Plate Fracture Research Articles

On the fracture of aluminum plates perforated by rigid flat-nosed projectiles

We present a series of 2D numerical simulations for the perforation process of aluminum plates impacted by rigid steel cylinders. The simulations accounted for the residual velocities of these projectiles as a function of their impact velocities, as obtained recently by several workers. The aluminum plates in these works were made of the quasi-brittle 2024-T351 and 7075-T651 alloys, and the more ductile 6061-T651 alloy. The material properties of these alloys, for their strength and failure parameters, were taken from published works. We find that the ductility/brittleness property of these alloys is related to the different values of their corresponding strains to failure at shear states. Our simulations for the two quasi-brittle alloys resulted in good agreement with the measured data. On the other hand, the simulations for the 6061-T651 alloy agreed with the corresponding data only when we used a relatively low value of the Taylor-Quinney coefficient for this alloy. We also highlight various problems with the issue of mesh sensitivity in simulating the perforation of metallic plates by rigid cylinders. Particularly, we found that these simulations do not converge to definite values for the residual velocities even when the mesh size is reduced to 0.025 mm. Moreover, we found that the experimental data for the residual velocities can be accounted for by different failure curves, depending on the mesh size of the simulation. Thus, a given failure criterion cannot be validated by such simulations.

Straight and helical plating with locking plates for proximal humeral shaft fractures- a biomechanical comparison under physiological load conditions.

Helical plating is an established method for treating proximal humeral shaft fractures, mitigating the risk of iatrogenic radial nerve damage. However, biomechanical test data on helical plates under physiological load condition is limited. Hence, the aim of this study was to compare the biomechanical performance of helical and straight PHILOS® Long plates in AO12C2 fractures using static and cyclic implant system testing. Helical and straight PHILOS® Long plates on artificial bone substitutes were tested under physiological axial static (n=6) and cyclic loading (n=12). The axial construct stiffness was the main parameter for comparing the biomechanical performance of the two groups. Mimicking a clinical scenario, the helical deformation was performed consecutively by an experienced surgeon using iron bending tools. The torsional angle was determined computationally from 3D-scanning models afterwards. Helical plating resulted in a significantly reduced axial construct stiffness in all test scenarios compared to conventional straight plating (static testing: p=0.012; cyclic testing: p≤0.010). No failure occurred within the range of physiological loading in both groups. Helical plating favors multidimensional deformation of the test sample in lateral-ventral direction under axial loading, resulting in a reduced axial construct stiffness and in an increased interfragmentary movement. No biomechanical failure is to be expected within physiological load boundaries.

Median Nerve Displacement during Hardware Removal after Distal Radius Fractures

Abstract Background This retrospective study aimed to evaluate median nerve displacement observed during hardware removal procedures following volar plating for distal radius fractures. Methods We reviewed all cases involving removal of distal radial volar locking plates at our institution by two surgeons from 2016 to 2021. Plating procedures and hardware removals were performed using the flexor carpi radialis (FCR) approach. We examined the position of the median nerve at the time of hardware removal. Results Median nerve displacement to the radial side of the FCR occurred in 17 out of 67 cases (25%). There were no significant differences in the degree of fracture severity or involved surgeons between the normal position and displaced groups. Conclusions The median nerve may be displaced radially from the FCR during hardware removal, and care should be taken to avoid causing iatrogenic nerve injury. Level of Evidence Level II.

Modern anatomical locking plates are associated with increased postoperative wound complications and unplanned surgical revisions compared to standard tubular plates in the management of unstable ankle fractures: a comparative cohort study in 595 patients

