Plate Fixation For Treatment Research Articles

Surgical outcomes of cable plate fixation in treatment of Vancouver type B1 and type C periprosthetic femoral fractures: a retrospective case series.

This study aimed to investigate the mid-to-long-term surgical outcomes of open reduction and internal fixation (ORIF) using a hybrid locking plate/cable technique for the treatment of Vancouver type B1 and type C periprosthetic femoral fractures (PPFs) in a consecutive group of patients from a single tertiary referral center. Twenty-five patients (25 PPFs; 17 female, 8 male) in whom a Vancouver type B1 or type C PPF was diagnosed and treated by a hybrid locking plate/cable technique from 2005 to 2016 were included in the study. Patients' functional status was categorized into 4 groups based on the Harris Hip Score (HHS) at the final follow-up: 70=poor result; 70-80=fair; 80-90=good, and 90-100=excellent. Intraand postoperative complications were also recorded. PPF union was defined clinically as the patient's ability to bear full weight with or without assistance and radiographically as the presence of a callus bridging the fracture. Subgroup analyses were conducted according to the Vancouver classification and type of fixation regarding the HHS and time to union. The mean age was 57 ± 16.6 (range, 17-82) years at the time of the primary hip replacement and 64 ± 18.7 (range, 24-88) years at the time of PPF. The mean follow-up was 5.6 ± 3.3 (range, 2-14) years from primary procedure to PPF and 6.5 ± 4.1 (range, 3-15) years following PPF. There were 7 type B1 and 18 type C PPFs. At the final follow-up, the mean HHS was 71 ± 7.74 (range, 57-89). According to HHS, functional results were poor in 8 patients, fair in 14 patients, and good in 3 patients. No major intra- or postoperative complications were noted. Fracture union was achieved in all patients without complications at an average of 13 ± 4.9 (range, 6-24) weeks. In subgroup analysis, while no significant differences were observed in the HHS (P=.87 for the Vancouver type, P=.96 for the type of fixation), time to union differed among groups. Time to union was significantly shorter in type B1 than in type C PPFs (P=.006). Time to union was considerably shorter in the uncemented group compared to the cemented one (P=.017). Adding cables to the locking plate can provide adequate stability to preserve fracture alignment and achieve bony union in Vancouver type B1 and C PPFs. Although union can be achieved by ORIF in such patients, a longer union time may be required for PPFs in the setting of a cemented femoral stem or Vancouver type C. Level IV, Therapeutic study.

Effect analysis of 90° hip locking compression plate fixation in treatment of femoral supracondylar fracture.

Effect analysis of 90° hip locking compression plate fixation in treatment of femoral supracondylar fracture.

Outcome of Plate Fixation in Treatment of Lisfranc Injuries

Outcome of Plate Fixation in Treatment of Lisfranc Injuries

Результат лечения пациентки с поражением бедренных костей множественной миеломой

Introduction Multiple myeloma (MM) is a malignant tumor that causes widespread bone damage. The bone is involved in 90 % of MM patients, and 60% of patients develop pathologic fractures. Material and methods We report a case of combined surgical treatment and chemotherapy of a multiple myeloma patient who sustained a pathological diaphyseal fracture of the left femur and later presented with a lytic myeloma lesion in the right femur. Closed reduction and interlocking intramedullary (IM) nailing of the left femur was performed for the patient who was diagnosed with bone destruction in the shaft of the right femur a few months later. The right femur was fixed with interlocking IM nail for prophylaxis. Results The left femur consolidated at 6 months. The patient had no pain in the right femur, and enlargement in the bone destruction was not seen in the femur. The patient could ambulate with a cane with signs of deforming arthritis in the adjacent joints of the lower limbs. Discussion Three common surgical approaches used for bone tumors being complicated or not complicated by a pathologic fracture include nailing/plating, bone replacement and joint arthroplasty. Bone tumor replacement with oncological endoprostheses can be produced in specialized oncological orthopaedic units and is not available with regular trauma and orthopaedic services for different reasons. The operating orthopedic surgeon is to choose the appropriate implant to address the tumor involvement. Conclusion Interlocking IM nailing can be the method of choice for a pathologic fracture or for prophylactic bone fixation with appropriate indications identified with the Mirels's scoring system. Intramedullary nailing offers the advantage of minimally invasive stability for the operated limb and early weight-bearing in contrast to plate fixation treatment for fractures and prophylactic plating.

