Plate Augmentation Research Articles

Incomplete Diaphyseal Atypical Femoral Fracture due to Increased Anterolateral Bowing: Treatment with Corrective Osteotomy and Intramedullary Nailing with Augmented Plate Fixation.

Increased anterolateral bowing of the femur is associated with atypical femoral fractures among older patients (including both those receiving and those not receiving treatment with bisphosphonates) as well as a greater likelihood of occurring in the diaphyseal versus the subtrochanteric region. Prophylactic intramedullary (IM) nailing is recommended for the treatment of incomplete atypical femoral fractures, which are radiographically evident. However, this bowing deformity is considered to be a major obstacle to IM nailing as it may be associated with postoperative complications. Corrective osteotomy combined with IM nailing straightens the exaggerated curvature of the femur. We hypothesized that this technique may lead to the safe and rapid healing of incomplete diaphyseal atypical femoral fractures, thereby reducing lateral tensile stress. From October 2015 through March 2020, 17 female patients (20 femora) with a mean age of 76.1 years (range, 68 to 86 years) underwent a surgical procedure for the treatment of an incomplete diaphyseal atypical femoral fracture associated with anterolateral bowing. The surgical technique consisted of minimally invasive osteotomy and reconstruction with use of IM nailing, with or without an augmentation plate. Preoperative and postoperative radiographic findings (lateral and anterior bowing angles, anterolateral bowing grade, and lateral distal femoral angle [LDFA]) were compared. Primary union, time to union, and complications were evaluated as the outcomes. Primary bone union was achieved in 19 of the 20 femora at a mean of 24.9 weeks (range, 20 to 40 weeks). There were 2 instances of delayed union, which healed at 36 and 40 weeks. The lateral bowing angle, anterior bowing angle, and LDFA significantly improved postoperatively (from 12.0° to 3.3°, from 17.3° to 11.5°, and from 93.5° to 88.8°, respectively) (p < 0.001). There was 1 instance of nonunion, which healed after plate augmentation without a bone graft. Given the pathophysiology of elevated lateral tensile stress, corrective osteotomy and IM nailing may be an acceptable solution for the treatment of incomplete diaphyseal atypical femoral fractures associated with increased anterolateral bowing. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Derotational Plate Augmentation with Retention of Intramedullary Interlocking Nail in Resistant Nonunion at Distal Femur Shaft

Background: Non-union in femur shaft after satisfactory treatment with closed intramedullary interlocking nail is not very common. This nonunion is always a challenging condition for surgeon. These nonunion are usually treated by dynamization, close exchange nail with larger diameter, retention of nail and onlay bone graft, removal of nail and fixed with plates and bone graft, removal of nail and application of cast brace and sometimes removal of nail and applications of external fixators. But no treatment is’ gold standard’ the rotational instability is blamed to be one of the most common reason of nonunion. Aim: To control rotational instability, we did plate augmentation with or without bone grafts without removing the nail to treat this nonunion. Methods: Total patients were 16. Proximal and distal interlocking screws were removed, nonunion site was opened, compression at nonunion site was done, and broad DCP was applied as de rotation plate with or without bone grating. We excluded fracture less than one-year duration and fracture with infective nonunion. Results: In 12 patients bone grafting was done where there was less callus or there was suspicion of atrophic non-union. We got union in all patients. 6.25 months were average time of union. 13 months was average time between the primary and secondary surgery. 71 minutes was means surgical time. Complications or implant failure were not noted. 0.9 cm was average residual limb shortening and 115 degrees was average range of motion at knee joint. Conclusion: Nonunion in distal femur shaft fracture with interlocking nail in situ is reliable and effective procedure Keywords: Distal femur, plate, External fixator. Bone grafting

Tectonic evolution of the Qinling Orogenic Belt, Central China – new evidence from geochemical, zircon (U-pb) geochronology and HF isotopes

