cell oxyhydrogen generators are more preferred in the production of brown gas as it is much safer and offers more benefits than wet cell oxyhydrogen generators. This further demonstrates that the attribute of the oxyhydrogen generator does influence the production of brown gas.

Electroplated super-hydrophobic Zn-Fe coating for corrosion protection on magnesium alloy

A superhydrophobic Zn-Fe alloy coating was prepared on the surface of a reactive magnesium alloy using a simple, low-cost, eco-friendly method. Firstly, the Zn-Fe coating was obtained in a neutral glycerol Zn-Fe plating solution, which is green, compositionally stable, and non-corrosive to the equipment. And then the superhydrophobic surface with a flower-like microstructure was obtained by grafting myristic acid onto the Zn-Fe coating via a chelation reaction. The water contact angle was >150° and the rolling angle was 3°-4°. The corrosion rate of the two groups of superhydrophobic magnesium alloy samples with electrodeposition time of 30 and 50 min, respectively, was reduced by about 87% compared to that of the bare magnesium alloy. The prepared superhydrophobic coatings exhibit high performance in self-cleaning, abrasion resistance, and corrosion resistance.

Enhancement of the performance and emissions reduction of a hydroxygen-blended gasoline engine using different catalysts

Recently, Egypt has been suffering from rapid and considerable growth in fossil fuel demand, especially in the transportation sector. Hydroxy (HHO) gas which is generated from water electrolysis process has a significant effect on increasing the engine performance, and reducing fuel consumption, and emissions. In the present work, a dry fuel cell is constructed and tested under different types of electrolysis, different concentrations of electrolytes, and different numbers of neutral plates (NP) to obtain the most economic, safe, and best cell quality suitable for different engine operating conditions. A 183-cc single cylinder SI engine connected with a hydraulic pump, in one unit, was used for the study. HHO gas was supplied to the intake manifold of the engine under different conditions. The results showed that engine performance is most improved by using HHO gas generated by KOH electrolyte, 4 NP, at 1500 rpm. Under the optimum conditions, the maximum increase in the engine/pump efficiency was 47.24 %, maximum decrease in specific fuel consumption (SFC) was 32.1 %, and maximum reduction in CO and HC emissions were 91.7 %, and 34.84 %, respectively.

Lateral malleolar fractures Weber Type A and B: does percutaneous intramedullary screw confer a solid alternative to the traditional neutralization plate?

PurposeTo compare the clinical results, complication rates, and radiographic outcome between both methods of fixation of lateral malleolar fractures: lateral neutralization plates and intramedullary fully threaded screws.Patients and methodsThis prospective case series study involved 73 patients with fractured lateral malleolus of type A, B according to Weber classification, to whom internal fixation was performed by either lateral plate and screws construct (Group A) or intramedullary screw (Group B). All patients were followed up for 12 months at least, with an average follow-up time of 12.7 months.ResultsThere was no significant difference in the functional outcome score between both groups. The intramedullary screw group had a significantly shorter operative time and time to full union (P<0.001 and =0.006 respectively). There was a relatively higher accuracy of reduction with the plate fixation group, but it was statistically insignificant. There was a relatively fewer complication rate with the use of intramedullary screw fixation compared to plate fixation.ConclusionThe use of intramedullary fixation is a good alternative for plate fixation in low fibular fractures (Weber A and B). Although plate fixation provides an optimal anatomic reconstruction of the fractures, intramedullary fixation may have a lower risk of complications.

Posterior Antiglide Plating vs Lateral Neutralization Plating for Weber B Distal Fibular Fractures: A Systematic Review and Meta-analysis of Clinical and Biomechanical Studies