Wrist arthroscopy combined with 2.7 mm titanium osteotomy plate fixation in treatment of ulnar impaction syndrome

Wrist arthroscopy combined with 2.7 mm titanium osteotomy plate fixation in treatment of ulnar impaction syndrome

Finite element analysis of dual small plate fixation and single plate fixation for treatment of midshaft clavicle fractures

BackgroundMidshaft clavicle fractures are one of the most familiar fractures. And, dual small plate fixation has been reported as can minimize hardware-related complications. However, the biomechanical properties of the dual small plate fixation have not yet been thoroughly evaluated. Here, we report the results of a finite element analysis of the biomechanical properties of midshaft clavicle fractures treated with dual small plating and superior and anteroinferior single plate fixation.MethodsA three-dimensional (3D) finite element model of the midshaft clavicle fractures was created, whose 4-mm transverse fracture gap, having an angle < 30 degree and devoid of overlapping triangles, was simulated between the fractured segments of the middle-shaft of the clavicle. The equivalent von Mises stress and displacement of the model was used as the output measures for analysis.ResultsNo significant differences were found between dual plating, superior or anteroinferior single plating in cantilever bending, axial compression, and axial torsion. Dual plating with a smaller plate-screw construct is biomechanically eligible to compare with superior and anteroinferior single plate fixation using larger plate-screw constructs.ConclusionsThis study demonstrated that larger plate-screw constructs for the treatment of simple are placed clavicular fractures; however, weight-bearing and exorbitant shoulder activity should be avoided after the operation. Therefore, dual plating may provide a viable option for fixing midshaft clavicle fractures and, thus, may be preferred for patients who need early activity.

Posteroanterior Lag Screws Versus Posterior Buttress Plate Fixation of Posterior Malleolar Fragments in Spiral Tibial Shaft Fracture

The aim of this study is to compare the clinical outcomes of posteroanterior (PA) lag screws versus posterior buttress plate fixation in treatment of posterior malleolar fragments (PMFs) in spiral tibial shaft fracture, and provide guidance for surgeons selecting a treatment strategy. A total of 48 eligible patients with PMFs associated with spiral tibial shaft fracture surgically treated from March 2009 to January 2016 were included in the study. They were divided into the screw group (n = 24) and the plate group (n = 24). All operations were performed via a posterolateral approach by a senior orthopedic surgeon. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS), and assessment of ankle range of motion (ROM) were used for clinical evaluation. The radiographic evaluation of posttraumatic arthritis scale was determined by Bargon reference criteria. At the mean follow-up period of 29.5 ± 4.3 and 30.4 ± 4.1 months, respectively (p > .05), all patients in both groups had bone union without severe wound problems or complications. There were no significant differences in AOFAS (92.5 ± 5.3 vs 94.7 ± 5.6, p = .129) and VAS (2.4 ± 0.8 vs 2.2 ± 0.9, p = .196) scores between the groups at final follow-up. No significant differences were found between the groups in injured/contralateral ankle ROM or posttraumatic ankle arthritis scale postoperatively (p > .05). For PMFs in spiral tibial shaft fracture, PA lag screws or posterior buttress plate fixation via a posterolateral approach can achieve good and equivalent clinical and radiological outcomes with minimal complications.

Five-Year Follow-up Results of a Randomized Controlled Study Comparing Intramedullary Nailing with Plate Fixation of Completely Displaced Midshaft Fractures of the Clavicle in Adults.

