Osteotomy Plate Research Articles

Clinical outcomes for linked fixation of distal humerus fractures: a multicenter study

BackgroundO’Driscoll popularized the principle of linked column fixation for distal humerus fractures. Despite the linked column concept being widely accepted, there are few reported techniques to accomplish this goal. A novel device was designed based on the principles of linked columns. An interlocking beam is used to connect the medial and lateral plates, creating a unified fixed angle construct. Our primary objective was to report clinical outcomes across multiple institutions for a linking beam used in distal humerus fracture fixation. MethodsA retrospective series was collected from five institutions for the TiBeam (Skeletal Dynamics, Miami, FL, USA) with a minimum follow-up of six months. Acute and chronic treatment of distal humerus fracture patterns, and all plate configurations were included for analysis. ResultsA total of 36 cases were collected at a mean age of 52 years and a mean follow-up of 19.3 months. AO C-type fractures were 56% of the series. The median MEPS was 85 (IQR 76.3 to 90), the median DASH was 21.4 (IQR 15.9 to 30), and the median VASa was 3.5 (IQR 2 to 5). An olecranon osteotomy was used in 86% of cases and an anatomic plate was used for fixation of the osteotomy in 94% of those cases. There were three cases of olecranon plate removal for a rate across the series of 13.7%. DiscussionOur short-term results demonstrate satisfactory clinical outcomes with low rates of revision for distal humerus fracture fixed with a linking beam. Further, the rate of removal for the olecranon osteotomy plate was lower than historical reports for aggregate methods of osteotomy fixation.

Assessing the Effectiveness of Modified Tibial Plateau Leveling Osteotomy Plates for Treating Cranial Cruciate Ligament Rupture and Medial Patellar Luxation in Small-Breed Dogs.

In small-breed dogs with concurrent cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL), correcting both disorders is are essential for restoring normal gait. However, the previously described surgical treatment, using two osteotomy technique, poses a high risk of fracture and instability. Addressing CCLR and MPL with a single osteotomy and implant was considered superior to the conventional method. Therefore, a pre-contoured modified tibial plateau leveling osteotomy (PCM-TPLO) plate facilitating medial shifting of the proximal tibia was developed. We compared postoperative alignment and strength between this novel plate group and a conventional tibial plateau leveling osteotomy (TPLO) plate group using eight small-breed dog cadavers each. Additionally, we investigated the potential of the novel plate as an alternative to tibial tuberosity transposition. Postoperative alignment and strength were assessed through radiographs and mechanical testing. Measurements including tibial plateau angle, mechanical medial proximal tibial angle, and number of screws within the joint were also analyzed. There were no significant differences in all measured parameters. For the novel plate, the medial displacement ratio of the proximal tibia was confirmed to be approximately 30%, and the result was thought to be appropriate. These findings suggest that the PCM-TPLO plate could be a promising alternative for treating concurrent CCLR and MPL in small-breed dogs.

Photobiomodulation therapy using a class 3b laser does not cause premature rupture of multivesicular liposomal bupivacaine suspensions in a cadaver model.

To determine if photobiomodulation causes a premature release of liposomal bupivacaine (LB) suspensions. A 25-kg mixed breed dog cadaver euthanized for reasons unrelated to this study. In September 2022, a proximomedial tibial incision was made in a dog cadaver, and a tibial plateau leveling osteotomy plate was implanted. A stab incision was made one-half inch distal to the incision, and a tunnel to the plate was created prior to closure of the primary wound. A 3-cc anal sac catheter was advanced through the distal incision until the bulb rested against the face of the plate. Seven treatment groups of treatment power (watts) and total energy (joules/cm2) were defined as: A, 0.5 W, 2.0 J/cm2; B, 0.5 W, 4.0 J/cm2; C, 0.5 W, 6.0 J/cm2; D, 1.0 W, 2.0 J/cm2; E, 1.0 W, 4.0 J/cm2; F, 1.0 W, 6.0 J/cm2; and sham, 0.0 W, 0.0 J/cm2. Ten samples per group of 2 mL of LB were infused into a new catheter and treated percutaneously with a class 3b laser. All samples remained in the catheter for 12 seconds to reflect the longest treatment time. Post-treatment free bupivacaine concentrations were identified with high-performance liquid chromatography. The median free bupivacaine concentration was reported as: sham, 1.89 mg/mL; A, 1.93 mg/mL; B, 2.01 mg/mL; C, 2.05 mg/mL; D, 1.92 mg/mL; E, 2.03 mg/mL; and F, 2.00 mg/mL. There were no differences in median free bupivacaine concentrations between groups (P = .988). Concurrent LB and photobiomodulation are recommended during the postoperative period. The results of this proof-of-concept study suggest that concurrent use of LB and photobiomodulation may be safe, but in vivo studies at similar and stronger photobiomodulation settings are warranted.

