Percutaneous Plate Fixation Research Articles

Percutaneous plate fixation of displaced proximal humerus fractures: Do minimally invasive techniques improve outcomes and reduce complications?

ObjectiveThe aim of this study was to analyze the outcomes and complications of minimally invasive plate osteosynthesis (MIPO) for displaced proximal humerus fractures and elucidate if the percutaneous technique reduces the rate of avascular necrosis (AVN) without jeopardizing fracture reduction. Material and methods118 patients with a displaced proximal humerus fracture were treated with a polyaxial locking-plate through a standardized percutaneous approach. 73 % were women and mean age was 63 years (18–89) with an average follow-up of 51 months (12–256). There were 32 two-part fractures (27 %), 57 three-part fractures (48 %) and 24 four-part fractures (25 %). Shoulder function at the last follow-up, including ROM and ability to perform daily living activities, was objectively evaluated with an adjusted Constant Score (CS). Subjective patient satisfaction was rated with an Visual Analogic Scale from 0 to 10 and the degree of residual pain with a Verbal Rating Scale (VRS). Radiographic analysis at the most recent follow-up evaluated the presence of AVN, degree of residual medial calcar displacement, and the cervicodiaphiseal angle. ResultsForty patients (34 %) had a complication, 25 of them (21 %) requiring further surgery. ROM at the last follow-up was 131° of elevation (40°-180°), 38° of external rotation (SD: 17.7) and internal rotation to L3. Average adjusted Constant Score was 68 (SD: 17.76). Twenty-one patients (18 %) complained of shoulder pain (14 moderate and 7 severe) and seven were not satisfied. Radiographically, 29 patients (25 %) had varus malunion and 17 patients (14 %) showed some degree of AVN. Patients with varus malunion (CS 64.3 versus 69.8, p = 0.16) and AVN (CS 56.9 versus 70.4, p = 0.005) had lower CS. The presence of a varus malunion was directly related to the degree of initial medial calcar displacement (p = 0.001) and deficient calcar reduction at surgery (p = 0.004). AVN was statistically more prevalent when the medial calcar was inadequately reduced (p = 0.01). ConclusionsMIPO surgery for proximal humerus fractures through an anterolateral approach does not reduce the rate of mechanical complications or AVN compared with standard ORIF techniques. Moreover, percutaneous plating may preclude adequate medial calcar reduction, leading to humeral head malunion and a worse clinical outcome.

Comparison of Three-Dimensional Navigation-Guided Percutaneous Iliosacral Screw and Minimally Invasive Percutaneous Plate for the Treatment of Zone II Unstable Sacral Fractures.

The percutaneous IS screws and the minimally invasive percutaneous plate are the most popular internal methods for Zone II unstable sacral fractures. However, the choice of fixation remains controversial for orthopaedic surgeons. The purpose of study was to evaluate and compare the clinical results of percutaneous iliosacral (IS) screw fixation under three-dimensional (3D) navigation and minimally invasive percutaneous plate fixation in the treatment of Zone II unstable sacral fractures. A retrospective study was performed, including 64 patients with Zone II unstable sacral fractures who underwent percutaneous IS screw fixation under 3D navigation (navigation group) and minimally invasive percutaneous plate fixation (plate group) from January 2011 and March 2021 in our department. The age, gender, fracture type, mechanism of injury, injury severity score (ISS), time from admission to operation, operative time, intraoperative blood loss, hospital stay, incision length, follow-up time, time to clinical healing, and complications were recorded and analyzed. Matta standard was used to assess fracture reduction outcomes. The Majeed function system assessed functional outcomes at the last follow-up. The average follow-up time was (14.42 ± 1.57) months in the navigation group and (14.79 ± 1.37) months in the plate group. No statistical difference between the two groups in age, gender, fracture type, mechanism of injury, ISS, time from admission to operation, and time to clinical healing. However, significant differences were detected in operative time, intraoperative blood loss, hospital stay, and incision length (p < 0.001). According to Matta standard at 2 days postoperatively, the excellent and good rate was 91.42% in the navigation group, and it was 93.10% in the plate group. There was no significant difference between the two groups (p=0.961). According to Majeed function system at the follow-up, the excellent and good rate was 97.14% in the navigation group, and 93.10% in the plate group. The difference between the two groups was not statistically significant (p=0.748). There were no neurovascular injuries associated with this procedure. The incidence of complications was 44.82% (13/29) in the plate group, while 14.28% (5/35) in the navigation group (p=0.007). This study found that compared with minimally invasive percutaneous plate fixation, percutaneous IS screw fixation under 3D navigation is a suitable option for the treatment of Zone II unstable sacral fractures. This approach is characterized by its shorter operation time, less surgical trauma, less bleeding, less hospital time, and fewer complications.