Background:Surgical management of completely displaced midshaft fractures of the clavicle is becoming more frequent, although long-term follow-up with Level-I evidence is scarce. Plate fixation (PF) of comminuted fractures provides faster functional recovery than elastic stable intramedullary nailing (ESIN). The 12-month follow-up of this randomized controlled trial, published previously, found no clinical differences at that time on the group level, but subtle differences on the subgroup level indicated that the results after closed ESIN were better than those after open ESIN. The primary aim of the study reported here was to compare the long-term clinical outcomes and sequelae after open reduction with those after closed reduction and to help surgeons develop a treatment strategy of either PF or ESIN for selected patients.Methods:At a median follow-up of 66 months (range, 49 to 89 months), the 123 patients in the original study were invited to an online secure survey. We used the survey results to compare the PF and ESIN treatment arms and to perform predetermined subgroup analyses of closed compared with open ESIN in relation to Disabilities of the Arm, Shoulder and Hand (DASH) score, pain assessment, and implant removal.Results:The questionnaire was completed by 114 (93%) of the 123 patients. There were no differences between the 2 treatment arms with regard to the DASH score (ESIN, 3.1 ± 7.0 and PF, 3.7 ± 7.5; p = 0.9). The 27 patients who had been treated with closed ESIN had a significantly superior DASH score compared with the 27 patients who had been treated with open ESIN (closed, 0.7 ± 1.4 and open, 5.2 ± 8.9; p = 0.015) and compared with the patients who had been treated with PF (closed ESIN, 0.7 ± 1.4 and PF, 3.9 ± 7.5; p = 0.002). Patients who had been treated with closed ESIN also reported fewer sequelae than patients who had been treated with open ESIN or PF.Conclusions:The results of this study, combined with those of our prior 1-year follow-up of the same patients, indicate that it seems to be advantageous to perform closed ESIN. The long-term results after PF were similar to those after open ESIN, but PF resulted in faster functional recovery and fewer patients needing to have the implant removed. Therefore, if open reduction is necessary for a comminuted fracture, it seems that the advantages of the minimally invasive ESIN procedure are lost, and the surgeon should consider conversion to PF.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Clinical observation of anterior cervical decompression and titanium mesh with locking plate fixation for treatment of cervical spondylosis

Objective To investigate the clinical effect of anterior cervical decompression and titanium mesh with locking plate fixation in the treatment of cervical spondylosis. Methods From January 2015 to January 2016, 58 patients with cervical spondylosis in Zhoushan Hospital of Traditional Chinese Medicine were selected and randomly divided into two groups, with 29 cases in each group.The control group received the anterior cervical decompression and autogenous iliac bone graft with locking plate fixation.The observation group received anterior cervical decompression and titanium mesh with locking plate fixation.The operation time, bleeding volume and postoperative complications were recorded in the two groups.The patients were followed up for 1 year after operation, the recovery of neurological function was evaluated by JOA standard, and the bone graft fusion rate was compared between the two groups. Results The operation time, blood loss of the observation group were (80.12±5.13)min, (61.45±3.75)mL, respectively, which were significantly less than those of the control group, the differences were statistically significant (t=2.956, 2.254, all P<0.05). The incidence rate of postoperative complications in the observation group was 6.90%, which was significantly lower than 24.14% in the control group, the difference was statistically significant (χ2=8.540, P<0.05). The postoperative JOA score of the observation group was (88.95±10.41)points, which was significantly higher than (82.11±7.03)points of the control group, the difference was statistically significant (t=2.192, P<0.05). After 1 year follow-up, the fusion rate of the observation group was 96.55%(28/29), which of the control group was 93.10%(27/29), the difference was not statistically significant (χ2=2.862, P=0.090). Conclusion Anterior cervical decompression and titanium mesh with locking plate fixation in the treatment of cervical spine injury has good curative effect, and has the advantages of small trauma and high bone fusion rate. Key words: Cervical spine injury; Anterior approach; Decompression; Titanium mesh; Internal fixators; Haemorrhage; Complication