Efficacy and Complications of Fixator-Assisted Correction with Internal Fixation in the Genu Valgum.

Two basic methods for genu valgum correction are osteotomy and internal fixation or external fixator assited correction. External fixators have the advantage of stabilizing fragments before osteotomy allowing better control of fragments and preventing secondary displacements. The purpose of this study was to evaluate the efficacy and complications of fixator assisted correction for genu valgum and internal fixation, using the AO distal femur pediatric osteotomy plate. Thirty-six limbs in 26 patients (age 10-16 years) underwent osteotomy in the distal femur at CORA. Open lateral wedge osteotomy was done; the desired position obtained was temporarily stabilized by connecting the pins with the AO external fixator and stabilized with 90 degrees AO distal femur pediatric locking plate and gap grafted with hydroxyapatite bone granules. Translation of distal fragment was required in 17 osteotomies (53.12%). Osteotomies united within 12 weeks; no non-union was observed. The range of motion was full in all patients. The mean tibiofemoral angle was corrected by 12 degrees and the mean mechanical LDFA was corrected to 87 degrees. There was no secondary deformity, either in the rotational or sagittal plane. This method combines the modularity of external fixator and the advantages of internal fixation.

Anterior Opening-Wedge Proximal Tibial Osteotomy for Slope Correction of Genu Recurvatum

Background: Symptomatic genu recurvatum is defined as greater than 5° of knee hyperextension and can be caused by osseous deformity, soft tissue laxity, or a combination. Common symptoms include pain, weakness, instability, decreased range of motion, leg length discrepancy, and stretching of the posterior capsuloligamentous structures of the knee. In instances where the genu recurvatum is caused by reverse tibial slope, literature supports the use of anterior opening-wedge proximal tibial osteotomy (OW PTO) to treat genu recurvatum by increasing tibial slope. Correction of anterior slope to a more anatomic, posterior orientation allows any stressed ligaments to return to their normal tension and restores the native biomechanics of the knee. Indications: The primary indication for OW PTO is genu recurvatum that is nonresponsive to physical therapy or genu recurvatum with concurrent ligamentous injury. The heel-height test provides an objective assessment for the identification and measurement of knee hyperextension. Technique Description: 2 guide pins are placed parallel to the tibial plateau, engaging the posterior cortex. A small micro sagittal saw is used to cut the anterior cortex. Osteotomes are used to complete the osteotomy, preserving a posterior hinge. An opening spreader device is placed and opened slowly while keeping the posterior cortex intact. The new slope is maintained by use of an opening wedge osteotomy plate and screws. Allograft bone graft is packed thoroughly into the osteotomy site. Fluoroscopy is used throughout the case to assess appropriate orientation and depth of the osteotomy, as well as the final opening width. Results: A review of 5 studies demonstrated adequate reduction in hyperextension, with a mean knee hyperextension ranging from 17° to 32° preoperatively and 0° to 7° postoperatively. Patients had significantly improved postoperative clinical outcomes compared with the preoperative state. Discussion/Conclusion: Anterior OW PTO has been shown to be a safe method of accurately correcting tibial plateau slope for the treatment of genu recurvatum. Patients can expect correction of knee hyperextension, restoration of anatomic posterior tibial slope, decreased posterior tibial translation, and increased subjective outcome scores. Patient Consent Disclosure Statement: The author(s) attest that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Patient-specific cutting guides in corrective osteotomy near to the knee joint