Abstract Background The clinical benefit of locking plates in distal fibula fractures has not yet been proven. In addition, the risk of wound complications appears to be higher than with conventional tubular plates. We hypothesize that the benefits of locking plates in terms of biomechanical properties are outweighed by a higher risk of wound complications. Methods We conducted a retrospective review of fibula fractures treated by osteosynthesis with either a conventional one-third tubular plate or an anatomically shaped locking plate from January 1, 2015 to December 31, 2021. We recorded baseline data and relevant comorbidities and defined the need for revision surgery due to wound-related or mechanical complications as primary endpoints. Results A total of 595 out of 727 patients were eligible for our study. Of these 595 fractures, 526 were fixed with a one-third tubular plate, 69 with a locking plate. Revision surgery was required in 54 patients, in 51 cases due to wound complications. Three patients required revision surgery for mechanical reasons and all of them were younger than 40 years of age, have not been diagnosed with osteoporosis, but experienced complex fracture types. As the third tubular plate and locking plate groups differed in terms of age and comorbidities, we performed a 2:1 matching based on age and gender, leaving data from 138 patients receiving a third tubular plate. While the two groups were comparable in many aspects, the rate of wound complications was significantly higher in the locking plate group. Although the locking plate group had a higher percentage of diabetes mellitus, there was no correlation between this comorbidity and the higher revision rate in this group. Conclusions Our data do not support the general use of locking plates in the treatment of distal fibular fractures. The risk of mechanical complications in osteoporotic ankle fractures seems to be overrated, as there were no mechanical revisions in the osteoporotic subgroup. The rate of wound-related revision surgery was significantly higher after the use of locking plates. This might be attributed to the greater thickness of locking plates.

Three-dimensional peridynamic modeling of damage and penetration in composite plates exposed to localized explosive blasts

Localized failures in composites can lead to catastrophic consequences in some vehicles and systems, such as airplanes and submarines. The paper presents a new three-dimensional (3D) peridynamic model to explore the localized explosive effects on composite plates. The study utilizes the peridynamic method to simulate fractures and deformations in composite plates when exposed to localized explosive blasts. Accurate prediction of composites' performance during explosive blast events is crucial in the design process to avoid the deadly effects of their failures. This study highlights the following novelties: (1) We present, for the first time, a novel 3D mesh-free model to simulate the fracture and damage behavior of composite plates when exposed to explosive blasts; (2) The adopted numerical modeling technique enables highly efficient simulations of fractures and failures in composites when compared with other mesh-based numerical models; (3) We introduce a new mathematical framework to reflect the explosive pressure loads through different composite layers; (4) The study provides an accessible and efficient tool for engineers and researchers to enhance the design of composites in several industries instead relying on limited-access commercial software packages. In addition to the previous novelties, the paper presents a new parametric study that investigates the performance of several composite plates, such as titanium-aramid and aluminum-aramid composites, in explosive blast scenarios. Moreover, the roles of explosive mass and plate thickness in the failure mechanisms of composites are examined.

Linking a nail and a plate for distal femur fractures: a technical trick.

The use of nail-plate constructs has been suggested for treatment of elderly patients with distal femur fractures to facilitate stable fixation and early ambulation. In this article, we describe a technique to link the 2 implants without the use of fluoroscopic "perfect-circle" technique. This technique can be used with implants from different manufacturers.

Optimizing surgical management of acetabulum fractures involving both columns using buttress plating of posterior column through AIP approach

IntroductionAcetabulum fractures involving both columns are complicated injuries to treat, and achieving satisfactory post operative reduction with less extensile approaches is difficult. These injuries often require dual approaches, associated with their own share of complications. The anterior intrapelvic approach (AIP) addresses both columns through a single approach, minimizing these complications. Specifically, posterior column fixation is of utmost importance. This study aims to evaluate functional outcomes and complications of posterior column fixation using medial surface buttress plate in fractures involving both columns. Materials and methodsBetween 2017 and 2024, 366 patients had fractures involving both columns, out of which 64 were operated using the AIP approach. Excluding patients with displaced posterior wall fractures, transverse fractures, delayed treatment, or aged under 18 years. Out of 64, we collected data from 60 patients, as 4 patients could not be followed up. All patients were operated using the AIP approach, and posterior column fixation was done using 3.5 mm reconstruction plates. Patients were followed for minimum 6 months–70 months, with an average of 29 months. The associations between variables and functional outcomes were examined using the Chi-Square Test or Fisher's Exact Test. ResultsThe study included 60 patients, with 48.3 % under 40 years old and 51.7 % older. Males comprised 68.3 % of the cohort. 46.7 % sustained road traffic accidents and 53.3 % had fall from height. T-type fractures were most common (50.0 %), with high posterior column fractures in 66.7 % of patients. Post-operative reductions less than 1 mm were achieved in 80.0 % of patients. Functional outcomes using the Harris hip Scores were found to be excellent to good in 90.0 % of patients. ConclusionWe conclude that medial surface buttress plating of the posterior column using the standard AIP approach can be utilised to treat even the most complex of acetabular fracture patterns involving both anterior as well as posterior columns, excluding those that contain a displaced posterior wall.