Comparative study of bridging Tricoticocancellous bone graft post medullary canal recanalization versus classical bone graft without opening medullary canal both procedures were used dynamic compression plate fixation in treatment of non-uniting fracture shaft humerus

Background: Nonunion of a Humerus shaft fracture after conservative treatments or repeatedly failed surgical attempts bone healing a difficult therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. We evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from June 2004 to December 2009 in Sulaimani Teaching Hospital, for healing of Nonunion fracture humerus. Aim of study: The lack of mechanical stability due to a flail arm functionally affected that interference with personal hygiene, dressing, and daily activities. The goal of surgery is to achieve a stable rigid fixation on healed nonunion fracture humerus, plus early mobilization. Methods: We evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from June 2004 to December 2009 in Sulaimani Teaching Hospital, for healing of nonunion humerus .44 patients randomly collected, classified into two groups. Group A, 22 patients were treated by recanalization opening the medullary canal with bridging Tricoticocancellous bone graft. Group B 22 patients were treated by bone graft alone without opening the medullary canal. Both groups were using compression plate Fixation in treatment of Non-uniting fracture shaft humerus. Results: In group a, 22 patients age range 22-60 years (mean age 41years). There were 16 males and 6 females. Four patients had open fractures; (one due to explosion of a truck tire, second due to machine injury, and two dues to road traffic accidents). 8 patients had treated conservatively, 14 patients had previous surgical treatment in the form of open reduction and internal fixation using plates and screws, intramedullary nails of different types. 12 patients autogenous ICBG were used previously at least once time together with internal fixation. The mean duration of nonunion was 4 years between 2- 6 years. Group B, the mean age between 25-64 years (mean age 44.5 years). There were 18 males and 4 females' patients. Two patients had open fractures. 10 patients had treated conservatively, 12 patients had previous surgical treatment in the form of open reduction and internal fixation using plates and screws, intramedullary nails of different types. 10 patients autogenous ICBG were used previously at least once time together with internal fixation. The mean duration of nonunion was 4.5 year between 3- 6 years. We detected improvements in our study for both bone healing index results and functional index outcome. The bone results were evaluated by the union rate, angular deformity, and limb shortening. The functional outcomes were evaluated for pain, function, movement, muscle power, and patients satisfaction. Conclusion: We confirm that recanalization opening medullary canal plus three Tricoticocancellous bone graft are superior in healing of Non-uniting fracture humerus than without recanalization non-opening medullary canal. However, we used dynamic compression plating in both techniques.

Anterior decompression and plate fixation in treatment of cervical myelopathy: A multicentric retrospective review

ObjectivesThe aim of this study was to evaluate the results on anterior decompression and fusion with titanium mesh or expanding cage and plate fixation in patients with cervical myelopathy. MethodsWe conducted a retrospective multicentric review of 114 patients, 75 males and 39 females, with cervical myelopathy who underwent surgical treatment between July 2009 to December 2011. All surgeries were performed via a ventral approach. Based on the type of surgery the patients received, they were divided into 3 groups: group 1 consisted of 49 patients who received multilevel corpectomies and fusion with strut iliac bone graft and plates; group 2 consisted of 26 patients who received multilevel corpectomies and fusion with titanium expanding cage and plating; group 3 consisted of 39 patients who received multilevel corpectomies and fusion using titanium mesh with autologous bone graft and anterior plating. ResultsDecompression of the cervical spinal cord and grafting with plate fixation via a ventral approach demonstrated a high rate of improvement in neurological function with minimal complications. Fusion was documented radiologically in all cases. Eighty-three patients experienced a partial improvement and 41 had a complete recovery according to Nurick's myelopathy grading. Sixty-two patients were ranked as excellent, 48 as good, 4 as fair; unsatisfactory outcome was related to donor site complications. ConclusionSpinal decompression and fusion with titanium cages and plates appears to be a safe and effective alternative in patients with cervical spinal myelopathy. Level of evidenceLevel IV, therapeutic study.

