Plate Fracture Research Articles

Trauma

The June 2023 Trauma Roundup360 looks at: Aspirin or low-molecular-weight heparin for thromboprophylaxis?; Lateral plating or retrograde nailing for distal femur fractures?; Sciatic nerve palsy after acetabular fixation: what about patient position?; How reliable is the new OTA/AO classification for trochanteric hip fractures?; Young hip fractures: is a medial buttress the answer?; When is the best time to ‘flap’ an open fracture?; The mortality burden of nonoperatively managed hip fractures.

Plating of Proximal Ulna Fractures Using Posterolateral Distal Humerus Plates: Surgical Technique and Case Series.

Precontoured olecranon plates are frequently used in the management of proximal ulna fractures. Occasionally, in comminuted proximal ulna fractures or segmental ulna fractures, available precontoured olecranon plates are too short for the management of these fractures. The authors have utilized posterolateral distal humerus plates in these instances. The coronal bend in some posterolateral distal humerus plates anecdotally fits well to the proximal ulna, despite being designed for the distal humerus. We sought to measure the coronal angulation of precontoured posterolateral distal humerus plates from various companies and compare these to established proximal ulna angles. Case examples are also provided.

Use of reconstruction plate in surgical treatment of primary and secondary tumors of the mandible

Introduction. Squamous cell carcinoma of the oral mucosa advances into the mandible in locally advanced tumors in 13–38 % of cases. Frequently, this situation requires inclusion of segmental resection of the mandible into the surgical plan. This approach requires adequate reconstruction for preservation of satisfactory functional and esthetic treatment results. Selection of reconstruction method remains an important clinical problem in everyday practice of a head and neck cancer specialist.Aim. To analyze clinical materials on the use of reconstruction plates in oncological practice, evaluate esthetic and functional results of their use in patients who underwent single-stage reconstruction after segmental resection of the mandible.Materials and methods. The results of treatment of 103 patients after segmental resection of the mandible with defect reconstruction using only a reconstruction plate or a reconstruction plate with a distant or free flap who were treated at the Loginov Moscow Clinical Scientific Center and N.N. Blokhin Scientific Medical Research Center of Oncology between 1998 and 2019 were analyzed.Results. Complications at various times (between 2 months and 3 years) were observed in 15 (14.6 %) patients. The most frequent complications were plate cutting through the skin and mucosa (6 (5.8 %) cases) and osteomyelitis of fragments of the mandible (7 (6.7 %) cases). In 2 (1.9 %) cases, plate fracture was observed. It is necessary to note that during anti-inflammatory treatment in 4 (3.9 %) patients, osteomyelitis was managed while 11 (10.7 %) patients required removal of the reconstruction plate. Per the data analysis, in patents with surgical defect in the anterior area (defects ТТ, АТТ, САТ per the J.S. Brown classification, 2016) complications are significantly more common (in 11 (23.9 %) of 46 cases) than in patients with limited defects of the body and condyle (defects АТ, АС) (in 4 (7.0 %) of 57 cases). The rate of complications is also significantly affected by radiation dose.Conclusion. Therefore, use of a plate for reconstruction of mandible defect is aesthetically and functionally acceptable reconstruction technique. Severe complications leading to plate removal are rare and were observed in 11 (10.7 %) patients.

Experimental Study and Numerical Modelling on Flexural and Shear Strengthening of RC Beam with Prestressed FRP Bars