Patient-specific cutting guides (PSCG) are used in osteotomy near to the knee joint to simplify the operative technique, shorten the duration of surgery, reduce radiation exposure and to exactly realize the preoperative planning during surgery, especially when complex deformities are corrected simultaneously in multiple planes. The application of PSCG is in principle possible in all osteotomies near to the knee joint but is especially useful in multidimensional, complex osteotomy. No specific contraindications. After multidimensional 3D analysis and planning using apreoperative computed tomography (CT) protocol, a3D-printed patient-specific cutting guide is produced. This PSCG is used during standard osteotomy near to the knee. Using this PSCG the guided sawcut and predrilling of the screw positions inside the bone for the screws of the planned angle stable osteotomy plate are performed. The amount of the deformity correction needed is "stored" in the PSCG and is converted to the bony geometry during placement of the screws in the predrilled holes through the plate after opening or closing the osteotomy. Apart from that, the surgical approach and technique are equivalent to the standard osteotomy types near to the knee. The application of PSCG in osteotomy near to the knee does not change the postoperative management of the specific osteotomy. The use of patient-specific cutting guides leads to a higher accuracy in the implementation of the preoperative planning and the desired target axis is achieved with greater accuracy. Multidimensional complex corrections can also be exactly planned and implemented. In addition, the intraoperative radiation exposure for the operation team can possibly be reduced.

Patient-specific Le Fort I Osteotomy Plates are More Stable than Stock Plates in Patients with Cleft Lip and Palate.

There is evidence that patient-specific plate fixation for Le Fort I osteotomies (LFI) is more stable than traditional plates. The purpose of this study was to evaluate stability of LFI in patients with cleft lip and palate (CLP) and determine stability differences between patient-specific and stock plates. Consecutive patients with CLP who underwent isolated LFI by one surgeon (BLP) between 2016 and 2021 were included. The predictor variable was type of plate used for fixation (patient-specific or stock). The outcome variable was magnitude of relapse in the vertical (Nasion-A point) and horizontal planes (Basion-A point) at one year post LFI using 3-dimensional cone beam computed tomography. Statistical analysis included Independent Samples T-test, Mann-Whitney U, Fisher's exact and Chi-square tests. P<0.05 was significant. The sample included 63 subjects; 23 (36.5%) in the patient-specific group and 40 (63.5%) in the stock group. Groups were comparable by sex, race, age at operation, cleft type, presence of pharyngeal flap and magnitude of horizontal movement (P>0.136, all). Subjects who underwent patient-specific plate fixation were less likely to have ≥1mm change at one year in the horizontal (4.3% vs. 50.0%, p<.001) and vertical planes (4.3% vs. 65.0%, P<.001) compared to stock plates. For patients who had >10mm horizontal advancement, the patient-specific plates had significantly less relapse (patient-specific 0.105mm ± 0.317mm vs. stock 1.888mm ± 1.125mm vs, P=.003). Patient-specific plate fixation of LFI is more stable and demonstrates less relapse after one year than stock plates. Therapeutic, III.

Is Previously Implanted Osteosynthesis Material an Obstacle for the Use of Customized Guides?: A Case Report.

We present the case of a 46-year-old patient with asymmetric deformity in the posterior tibial slope after previous high tibial osteotomy surgeries with the presence of a medial osteotomy plate. A customized cutting guide was designed to fit on the plate to perform a single surgery and avoid possible soft-tissue complications after multiple surgeries. The presence of a previous internal fixation device may affect the manufacture of 3-dimensional cutting guides. However, in this case, the previously placed osteosynthesis plate was used as an aid for creating the guide.

Use of a jumbo plate in dogs greater than 50 kg following tibial plateau leveling osteotomy does not prevent increase in tibial plateau angle through convalescence.

To investigate the use of a locking 3.5/4.0-mm jumbo tibial plateau leveling osteotomy (TPLO) plate in maintaining the postoperative tibial plateau angle (TPA) in giant-breed dogs weighing > 50 kg and to report the associated complications. Canine patients weighing > 50 kg that underwent TPLO stabilized with a locking 3.5/4.0-mm jumbo TPLO plate between January 2017 and May 2022. Retrospective case series retrieving postoperative outcomes from the medical records. Healing scores and TPAs were calculated using postoperative and recheck radiographs. Owner-perceived outcomes were obtained via questionnaire. 24 stifles in 22 dogs were included. Postoperative complications were recorded in 11 of 24 cases (45.8%) inclusive of 1 minor, 1 catastrophic, and 9 major complications. A statistically significant increase in TPA over the convalescent period was found. Grade 4 healing was present in 18 of 24 (75%) stifles, while the remainder were scored as grade 3. The use of a locking 3.5/4.0-mm jumbo TPLO plate did not prevent a statistically significant increase in TPA through convalescence. This procedure displayed an unacceptably high complication rate when compared with contemporary literature of TPLO. Despite a high complication rate in this patient population, most complications were successfully managed with medical and/or surgical treatment, and high mean and median healing scores were achieved at the radiographic recheck. Additionally, owner-perceived long-term outcomes were excellent.

