Plate Osteosynthesis Research Articles

Mid-term functional outcome (minimum 24 months, mean 4 years) after locking plate osteosynthesis for displaced fractures of the proximal humerus in 557 cases

BackgroundThe best surgical management of displaced proximal humeral fractures remains a matter of considerable debate. This study presents mid-term functional outcome (median 4 years) after locking plate osteosynthesis for displaced proximal humeral fractures. MethodsBetween February 2002 and December 2014 1031 patients with 1047 displaced proximal humeral fractures were treated by open reduction and locking plate fixation with the same implant and received consecutive prospective follow up at least 24 months after surgical treatment. Clinical follow-up consisted of Constant Murley score (CS), Disabilities of the Arm, Shoulder and Hand score (DASH), and Short Form 36 questionnaire (SF-36). Complete follow-up could be performed in 557 (53.2%) cases, with a mean follow-up of 4.0 ± 2.7 years. ResultsOf 557 patients (67% women; mean age at time of osteosynthesis: 68.3 ± 15.5 years) absolute CS of all patients 4 ± 2.7 years after surgery was 68.4 ± 20.3 points. Normalized CS according to Katolik was 80.4 ± 23.8 points, and CS in percentage to the contralateral side (%CS) was 87.2 ± 27.9%. DASH score was at 23.8 ± 20.8 points. Osteosynthesis related complications (secondary displacement, screw cutout, avascular necrosis (n = 117 patients) were associated with lower functional scores (mean CS was 54.5 ± 19.0 p.; nCS 64.5 ± 22.9 p.;%CS 71.2 ± 25.0%; DASH score 31.9 ± 22.4 p.). The SF 36 was 66.5 points in the case cohort and a vitality mean of 69.4 points. Patients with a complication showed lower results (SF 36 56.7; vitality mean 64.9 points). ConclusionsOverall, patients following locking plate osteosynthesis of displaced proximal humeral fractures showed good to moderate outcomes four years after surgery. Mid-term functional outcomes correlate significantly with those at 1 year postoperatively. Furthermore, there is a significant negative correlation of midterm functional outcome with the occurrence of complications. Level of evidenceLevel III, prospective nonconsecutive patients.

Treatment of distal radius fracture by MIPO technique at Thu Duc City Hospital

Objective: To assess the possibility of anatomical correction when treating fractures of the distal radius fracture with a locking plate through a minimally invasive incision and evaluate the possibility of early recovery of wrist function after treatment of the distal radius fracture with minimally invasive incision preserving the pronator quadratus (PQ) muscle. Subject and method: Acute distal radius fracture patients aged 18 to 65 years old, who came for examination and treatment at the Orthopedic and Trauma Department of Thu Duc City Hospital from October 2020 to May 2021. Classification of the distal radius fracture according to AO: A2, A3, B3, C1 and C2. Result: The result of anatomical reduction included VT 6.22o, RI 22.0o, and UV 0.81 mm. X-ray grading gave 75.0% excellent and 25.0% good results, with 100% bone healing after 12 weeks. At 12 weeks, the mean GRIP Strength score was 71.3%, the VAS score was 1.7 points, the Q-DASH score was 18.1 good function points, and the MAYO score was 74. The average time to return to normal activities was 7 weeks. Conclusion: minimally invasive plate osteosynthesis (MIPO) is a method that gives good results for some fracture types in treating distal radius fractures, by indirect reduction with small incisions to help preserve the PQ muscle and early return the wrist function.

Current global research on mandibular defect: A bibliometric analysis from 2001 to 2021.