Abstract: The most prevalent and widely used building material in the world is reinforced concrete. The primary building material for the majority of constructions, including buildings, bridges, etc., is reinforced concrete. Because of various factors, some of these buildings or portions of them are failing to perform as designed. The best solution to increase the load carrying capacity and extend the useful life of these inadequate structures is to strengthen them because replacing them would need significant investments and not be an appealing alternative. Even though the effectiveness of other techniques is widely accepted,a new effective and promising technique of strengthening civil engineering structures externally is gaining popularity, where fibre-reinforced polymer (FRP) is used. One of the most popular strengthening methods recently is the use of carbon fibre reinforced polymer (CFRP) to strengthen reinforced concrete beams. It provides a desirable way to improve the shear and flexural strengths of RC beams. The manner in which these composites are bonded to the beam has a significant impact on the behaviour of reinforced concrete beams in shear and flexure. The purpose of this study was to present a three-dimensional nonlinear finite element analysis (FEA) of a reinforced concrete beam (RC beam) reinforced by prestressed carbon fibre plate (CFRP plate). While there are many commercial programmes available for three-dimensional nonlinear FEA, each one has a unique ability to represent complex behaviour of composite materials, such as RC beams strengthened with prestressed CFRP plate and the contact interaction. Because of its reputation for accuracy in simulating the behaviour of a range of materials, including concrete, and its potent contact algorithms, the ABAQUS finite element programme was chosen for this work. Steel reinforcements were modelled as elastic- perfectly plastic materials, while concrete was studied using the concrete damage plasticity (CDP) constitutive model. The CFRP plate was modelled as an entirely elastic substance that breaks under the highest tensile strain. Concrete and steel reinforcement were considered to have a perfect connection, and the behaviour of concrete and CFRP plate was represented using a contact model. The FEA's findings were verified against experiment findings that were published in the literature. In terms of load-deflection behaviour, crack patterns, and mode of failure, the results were compared. The proposed FEA model was able to accurately simulate the behaviour of RC beams strengthened with prestressed CFRP plate based on the validation. To find out the impact of the thickness, width, and length of the CFRP plate, as well as the prestressing levels and steel grades, a parametric research was done. In particular, the strength of the RC beam for the ultimate load was shown to be increased by increasing prestressing of the CFRP plate. However, as prestressing increased, the fracture of the CFRP plate altered the mechanism of failure, preventing the ultimate load from increasing further. The use of higher grade steel improved the ability to support additional weight. Although the general load carrying capability of the CFRP plate was increased by lengthening the plate, it was discovered that strengthening RC beams by 25% of their shear span was sufficient and cost- effective. The load-deflection curve, failure modes, and crack patterns from the experiments are fairly reflected in the FE model.

Anaesthetic Management of a Case of Down Syndrome with Chronic Kidney Disease Undergoing Major Orthopaedic Surgery

Background: Down syndrome is one of the common congenital chromosomal disorders. Renal complications in Down syndrome patients are rare but is increasing in number due to increased survival. Anaesthesia in such patients is challenging due to intellectual disability, anatomical complications and multiple comorbidities. Case: This case report describes the pre-operative evaluation and anaesthetic management of a 19 -year-old male patient with Down syndrome with hypothyroidism with Chronic Kidney Disease stage 4 who underwent open reduction internal fixation with plating for bilateral subtrochanteric fracture under general anaesthesia. It was a complicated surgery for both surgeon and anaesthetist because the patient was anaemic with significant anticipated blood loss along with fluid restriction during the perioperative period. We had major challenges like patient positioning, significant blood loss, hypotension, and early fluid overload. But an extensive preoperative evaluation, optimization prior and proper coordination we overcame the challenges. Conclusion: Major orthopaedic surgeries in patients like Down syndrome with chronic kidney disease create a major anaesthetic challenge due to expected significant blood loss, chances of fluid overload, multiple comorbidities and intellectual disability. Thorough preoperative evaluation, intraoperative monitoring as well as postoperative period is important as several complications are envisaged. So a closed group management with orthopaedic surgeon, nephrologist, anaesthesiologist, endocrinologist, nursing team is required to handle such complicated cases.

Comparative study between interlock nailing and dynamic compression plating in humerus diaphyseal fractures in its functional and surgical outcome

Background: The aim of the study was to analyse compare study between interlock nailing and dynamic compression plating in humerus diaphyseal fractures in its functional and surgical outcome. Methods: The 2019 to 2022, patients were randomly divided into two groups with the help of computer-generated coded envelopes, group A (humerus diaphyseal fractures treated with dynamic compression plating) and group B (humerus diaphyseal fractures treated with interlock nailing) with 20 patients in each group. Outcomes were evaluated based on operative time, blood loss, neurovascular deficit, surgical site infection, union, shoulder stiffness, constant Murley score, Mayo elbow performance index at 1 year of follow up. Results: On radiology as non-union and union, most common study participants show union, on follow up of 1 year constant Murley score and Mayo elbow performance index was calculated and constant Murley score was more in patients treated with dynamic compression plating, shoulder stiffness was more in patients treated with interlock nailing. However blood loss was more in patients treated with dynamic compression plating. Conclusions: The result of our study shows that interlock nailing is associated with less blood loss but it is associated with decreased shoulder function postoperatively and marked shoulder stiffness which is more than patients treated with dynamic compression plating. Hence dynamic compression plating should be considered gold standard for operative treatment of humerus shaft fracture.