A comparative study between intraoral external oblique ridge fixation with transbuccal lateral cortical plate fixation for treatment of mandibular angle fractures, a prospective study

A comparative study between intraoral external oblique ridge fixation with transbuccal lateral cortical plate fixation for treatment of mandibular angle fractures, a prospective study

Intramedullary fixation versus plate fixation for displaced mid-shaft clavicle fractures: A systematic review of overlapping meta-analyses.

Background:Displaced mid-shaft clavicle fractures (DMCFs) are common injuries. Both intramedullary fixation (IMF) and plate fixation (PF) have been described and routinely used. Multiple trials have been conducted to compare these treatments. Multiple meta-analyses have been published to compare IMF and PF treatment for DMCFs; however, the results remain controversial. The purposes of this study were to perform a systematic review of overlapping meta-analyses comparing IMF and PF treatment for DMCFs, to help decision makers critically evaluate the current meta-analyses, and to propose a guide through the best available evidence.Method:We searched the Cochrane library, PubMed, and EMBASE data bases. Two authors independently scanned titles and abstracts to exclude irrelevant articles and identify meta-analyses that met the eligibility criteria. The methodological quality of the meta-analysis was independently assessed by the 2 authors using the Oxford Centre for Evidence-based Medicine Levels of Evidence and the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Heterogeneity information of each variable was extracted from the included studies. An I2 of <60% is accepted in this systematic review. The Jadad algorithm was then applied to determine which of the meta-analyses provided the best evidence.Results:Eight meta-analysis met the inclusion criteria in this study. AMSTAR scores varied from 7 to 9. Heterogeneity of each outcome was acceptable. Four authors independently selected the same meta-analysis as providing the highest quality of evidence using the Jadad decision algorithm.Conclusion:This systematic review of overlapping meta-analyses suggests that compared with PF, major reintervention and refracture after implant removal occurred more frequently after PF of DMCFs. No differences in terms of function and non-union between PF and IMF were observed. Future research should focus on fracture selection for IMF and further improvement of plates and IM devices.

A finite element analysis of petal-shaped poly-axial locking plate fixation in treatment of Y-shaped patellar fracture

To establish the finite element model of Y-shaped patellar fracture fixed with titanium-alloy petal-shaped poly-axial locking plate and to implement the finite element mechanical analysis. The three-dimensional model was created by software Mimics 19.0, Rhino 5.0, and 3-Matic 11.0. The finite element analysis was implemented by ANSYS Workbench 16.0 to calculate the Von-Mises stress and displacement. Before calculated, the upper and lower poles of the patella were constrained. The 2.0, 3.5, and 4.4 MPa compressive stresses were applied to the 1/3 patellofemoral joint surface of the lower, middle, and upper part of the patella respectively, and to simulated the force upon patella when knee flexion of 20, 45, and 90°. The number of nodes and elements of the finite element model obtained was 456 839 and 245 449, respectively. The max value of Von-Mises stress of all the three conditions simulated was 151.48 MPa under condition simulating the knee flexion of 90°, which was lower than the yield strength value of the titanium-alloy and patella. The max total displacement value was 0.092 8 mm under condition simulating knee flexion of 45°, which was acceptable according to clinical criterion. The stress concentrated around the non-vertical fracture line and near the area where the screws were sparse. The titanium-alloy petal-shaped poly-axial locking plate have enough biomechanical stiffness to fix the Y-shaped patellar fracture, but the result need to be proved in future.

Mini-open reduction through lateral deltoid muscle and locking plate fixation for proximal humeral fractures