Background: Mandibular defects can result from congenital deformities, trauma, tumor resection, and osteomyelitis. The shape was irregular because the lower jaw was radians. This involves teeth and jaw functions; therefore, the difficulty of bone repair is greater than that in other body parts. Several standard treatments are available, but they result in various problems, such as difficulties in skin flap transplantation and possible zone dysfunction, artificial material boneless combining ability, and a long treatment period. This study aimed to introduce the present status of research on mandibular defects to analyze the current introduction and predict future research trends through a bibliometric study. Methods: From 2001 to 2021, publications on mandibular defects were collected for bibliometric visualization using VOSviewer, CiteSpace, and Scimago Graphica software based on the Web of Science Core Collection. Results: This study analyzed 4,377 articles, including 1,080 published in the United States, 563 in China, and 359 in Germany, with an increase in the number of articles published over the past 20 years. Wikesjoe and Ulf Mai E had the most publications (p = 36) and citations (citations = 1,553). Shanghai Jiaotong University published the highest number of papers among the research institutions (p = 88). The most productive journal was Journal of Oral and Maxillofacial Surgery, and the cited literature was primarily classified as dentistry, dermatology, and surgery. Cluster Analysis of Co-occurrence Keywords revealed that highest number of core words were mandibular defects, mandibular reconstruction, and bone regeneration. The highest cited words were head and neck cancer, accuracy, and osteogenic differentiation. High-frequency terms of Cluster Analysis of References were osteosynthesis plate, tissue engineering, and rapid distraction rate. Conclusion: Over the past 20years, the number of studies on mandibular defects has gradually increased. New surgical procedures are increasingly being used in clinical practice. Current frontier topics mainly focus on areas such as computer-aided design, 3D printing of osteotomy and reconstruction guide plates, virtual surgical planning, and bone tissue engineering.

Experimental analysis and numerical fatigue life prediction of 3D-Printed osteosynthesis plates.

The trend towards patient-specific medical orthopedic prostheses has led to an increased use of 3D-printed surgical implants made of Ti6Al4V. However, uncertainties arise due to varying printing parameters, particularly with regards to the fatigue limit. This necessitates time-consuming and costly experimental validation before they can be safely used on patients. To address this issue, this study aimed to employ a stress-life fatigue analysis approach coupled with a finite element (FE) simulation to estimate numerically the fatigue limit and location of failure for 3D-printed surgical osteosynthesis plates and to validate the results experimentally. However, predicting the fatigue life of 3D components is not a new concept and has previously been implemented in the medical device field, though without experimental validation. Then, an experimental fatigue test was conducted using a proposed modification to the staircase method introduced in ISO 12107. Additionally, a FE model was developed to estimate the stress cycles on the plate. The stress versus number of cycles to failure curve (S-N) obtained from the minimum mechanical properties of 3D-printed Ti6AI4V alloy according to ASTM F3001-14 to predict the fatigue limit. The comparison between experimental results and fatigue numerical predictions showed very good agreement. It was found that a linear elastic FE model was sufficient to estimate the fatigue limit, while an elastic-plastic model led to an accurate prediction throughout the implant's cyclic life. The proposed method has great potential for enhancing patient-specific implant designs without the need for time-consuming and costly experimental regulatory testing.

Bridge Plating Versus Hybrid External Fixation in the Management of Proximal Tibia Metaphyseal Fractures.

Due to the surge in high-speed road traffic accidents during the past few years, extra-articular proximal tibia fractures have also risen in number. For the treatment of such fractures, various options are available like conservative treatment with casting, surgical treatment with plate osteosynthesis, or a hybrid external fixator. Exposure of the bone surface and extensive soft tissue dissection is needed in bridge plating, posing a risk of bleeding, infection, and soft-tissue healing issues, and the blood supply of the fractured area is also hampered as the periosteum is also destroyed. To avoid these complications, a hybrid external fixator can be used but it has its own risks of malunion, non-union, and pin-tract infections; another drawback is patient compliance. In this study, we compare the clinical and functional outcomes of two treatment modalities, i.e., bridge plating and hybrid external fixator, in the treatment of proximal tibia metaphyseal fractures. This prospective randomized study was conducted from February 2021 to June 2022 on 46 adult patients diagnosed with proximal tibia metaphyseal fracture and willing to participate. An odd number of patients were treated with a bridge plate and even with a hybrid external fixator. A total of 46 patients were included in the study, sustaining proximal tibia metaphyseal fracture, out of which23 patients underwent hybrid external fixation with an outcome of 69.43 ± 8.11 according to the Knee Society Score (KSS) and 23 for bridge plating which showed better results as their score at final follow-up was 75.00 ± 8.22. According to our study, we found that bridge plating is a better treatment modality than the hybrid external fixator as the former showed better postoperative knee range of motion and functional outcome and led to a smaller number of complications. But the clinical outcome would also be influenced by the type of fracture, degree of comminution, type of injury, i.e., open or closed, and quality of bone.