Novel Claw-shaped Bone Plate in Complex Unstable Scapular Neck and Body Fractures: Comparison with Reconstruction Locking Plate.

For complex and unstable scapular fractures requiring simultaneous fixation of the glenoid neck, the lateral margin of the body, and/or the scapular diaphysis, reconstruction locking plate is difficult to achieve satisfactory fixation. In order to optimize the fixation effect, the newly designed claw-shaped bone plate was designed for fixing such fractures. We also evaluate the clinical effects and follow-up at an average of 1 year after treatment in scapular internal fixation by using reconstruction locking plate and claw-shaped bone plate in complex unstable scapular body and glenoid neck fracture. A retrospective study was conducted from 2018 to 2021, thirty-three patients (27 males and six females) who were defined unstable scapular fractures by Ada-Miller. Fifteen patients (52.86 ± 8.26 years) received claw-shaped bone plate and 18 cases (51.61 ± 11.31 years) received reconstruction locking plate with the intermuscular approach. The clinical effect was evaluated based on the operation time, intraoperative blood loss, surgical complications, clinical healing time and Constant-Murley score (CMS). The data analysis by Student t, Mann-Whitney U test and Pearson's chi squared test. Compared with reconstruction locking plate, the claw-shaped bone plate showed shorter operation time (102.73 ± 18.43 min vs. 156 ± 37.53, P < 0.0001), higher CMS (94.00 ± 4.07 vs. 89.88 ± 5.42, P = 0.02) and no differences between the two groups regarding intraoperative blood loss (208.00 ± 96.45 mL vs. 269.44 ± 120.21, P = 0.12) and clinical healing times (9.96 ± 1.52 vs. 10.05 ± 1.67, P = 0.87). Follow-up were conducted at first, third, 6 and 12 months after surgery. The operation was successful in all patients with no intraoperative complications. For the treatment of complex and unstable scapular neck body fractures, the application of claw-shaped bone plate demonstrated short operation time, better stability of the fracture block, and higher CMS. In the intraoperative and postoperative follow-up showed better clinical results and rehabilitation effects.

Biomechanical analysis of a novel Y-plate designed for the treatment of extraarticular distal humerus fractures

Adult distal humerus fractures are infrequent, yet they account for one-third of all humerus fractures. For the treatment of comminuted and osteoporotic fractures, locking plates are claimed to be biomechanically superior to alternative internal fixing techniques. Treatment remains difficult despite recent advancements and the use of locking plates due to frequent comminution, low bone quality, and limited healing ability in osteoporotic bone. An optimal design of the newly constructed plate and the control model were selected. The biomechanical characteristics of non-osteoporotic and osteoporotic synthetic bone were compared on six models. The biomechanical properties of the new plate were tested and compared on 54 osteoporotic synthetic humerus models. The control models were reconstructive and parallel LCPs. The tests were carried out under static and dynamic axial, lateral and bending loads. Fracture displacements were measured by optical measuring system Aramis. The test model is significantly stiffer for lateral load (p = 0.0007) and for bending load at the moment of model failure (p = 0.0002), while for axial load the LCP model showed greater stiffness (p = 0.0017). During lateral dynamic loading, all three LCP models broke and there was a significant difference compared to the test model (p = 0.0125). The LCP model is dynamically significantly more durable under axial load, while the largest displacements were recorded with the test model (p = 0.029). The displacements induced by all three loads are within the limits that fulfil the parameters of appropriate biomechanical stability. A novel locking plate for extra-articular distal humerus fractures may provide an alternative to the traditional two-plate.