Intraoperative Detection of Screw Penetration Following Volar Plating of the Distal Radius: A Cadaveric Study Comparing Fluoroscopic Imaging and Ultrasound

Abstract Introduction Hardware prominence is one of the major established complications following volar plating of distal radius fractures. The purpose of this cadaveric study is to compare two conventional fluoroscopic imaging views (carpal shoot-through view [CSV] and dorsal horizon view [DHV]) with ultrasound (US) to establish the best intraoperative imaging modality for surgeons to use to identify penetration of screws through the dorsal cortex and/or into the distal radioulnar joint (DRUJ). Materials and Methods Twelve human cadaveric limbs were included in the study, instrumented with distal radius plates via a volar approach. The three imaging modalities, CSV, DHV, and US, were compared in terms of detecting prominent screws during volar plate fixation. Six surgeons with varying levels of expertise performed the evaluations. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and the area under the receiver operating characteristic curve were computed for every surgeon and imaging method. Results The CSV was found to be more sensitive compared with the DHV and US for detecting dorsal cortex penetration (99% vs. 94% vs. 56%, respectively). The DHV was found to be more sensitive in recognizing DRUJ screw penetration compared with CSV and US (89% vs. 78% vs. 11%, respectively). US evaluation demonstrated considerably lower diagnostic utility compared with CSV and DHV. Surgeon's ability to perform as well as confidence in evaluating for screw penetration was highest with the CSV view. Conclusion Fluoroscopic imaging, particularly the CSV, demonstrates greater diagnostic reliability compared with US for intraoperative detection of prominent screws following volar plate fixation of the distal radius. CSV was also identified as the most reproducible examination for all levels of expertise with minimal formal training required. Level of Evidence: Therapeutic level V.

TiNbSn alloy plates with low Young's modulus modulates interfragmentary movement and promote osteosynthesis in rat femur

Orthopedic implants such as arthroplasty prostheses, fracture plates, and intramedullary nails often use materials like Ti6Al4V alloy and commercially pure titanium (CP-Ti), which have Young's modulus significantly higher than that of human cortical bone, potentially causing stress shielding and inhibiting effective fracture healing. TiNbSn alloy, a β-type titanium alloy with a lower Young's modulus (40–49 GPa), has shown promise in reducing stress shielding and enhancing bone healing by promoting effective load sharing with bone. This study used 5-hole plates made from TiNbSn alloy and CP-Ti to investigate their effects on bone healing in a rat femoral fracture model. Micro-CT analysis and mechanical testing were performed six weeks postoperatively to assess bone healing. Additionally, Finite element method (FEM) analysis was employed to evaluate stress shielding and interfragmentary movement (IFM) at the fracture site. Micro-CT analysis revealed significantly higher bone volume and mineral density in the TiNbSn group than in the CP-Ti group. Mechanical testing showed increased maximum load and stiffness in the TiNbSn group (77.2 ± 10.0 N for the TiNbSn alloy plate group versus 53.3 ± 8.5 N for the CP-Ti group (p = 0.002)). FEM analysis indicated that TiNbSn plates reduced stress shielding and allowed for greater displacement and strain, promoting IFM conducive to bone healing. The findings suggest that TiNbSn alloy plates are more effective than CP-Ti plates in promoting bone healing by reducing stress shielding and enhancing IFM. The lower Young's modulus of TiNbSn allows better load distribution, facilitating bone regeneration and strengthening at the fracture site.