Minimally invasive plate osteosynthesis (MIPO) for distal humeral fractures: a cadaveric study and first clinical application

BackgroundThe indication for minimally invasive plate osteosynthesis (MIPO) may include articular fractures depending on the fracture pattern. The goal of this study was to evaluate the feasibility of the MIPO technique for extra- and intra-articular distal humeral fractures.MethodsThe feasibility of the MIPO technique was assessed on 8 cadaveric elbows and 2 clinical cases. The four surgical approaches tested included a 20-mm ulnar incision, a 20-mm dorsoradial incision, and two incisions for olecranon osteotomy (A and B). Surgical incision A was 40 mm on the osteotomy level of the olecranon, and surgical incision B was an extension of the radial incision toward the osteotomy of the olecranon (80 mm).The four approaches were tested on 4 extra-articular (AO 13 A3) fractures and 4 intra-articular (AO 13 C3) fractures.ResultsReduction and plate fixation of all distal humeral fractures (8 cadaveric) with and without osteotomy was feasible. However, when using approach B, the soft tissue tension is reduced due to the wider incision. Nevertheless, both approaches A and B showed the same adequate intra-articular fracture control and reduction.ConclusionThe MIPO technique for reduction and plate fixation in distal humeral fractures is feasible.Level of evidenceAs a feasibility study, this study cannot be clearly classified into a level of evidence. It corresponds most closely to level IV.

A Modified of Bilateral Sagittal Split Osteotomy: Technical Note and Proposal of a Nomenclature on the Osteotomy Lines

Bilateral sagittal split osteotomy for orthognathic surgery is the most used technique for mandible advancement or setback and has been well documented and modified over the years since Trauner and Obwegeser described it. The improvement brought by each technique allowed the surgeons to perform safer osteotomies, shorten the operative time, and increased the flexibility of the programmed mandibular movements. The authors present a modification of the bilateral sagittal osteotomy technique with the aim of making the technique easier to perform and more comfortable for the surgeon for the purpose of positioning the osteosynthesis plates and screws. Finally, the authors describe a nomenclature on the osteotomy lines of the bilateral sagittal split osteotomy.

Prophylactic Coronoidectomy Approach during Stable Bone Osteosynthesis after Major Cranio-Facial Injury in the Temporal Region with Muscle Contusion—Should It Be Used?

The coronoidectomy approach is a known but still quite underestimated procedure focused on the removal of the coronoid process of the mandible. Most cases related to outer-joint-related factors causing limited mouth opening (LMO) might be related to a great variety of factors. Quite often, patients suffer a lot from the inability to fully open their mouths. During this time, they are scheduled for limitless conservative, pharmacological, and diagnostic steps to estimate the cause of LMO and increase patients’ mouth opening. In those cases, a diagnostic coronoidectomy might be useful to estimate the potential cause of such a problem. On the other hand, a prophylactic coronoidectomy is still quite randomly described in the world literature and mostly selected for a limited number of special cases. Herein, we would like to present a special issue of the major trauma in the temporal bone, middle cranial fossa, and zygomatico-malar area that resulted in temporal muscle contusion, scarring, and later contraction. A hemicoronal approach was performed to stabilize the fractures of the left zygomatico-orbital area with titanium osteosynthesis plates and screws. Over time, the LMO increased. All temporomandibular joint (TMJ)-related pathologies have been excluded. In the second week, the post-op patient was only able to open his mouth at 12 mm. Temporal muscle injury over time caused major contractions, greatly influencing LMO. The following paper describes the influence of temporal muscle trauma on limited mouth opening and indications for simultaneously performing coronoidectomy during stable bone osteosynthesis.