Multifactorial assessment of leukocyte reduced platelet rich plasma injection in dogs undergoing tibial plateau leveling osteotomy: A retrospective study.

This study assessed the effects of concurrent intra-articular injection and Tibial Plateau Leveling Osteotomy (TPLO) plate surface treatment with leukoreduced platelet rich plasma (lPRP) on outcomes of dogs undergoing TPLO. A retrospective study of medical records for cases presenting from January 2018 to December 2020 was performed. Client-owned dogs with naturally occurring cranial cruciate ligament rupture that underwent TPLO surgery were divided into two groups. The lPRP group included cases that underwent intra-articular injection and plate surface treatment at the time of their TPLO. The control group (C) underwent TPLO without PRP treatment. Data analyzed included: presence of surgical site infection, implant removal rate, degree of change in OA progression score, lameness score progression and radiographic bone healing. The short- and long-term complication rate, hospitalization and antibiotic therapy were also compared between the groups. Descriptive statistics, comparison analyses (Chi square test, t-test, Fisher's exact test) and multi-level logistic regression models were used for statistical analysis. A total of 110 cases met the study inclusion criteria: 54 = lPRP, 56 = C. There were no significant differences between groups with regard to gender, age, presence of meniscal tear, weight, or body condition score. Significant findings included: improved radiographic healing of the osteotomy in the lPRP group, improved global OA scores in the lPRP group, and improved lameness score at recheck examination in the lPRP group. There was no significant difference between the lPRP and C group with regard to surgical site infection and implant removal rate. Concurrent intra-articular injection and plate surface treatment with leukocyte reduced PRP at the time of TPLO, is beneficial in slowing the progression of OA, hastening the radiographic evidence of osteotomy healing, and improved lameness score on recheck examination. Leukocyte reduced PRP was not a significant factor in reducing SSI or implant removal rate.

DUAL APPLICATION OF BACTERIOPHAGES AND MEROPENEM USING MICROBEAD-LOADED HYDROGEL FOR TREATMENT OF MULTIDRUG-RESISTANT PSEUDOMONAS AERUGINOSA IN A MOUSE MODEL OF BONE INFECTION

Fracture related infection remains a major challenge in musculoskeletal trauma surgery. Despite best practice, treatment strategies suffer from high failure rates due to antibiotic resistance and tolerance. Bacteriophages represent a promising alternative as they retain activity against such bacteria. However, optimal phage administration protocols remain unknown, although injectable hydrogels, loaded with phage and conventional antibiotics, may support conventional therapy.In this study we tested the activity of meropenem, and two newly isolated bacteriophages (ϕ9 and ϕ3) embedded within alginate-chitosan microbeads and a hydrogel. Antibiotic and phage stability and activity were monitored in vitro, over a period of 10 days. In vivo, the same material was tested in treatment of a 5-day old Pseudomonas aeruginosa infection of a tibial plate osteotomy in mice. Treatment involved debridement and 5 days of systemic antibiotic therapy plus: i- saline, ii-phages in saline, iii-phages and antibiotics loaded into a hydrogel (n=7 mice/group). To assess the efficacy of the treatments, the infection load was monitored during revision surgery with debridement of the infected tissue after 5,10 and 13 days (euthanasia) by CFU and PFU quantification.In vitro testing confirmed that the stability of meropenem and activity of ϕ9 and ϕ3, was not affected within the alginate beads or hydrogel over 10 days. The in vivo study showed that all mice receiving phages and antibiotics loaded into a hydrogel survived the infection with a reduction of the bacterial load in the soft tissue. Active phages could be recovered from the infected site at euthanasia (104 PFU/g).The hydrogel loaded with bacteriophages and meropenem showed a positive result in locally reducing the infection load indicating a synergistic effect of the selected antimicrobials. Overall, our new strategy shows encouraging results for improving the treatment of antibiotic-resistant biofilm infections that are related to medical implants.

Effects of Angled Dynamic Compression Holes in a Tibial Plateau Levelling Osteotomy Plate on Cranially Directed Fragment Displacement.