Surgical (percutaneous pinning or plate fixation) versus non-surgical interventions for distal radius fractures in adults: an individual participant data review

Surgical (percutaneous pinning or plate fixation) versus non-surgical interventions for distal radius fractures in adults: an individual participant data review

Percutaneous posterior transiliac plate versus iliosacral screw fixation for posterior fixation of Tile C-type pelvic fractures: a retrospective comparative study

BackgroundThis study aimed to compare the clinical outcomes and complications between two minimally invasive surgical techniques: percutaneous transiliac plate fixation and iliosacral (IS) screw fixation for the treatment of Tile C-type pelvic bone fractures.MethodsWe retrospectively reviewed the data of 77 consecutive patients with Tile C pelvic ring injuries who underwent either percutaneous transiliac plate fixation or IS screw fixation in a single academic center between November 2007 and January 2018. We recorded patients’ demographics, surgery-related data, and postoperative surgical outcomes and compared the incidence of complications and revision surgery rates between the two groups.ResultsOverall, 14 patients were included in the plate group, while 63 were included in the IS screw fixation group. No significant differences were observed in the patients’ demographics between the two groups except for a longer interval from injury to surgery (13.5 days vs. 5.4 days, P = 0.001). Both groups acquired fracture union in all cases. There was one case of infection requiring surgical debridement in the plating group. Notably, nerve injury (n = 3) and implant loosening (n = 5) occurred in the IS screw group, but the difference was not significant.ConclusionsBoth percutaneous posterior transiliac plating and IS screw fixation in patients with Tile C-type pelvic bone fractures showed good results. We recommend IS screw fixation as the primary treatment and propose posterior plating as treatment for sacral dysmorphism and bilateral sacral alar fractures in patients with spinopelvic dissociation.Level of evidenceIII

Surgical Results of Minimally Invasive Percutaneous Plate Fixation in the Treatment of Clavicle Shaft Fracture

Surgical Results of Minimally Invasive Percutaneous Plate Fixation in the Treatment of Clavicle Shaft Fracture

Percutaneous locked plating for complex distal tibial fractures

Objective To evaluate the clinical outcome and advantages of percutaneous plate fixation for complex distal tibial fractures using locking compression plate-distal tibial plate (LCP-DTP). Design This is a prospective case series study. Setting Urban, level I trauma center. Patients and methods Twenty-seven adult patients, who met the inclusion criteria, with closed traumatic distal tibia with or without fibular fractures were treated using the minimally invasive plate osteosynthesis technique with LCP-DTP. According to the AO fracture classification, there were 12 AO 43A fractures and 15 AO 43B fractures. The fibula was fractured in 15 patients and it was fixed in all of them. Main outcome measurements Perioperative complications following percutaneous fixation of the distal tibia such as infection, deformity, leg length discrepancy, ankle joint function, bony union, and metal failure within 1 year after the surgery. Results This study included 27 adult patients with traumatic fracture distal third tibia, 21 of them were men and six were were women. They were followed up for a period ranging from 14 to 19 months with an average of 16. None of the patients developed early perioperative complications. Deep venous thrombosis occurred in three patients, who were treated medically, residual loss of a few degrees of ankle motion in six and late infection related to the proximal screws was also observed in three obese uncontrolled diabetic patients. Union was achieved in all of them within 12–20 weeks with an average of 16. Conclusion Minimally invasive plate osteosynthesis for the distal tibia using the LCP-DTP is safe and effective in the treatment of complex distal tibial fractures.

Minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft fractures

Background The most notable change in the treatment of fractures has been the shift from the mechanical aspects of internal fixation with absolute stability and primary bone union as the goal to the biological aspects of internal fixation with relative stability and healing with callus as the preferred method, with a huge focus on preservation of the blood supply of bone and soft tissue to ensure the continued vitality of the individual fragments to improve fracture healing. Percutaneous plate fixation minimizes soft tissue compromise with decreased incidence of wound breakdown and deep infection. It also preserves the vascularity of the bone fragments, and thus reduces the time for union, decreases the need for bone grafting even in comminuted fractures, and also decreases the incidence of nonunion, which requires a second major open intervention. Aim The aim of this study was to evaluate the outcome of minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft (upper and middle thirds) fractures in adults using conventional nonlocked plates through the medial approach. Patients and methods This prospective study included 16 adult male patients who had high-energy closed tibial shaft fractures (upper and middle thirds) with varying degrees of displacement and comminution. All patients were evaluated clinically and radiologically before and after surgery, followed up for a mean time of 14 months postoperatively, and evaluated radiologically and functionally according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system. All patients were treated using conventional nonlocked plates inserted percutaneously on the medial surface of the tibia. Results All the fractures united with a mean union time of 16.2 weeks, ranging from 13 to 36 weeks. Clinical and radiological outcomes according to the ASAMI scoring system in this study showed excellent results in 14 patients, representing 87.5% of the studied group, and good results in two patients, representing 12.5% of the studied group. No neurovascular complications, no persistent limitation of the knee or ankle motions, no deep wound infection, and no implant failure occurred in any of the patients until the last follow-up, and none of the patients required a second major open intervention. Conclusion The minimally invasive percutaneous plate fixation technique is an effective method of stabilization for closed tibial shaft fractures, yielding good bone alignment and protecting soft tissues, leading to higher union rates with good functional outcome. The use of conventional nonlocked plates applied through the medial approach decreases the surgical time and the risk of postoperative compartmental syndrome.

Fixator-assisted Percutaneous Plate Fixation of Complex Diaphyseal Tibial Fractures.

ABSTRACTAimThe purpose of this study is to evaluate the results of indirect reduction and fixation of comminuted diaphyseal tibial fractures using temporary simplified external fixator and plate osteosynthesis through a limited incision approach with special consideration of the duration of surgery and rate of complications.Materials and methodsIn this prospective case series study, 41 cases of comminuted diaphyseal tibial fractures were included. Twenty-two were closed fractures, 15 grade I open fractures, and four were grade II open fractures. Patients were evaluated clinically according to the lower extremity functional scale (LEFS).ResultsOf the 41 cases, 38 were followed up for at least 1 year. Using the LEFS, final scores ranged from 67–80 (mean 75). Union was achieved in all cases except one which united after bone grafting. The mean time to radiological healing was 12 weeks. Operative time from skin incision to closure ranged between 65 minutes and 100 minutes (mean of 80 minutes). There were four cases of superficial infection.ConclusionTreatment of comminuted tibial fractures through use the of a simplified external fixator to aid and maintain the reduction of comminuted tibial fractures whilst limited incisions are then used for minimally-invasive plate osteosynthesis in an effective and time-saving method with a low complication rate.How to cite this articleNada AA, Romeih M, El-Rosasy M. Fixator-assisted Percutaneous Plate Fixation of Complex Diaphyseal Tibial Fractures. Strategies Trauma Limb Reconstr 2019;14(1):25–28.