The paper deals with a review of tectonic evolution in different regions of China with the help of different techniques and models. Tectonic evolution shows that in the shallow layers of China the structural impact is not solid, and huge structural zones are deficient within the list and incline zones where the principal wretchedness and delicate slant zones framed. The Qinling Orogenic Belt (QOB) situated between the North China Craton (NCC) and the Yangtze Craton (YZC) is made from the Northern Qinling Belt (NQB) and the Southern Qinling Belt (SQB). The Hf isotopic creations of zircons from the different rocks recommend that the NQB most likely created on the cellar of the southern NCC. The stones in the SQB show zircon age spectra and Hf-isotope structures like those in the northern YZC, recommending a nearby proclivity. We thusly decipher the SQB to have created on the cellar of the northern YZC. Incorporating the new information in this investigation with those from past works, we propose another structural model for the development and advancement of the QOB during late Mesoproterozoic to early Paleozoic including the accompanying significant occasions: (1) Late Mesoproterozoic to early Neoproterozoic (Grenvillian) toward the north subduction of the Songshugou Ocean; Early-center Neoproterozoic (870-800 Ma) bidirectional subduction and impact; Middle Neoproterozoic (∼800-710 Ma) post-crash expansion; Middle-late Neoproterozoic (710-600 Ma) inside plate augmentation; Late Neoproterozoic-early Paleozoic (600-520 Ma) opening of the Shangdan Ocean; and Early Paleozoic (520-420 Ma) subduction-crash. We accordingly follow in any event two unmistakable Wilson cycles in the QOB.

Biomechanical comparison of four different fixation methods in the management of Pauwels type III femoral neck fractures: Is there a clear winner?

BackgroundCannulated screws augmented with the medial buttress plate could confer greater biomechanical stability and higher union rates than the screw fixation alone for treating young patients with Pauwels type III femoral neck fractures (FNFs). No study has evaluated the effects of distal bicortical screw fixation and biomechanical properties of buttress plate augmentation under simultaneous vertical and rotational forces, physiologically acting on the hip joint. This study aimed to compare the biomechanical properties of four methods of three cannulated screw fixation under the combined axial and torsional loading in a synthetic femur model of type III FNF. MethodsTwenty-four third-generation composite femora were divided into four groups (6 femora in each group) based on the screw fixation configuration: inverted triangle configuration (Group A), Pauwels' configuration (Group B), inverted triangle configuration combined with medial buttress plate using distal unicortical (Group C), and distal bicortical screw placement (Group D). A Pauwels type III FNF was simulated on the sawbones. Each model was subjected to the combined axial and torsional cyclic loading and subsequently tested to failure. ResultSignificant differences were determined in axial stiffness (AS) among the four groups (p = 0.024), whereas there was no significant difference in torsional stiffness (p = 0.147). The mean AS was higher in group D (639.5 ± 86.2 N/mm) than in group A (430.6 ± 94.8 N/mm), group B (426.2 ± 41.9 N/mm), and group C (451.2 ± 156.7 N/mm). Failure forces (FFs) were significantly different among four groups (p = 0.007), while there was no considerable difference in failure moment values (p = 0.555). The mean FF was significantly higher in group D (1307.1 ± 96.4 N) than in group A (1076.9 ± 371.2 N) and group B (1075.5 ± 348.3 N) (p = 0.014 and p = 0.018, respectively). There was no significant difference in the mean FF between groups D and C. ConclusionRegardless of the medial plate use, multiple cannulated systems could provide similar biomechanical results regarding torsional stiffness and failure moments. Bicortical placement of the most distal screw in medial buttress plate application could improve axial stability but not significantly affect the rotational stability of the inverted triangle screw fixation system in managing type III FNFs.