Comparing Conservative Treatment of Distal Ulna Fractures with Operative treatment

Objective: To compare the outcome of conservative treatment of distal ulna fractures with operative treatment Study design: A randomized control trial Place and duration: This study was conducted at Muhammad Medical College and Hospital Mirpurkhas from September 2021 to September 2022 Methodology:Patients with different types of ulnar fractures (base fractures, head fractures, and subchondral fractures) were divided into two groups based on a systematic approach that established the course of treatment for forearm fractures. The fractures of the distal radius in Group A were treated with plating osteosynthesis, while the fractures of the distal ulna were taken care of with a surgical procedure involving the implantation of an LCP Distal Ulna Plate (De PuySynthes, USA) Results: A total of 120 patients were enrolled in the study, 8 of whom had to be excluded due to the development of carpal ligament damage symptoms. The 112 patients who remained were divided into three groups: 36 in group A, 42 in group B, and 34 in group C. The results of distal forearm fractures were initially treated with closed repositioning in local anesthesia and plaster fixation in 89 cases. In 10 cases, external fixation was primarily applied due to soft tissue conditions. The definitive surgical procedure was performed on average 10 days (3-19) from the injury. In group A, osteosynthesis of both bones was performed during one operation in 30 patients. In 7 cases, it was necessary to perform a two-phase procedure due to the state of the soft tissues. Conclusion: Based on the study's results, osteosynthesis is the more successful treatment for sub-capital fractures, as it results in better early outcomes than a conservative approach. However, due to the low number of patients with this type of fracture, it is impossible to make definitive treatment recommendations Keywords: distal ulnar fracture, osteosynthesis, conservative treatment

Biomechanical comparison of intramedullary nail and plate osteosynthesis for extra-articular proximal tibial fractures with segmental bone defect.

Purpose: Proximal tibial fractures are common, but the current available internal fixation strategies remain debatable, especially for comminuted fractures. This study aimed to compare the biomechanical stability of three internal fixation strategies for extra-articular comminuted proximal tibial fractures. Methods: A total of 90 synthetic tibiae models of simulated proximal tibial fractures with segmental bone defects were randomly divided into three groups: Single lateral plating (LP), double plating (DP) and intramedullary nailing (IN). Based on the different number of fixed screws, the above three groups were further divided into nine subgroups and subjected to axial compression, cyclic loading and static torsional testing. Results: The subgroup of intramedullary nailing with five proximal interlocking screws showed the highest axial stiffness of 384.36 ± 35.00N/mm. The LP group obtained the lowest axial stiffness performance with a value of 96.59 ± 16.14N/mm. As expected, the DP group offered significantly greater biomechanical stability than the LP group, with mean static axial stiffness and mean torque increasing by approximately 200% and 50%, respectively. According to static torsional experiments, the maximum torque of the DP subgroup was 3,308.32 ± 286.21N mm, which outperformed all other groups in terms of torsional characteristics. Conclusion: Utilizing more than four distal screws did not provide improved biomechanical stability in the LP or DP groups, while a substantial increase in the biomechanical stability of DP was obtained when an additional medial plate was used. For the intramedullary nailing group, increasing the number of proximal interlocking screws could significantly improve biomechanical stability, and the intramedullary nailing with three proximal interlocking screws had similar static and cyclic stiffness as the DP group. The intramedullary nailing with five proximal screws had better axial stability, whereas DP had better torsional stability.