A Comparative Study Between Plate Osteosynthesis and Elastic Nailing for Diaphyseal Fracture of Radius and Ulna in Adults

Background and Objectives: Diaphyseal fractures of the radius and ulna are common in adults and can be managed with various treatment methods. This study aimed to evaluate and compare the functional, radiological, and clinical outcomes of two treatment methods: plating and intramedullary nailing for diaphyseal fractures of both forearm bones in adults. Methods: This prospective cohort study was conducted in Sulaimani City, Kurdistan, involving 40 adult patients (mean age 34.25 years) who sustained primary diaphyseal fractures of the radius and ulna between January 1, 2022, and June 1, 2024. Patients were divided into two groups: Group A, with 20 patients, underwent closed reduction and internal fixation using flexible intramedullary nailing, while Group B, also with 20 patients, underwent open reduction and internal fixation using 3.5 mm dynamic compression plate. Outcomes were assessed using the Modified Grace Eversmann score, with pronation and supination of the forearm compared to the contralateral side. Results: The mean operation time was 81.4 minutes for the plating group, compared to 62.5 minutes for the nailing group. The mean union time was 13.15 and 10.85 weeks for the plating and nailing groups, respectively. In terms of functional outcomes, 27 patients achieved Excellent scores, 9 Good, 3 acceptable, and 1 unacceptable. Complications occurred in 5 patients in the nailing group and 2 in the plating group. Overall, the union and operation times showed a statistically significant difference, with a higher complication rate in the nailing group. Conclusion: Adults with diaphyseal radius and ulna fractures are usually treated with plating. An alternate fixation method for fracture with distinct risk and benefit profile is intramedullary nailing.

A prospective cohort study: promising results with minimally invasive plate osteosynthesis of anterior bridge plating in adult humeral shaft fractures.

Adult humeral shaft fractures have traditionally been managed conservatively, but surgical intervention is considered for displaced fractures or when conservative treatment is unlikely to be successful. The optimal surgical approach remains controversial, with open reduction and internal fixation (ORIF) using plates and screws considered the gold standard. However, concerns about soft tissue damage have led to the development of less invasive techniques, such as anterior bridge plating using minimally invasive plate osteosynthesis (MIPO). This study aimed to evaluate the outcomes of MIPO for humeral shaft fractures. A prospective cohort study included 43 patients who underwent anterior bridge plating with MIPO for closed, displaced humeral shaft fractures. Forty patients had full follow-up (functional and radiological) and three patients were lost to follow-up. Fractures were classified using the AO classification system. Surgical technique involved incision, reduction, and fixation with locking compression plates. Follow-up assessments were conducted at various intervals, and functional outcomes were evaluated. Fracture union was achieved in 38 of 40 patients (95%). Two patients required secondary bone grafts for non-union. The mean time to union was between 12 and 16 weeks. Excellent shoulder function was observed in 82.5% of patients, and excellent elbow function in 77.5%. The range of motion on the operated side differed statistically significantly from the non-operated side but was not clinically significant. MIPO with anterior bridge plating is a viable option for the surgical management of humeral shaft fractures. It offers good fracture healing rates and satisfactory functional outcomes and avoids extensive soft tissue dissection associated with ORIF. Level of evidence: II.

Management Options and Clinical Outcomes After Flexor Tendon Ruptures Following Volar Plating of Distal Radius Fractures.

The transition to volar locking plates for the treatment of distal radius fractures has improved patients' range of motion, reduced extensor tendon issues, and hastened return to activity compared to older fixation methods or nonoperative treatment. One drawback to volar plating is the potential for flexor tendon ruptures due to aberrant plate or screw placement. This study aims to describe the reconstruction options and patient outcomes after flexor tendon rupture due to volar plating. This is a single-institution, retrospective review of patients who presented with flexor tendon rupture from 2014 to 2023 after a distal radius fracture previously managed with a volar plate. Patient demographics, operative details, range of motion, complications, and patient-reported outcomes were collected. Ten patients presented with flexor tendon ruptures after volar plating for distal radius fractures from 2014 to 2023. The most common rupture was flexor pollicis longus (FPL) in 7 patients, followed by index finger flexor digitorum profundus (FDP) in 2 patients, and small and ring finger FDP rupture in 1 patient. Flexor pollicis longus (FPL) was reconstructed with a palmaris longus (PL) graft in 4 patients, ring finger flexor digitorum superficialis transfer in 2 patients, and repaired primarily in 1 patient. All patients with FPL ruptures regained functional thumb interphalangeal flexion except for 1 patient who reruptured 4 weeks after surgery. Flexor tendon ruptures can occur following volar plating of distal radius fractures, even years after fixation of the fracture. These are attritional ruptures and generally reconstructed with tendon grafting of transfer, providing functional flexion of the affected digit.