Distal fibular fractures are extremely common, yet there remains controversy about which type of plating technique is the most appropriate. We aimed to compare clinical and biomechanical outcomes following posterior antiglide plating and lateral neutralization plating for Weber B distal fibular fractures. A systematic review and meta-analysis of the literature was conducted by two independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included all comparative studies of distal fibular fracture fixation with either a posterior antiglide plate or a lateral neutralization plate. Our primary outcome of interest was reoperation for hardware removal. Secondary outcomes included hardware discomfort, peroneal tendon irritation, infection, wound complications, and mechanical torque to failure. A total of 1122 patients with Weber B ankle fractures were included across nine eligible clinical studies, and 76 cadaveric ankles were subject to testing across three eligible biomechanical studies. Meta-analyses revealed a two-fold greater odds of requiring removal of hardware in the lateral plating group compared to the posterior plating group (odds ratio [OR] 2.48, 95% CI 1.58 to 3.91, P < .0001), and a three-fold greater odds of experiencing hardware discomfort in the lateral plating group compared to the posterior plating group (OR 2.96, 95% CI 1.83 to 4.80, P < .0001). There were no significant differences in rates of peroneal tendon irritation, infection, wound complications, operative time, and torque to failure when comparing the two plating methods. The results of this review indicate that using posterior antiglide plating for distal fibular Weber B-type fractures is associated with significantly fewer reoperations due to hardware complications and less hardware discomfort compared to lateral neutralization plating. This technique does not appear to increase the risk of peroneal tendon irritation or increase operative time.

Self‐assembly of triblock copolymers in the slits of neutral plates to form porous membranes and the pore size distribution: dissipative particle dynamics simulation

AbstractThe self‐assembly morphology of triblock copolymers confined between the slits of neutral plates is investigated with the dissipative particle dynamics simulation method. A porous membrane structure with uniform pore size distribution is obtained. The pore size distribution shows linear laws affected by the concentration of the polymer solution, the hydrophilic and hydrophobic properties of the block as well as the polymer topology and slit thickness. When the concentration is in the range 0.4 to 0.7, the linear triblock copolymer forms continuous circular pores through self‐assembly, and block components present a laterally layered texture. The ring triblock copolymer has no end groups and exhibits a unique self‐assembly behavior. The cyclic triblock copolymer self‐assembled in the slit is able to form an interpenetrating porous continuous structure, and the polymer film has a longitudinal layered structure. The star triblock copolymer has a more unique structure and can self‐assemble into worm micelles with irregular pore structure and continuous interpenetration. In addition, the microphase separation structure of the triblock copolymer melt between the slits is studied. Generally, linear triblock copolymers generate longitudinal stripes, ring triblock copolymers form horizontal stripes and star triblock copolymers form a ‘lattice’ structure. © 2022 Society of Industrial Chemistry.

Detailed analysis on engine operating in dual fuel mode with different energy fractions of sustainable HHO gas

AbstractCarbon emission and problems associated with the world have been the major concerns for the past few decades. The world governments have implemented stringent emission norms to reduce the pollution created by hydrocarbon combustion in automobiles. The use of gaseous fuels in IC engines has gained interest among the research community. In the present research work, hydrogen, and oxygen (HHO gas) are produced together in an electrolyzer unit and is fed into the engine intake manifold before the carburetor. The electrolyzer consists of an anode, cathode and five neutral plates made of 316 L SS. Electrolyser production rate was tested with four different molarity conditions of NaOH electrolyte solution ranging from 0.24 to 1 N. It was noted that a maximum of 2 LPM of HHO gas was produced with the supply of 90 A‐h current at 1 N solution concentration. The performance and emission characters of the SI engine were conducted at six different load conditions and four flow rates of HHO gas. HHO gas induction has significantly increased the thermal brake efficiency by 8% and decreased the specific fuel consumption by 20%. With the supply of 2 LPM of HHO gas, CO2, HC, and NOx emissions were reduced by 67%, 59%, and 34%, respectively.

Design of a novel austenitising bending process in forming characteristics of high-strength quenched and micro-alloyed steel: Experiment and simulation

A systematic study was carried out on a novel designed austenitising bending process to explore the effects of quenching temperatures on the evolution of microstructure and mechanical properties of high-strength micro-alloyed steel. Results reveal that the qualified parts could be bent into a satisfactory shape without spring-back and cracks in bending temperatures of 850–1000 °C. The simulation was applied to predict the equivalent stress, stress neutral layer (SNL) and plate thickness. Strength presents a decreasing trend with the increase of bending temperature owing to integrated influences of high-temperature dynamic recovery (DRV) and dynamic recrystallisation (DRX). Beyond that, SNL nearby the geometrical centre line throughout the plate thickness and dislocation pile-ups on the tension/compression zones are responsible for the smaller hardness on middle regions while higher hardness on the surface areas. Through austenite reconstruction, a smaller martensite packet size would directly improve the strength of the plates bent at a lower temperature. The prior austenite size may be related to the appearance of martensite variants but not necessary. Furthermore, the high accuracy by comparing the experimental results with simulation would provide a high-value reference for the practical manufacturing process of railway spring clips.