A minimally invasive sinus tarsi approach with percutaneous plate and screw fixation for intra-articular calcaneal fractures

According to characteristic of anatomical structure of calcaneus and sinus tarsi approach, the minimally invasive plate for treatment of displaced intra-articular calcaneal fractures had been designed. Here we aimed to review the effect of this treatment. Forty intra-articular calcaneal fractures in 38 patients from September 2006 to September 2008 were treated with percutaneous plate via sinus tarsi approach under the monitoring of C-shaped arms. All calcaneal anatomical parameters, including height, width, length, Böhlers angle and Gissane angle were measured by X-ray before and after surgery. Postoperative lateral wound healing was also evaluated and clinical functional outcomes were graded using the Maryland foot score. All patients had been followed up for an average of 12 months ranged from 3 months to 24 months. X-ray indicated satisfactory restoration of the calcaneal height, width, length, Böhlers angle and Gissanes angle. Maryland foot score demonstrated that excellent result was achieved in 32 cases, good in 6 cases, fair in 2 cases, and the excellent and good rate was 95%. Postoperative complications were not found in all fractured feet. Our results suggest that this minimally invasive sinus tarsi approach with new designed plate and screw fixation technique for the treatment of intra-articular calcaneal fractures can not only obtain the satisfactory outcomes, but also can effectively prevent surgical complications.

Parallel analysis of finite element model controlled trial and retrospective case control study on percutaneous internal fixation for vertical sacral fractures.

BackgroundAlthough percutaneous posterior-ring tension-band metallic plate and percutaneous iliosacral screws are used to fix unstable posterior pelvic ring fractures, the biomechanical stability and compatibility of both internal fixation techniques for the treatment of Denis I, II and III type vertical sacral fractures remain unclear.MethodsUsing CT and MR images of the second generation of Chinese Digitized Human “male No. 23”, two groups of finite element models were developed for Denis I, II and III type vertical sacral fractures with ipsilateral superior and inferior pubic ramus fractures treated with either a percutaneous metallic plate or a percutaneous screw. Accordingly, two groups of clinical cases that were fixed using the above-mentioned two internal fixation techniques were retrospectively evaluated to compare postoperative effect and function. Parallel analysis was performed with a finite element model controlled trial and a case control study.ResultsThe difference of the postoperative Majeed standards and outcome rates between two case groups was no statistically significant (P > 0.05). Accordingly, the high values of the maximum displacements/stresses of the plate-fixation model group approximated those of the screw-fixation model group. However, further simulation of Denis I, II and III type fractures in each group of models found that the biomechanics of the plate-fixation models became increasingly stable and compatible, whereas the biomechanics of the screw-fixation models maintained tiny fluctuations. When treating Denis III fractures, the biomechanical effects of the pelvic ring of the plate-fixation model were better than the screw-fixation model.ConclusionsPercutaneous plate and screw fixations are both appropriate for the treatment of Denis I and II type vertical sacral fractures; whereas percutaneous plate fixation appears be superior to percutaneous screw fixation for Denis III type vertical sacral fracture. Biomechanical evidence of finite element evaluations combined with clinical evidence will contribute to our ability to distinguish between indications that require plate or screw fixation for vertical sacral fractures.

Minimally Invasive Percutaneous Plate Fixation of Tibia Fractures: Results in 80 Patients