Objective To discuss the feasibility and clinical outcomes of mini-open reduction through lateral deltoid muscle and locking plate fixation in treatment of proximal humeral fractures. Methods A retrospective study was carried out on 39 patients with proximal humeral fractures treated with mini-open reduction through lateral deltoid muscle and locking plate fixation from September 2012 to September 2015. There were 7 males and 32 females, with a mean age of 66.8 years (range, 33-86 years). According to the Neer's classification system, there were 26 patients with two-part fracture and 13 with three-part fracture. visual analogue scale (VAS), Constant-Murley shoulder score, time of bone healing and complications were evaluated for all patients. Results All patients were followed up for 12-48 months (mean, 21.3 months). All fractures were proved to be bone healing with duration of (12.0±2.7)weeks. The VAS was improved from preoperative (5.7±1.0)points to (0.9±0.6)points at the final follow-up (P<0.05). The Constant-Murley shoulder score was increased from preoperative (42.3±5.1) points to (89.2±2.5)points at the final follow-up (P<0.05). Ranges of shoulder motion were improved with satisfactions. There were no complications like axillary nerve injury, loss of reduction, nonunion or humeral head necrosis. Conclusion For proximal humeral fractures, the mini-open reduction through lateral deltoid muscle and locking plate fixation has advantages of minimal invasion, excellent shoulder function, high rate of bone healing and low incidence of complications. Key words: Humeral fractures; Fracture fixation, internal; Incision

Effect of locking plate fixation for proximal humeral fractures in elderly patients

Objective To investigate the clinical effect of locking plate fixation in treatment of proximal humeral fractures in the elderly. Methods This retrospective case control study enrolled 96 patients with closed proximal humeral fractures admitted from October 2013 and October 2015. There were 52 males and 44 females, with age of (68.2±1.4)years (range, 62-74 years). According to the Neer classification of proximal humeral fractures, two-part fractures were noted in 27 patients, three-part fractures in 57, and four-part fractures in 12. According to the surgical methods, the patients were assigned to locking plate fixation (observation group) and anatomic plate fixation (control group), with 48 cases each. Operation time, intraoperative blood loss, hospitalization time, fracture healing time, varus angle of the humeral head, visual analogue score (VAS), Neer shoulder score for shoulder function and related complications were observed. Results All patients were followed up for 13-24 months (mean, 18.5 months). Better results were observed in observation group than control group in aspects of operation time [(51.2±14.8)minutes vs. (73.2±27.3)minutes], intraoperative bleeding[(158.3±32.9)ml vs. (270.9±34.8)ml], hospitalization time [(8.2±2.9)days vs. (13.1±2.2)days], fracture healing time [( 93.7±18.4)days vs. (122.9±18.9)days], varus angle of the humeral head [(2.2±1.8)° vs. (4.2±1.3)°], VAS[(2.0±0.7)points vs. (5.1±1.2)points], excellence rate of Neer score (98% vs. 90%) and postoperative complication incidence (10% vs. 21%) (P<0.05). Conclusion Compared with the anatomical plate, locking plate fixation has advantages of shorter operation time, less intraoperative bleeding, earlier bone healing, better shoulder movement and less postoperative complications in treatment of proximal humeral fractures. Key words: Humeral fractures; Aged; Fracture fixation, internal; Locking plate

Locking plate fixation for treatment of coronoid process fractures

Objective To evaluate the clinical outcomes of locking plate fixation for coronoid process fractures. Methods Thirteen patients with a coronoid process fracture were included in the study. According to O'Driscoll classification, there were five type -Ⅰ fractures, six type -Ⅱ fractures and two Type-Ⅲ fractures. Locking plate fixation via a medial approach in 8 cases and a posterior approach in 5 cases were performed within four days of the injury. Clinical, radiographic, and the Mayo Elbow Performance Score (MEPS) evaluations were conducted postoperatively. Results The follow-up time ranged from 24 to 31 months, with a mean of 27.2 months. All fractures healed at an average of 9.6 weeks (range, 8 to 14 weeks). The mean MEPS was 89.2 points (range, 75 to 100). Average range of motion was 118.8° for flexion-extension and 141.9° for pronation-supination. According to the Broberg-Morrey criteria, the signs of posttraumatic arthritis were observed in 4 patients, including 3 cases of grade 1 and 1 case of grade 2. No patient reported pain or had any subjective complaints consistent with elbow instability. Conclusion Locking plate fixation for coronoid process fracture followed by early rehabilitation can lead to functional range of motion and satisfactory outcomes. Key words: Ulna fractures; Fracture fixation, internal; Coronoid process; Locking plate