The correct derivation of the buckling equations of the shear-deformable FGM plates for the extended Kantorovich method

This article presents the derivation of the elastic buckling equations and boundary conditions of shear-deformable plates in the frame of the extended Kantorovich method (EKM). Surveying the literature shows that those stability equations are often obtained using a wrong derivation by confusing them with the linear equilibrium condition. This work aims at providing the correct derivation that is built on the stability of the equilibrium condition. Buckling equations are derived for three different plate theories, namely, the first-order shear deformation plate theory (FSDT), the refined-FSDT, and the refined plate theory (RPT). This article is the first to implement the EKM based on a refined theory. Also, it is the first time to implement the refined-FSDT in buckling analysis. For the generic FGM plates, buckling equations derived based on the FSDT and refined-FSDT are both found to be simple and contain only the lateral displacements/rotations variations. On the other hand, those of the RPT, have coupled lateral and in-plane displacement variations, even if the physical neutral plate is taken as the reference plane. The considered plate is rectangular and under general in-plane loads. The properties of the plate are continuously varying through its thickness which is assumed to change smoothly with a separable function in the two in-plane directions. The von Kármán nonlinearity is considered. The stability equations are derived according to the Trefftz criterion, using the variational calculus. The solution methods of the obtained equations are out of the scope of this article, however, a brief on the solution strategy is presented.

Plantar Plating for Medial Naviculocuneiform Arthrodesis in Progressive Collapsing Foot Deformity.

Background:Medial column procedures are commonly used to treat progressive collapsing foot deformity (PCFD) reconstruction. The aim of this research is to present the clinical results of plantar plating for medial naviculocuneiform (NC) arthrodesis when NC joint pathology contributes to medial arch collapse. The authors hypothesized that lag screws with a plantar neutralization plate would result in a satisfactory NC joint fusion rate.Methods:A single-surgeon, retrospective case series was performed on patients with flexible PCFD who underwent NC arthrodesis using lag screws and a contoured neutralization plate applied plantarly across the medial NC joint as part of PCFD reconstruction. Thirteen patients (11 females, 2 males; mean age 53.1 [34-62] years) between 2016 and 2019 were identified for inclusion. Mean follow-up was 25.2 ± 12.7 months. Preoperative and postoperative anteroposterior talo–first metatarsal angle, lateral talo–first metatarsal angle, talonavicular coverage angle, and calcaneal pitch were measured. Union was evaluated radiologically. AOFAS midfoot scores were recorded at final follow-up.Results:All parameters demonstrated a significant improvement. Fusion was confirmed in 11 of 13 patients (85%) at a mean 5.7 ± 2.1 months. One patient required a revision of their NC fusion because of symptomatic nonunion. There were no cases of symptomatic plantar hardware.Conclusion:The results of this small cohort series suggest that lag screw with plantar plate NC arthrodesis yielded generally improved short-term radiographic and clinical outcomes in PCFD patients with medial arch collapse through the NC joint.Level of Evidence: Level IV, retrospective case series.

Three internal fixation methods for Danis-Weber-B distal fibular fractures: A biomechanical comparison in an osteoporotic fibula model

A common agreement for the surgical treatment of osteoporotic ankle fractures has not been defined yet although locking plates are preferred for fractures with poor bone quality. This study aims to evaluate the mechanical stability of locked and conventional plates on osteoporotic Danis-Weber-B-fibula fracture models.Fractured custom-made osteoporotic fibulae were treated with neutralization plate plus lag screw, locking plate plus lag screw, or a standalone locking plate. Load until failure was applied mimicking single-leg stance. Stiffness, failureload, and interfragmentary movements were investigated.Stiffness, failureload and axial fragment movement showed no significant differences among groups. Shear movements and fragment rotation around the shaft of the neutralization plate were on average twice as high as those of the locking plates.Although no superiority was shown for overall mechanical performance, the locking plate groups exhibited higher shear and rotational stability than the neutralization plate.