To compare angled dynamic compression holes in a tibial plateau levelling osteotomy (TPLO) plate to a commercially available TPLO plate in an ovine cadaveric model. Ovine tibias (40 bones) were mounted on a custom-made securement device and radiopaque markers were placed to aid radiographic measurements. A standard TPLO procedure was performed on each tibia with either a custom-made six-hole 3.5 mm angled compression hole plate (APlate) or a six-hole 3.5 mm standard commercial plate (SPlate). Radiographs were obtained before and after tightening of the cortical screws and evaluated by an observer blinded to the plate. Measurements of cranio-caudal displacement (CDisplacement), proximo-distal displacement (PDisplacement) in relation to the long axis of the tibia, and change in tibial plateau angle (TPA) were determined. CDisplacement was significantly greater in APlate (median 0.85 mm, Q1-Q3: 0.575-1.325 mm) compared to SPlate (median 0.00 mm, Q1-Q3: -0.35-0.50 mm, p < 0.0001). There were no significant differences in the PDisplacement (median 0.55 mm, Q1-Q3: 0.075-1.00 mm, p = 0.5066) or TPA change (median -0.50°, Q1-Q3: -1.225-0.25°, p = 0.1846) between the two plate types. APlate increases cranially directed displacement of the osteotomy in a TPLO procedure without causing TPA change. The reduced interfragmentary distance across the whole osteotomy could improve osteotomy healing compared to standard commercial TPLO plates.

Comparison of ulnar shortening osteotomy for idiopathic ulnar impaction syndrome using conventional or ulnar osteotomy plates and with or without interfragmentary screw fixation

Purpose This study investigated the impact of plate type on the clinical and radiological outcomes of ulnar shortening osteotomy (USO) by comparing conventional and ulnar osteotomy plates. The effect of interfragmentary screw fixation (ISF) during USO was also assessed.Methods Seventy-eight patients were divided into three groups according to the type of plate: 3.5-mm dynamic compression plate (DCP), 3.5-mm limited contact DCP, and 2.7-mm locking compression plate ulna osteotomy system (all from Depuy-Synthes). The patients were also divided into two groups according to whether ISF was performed. Clinical and radiological outcomes, including time to bone union, presence of delayed union, and refracture after hardware removal, were analyzed. Other factors that might affect bone union, such as smoking and underlying diseases, were also evaluated.Results No significant differences were found in clinical and radiological outcomes according to the type of plate. Eight of 51 patients (15.7%) in the without-ISF group showed delayed bone union. Forty-three patients in the without-ISF group underwent hardware removal, and refracture due to low-energy trauma after hardware removal was observed in five of those 43 patients (11.6%). Bone union time was significantly shorter in the with-ISF group (7.6±2.7 weeks vs. 9.8±6.6 weeks). Diabetes mellitus and ISF were associated with the delayed bone union.Conclusion The plate type had no influence on the clinical and radiological outcomes of USO in patients with idiopathic ulnar impaction syndrome. However, ISF during USO has several advantages, such as early bony union and prevention of refracture after hardware removal.

Comparação biomecânica entre placa de TPLO modificada, placa bloqueada e construção placa-pino intramedular aplicadas medialmente em modelo de fratura proximal em tíbias sintéticas caninas

ABSTRACT The aim of this study was to develop a modified tibial plateau leveling osteotomy (TPLO) plate and to compare its biomechanical properties with a locking compression plate (LCP) and plate-rod constructs for the stabilization of experimentally induced gap fractures in canine synthetic tibias. The tibial models were assigned to either repair with a modified TPLO plate (Group 1), locking compression plate construct (Group 2), or plate-rod construct (Group 3). The specimens were loaded to failure in axial compression, three-point mediolateral and craniocaudal bending. There was no statistical difference between the three groups regarding stiffness (N/mm) and deformation (mm) in axial compression. The modified TPLO plate achieved load to failure similar to the plate-rod construct in craniocaudal bending. There was no significant difference between groups on mediolateral bending tests regarding load to failure and deformation. Furthermore, there was no significant difference in stiffness between groups 1 and 2. In conclusion, the modified TPLO plate had similar mechanical properties to LCP and plate-rod construct in the axial compression and bending tests. Nonetheless, clinical studies with a large population of dogs are required to determine the value of this new implant in proximal tibial fracture repair.