Outcomes of Total Hip Replacement for Failed Hemiarthroplasty.

Our study aims to analyze the outcomes of conversion total hip replacement (THR) done for failed hemiarthroplasty. We retrospectively analyzed 104 consecutive patients who underwent conversion THR for failed hemiarthroplasty between January 2012 and December 2018. The patient's records were analyzed for demographic information, index surgery details, preoperative functional status, and perioperative complications. Patients were analyzed according to the various modes of failure of hemiarthroplasty. The radiographs were analyzed for any progressive osteolysis, cup migration and stem subsidence. All the patients were evaluated using the modified Harris hip score (HHS) for clinical outcome. Complications, revision or reoperation in the follow-up period was recorded. A total of 73 patients were included in the study for final analysis after exclusion criteria. The average follow-up was 48.2 ± 29.6months. There was a significant improvement in mean HHS from 38.5 ± 9.1 preoperatively to 80.9 ± 4.3 at the last follow-up (p < 0.05). The different modes of failure had no statistically significantdifference in the postoperative Harriship score (p = 0.393). None of the patients had progressive radiolucent lines more than 2mm or significant subsidence in the final follow-up compared to the initial postoperative radiograph. There was one deep infection, one patient had grade 2 heterotopic ossification, intraoperative calcar fracture was fixed with cerclage wiring in 11 patients, and postoperative periprosthetic fracture in two patients was treated with plate osteosynthesis. There were no neurovascular complications or dislocation during the follow-up. Conversion THR for failed hemiarthroplasty is a challenging procedure and results in good functional outcome and provides reliable pain relief. Conversion THA for septic loosening by two stage revision have comparable postoperative outcomes like THA for aseptic loosening. Caution is required owing to high incidence of peri-prosthetic fracture during conversion THA. Dislocation rate is negligible even with smaller head provided the prosthesis is implanted in the proper orientation and adequate soft tissue balancing is achieved.

Intraoperative Acetabular Fracture.

Intraoperative acetabular fracture is a rare complication in total hip arthroplasty. It occurs mainly as a result of impaction of a cementless press-fit cup. Risk factors include decreased bone quality, highly sclerotic bone, and a press-fit that was relatively too large. The timing of the diagnosis determines the therapeutic approach. Fractures detected intraoperatively should be treated with appropriate stabilisation. Postoperatively, the stability of the implants as well as the fracture pattern determine whether a conservative treatment is initially feasible. Most acetabular fractures diagnosed intraoperatively are to be treated with a multi-hole cup, with additional screws anchoring in the different acetabular regions. In cases of large posterior wall fragments or pelvic discontinuity, plate osteosynthesis of the posterior column is indicated. Alternatively, cup-cage reconstruction can be utilised. Especially in elderly patients, the therapeutic goal must be rapid mobilisation through adequate primary stability, in order to minimise the risk of complications, revision, and mortality.

Surgical Technique: Lateral Plate Osteosynthesis of Proximal Phalanx Fractures.

Dorsal plate fixation of proximal phalanx (PP) fractures is a conventional approach but interferes with the extensor mechanism and results in stiffness. Biomechanical studies have shown that laterally placed plates on the proximal phalanges are equally stable and rigid. This technique obviates the issue of tendon adhesion and may result in better postoperative range of motion and lower secondary procedures such as removal of implant and tenolysis. The low adoption of this technique may be related to lack of familiarity with the surgical approach. We describe our surgical technique with lateral plating of PP fractures and present our case that lateral plate osteosynthesis is an acceptable surgical fixation option for PP fractures, which extends the hand surgeon's armamentarium for more challenging and comminuted fractures.

Medial and lateral dual plating of native distal femur fractures: a systematic literature review.