Minimally invasive percutaneous plate fixation (MIPPF) has gained wide acceptance for treating periarticular fractures of the tibia. Despite the theoretical biological advantages of MIPPF, it is unclear whether these are offset by wound complications, union rate, and malalignment. We therefore estimated the rate of union in tibial fractures treated by MIPPF, the rate of major and minor wound complications, occurrence of malunion, and level of function. We retrospectively reviewed 80 patients with tibia fractures treated by MIPPF. Mean age of patients was 43 years (range, 18-74 years); there were 54 male and 26 female patients. Severe soft tissue injuries were seen in 16 patients. Patients were examined clinically for soft tissue condition, ROM, alignment, and determination of function (Lower Extremity Functional Score). Radiographs and CT were obtained to determine union and malunion. The minimum followup was 12 months (mean, 23 months; range, 12-48 months). Sixty-three patients (79%) had uneventful healing of the fractures. We identified minor wound complications in seven patients (9%). Delayed union occurred in three (4%) and nonunion in seven (9%); noticeable axial malalignment occurred in five (6%), whereas rotational deformities greater than 10° were revealed with the use of CT in 25% of cases. MIPPF allowed uneventful healing and restoration of the preinjury level of function in most patients. However, complications occurred in a substantial number of patients, which needs attention when planning surgery.

The different operative curative effect comparison of distal tibial pilon fractures

Objective To investigate the effects of different operation methods for the treatment of distal tibial pilon fractures.Methods 40 cases of distal tibial pilon fractures were randomly divided into study group and control group,each of 20 cases.The research group used percutaneous insertion of the distal tibia locking plate internal fixation,the control group used the traditional open reduction and anatomical locking plate fixation.The average healing time,the incidence of complications and high rate of fracture healing were compared between the two group.Results The average healing time of the fracture study group(3.0±0.2)months was significantly shorter than that in the control group(4.0±0.3)months.Complication rate in the study group 5.0％ was significantly lower than that in the control group 35.0％.Fracture healing rate of study group 95.0％ was significantly higher than that of control group 65.0％.There was significant difference(P＜0.05).Conclusion The insertion of percutaneous locking plate fixation in the treatment of distal tibia has less trauma,simple operation,ankle joint function recovery,and the complication rate is low. Key words: Tibial fracture; Fracture fixation,internal

Less invasive polyaxial locking plate fixation in periprosthetic and peri-implant fractures of the femur—A prospective study of 41 patients

BackgroundA great variety of methods for the stabilisation of periprosthetic fractures around total hip (THA) or total knee arthroplasty (TKA) have been described. We present the data of our experience in combining a polyaxial, anatomical locking plate with a standardised less invasive technique in the treatment of periprosthetic and peri-implant (femoral nail) femur fractures in this prospective study. Patients and methodsA consecutive series of 41 patients (33 women; age 79.8±11 years) with 41 fractures (n=17 periprosthetic THA, n=10 periprosthetic TKA, n=3 interprosthetic, n=11 perinail) was treated in a ‘mini-open’ (MO; direct reduction of the fracture and percutaneous plate fixation in two-part fractures; n=22) or a ‘minimally invasive’ (MI; indirect reduction and percutaneous fixation; n=19) technique. All patients were followed up for 12 months postoperatively. ResultsThe polyaxial locking mechanism allowed for the setting of a mean of 5.3 screws around an intramedullary implant. Supported by the less invasive strategy, mainly long plates (n=36; 88% were longer than 24cm) were applied without relevant soft-tissue complication. Five surgical revisions (12.1%) had to be performed. During the first postoperative stay, one seroma was evacuated and in two cases the plate broke due to failed biological healing 6 months after the MO technique. In one case, a revision prosthesis had to be implanted due to ligamentous instability, and in another case, soft-tissue balancing of the patella was performed. In the MO group, four of the five complications requiring surgical revision were seen. There was no infection. No statistical difference was seen between the MO and the MI groups for operating room (OR) time and perioperative need for transfusion. In patients with a poor state of health (n=8; immobile and Glasgow Coma Outcome Scale=3), no local complications were seen. All fractures in the peri-implant fracture group (n=11) healed uneventfully. ConclusionPeriprosthetic fracture fixation can be performed as part of a standardised less invasive strategy, but the MI technique should be the preferred treatment. The NCB® system allows for a stable plate fixation around an intramedullary implant. With the less invasive technique, long plates can be applied with low rates of soft-tissue complication and implant failure.