Comparative Prospective Study: Treatment of Distal Third Tibial Fracture through Medial and Lateral Compression Plate Methods

The most frequent fracture of a long bone is a tibial fracture. Anatomical reduction and rigid fixing may arise from open reduction and plating. To assess and contrast the outcomes of medial and lateral locking compression plates for fractures in the distal part of the tibia. 32 patients with distal tibial fractures were enrolled in the prospective clinical study from November 22, 2019, to November 12, 2020, at Nangarhar University and Public Health Hospital. With a mean age of 34.57 years, 26 closed fractures, and 6 open fractures. Based on the manner of therapy, 32 patients were split into two groups, with the medial plating group (16) included (16 patients) and the lateral plating group. After being released, they were monitored for at least 5 months. The clinical assessment criteria developed by Tinny and Wiss were used to evaluate the functional outcomes. Malunion arose in two cases of the medial plating group and two cases of the lateral plating group as a result.4 cases of superficial and 2 cases of deep infections, 1 nonunion, and 2 wound dehiscence were found in the medial plating group. There were two cases of superficial and one case of deep infection as well as two nonunion in the group3 cases that were classified as excellent-1, good-7, fair-8, and poor. In the lateral plating group, the scores were Excellent 2, good 6, fair 7, and poor 1 respectively. Ankle dorsiflexion and plantar flexion ultimate ranges of motion in the medial plating group were 18.2° and 29.5°, respectively. The end range of motion for the lateral plating group was 20° for ankle dorsiflexion and 33.2° for ankle plantar flexion. Finally, it is safe and practical to plat the distal tibia laterally, which can provide biological fixation and avoid soft tissue complications.

Investigation of lattice infill parameters for additively manufactured bone fracture plates to reduce stress shielding

BackgroundStress shielding is a detrimental phenomenon caused by the stiffness mismatch between metallic bone plates and bone tissue, which can hamper fracture healing. Additively manufactured plates can decrease plate stiffness and alleviate the stress shielding effect. MethodsRectilinear lattice plates with varying cell sizes, wall thicknesses, and orientations are computationally generated. Finite element analysis is used to calculate the four-point bending stiffness and strength of the plates. The mechanical behaviors of three different lattice plates are also simulated under a simple diaphyseal fracture fixation scenario. ResultsThe study shows that with different combinations of lattice infill parameters, plates with up to 68% decrease in stiffness compared to the 100% infill plate can be created. Moreover, in the fixation simulations, the least stiff lattice plate displays 53% more average stress distribution at the healing callus region compared to the 100% infill plate. ConclusionsUsing computational techniques, it has been demonstrated that additively manufactured stiffness-reduced bone plates can successfully address stress shielding with the strategic modulation of lattice infill parameters. Lattice plates with design versatility have the potential for use in various fracture fixation scenarios.

Plasticity and Ductile Fracture of High-Strength Steel Center-Holed Plates under Tension

The mechanical behavior of bolted connections in high-strength (HS) steel structures is a matter of concern, since the less ductility compared to mild steels may affect the load transfer and stress distribution of bolted connections. Conducting advanced finite element (FE) analysis incorporating validated material plasticity and ductile fracture criterion allows for a deeper understanding for the load transfer mechanism of HS steel joints. This paper focused on the plasticity and ductile fracture behaviors of HS (S700MC and S960Q) center-holed (CH) plates under tension, which are the essential component in bolted connections. Firstly, a combined linear and power law was used to calibrate and describe the post-necking stress–strain relations of the investigated HS steels. Then, a void-growth-model based on Rice–Tracey criterion was used to simulate the ductile fracture of five groups of CH plates with different hole diameters. The tensile strength and deformation capacity of the CH plates were discussed. The results showed that S700MC had a strain-hardening plasticity until the tensile fracture, while S960Q had a strain-hardening plasticity with a strain-softening behavior followed near the tensile fracture. Incorporating the calibrated plasticity and ductile fracture criterion in FE analyses generated close force-displacement curves as the experimental results. The equation specified in Eurocode produced conservative predictions for the net cross-sectional tensile strength of the investigated HS steels.