Treatment of cranial cruciate ligament insufficiency and medial patellar luxation in a small‐breed dog with a true spherical osteotomy

AbstractA 9‐year‐old, neutered, male, Cairn Terrier dog presented with a 3‐year history of progressive pain and lameness of the right hindlimb. After an acute episode of severe pain and non‐weight‐bearing lameness, the dog was referred to our clinic for evaluation. The physical examination was unremarkable; the orthopaedic examination revealed a positive cranial drawer sign and medial patellar luxation grade 3/4. Orthogonal radiographs were taken. Chronic degenerative changes consistent with cranial cruciate ligament insufficiency and medial patellar luxation were noted. Preoperative planning was performed using veterinary preoperative planning software. A spherical osteotomy was performed to level the tibial plateau, correct the medial patellar luxation and improve a valgus deformity. The osteotomy was stabilised using a polyaxial 2.0 tibial plateau levelling osteotomy plate. At the 8‐week postoperative follow‐up examination, the dog had normal weight‐bearing ability without evidence of lameness or pain.

Postoperative Complications of Double Pelvic Osteotomy Using Specific Plates in 305 Dogs.

The aim of this clinical retrospective study was to describe the postoperative complications and associated factors of double pelvic osteotomy (DPO) using DPO plates. Medical records were searched for dogs that underwent unilateral or bilateral DPO using DPO plates from February 2009 to October 2018 and were re-evaluated for a minimum of 1 to 2 months postoperatively. A variety of commercially available, specific DPO plates were used. Complications were determined during the immediate postoperative period and at the time of the clinical and radiographic re-evaluations done 1 and/or 2 months postoperatively. A total of 458 DPO (226 right, 232 left) performed in 305 dogs satisfied the inclusion criteria. Double pelvic osteotomy plates from eight different manufacturers were used: Fixin (n = 160), Kyon (n = 154), New Generation Device (n = 63), Hofmann (n = 61), Veterinary Instrumentation (n = 12), DePuy Synthes (n = 4), Porte (n = 3) and Koenigsee (n = 1). Mean age of the dogs was 6.2 months (range: 5-8 months), and the body weight ranged from 10 to 47 kg. Overall, a total of 42 complications occurred in 38 DPO (8.2%). Complications included greenstick fracture of the ischium in 14 DPO (3%), isolated screw loosening in 13 DPO involving 16 of a total of 2,947 screws (0.5%), isolated screw breakage in 4 DPO involving 5 of 2,947 screws (0.1%), incomplete ilium fracture in 3 DPO (0.6%), partial caudal plate avulsion in 3 DPO (0.6%), iatrogenic sciatic neuropraxia in two DPO (0.4%), suspected surgical site infection (SSI) in 1 DPO (0.2%) and persistent pain and lameness caused by the implant in 2 DPO (0.4%). The case of suspected SSI and the two cases of persistent pain were classified as major complications (3 DPO, 0.6%), requiring medical and surgical intervention, respectively, whereas other 39 complications in 35 DPO were classified as minor, not requiring treatment (7.6%). Double pelvic osteotomy using DPO plates appears to be a safe surgical option for the treatment of hip dysplasia in growing dogs; no catastrophic complications were reported and the incidence of complications (0.6% major complications and 7.6% minor complications) was low. This study showed that DPO using DPO plates and proper technique was safe in 92% of cases. The only two factors found to be significantly associated with the development of complications after DPO were the laterality (left-sided or right-sided) and body weight.

A 3D-printed Personalized, Combined, Modular Pedicle Subtraction Osteotomy Guide Plate System: An Experimental Study.

Experimental study. The goal of this study was to develop a threedimensional (3D)-printed pedicle subtraction osteotomy (PSO) guide plate system. A 3D model and postoperative computed tomography (CT) data were used to evaluate the accuracy of osteotomy with this system. The key to the success of spinal orthopedic treatment is an effectively performed osteotomy. A 3D-printed osteotomy plate can be used for preoperative surgical planning. Due to the anatomical complexity of the spinal region, the clinical application of 3D-printed osteotomy plates remains challenging. The CT scans of 10 patients with thoracolumbar spinal deformities were obtained in the digital imaging and communication in medicine (DICOM) format. The diseased vertebrae and adjacent vertebrae were reconstructed and reduced by computer- aided design software, and an osteotomy plate was designed for the diseased vertebrae. The 3D-printed spinal model and osteotomy plate were used to simulate the operation for PSO. After the operation, the vertebral body treated by osteotomy underwent a CT scan, and the findings were compared with the preoperative design to evaluate the osteotomy accuracy. The new 3D guide plate and spine model were used to successfully simulate 10 cases of PSO, and the comparison of the preoperative and postoperative states indicated that the osteotomy outcomes were excellent. The new 3D-printed PSO guide plate system can be used for preoperative osteotomy planning and demonstrates good accuracy. The results can be used to develop 3D-printed plans for PSO in clinical practice.