The Effect of Augmentative Plating for the Treatment of Nonunion of Femoral Shaft Fractures after Intramedullary Nailing: A Case Series

Background: Several treatment approaches are now considered to manage femoral nonunion following intramedullary (IM) nailing. Augmentation plating over a maintained IM nail was a successful treatment for femur fracture nonunion in recent years. We aimed to describe our experiences in evaluating the union of bone for these patients after plate augmentation with serial examinations and radiologic studies.&#x0D; Methods: This was a case study on 21 patients who had a nonunion or delayed union of the femoral shaft fracture (FSF) after IM nailing. After initial intervention, they were monitored for 20.4 months (range: 12-72 months).&#x0D; Results: A closed IM nail was used in 18 patients, while the other three patients were shown as non-IM nail cases with a dynamic hip screw (DHS) in one patient, an external fixator in one other patient, and plate fixation in another one that was planned for augmentation plating. After plating, appropriate union appeared in all patients. Fracture union took an average of 7 months ranging from 3 to 12 months.&#x0D; Conclusion: Augmentation plating for treating FSF nonunion with leaving the nail in place results in excellent and favorable clinical outcomes with the radiographic recovery of the nonunion site in all of the cases with no complication.

Assessing the Effectiveness of Dorsal Flap in Surgical Repair of Hypospadias by Tubularized Incised Plate Urethroplasty

Background: Hypospadias is a congenital abnormality of the urethral meatus opening which is located anywhere along the length of the penis except the tip of the glans. The management of this congenital disease is surgical and comprises orthoplasty, urethroplasty, glanuloplasty and cosmetic correction. Urethroplasty is the key step of surgical correction of hypospadias. . Tubularized incision plate (TIP) urethroplasty by dorsal flap is frequently used for distal hypospadias. The reason for the preference is usually wide acceptability of low post-surgical complications and optimum cosmetic results. Other techniques include urethral plate augmentation and urethral plate replacement. Aims: The aim of this study is to assess the effectiveness of dorsal flap assisted TIP urethroplasty in patients with hypospadias of recruited population. The effectiveness will be measured against postoperative outcomes such as wound rupture, wound necrosis, meatal stenosis, and urethrocutaneous fistula formation. Methodology: This prospective study was conducted on 11 primary hypospadias cases undergoing TIPU in Dr Ziauddin Hospital, Karachi for the period of one year from November 2020 to October 2021. The inclusion criteria included infants with distal and midshaft hypospadias with sufficient width of the urethral plate. Whereas individuals with proximal hypospadias or other factors complicating the surgical procedure were excluded from the study population. Result: The total number of participants included was 11 children. The age of participants varied between 18 – and 28 months with a mean age of 24.2 ± 3.1 months. The meatus opening was seen at the distal end near the coronal sulcus in 8 participants whereas 3 participants showed preoperative meatus opening in the distal third of the shaft. An immediate follow up was done at 2 weeks intervals to assess wound health and situation. 1 out of 11 infants showed wound dehiscence which was immediately corrected. A late follow up was carried out after 2-3 years, no case presented with significant complications such as urethrocutaneous fistula or stenosis of the meatus. Conclusion: the study shows measured the post-operative complications followed by TIP urethroplasty using a dorsal flap. Immediate complications showed a single case of wound dehiscence. Whereas all long term follows up after 2-3 years showed no significant complications. After predisposing the clinical outcomes of this research against and in favour of pre-existing literature, it is concluded that dorsal flaps assisted TIP urethroplasty is a safe surgical procedure and is effective in terms of avoiding postoperative complications in individuals with hypospadias. Keywords: Dorsal flap, Hypospadias, Tubularized incised plate urethroplasty

Ex vivo biomechanical characteristics and effects on gap formation of using an internal fixation plate to augment primary three-loop pulley repair of canine gastrocnemius tendons.