Comparative Prospective Study between Medial and Anterolateral Plating for Distal Tibial Fractures

Comparative Prospective Study between Medial and Anterolateral Plating for Distal Tibial Fractures

Plate or Arthroplasty for complex Mason Type-III Radial Head Fractures? Mid-to-long term results from a blinded outcome assessor study

BackgroundThe surgical treatment of radial head fractures like Mason type III comminuted radial head fractures is challenging and controversial. Whether to use open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA) as treatment methods is under constant debate. MethodsWe retrospectively analyzed clinical and radiographic mid- to long-term results of 42 patients with a mean follow-up time of 4.56 years (1.92-7.58 years). Patients were grouped according to fragment numbers and the type of intervention performed (3-4 fragments vs. 4+ fragments; ORIF vs. RHA). At the final follow-up, range of motion (ROM), functional rating scores and subjective pain and function levels were documented by a blinded outcome assessor. ResultsAlthough minor differences in the mean values were detected when comparing the results of the functional scores, ROM and subjective pain and function levels, only the movement in pronation and supination direction yielded statistically better results in the group of 4+-fragments for the RHA compared to ORIF. However, the 33% rate of required implant removal amongst the ORIF group should be considered. ConclusionsThis study provides evidence that 3- and 4-part Mason type III fractures are prone to plate osteosynthesis. In contrast, greater than 4-part fractures can more reliably be treated by replacement. This leads to a proposed increase in fragment numbers to four, where ORIF most likely leads to good clinical results. However, in patients with 4+ fragment patterns, ORIF did not show statistically significantly worse results concerning the collected clinical values. This study supports the use of the ORIF approach to save the radial head.

Rapid-printed Three-dimensional Models for Craniomaxillofacial Trauma.

Advances in surgical planning and 3-dimensional (3D) printing have benefitted the field of craniomaxillofacial surgery by allowing visualization of patient anatomy in settings of otherwise restricted surgical fields. Long 3D print times limit the usability of surgical planning workflows in acute trauma reconstruction. We sought to identify variables affecting print time and produce rapid-printed models with sufficient quality for prebending osteosynthesis plates. Three-dimensional printing variables, including resolution, print orientation, and region of interest cropping, were optimized on a single mandibular and midface fracture model to maximize print time efficiency. Five mandibular and 5 midface fractures were printed both in the high-resolution and time-efficient protocol. Fixation plates were contoured to fit the optimized models and computed tomography scan. Distances and volumes between the fracture surface and plate were computed. High-resolution mandible models were printed in 7.47 hours and maxillae in 7.53 hours. Optimized models were printed in 0.93 and 1.07 hours, respectively. Cropping to regions of interest, rotating the model, and decreasing print resolution significantly reduced print time. The difference (optimized versus high resolution) in distance between the plate and model averaged 0.22 and 0.34 mm for mandibles and maxillae; the air space volume differed by 1.39 and 0.90 mm3, respectively. Adjusting size, resolution, and position on the printing platform allows rapid fabrication of 3D models for surgical reconstruction without sacrificing surface quality. These edits reduce printing time, enabling the implementation of 3D-printing workflows for surgical planning in acute craniomaxillofacial trauma settings.