Lateral locked plating (LLP) development has improved outcomes for distal femur fractures. However, there is still a modest rate of nonunion in fractures treated with LLP alone, with higher nonunion risk in high-energy fractures, intra-articular involvement, poor bone quality, severe comminution, or bone loss. Several recent studies have demonstrated both the safety and the biomechanical advantage of dual medial and lateral plating (DP). The purpose of this study was to evaluate the clinical outcomes of DP for native distal femoral fractures by performing a systematic review of the literature. Studies reporting clinical outcomes for DP of native distal femur fractures were identified and systematically reviewed. Publications without full-text manuscripts, those solely involving periprosthetic fractures, or fractures other than distal femur fractures were excluded. Fracture type, mean follow-up, open versus closed fracture, number of bone grafting procedures, nonunion, reoperation rates, and complication data were collected. Methodologic study quality was assessed using the Coleman methodology score. The initial electronic review and reverse inclusion protocol identified 1484 publications. After removal of duplicates and abstract review to exclude studies that did not discuss clinical treatment of femur fractures with dual plating, 101 potential manuscripts were identified and manually reviewed. After final review, 12 studies were included in this study. There were 199 fractures with average follow-up time of 13.72 months. Unplanned reoperations and nonunion occurred in 19 (8.5%) and 9 (4.5%) cases, respectively. The most frequently reported complications were superficial infection (n = 6, 3%) and deep infection (n = 5, 2.5%) postoperatively. Other complications included delayed union (n = 6, 3%) not requiring additional surgical treatment and knee stiffness in four patients (2%) necessitating manipulation under anesthesia or lysis of adhesions. The average Coleman score was 50.5 (range 13.5-72), suggesting that included studies were of moderate-to-poor quality. Clinical research interest in DP of distal femoral fractures has markedly increased in the past few decades. The current data suggest that DP of native distal femoral fractures is associated with favorable nonunion and reoperation rates compared with previously published rates associated with LLP alone. In the current review, DP of distal femoral fractures was associated with acceptable rates of complications and generally good functional outcomes. More high-quality, directly comparable research is necessary to validate the conclusions of this review.

FUNCTIONAL AND RADIOLOGICAL OUTCOME OF LOWER THIRD TIBIAL FRACTURES IN ADULTS TREATED BY MIPPO WITH LOCKING COMPRESSION PLATE - A PROSPECTIVE STUDY

Background: Treating distal tibia fractures can be challenging because of the limited soft tissue available at this region, the subcutaneous location of the bone , precarious blood supply and its close proximity to ankle joint. Treatment for fractures of distal tibia remains a controversial subject despite an ample amount of advances in both non-surgical (conservative) and operative care. This is a prospective study Material And Methods: to analyse the functional and radiological outcome of xing the distal third of tibia treated with Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO). 30 patients were treated for extra articular dista Results: l third tibia fracture with MIPPO. In our study all 30 patients achieved radiological union at a mean time of 15.6 weeks. 94% had excellent to good objective results based on AOFAS criteria and 97% had excellent subjective criteria. We observed ankle joint stiffness in 2 patients and 3 had supercial infection. Treating the closed distal Conclusion: third tibial fractures with LCP with MIPPO technique provides an early union and excellent to good functional outcome

Minimally Invasive Plate Osteosynthesis (MIPO) Through the Posterior Approach for the Humerus: A Cadaveric Study.