To compare the outcome of intramedullary nailing and locking compression plate fixation in treatment of proximal one third tibia fracture: A randomized control trial

Background: Fractures of tibia shaft are most common of long bone fractures. Proximal tibia fractures account for approximately 5% to 11% of all tibial injuries and affect knee function and stability in most of the cases. Higher rates of malunion and increased incidence of associated complications have made these fractures particularly problematic. In recent years due to advancement in technique, proximal tibia plating and multidirectional locked intramedullary nailing, both have become widely used treatment modalities for proximal tibial metaphyseal fractures. This study was performed to compare plating and nailing options in proximal tibia extra-articular fractures. Materials and methods: This randomized prospective clinical study was conducted on 62 skeletally mature patients with closed extra-articular fracture of the proximal tibia treated with proximal tibial locking compression plating (PTLCP) or intramedullary nailing (IMN) by expert surgeons at a tertiary trauma center. Results: Postoperative hospital stay (p = 0.043), postoperative infection rate (p = 0.036) were significantly high in the PTLCP group than in the IMN group, while rate of malunion (p=0.041) and nonunion(0.037) were significantly high in IMN group than in PTLCP group. However there was no clear advantage of either technique in terms of functional recovery of knee. Conclusion: Present comparison of IMN and PTLCP for the treatment of proximal one third tibia fracture showed no clear advantage of either technique. Present study concluded that both forms of treatment (IMN and PTLCP) provide adequate fracture stability. Level of evidence: Level 2, randomized controlled trial.

Biomechanical evaluation of periprosthetic refractures following distal femur locking plate fixation.

Distal femur fractures proximal to total knee femoral component constitutes the most prevalent type of periprosthetic fracture, and plate fixation treatment is associated with a 7.7% incidence of refracture proximal to the plate. The primary objective of this study was to compare proximal fixation techniques of a periprosthetic distal femur fracture plate in an osteoporotic bone model. The secondary objective was to determine the subsequent periprosthetic plate fracture pattern and/or complexity associated with each proximal plate fixation configuration. A segmental defect was created in 21 synthetic osteoporotic adult femurs 6 cm proximal to the distal femur and all specimens were stabilised with a 246 mm locking femur plate. Fixation in the most proximal hole was varied by use of either a cerclage cable, unicortical locking screw, or a bicortical locking screw. Specimens were tested to failure in simultaneous eccentric compression and torsion. Proximal cerclage fixation demonstrated higher mean maximum axial force at failure (4142.67±178.71 N, p<0.001), stiffness (443.8±61.64 N/mm), and maximum torque (20.9±0.93 N m, p<0.001). Unicortical and bicortical screw refractures occurred at the screw, cerclage wire refractures occurred at the first proximal screw distal to the cerclage. In periprosthetic distal femur fracture locking plate fixation, proximal hole stabilization with a cerclage wire tolerates significantly higher failure forces while distributing forces distal to the area within the plate fixation. Cerclage wiring may be an option in distal femur periprosthetic fractures to alleviate stress risers in vulnerable bone.

Anatomical plate for the treatment of proximal humeral fractures 30 Cases

Objective To analyze the clinical application and efficacy of anatomical plate in the treatment of complicated proximal humeral fractures. Methods Retrospective analysis was carried out to 30 cases in our hospital from January 2001 to December 2008, for analyzing surgical methods and treatment effect by surgical incision anatomical repositioning plate fixation treatment of part 3, 4 complexity proximal humeral fractures. Results Followed-up 9 to 28 months (14 months as average), all the 30 patients were assessed by the Neer classification and assessment criteria, 23 cases recovered excellently,good in 5 cases and common in 2 cases, the fine rate was 90%, no wound infection, fracture nonunion and humeral head avascular necrosis occurred. Conclusion The anatomical plate fixation can be used to treat complex proximal humerus fractures with good results. Key words: Proximal humeral fractures; Anatomical plate; Fixation