Functional Outcome Of Delayed Anterolateral Plating For Tibial Pilon Fractures

BACKGROUND & OBJECTIVES: The Management of Tibial pilon fractures have always been perplexing. Our study was planned to evaluate functional outcome of delayed anterolateral plating for tibial pilon fractures by assessing the range of motion of ankle along with pain and affection in the activities of daily living. MATERIALS AND METHODS: A prospective observational study was done for 45 patients with tibial pilon fracture, for whom delayed anterolateral plating was done in Orthopaedics department of Government medical college, Thiruvananthapuram. The study was conducted at 6 months of follow up after surgery is done. Data collected using a structured proforma. The evaluation of results is based on scoring system given by kaikkonen ankle score RESULTS: Functional outcome was assessed at 6th month follow up using kaikkonen ankle score. The mean age of the patients was 38.53(19-72) and among them 52.78% had right side affected. 37.78% had excellent functional outcome and 51.11% had good functional outcome at the end of 6 months. Best functional outcome was obtained in Ruedi Allgower type 1 fractures. Wound related infections were noted in 6.7% cases who had significantly poor functional outcome CONCLUSION: Hence delayed anterolateral plating greatly improves the functional outcome in patients with tibial pilon fractures and allows for earlier mobilization and prevents complications like malunion.

Can the screw number in volar locking plate fixation for distal radius fractures predict the Patient-Rated Wrist Evaluation outcome?

The optimum number of screws in a volar locking plate (VLP) for distal radial fractures (DRF) fixation has not been established. We conducted a retrospective observational study aimed to evaluate the relationship between the number of used screws and the post-operative results provided by the patient-rated wrist evaluation (PRWE) questionnaire. A total number of 62 surgically treated participants for DRF were included in the study between July 2019 and September 2022. Information was gathered regarding the number and arrangement of screws by examining X-ray images and using health records. We were looking at five variables: the total number of screws, the number of proximal fragment screws, the number of distal fragment screws, the number of locking screws, and finally number of cortical screws. Our data suggests that the number of screws in VLP for DRF fixation is a weak predictor of post-operative results and is therefore unlikely to influence the PRWE score. The ability to predict outcome by knowing the number of screws turned out to be an unreliable prognostic sign.

Anatomy of Lister's Tubercle: Implications for Volar Locked Plating of the Distal Radius.

Determining accurate intraoperative screw length in complex distal radius fractures may pose difficulties. With volar plate fixation, excessive screw length may result in extensor pollicis longus injury and this can be challenging to determine via intraoperative imaging. This study aims to identify the precise anatomic location and parameters of Lister's tubercle on the dorsal aspect of the radius. The anatomy and location of Lister's tubercle was evaluated in 26 cadaveric arms, of which 27% were female, with a mean age of 73.6 years. Additionally, Lister's tubercle was evaluated on 198 computed tomography (CT) scans using a quantitative distal radius surface map. Median age was 28 years, and 28% of the patients were female. As measured in cadaveric arms, the mean Lister's tubercle length was 12.6 mm, and width was 5.4 mm. The distance from the radial styloid to the distal and proximal border of Lister's tubercle averaged 23.0 and 10.4 mm, respectively. Of the total distal radial width, Lister's tubercle begins 43% from the radial border and spans to 42% of the ulnar border, encompassing 16% of the entire width of the dorsal distal radius. On CT mapping, the distance between the peak of Lister's tubercle and the ulnar and radial border of the radius was 46% and 54%, respectively. Female sex was associated with a smaller distal radius width, but not with a smaller Lister's tubercle. Knowledge of Lister's tubercle anatomy may assist in more precise screw placement in volar locked plating of distal radius fractures. IV-Therapeutic.

Study of Treatment with Locking Compression Plate for Distal Femur Fractures and its Functional Outcome

Study of Treatment with Locking Compression Plate for Distal Femur Fractures and its Functional Outcome

Fatigue Fracture Mechanism and Life Prediction of TA1 Titanium Alloy Clinched Joints

ABSTRACTThis study investigated the fatigue fracture mechanisms and life prediction of clinched joints made from titanium alloy TA1. The fatigue tests revealed that TA1 titanium alloy clinched joints exhibited failure characterized by fracture of the lower plate at three distinct fatigue load levels. Additionally, finite element analysis indicated that cold work hardening enhanced the fatigue performance of these joints. Observations of fracture surfaces using scanning electron microscopy identified the crack source and its propagation path, which correlated with the location of maximum principal stress from the finite element simulations. Fretting wear was also observed in this critical region. Furthermore, fatigue life predictions for TA1 titanium alloy clinched joints were made using Paris' law and the local strain approach. Both methods closely matched experimental results across different fatigue life intervals. Overall, the local strain approach exhibited superior predictive capability compared to Paris' law, taking into account various influencing factors.