Periprosthetic fractures around the knee—the best way of treatment

BackgroundA variety of methods has been described to stabilise periprosthetic fractures around total knee arthroplasty (TKA). Our report offers a review of the actual strategies in the reduction and fixation of these fractures. Surgical treatment should be based on the following four steps:Diagnostics: By taking the patients' history together with an X-ray of the knee and femur, the fracture is analysed. It is crucial to define whether any losening of the prosthesis had occurred. In selected cases, CT-scan may add important information on the stability of the implant.Classification and planning: For most fractures around the distal femur, the Rorabeck classification is used while fractures around the proximal tibia are best classified according to the Felix classification. Additionally the Orthopaedic Trauma Association (OTA) may be helpful in the planning process for reduction and fixation.Surgigal technique: In fractures around a stable implant (Rorabeck type I and II; Felix type A and C), it is favourable to use plates and retrograde nails (in Rorabeck I or II with an open box of a TKA). For reduction, three methods are available: (a) the open technique (with direct or indirect reduction); (b) the mini open technique (direct reduction of the fracture by cerclage or lag screw and percutaneous plate fixation in OTA type 32 or 33-A1) and (c) the minimally invasive technique (indirect reduction and percutaneous fixation in all other OTA types). Fractures with a loose prosthesis (Rorabeck III and Felix B) are best stabilised by hinged revision arthroplasty.Rehabilitation: It is of great importance for the aged patient to be mobilised out of bed early. In most of the cases, partial weight bearing has to be performed by the aid of frames during the first 6 weeks after surgery. In a well-fixed revision prosthesis with a cemented stem, early full weight bearing might be allowed. ConclusionStandardised less invasive procedures to treat periprosthetic fractures present a valuable alternative to open techniques. The main advantages are lower rates of oft tissue complications and implant failures following less invasive techniques of long plate application. Polyaxial locking systems allow for stable plate fixation around intramedullary implants.

A simple method to protect the great saphenous vein and saphenous nerve in percutaneous plate fixation of distal tibial fractures

Open reduction and internal fixation for distal tibial fractures can achieve anatomical reduction, but may result in delayed union, nonunion or soft-tissue complications. Minimally invasive plate osteosynthesis (MIPO), which involves insertion of the plate through a limited incision, placement of screws through stab incisions and using the principles of biologic fixation with indirect reduction techniques to reduce the fracture, is believed to decrease the rates of nonunion and lower soft-tissue complications because of the undisrupted local fracture environment and limited skin incisions. Locking plates (LPs) have the biomechanical properties of internal and external fixators, with superior holding power because of fixed angular stability through the heads of locking screws. As a result, percutaneous plate fixation of distal tibial fractures is becoming more and more popular as a minimally invasive technique. However, because the great saphenous vein (GSV) and saphenous nerve (SN) lie in the medial facet of the distal tibia, and cross the tibia from anterior to posterior, percutaneous plates must be inserted underneath these structures. These structures are difficult to dissect and identify through the stab incisions used to place screws. Therefore, percutaneous insertion of the drill sleeves and screws can increase the risk of injury to the GSV and SN more than does open reduction and internal fixation. Despite this risk, the incidence of numbness resulting from iatrogenic injury to the SN has not been reported in the literature. Although minimal attention has been paid to this complication, having little overall clinical importance, it can be a source of patient dissatisfaction and impaired quality of life as a result of the sensory disturbance, and furthermore, may be readily preventable. On the other hand, injury to the GSV is thought to have little clinical importance other than increased bleeding from the incision, because drainage can be achieved through the communicating veins. However, haematoma, foot oedema and possible decrease in venous return from the already injured local soft-tissue