To evaluate the effects of using an internal fixation plate to augment primary 3-loop pulley (3LP) repair of canine gastrocnemius tendons (GTs). 48 cadaveric GTs from 24 adult dogs. GTs were dissected free from other tissues, transected, and randomly assigned to 4 groups (n = 12/group). GTs were repaired with 2-0 polypropylene with a 3LP repair alone or a 3LP repair augmented with a 3-hole veterinary cuttable plate (3VCP), a 5-hole veterinary cuttable plate (5VCP), or a 7-hole veterinary cuttable plate (7VC P). Biomechanical loads, construct stiffness, gap formation, and failure modes were compared between groups. Yield, peak, and failure loads were all significantly increased for the 5VCP and 7VCP groups, compared with the 3LP alone group. Increasing plate length from 3VCP to 5VCP and from 3VCP to 7VCP increased yield, peak, and failure loads. No differences were found between the 3LP and 3VCP groups with regard to yield and peak loads, but failure load was increased in the 3VCP group. Loads to create 1-mm and 3-mm gaps were significantly greater for the 5VCP and 7VCP groups, compared with the 3LP alone and 3VCP groups. Mode of plate attachment failure differed among groups. Tendon plate augmentation may be a viable surgical option to increase the strength of the tenorrhaphy in dogs. However, in vivo studies evaluating the effects of plate augmentation on the tendon blood supply and progression of healing are needed prior to clinical application.

Clinical outcomes of dual fixation of femoral shaft fracture nonunion: synchronous nailing and plate augmentation

Background The key to success in femoral shaft nonunion cases is the achievement of mechanical stability. We aimed to provide the clinical outcome of dual-fixation femoral shaft fracture nonunion using intramedullary nailing and plate augmentation in the same setting. Patients and methods This was a retrospective study of 12 patients with femoral shaft fracture aseptic nonunion operated at our university hospital between January 2017 and June 2021. All patients underwent revision surgery with synchronous nailing and plate augmentation. Demographics, comorbidities, history of previous trauma, fracture healing, and complications were recorded. We also reviewed radiological images. Results Twelve patients (nine males and three females) with a mean age of 31.1±9.8 years were included. Six patients had a previous fixation with an intramedullary nail, five with a plate, and one with an external fixator. Ten patients had atrophic nonunion, and two patients had hypertrophic nonunion. Patients achieved fracture healing after the surgical intervention, except two patients required another surgical intervention for delayed union as bone grafting (at 6 and 8 months, respectively). At the end of the study, they achieved fracture healing in all patients. The mean healing time was 6.1±2.4 months. Conclusion s Good mechanical stability and hence union can be achieved with synchronous nailing and plate augmentation as a treatment option for femoral shaft fracture aseptic nonunion.

Plate augmentation and bone grafting in treatment of femoral shaft nonunion initially fixed by intramedullary nail.

Introduction: This study aims to evaluate the results of plate augmentation and bone grafting without removing the nail in the treatment of nonunited, nailed femoral shaft fractures. Methods: Twenty patients with atrophic nonunion femoral shaft fractures initially fixed by intramedullary nail were treated by augmentation plating and iliac bone graft with retention of the nail. Patients were evaluated at regular intervals using an X-ray and Wu scoring system, which assesses clinical and radiological signs of healing. Results: All 20 patients achieved bony union at a mean time of 4.9 months (3–8 months). According to Wu’s score, 12 cases showed excellent results, and 8 cases obtained good results with no complications recorded. Conclusion: augmentation plating and iliac bone graft provide a good and safe method of treatment of previously nailed and non-united femoral shaft fractures.Level of evidence: Level 4; Case Series.

Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing

<i>Background:</i> Despite the multitude of studies on non union no clear criterion has been established for declaring a fracture as non united. A diagnosis of non union is unjustified, however, until clinical or radiographic evidence shows that healing has ceased and that union is highly improbable. A fracture of the shaft of a long bone should not be considered a non union until at least 6 months after the injury. The incidence of non union in the long bone varies with each bone and with methods of treating acute fractures. More recently, the tibia probably is the most frequent site of non union. Nonunion following intramedullary fixation of tibial fractures is a challenge. Although reamed exchange nailing results are encouraging with union rates, exchange nailing could be extremely challenging due to situations when nail removal is difficult. Augmentation plates gained popularity in management of femoral nonunion with few reports in tibial nonunion. The aim of the current study is to present our results in augmentation plate in management of tibial nonunion with intramedullary nail. <i>Patient and methods:</i> From 2017 till 2021, 20 cases of nonunited tibial fractures fixed by IM nails was included. Augmentation plate without removing the nail in addition of autogenous iliac graft. <i>Results:</i> Union was obtained in all the cases (20 cases) in an average time of about 6.22 months (range 3-12 months). Complications are few included 3 casea of superficial infection and parasthesia at iliac graft site. <i>Conclusion:</i> Plate augmentation without removal of IM nail is a good option in management of aseptic nonunion tibia with excellent results and few complications.