Background Minimally invasive plate osteosynthesis (MIPO) has been effectively used in femur and tibia fractures. MIPO in the humerus is conducted by anterior (most commonly used), lateral, and posterior approaches. However, in the anterior approach, in distal humeral diaphyseal fractures, there is a lack of adequate room for screw placement in the distal fragment for good stability. In such cases, the posterior approach for MIPO may be a propitious treatment method. However, the literatureon MIPO using the posterior approach for humeral diaphyseal fractures is limited. This study aimed to evaluate the feasibility of MIPOthrough the posterior approachand study the association of radial nerve injury with MIPOthrough the posterior approach for the humerus. Methodology This experimental study was conducted in the Department of Orthopedics, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India, and 20 cadaveric arms (10 right and 10 left) of 11 embalmed (formalin) cadavers were included (seven males and four females). Cadavers were placed prone on the dissection table. The posterolateral tip of the acromion and lateral epicondyle of the humerus were used as bony landmarks that were marked under C-Arm (Ziehm Imaging, Orlando, FL, USA) using K wires (Kirschner wires, Surgical Holdings, Essex, UK). Two incisions on theposterior part of the arm were made, and the radial nerve was identified at the proximal incision. After creating a submuscular tunnel, a 3.5 mm extraarticular distal humerallocking compression plate (LCP) was introduced over the posterior surface of the humerus and fixed to the humerus distally with one screw and then adjusted proximally and fixed to the humerus with another screw in the proximal window, followed by placement of couple more screws under C-Arm. After plate fixation, the dissection was completed to meticulously explore the radial nerve. The radial nerve was examined thoroughly for any injury sustained after completion of dissection, from the triangular interval to the lateral intermuscular septum where the nerve enters the anteriorchamber. The position of the radial nerve with respect to plate holes was noted.The distance from the posterolateral tip of the acromion to the lateral epicondyle was measured as humeral length.The medial and lateral points where radial nerve passed over the posterior surface of the humerus were measured from the posterolateral tip of the acromion and compared with the humeral length. Results In this study, the radial nerve was lying over the posterior surface of the humerus for a mean distance of 52.161 ± 5.16 mm. The mean distance at which the radial nerve crossed the medial and lateral borders of the posterior surface of the humerus, measured from the posterolateral tip of the acromion, was 118.34 ± 10.86 mm (40.07% of humeral length) and 170 ± 12.30 mm (57.57% of humeral length), respectively, and the mean humeral length in this study was 295.27 ± 17.94 mm. The radial nerve and its branches were found to be intact in all cases. The radial nerve was related to the fifth, sixth, and seventh holes, with the nerve lying most commonly over the sixth hole (3.5 mm extraarticular distal humerus locking plate). Conclusions The posterior approach of MIPO in humeral fractures is a safe and reliable treatment modality with minimal risk of radial nerve injury. The radial nerve can be safely identified at the spiral groove using the bony landmarks described in our study.

Prospective study comparing between plate osteosynthesis and antegrade interlocking nailing its functional and radiological outcome in treating humeral shaft fractures

Humeral shaft fractures are common injuries making upto 1-3% of all fractures. They are widely treated by conservative methods leading to higher rates of non-union. Henceforth surgeons tend to perform operative procedures to treat them. To statistically analyse and compare the functional and radiological outcome of two treatment modalities of humeral shaft fractures, they are plate osteosyntheis and antegrade intramedullary nailing. A total of 22 patients of humeral shaft fractures were operated by either of two methods 12 in plating (P) group ,10 in nailing (N) group and their radiological outcome was assessed by rate of union, time taken for callus formation etc and their Functional outcome was analysed based on Rodriguez Merchan criteria. The commonest age group of patients operated is 21-40 years (70%) majority being males (70%) and road traffic accident being commonest mode of injury. The plate osteosynthesis group stands superior than nailing group in terms of duration of union (20 weeks), rate, percentage of union (100%), least risk of non-union (0). Statistically significant (p&lt;0.05) improvement in shoulder joint function with minimal complications. The plate osteosynthesis method is the most promising surgical procedure for treating humeral shaft fracture due to negligible rates of non-union and early recovery of motion. Though nailing group has minimal need of soft tissue dissection, preserves fracture biology, decreased operative time and early rehabilitation period it still stands inferior when it comes to complications like rotator cuff injury, shoulder impingement pain and restriction of shoulder movements. Ultimately the post operative quality of life is equally good in both techniques.

Biomechanical analysis of helical versus straight plating of proximal third humeral shaft fractures.