Is percutaneous plate fixation better than ORIF for distal tibial fractures

Objective To compare the clinical results of minimally invasive percutancous plate os-teosynthesis (MIPPO) and open reduction with internal fixation (ORIF) for treatment of distal tibial fractures. Methods From October 2006 to June 2007, 94 cases of closed distal tibial fracture with intact articular surface were treated by internal fixation with plates. Of them, 42 were treated with ORIF and 52 with MIPPO. We retrospectively analyzed their union time, malunion and complications. Results The average follow-up was 14.5 (8 to 24) months. In the ORIF group, 35 cases got union, 3 cases delayed union and 4 cases nonunion. The average time for union was 3.83 (3 to 8) months. There were no cases of malunion and 2 cases of superficial infection in this group. In the MIPPO group, 47 cases obtained union, 5 cases delayed union and none nonunion. The average time for union was 3.66(2 to 8) months. No significant differences were found between the 2 groups in total union time or in the union time for Type AI, Type A2 and Type B fractures respectively. The union time for Type A3 fracture was longer in the MIPPO group than in the ORIF group, but the union time for Type C fracture in the MIPPO group was shorter than in the ORIF group. In the MIPPO group, external rotation occurred in 2 cases and posterior angnlation displacement in 3, and 8 cases com-plained of discomfort around the ankle which was relieved after removal of the plate. Conclusions Gen-erally speaking, there is no significant difference between ORIF and MIPPO in union time for distal tibial fractures. ORIF may be superior to MIPPO in treatment of Type A3 fracture, but inferior to MIPPO in treatment of Type C fracture. A high rate of delayed union may be expected in patients who have been treated with MIPPO and have had anteroposterior angnlation. Key words: Tibia; Fracture; Fracture fixation, internal

Cowden syndrome. Managing multiple skeletal metastases of different origin: a case report

BackgroundCowden Syndrome is a rare autosomal dominant multiple hamartomatous condition, characterised by both benign and malignant tumours affecting multiple systems.Case presentationWe present a 47-year-old female patient with thigh pain that was diagnosed with Cowden syndrome 20 years ago and developed multiple and different skeletal metastases which became resistant to radio-chemotherapy. A percutaneous plate fixation of the distal femur with an intralesional excision and cementoplasty of the metastasis was performed initially. This was combined with a cemented total hip arthroplasty using an Exeter long revision stem and a cementoplasty of the femoral canal for the proximal lesions.ConclusionA meticulous approach to her complex metastatic disease resulted in successful palliative prophylactic reconstructive surgery that improved her quality of life, allowing her independent pain free walking for 12 months.

Percutaneous Plate Fixation of Two- and Three-part Proximal Humerus Fractures

If proper meticulous technique is used, optimal fracture fixation with avoidance of extensive soft tissue disruption, large incision sizes, and neurovascular injury can be attained.

Tibial Plafond Fractures: Limited Incision Reduction with Percutaneous Fixation

This study was a retrospective review of 18 patients with 19 pilon fractures treated with limited incision reduction and percutaneous plate fixation of the tibia. Patients were treated with either a 1- or 2-stage protocol. The latter consisted of placement of an external fixator followed by definitive reduction. The emphasis of analysis was placed on the identification of complications to the soft tissue envelope or bone-healing problems within the first 6 months after surgery. A major complication was defined as an unplanned operation within the first 6 months. Minor complications were any superficial wound defects that did not require operative intervention to resolve or any malunion or delayed union. With this protocol, no major complications were encountered. Minor complications were identified in 4 patients (4 fractures) of which 2 were minor wound problems. One patient developed a malunion, and the other had a delayed union. Four patients requested removal of prominent hardware. These results indicate that limited incision reduction and percutaneous plate fixation lead to safe methods of stabilization. The authors also provide guidance and strategies for the consistent execution of this technique.

Percutaneous Plate Fixation of Comminuted Ulnar Fractures

The superficial location of ulnar fractures allows minimally invasive insertion of percutaneous plates, which improves stability and creates a friendly healing environment.