Management of nonunion of diaphyseal femoral fractures using exchange nailing versus plate augmentation

ObjectivesThe aim of this study was to compare the clinical and radiographic outcomes of exchange nailing versus plate augmentation for the management of patients with nonunion of diaphyseal femoral fractures.BackgroundDue to its superior biomechanical and biological properties, intramedullary nailing of the femur has enjoyed widespread acceptance in the management of femoral diaphyseal fractures. However, nonunion occasionally occurs secondary to malreduction, inaccurate implant placement, and unfavorable fracture pattern.Patients and methodsThis was an interventional prospective cohort study to evaluate the treatment options, which was conducted at the Department of Orthopedics and Traumatology, Menoufia University Hospital between May 2017 and July 2019.ResultsThere was no significant difference between the studied groups as regards postoperative blood loss, P value of 0.183. There was no significant difference as regards preoperative versus postoperative range of motion, P value of 0.561.ConclusionDiaphyseal femoral fracture nonunion can be successfully treated by either exchange nailing and bone grafting or by augmentation plating and bone grafting; however, the later has less operative time and lower reoperation rate.

Tertiary Care Orthopedic Hospital Experience to Find Effect of Dynamisation in Delayed Union Tibia Shaft Fracture

Objective: Our study was designed to evaluate the effect of dynamisation in delayed union tibia shaft fractures.&#x0D; Methodology: This prospective study was conducted at the Orthopedic Department, Shaheed Mohtarma Benazir Bhutto Medical College, from March 2020 to March 2021. During this timeframe total of 20 patients who underwent dynamisation for reamed intramedullary nailing were recruited. After two successive visits, those patients whose fracture failed to show progressive signs of callus formation underwent dynamisation. We removed the single static screw from the longer fracture segment to perform the dynamisation procedure. We inserted a poller screw slightly medial to the nail from anterior to posterior to provide additional stability to the proximal fragment. Statistical analysis was performed by using SPSS 23.0. For evaluating the success of dynamisation Chi-square test was used.&#x0D; Results: The mean age of recruited patients was reported as 35.92 years ranging from 16 years to 63 years old. Out of these twenty cases, 17 were male (85%). The mean time duration of nailing was reported as 35.4 hours. Total fourteen patients were immediately treated with nailing within 20 hours of injury, while the rest six underwent delayed nailing. Total four cases of tibial fracture were turned out as failure because the patient failed to achieve union after dynamisation and underwent augmentation plating with bone grafting for the complete union.&#x0D; Conclusion: Delayed dynamisation is a convenient and cost-effective technique to achieve union in femoral shaft fractures. Overall, our study reported an 80% success rate but failed to achieve early dynamisation in comminuted fractures.

Enhancement of Stability of Subtrochanteric Fracture Fixation by Sign Nail and Plate Augmentation

Enhancement of Stability of Subtrochanteric Fracture Fixation by Sign Nail and Plate Augmentation