Evaluation of depth gauge accuracy in a canine tibial plateau leveling osteotomy model.

To evaluate the accuracy of six depth gauges used in three tibial plateau leveling osteotomy (TPLO) plate holes. Ex vivo experimental study. Cadaveric canine limbs (n=10), one 25-mm-thick wood board, and one 33.8-mm-diameter polyvinyl chloride (PVC) pipe. A TPLO was performed on 10 canine cadaveric pelvic limbs. Three 3.5-mm plate holes were filled with screws. The remaining three plate holes: a compression hole, a combination compression-locking hole, and a stacked combination compression-locking hole were measured by three observers using six commercial depth gauges and using a micrometer as gold standard. The process was repeated on one wood board and one PVC pipe. Bone measurements collected using two depth gauges with base diameter < 5 mm were smaller than measurements collected using the four depth gauges with base diameter > 5.5 mm (p ranging from < .001 to .038). Mean depth gauge measurements were smaller than micrometer measurements by 2.20 mm for the compression hole, 0.82 mm for the combination hole, and 3.57 mm for the stacked combination hole. Measurement differences among depth gauges were also present for wood board and PVC pipe measurements. Bone measurement variability between depth gauges was less for the combination and compression holes than for the stacked combination hole. Depth gauges lacked accuracy. Measurements differed among gauges and measurement variability varied based on plate hole geometry. Depth gauge measurement accuracy varies based on measuring devices and on 3.5-mm plate hole geometry.

Distal metatarsal osteotomy and dorsal neutralization plate in the treatment of hallux valgus.

Hallux valgus is a disease that can be treated with many different surgical procedures. In our study, we aimed to compare patients with and without dorsal neutralization plate after distal metatarsal osteotomy and fixation with compression screws. The files of 59 patients with 89 feet operated with the diagnosis of moderate degree hallux valgus have been examined retrospectively. Hallux valgus angles, AOFAS, VAS and satisfaction scores, time to return to work of both groups were compared. The cases in which only screw fixation was performed were mobilized with the hallux valgus apparatus for 6weeks postoperatively, while the cases in which dorsal neutralization plate was performed were immediately mobilized full weightbearing without using an additional apparatus. Patients with a minimum follow-up of 2years were included in the study. There was no statistically significant difference between the two groups in terms of being bilateral (p = 0.457), mean age (p = 0.105) and gender data (p = 0.105). There was no significant difference in the preop and postop second year hallux valgus angles, AOFAS, VAS and satisfaction scores of the patients. There was a significant difference in the time to return to work (p < 0.001) and the 6th week AOFAS (p < 0.001), VAS (p < 0.001) and postop satisfaction (p < 0.001) scores between the two groups. The dorsal neutralization plate performed in addition to the compression screw after distal metatarsal osteotomy can cause painless early postoperative results that do not require the use of an additional apparatus, and early good functional results.

Biomechanical evaluation of high tibial osteotomy plate with internal support block using finite element analysis.

High tibial osteotomy (HTO) is a common treatment for medial knee arthrosis. However, a high rate of complications associated with a plate and a significant loss of correction have been reported. Therefore, an internal support block (ISB) is designed to enhance the initial stability of the fixation device that is important for successful bone healing and maintenance of the correction angle of the osteotomy site. The purpose of this study was performed to examine if an internal support block combined with a plate reduces the stress on the plate and screw area. Finite element models were reconstructed following three different implant combinations. Two loading conditions were applied to simulate standing and initial sit-to-stand postures. Data analysis was conducted to evaluate the axial displacement of the posteromedial tibial plateau, which represents the loss of the posteromedial tibial plateau in clinical observation. Moreover, the stresses on the bone plate and locking screws were evaluated. Compared to the TomoFix plate, the ISB reduced the axial displacement by 73% and 76% in standing and initial sit-to-stand loading conditions, respectively. The plate with an ISB reduced stress by 90% on the bone plate and by 73% on the locking screw during standing compared to the standalone TomoFix plate. During the initial sit-to-stand loading condition, the ISB reduced the stress by 93% and 77% on the bone plate and the locking screw, respectively. The addition of the PEEK block showed a benefit for structural stability in the osteotomy site. However, further clinical trials are necessary to evaluate the clinical benefit of reduced implant stress and the internal support block on the healing of the medial bone tissue.