Proximal humeral shaft fractures are surgically challenging and plate osteosynthesis with a long straight plate is one operative treatment option in these patients although endangering the radial nerve distally. Helical plates potentially avoid the radial nerve by twisting around the humeral shaft. Aim of the study was to investigate in a human cadaveric model the biomechanical competence of helical plates versus straight lateral plates used for fixation of proximal third comminuted humeral shaft fractures. Eight pairs of humeral cadaveric humeri were instrumented using either a long 90°-helical plate (Group1) or a straight long PHILOS plate (Group2). An unstable proximal humeral shaft fracture was simulated by means of a 5cm osteotomy gap. All specimens were tested under quasi-static loading in axial compression, internal and external rotation, and bending in four directions. Subsequently, progressively increasing cyclic loading in internal rotation until failure was applied and interfragmentary movements were monitored by motion tracking. During static testing flexion/extension deformation in Group1 was significantly higher, however, varus/valgus deformation as well as shear and torsional displacement under torsional load remained statistically indifferent between both groups. During cyclic testing shear and torsional displacements were both significantly higher in Group1 compared to Group 2. However, cycles to catastrophic failure remained statistically indifferent between the groups. From a biomechanical perspective, although 90°-helical plating is associated with higher initial stability against varus/valgus collapse and comparable endurance under dynamic loading, it demonstrates lower resistance to flexion/extension and internal rotation with bigger shear interfragmentary displacements versus straight lateral plating and, therefore, cannot be considered as its real alternative. Alternative helical plate designs should be investigated in the future.

Minimally Invasive Plating of Distal Radius Fracture: A Series of 42 Cases and Review of Current Literature.

Surgical techniques developed for distal radius fracture fixation have become increasingly advanced, including minimally invasive plate osteosynthesis (MIPO). This study aimed to introduce and evaluate the functional outcome of a novel MIPO technique that differs from previous reports. This study included 42 patients with distal radius fractures who underwent minimally invasive surgical plating of the distal radius. All patients were treated with closed reduction, fixation using K-wire, and subsequent insertion of a volar anatomical stable angle short plate on the distal radius. An arthroscopy-assisted evaluation and repair procedure were performed to correct intra-articular involvement, triangular fibrocartilage complex tears, and scapholunate injuries. Functional outcomes were assessed using a visual analog scale score; quick disabilities of the arm, shoulder, and hand score; and postoperative range of motion of flexion, extension, supination, and pronation at the 3-month follow-up, showing significant improvement in all parameters (all p ≤ 0.05). This study provides a simpler yet reliable method with reproducible and consistent results to treat distal radius fractures using minimally invasive plating with closed reduction and plate insertion, resulting in satisfactory clinical outcomes in all patients.

Single Versus Two Plate Osteosynthesis for Parasymphysis Fractures of the Mandible: A Prospective Comparative Study.

Background The treatment of mandibular fractures has undergone a revolutionary change after the invention of miniplate osteosynthesis. There aren't manystudies in the literature comparing the outcomes of treating mandibular parasymphysis fractures with two miniplates versus one miniplate. Aim To evaluate the outcomes of single vs. two plate osteosynthesis in the management of parasymphysis fractures of the mandible. Materials and methods Sixteen patients with parasymphysis fracture of the mandible treated with a single high-profile miniplate or with two miniplates were included in the study. Multiple outcome variables such as fracture union, wound infection, dehiscence, iatrogenic dental injury,intraoperative time,plate exposure, and need for plate removalwere recorded andanalyzed statistically using the Student's t-test. Results The occurrence of iatrogenic dental injury (P= 0.021) and the mean operating time showed a statistically significant difference between the groups, whereas variables such as osseous healing, plate exposure, wound dehiscence, and postoperative paresthesia had no significant difference (P > 0.05). Conclusion Despite both systems providingenough stability for osseous healing, the use of a single high-profile miniplate demonstrated fewer post-operative problems, such as iatrogenic injury to the dental rootsand occurrence of infection/dehiscence and plate exposure, than the use of two miniplates.