Recent Methods of Neck Femur Fixation A Systematic review and meta-analysis

Abstract Background Femoral neck fractures in adults younger than age 50 years are uncommon and often the result of high energy trauma. They account for only 2-3% of all femoral neck fractures. Femoral neck fractures are associated with aging and osteoporosis and can occur after relatively trivial trauma in elderly patients. femoral neck fractures are associated with higher incidences of femoral head osteonecrosis and nonunion. Fixation options include cannulated screws, non parallel cannulated screws, medial augmentation plate, and fixed angle femoral neck fixation implants. A systematic review of literature done to evaluate which technique is better. Methods After literature search thirteen articles were found and were reviewed to evaluate final outcome of fixation of neck femur fractures by cannulated screws, non parallel cannulated screws, medial augmentation plate, and fixed angle femoral neck fixation implants. Results After evaluation of all studies the incidence of nonunion, osteonecrosis of femoral head, implant failure &amp; revesion surgery is lower in comparing Targon plate with multiple cannulated screws while we need further studies for application of non parallel screws and medial plate. Conclusion Targon plate recorded low incidence of complications in the final outcome in comparison with multiple cannulated screw while we need further studies for application of Non parallel screws and medial plate.

Biological and biomechanical basis of long-bone diaphyseal fractures: from fracture to non-union

Bone healing of diaphyseal fractures is a complex biological process that can often be adversely affected by patient-related and fracture-related factors and eventually end in delayed union and non-union. Surgical and non-surgical approaches have been widely applied, according to the fracture pattern and patient characteristics. For humeral diaphyseal fractures, plate fixation provided excellent results in terms of healing rate and time to union. For femoral and tibial shaft fractures, locked intramedullary nailing is considered the technique of choice. If impaired, the reparative process after intramedullary nailing can be enhanced through different surgical techniques, such as dynamization or exchange nailing. Moreover, the mechanical stability of the fracture site can be improved through augmentation plating, bone grafting or external fixation techniques, with satisfactory results. This article aims to review the biomechanical principles of reparative osteogenesis in long bone fractures after conservative and surgical treatment. Moreover, the evidence on the current options for bone healing enhancement, and treatment and prevention of delayed union and non-union will be discussed.

Exchange nailing with Uni-cortical plate augmentation +/- bone grafting for proximal 2/3rd distal 1/3rd junction shaft non-union femur

The femur is prone to fracture when struck by strong external forces, such as in motor vehicle accidents, falling from height. Intramedullary nailing (IMN) has achieved good results in the treatment of adult femoral shaft fractures. However, poor blood supply and severe soft tissue damage often result from inappropriate surgical operations or deep infection, leading to delayed union or bone non-union. The incidence of non-union of femoral fractures after trauma is 5%–10%. The treatment options available to deal with NON-UNION include Exchange Nailing, removal of the nail, and Re-osteosynthesis with plating +/- Bone grafting, or Ilizarov fixation. We present our experience of plate augmentation with Exchange nailing +/- bone grafting for non-union at junction of proximal 2/3rd and distal 3rd of femoral fractures. It is an efficient technique, which provides additional rotational stability at the non-union site, the additional advantages of this technique are that it can be done with minimally invasive technique, allows early rehabilitation of the patient, and carries lesser morbidity.

Coracoclavicular Ligament Augmentation at Clavicle Distal-Third Fracture Treatment

Background. Type 2B clavicle fractures with conoid ligament rupture are considered unstable. Although surgical treatment is recommended as the standard treatment modality for type 2B fractures, there is no consensus about the type of operative treatment. Material and methods. 15 patients that diagnosed with distal clavicle fractures, who underwent surgery for unstable type 2 fractures. Surgical treatment was done with a distal clavicle anatomic locked plate augmentation (ZipTight™) at all cases. The mean follow-up period was 24 months (range 12–40 months). Results. Bony union was achieved at a mean follow-up of 8 weeks (range 6–10 weeks). The mean Constant score was 97 (range 92–100). There were no complications or no need to second operation. Conclusions. The augmented technique reported here, provides early motion, increased stability and anatomic healing compared to other conventional options.

Coracoclavicular ligament augmentation at clavicle distal-third fracture treatment

The aim: type 2B clavicle fractures with conoid ligament rupture are considered unstable. Although surgical treatment is recommended as the standard treatment modality for type 2B fractures, there is no consensus about the type of operative treatment. We aimed to evaluate results of surgical treatment with an anatomical distal clavicle plate using CC ligament augmentation. Materials and methods: 15 patients that diagnosed with distal clavicle fractures, who underwent surgery for unstable type 2 fractures. The average patient age was 38 years (range 24–52 years). All patients were male; the right clavicle was injured in 10 patients whereas the left clavicle was injured in 5 cases. Surgical treatment was done with a distal clavicle anatomic locked plate augmentation (ZipTight™) at all cases. The mean follow-up period was 24 months (range, 12–40 months). Results: bony union was achieved at a mean follow-up of 8 weeks (range 6-10 weeks). The mean Constant score was 97 (range, 92–100). There were no complications or no need to second operation. All patients achieved satisfactory full range of shoulder motion. Hardware removal was performed for prominence in one case after the union was completed. Conclusion: the augmented technique reported here, provides early motion, increased stability and anatomic healing compared to other conventional options. We recommend augmentative CC ligament repair techniques over the distal locking anatomic plate for type 2 fractures

Concomitant intramedullary nailing and plate augmentation as a single-stage procedure in treating complicated nonunited femoral shaft fractures

Background and Purpose: Complicated femur fracture represents a major challenge for the orthopedic surgeon, with failed internal fixation, nonunion with broken intramedullary nail (IMN), and infected nonunion among the complications. Mechanical instability, as well as the poor biological environment, is considered as a concern when treating these cases. The purpose of this study was to evaluate concomitant IMN and plate augmentation as a single-stage procedure for the management of multiply operated nonunited femoral shaft fractures. Materials and Methods: Between January 2015 and May 2018, nine patients (eight men) with an average age of 40.8 years (range 25–70) diagnosed as nonunion femoral fractures after an average of four previous surgeries (range 2–6). All patients were available for follow-up with an average of 22 months (range 12–36). Results: The average time for fracture union was 6.7 months (range 3–12); five patients needed bone grafting to compensate for the bone defect encountered during the initial procedure, and two patients required secondary bone grafting after 6 months follow-up. Two patients presented with surgical site infection which was treated by antibiotics and daily dressing. The average leg length discrepancy at last follow-up was 1 cm (range 0.5–1.5). No patient had a metalwork failure or needed removal of the implants. Conclusion: In treating complicated multiply operated nonunited femoral shaft fractures, we believe that this technique can provide a robust mechanical foundation as well as an improved biological environment for such nonunited fractures to heal.

The Role of Medial Buttress Plate Augmentation of Cannulated Screws in Unstable Femoral Neck Fractures: A Pilot Study

Background: About 20% of femoral neck fracture surgeries require re-operation. The use of medial buttress plate may reduce the reoperation rate. The purpose of this study is to examine the results of using the method of augmentation of the cannulated screws with medial buttress plate for treatment of unstable femoral neck fractures. Methods: This study included patients with femoral neck fractures of Pauwels type 2 and 3 in which closed reduction was not successful. The patients underwent open anatomical reduction and implantation of three screws, and then the medial placement of the buttress plate was performed. Patients were followed up after 2 weeks, 6 weeks, 3 months, and 6 months. Union and fracture healing and operative complications were assessed using plain radiography. Results: This study included 8 patients with Pauwels type 2 and 3 femoral neck fractures. All patients were men with the mean age of 38.0 ± 11.3 years. Re-hospitalization 30 days after surgery, surgical site infection, deep vein thrombosis (DVT), and deep infection were not observed in any of the patients. The angle between the neck and the femur shaft dramatically increased during the 6-month follow-up (P = 0.049). Union occurred in 6 (75%) patients after 6 months, while 2 patients were lost to follow up. Participants’ Harris Hip Score (HHS) had a significant improvement from 3 months to 6 months after surgery (P = 0.02). Conclusion: Augmentation of cannulated screws with medial buttress plate for unstable femoral neck fractures in patients has advantages in short-term clinical follow-up.