Nonanatomic healing of the greater tuberosity after plating in proximal humeral fractures: a case control study

BackgroundOpen reduction and plate internal fixation (ORIF) is one of the most common treatment methods for proximal humeral fractures. Complications associated with the greater tuberosity (GT) are rarely reported, therefore, the purpose of this study was to analyze the complications associated with the GT and the risk factors after locked-plate internal fixation.MethodsWe retrospectively analyzed the medical and radiographic data of patients with proximal humeral fractures involving the GT treated with locking plates between January 2016 and July 2019. We divided all patients into two groups, the anatomic GT healing group and the nonanatomic GT healing group, depending on the radiographic outcomes of the GT. Clinical outcome was assessed by the Constant scoring system. Potential risk factors included preoperative and intraoperative factors. Preoperative factors included sex, age, body mass index, fracture type, fracture-dislocation, proximal humeral bone mineral density, humeral head extension, hinge integrity, comminuted GT, volume and surface area of the main GT fragment, and displacement of the main GT fragment. Intraoperative factors were adequate medial support, residual head-shaft displacement, head-shaft angle and residual GT displacement. Univariate logistic regression and multivariate logistic regression were used to identify risk factors.ResultsThere were 207 patients (130 women and 77 men; mean age, 55 years). GT anatomic healing was observed in 139 (67.1%) patients and nonanatomic healing in 68 (32.9%). Patients with GT nonanatomic healing had significantly inferior Constant scores than those with GT anatomic healing (75.0 ± 13.9 vs. 83.9 ± 11.8, P < 0.001). Patients with high GT malposition had worse Constant scores than patients with low GT malposition (73.3 ± 12.7 vs. 81.1 ± 11.4, P = 0.039). The multivariate logistic model showed that GT fracture characteristics were not risk factors for nonanatomic GT healing, while residual GT displacement was.ConclusionsNonanatomic healing of the GT is a high-rate complication of proximal humeral fractures, resulting in inferior clinical outcomes, especially for high GT malposition. Fracture characteristics of the GT are not risk factors for GT nonanatomic healing and GT comminution should not be regarded as a contraindication to ORIF for proximal humeral fractures.

Fixation of pelvic acetabular fractures using 3D-printed fracture plates: a cadaver study

Open reduction and internal fixation of pelvic acetabular fractures are challenging due to the limited surgical exposure from surrounding abdominal tissue. There have been a number of recent trials using metallic 3D-printed pelvic fracture plates to simplify and improve various elements of these fracture fixation surgeries; however, the amount of time and accuracy involved in the design and implantation of customised plates have not been well characterised. This study recorded the amount of time related to the design, manufacture and implantation of six customised fracture plates for five cadaveric pelvic specimens with acetabular fracture, while manufacturing, and surgical accuracy was calculated from computed tomography imaging. Five of the fracture plates were designed within 9.5 h, while the plate for a pelvis with a pre-existing fracture plate took considerably longer (20.2 h). Manufacturing comprised 3D-printing the plates in Ti6Al4V with a sintered laser melting (SLM) 3D-printer and post-processing (heat treatment, smoothing, tapping threads). The manufacturing times varied from 27.0 to 32.5 h, with longer times related to machining a thread for locking-head screws with a multi-axis computer numerical control (CNC) mill. For the surface of the plate in contact with the bone, the root-mean-square errors of the print varied from 0.10 to 0.49 mm. The upper range of these errors was likely the result of plate designs that were relatively long with thin cross-sections, a combination that gives rise to high thermal stresses when using a SLM 3D-printer. A number of approaches were explored to control the trajectories of locking or non-locking head screws including guides, printed threads or hand-taps; however, the plate with CNC-machined threads was clearly the most accurate with screw angulation errors of 2.77° (range 1.05–6.34°). The implanted position of the plates was determined visually; however, the limited surgical exposure and lack of intra-operative fluoroscopy in the laboratory led to high inaccuracies (translational errors of 1.74–13.00 mm). Plate mal-positioning would lead to increased risk of surgical injury due to misplaced screws; hence, it is recommended that technologies that can control plate positioning such as fluoroscopy or alignment guides need to be implemented into customised plate design and implantation workflow. Due to the plate misalignment and the severe nature of some acetabular fractures comprising numerous small bone fragments, the acetabular reduction exceeded the clinical limit of 2 mm for three pelvises. Although our results indicate that customised plates are unsuitable for acetabular fractures comprising six or more fragments, confirmation of this finding with a greater number of specimens is recommended. The times, accuracy and suggested improvements in the current study may be used to guide future workflows aimed at producing customised pelvic fracture plates for greater numbers of patients.

Effectiveness of locking compression plate for proximal humeral fracture in elderly patients without structural bone grafting: age group of 65-79 compared to 80 and above.

This study shows the effectiveness of locking compression plate for proximal humeral fractures in elderly patients over 80years old without structural bone grafting compared age group of 65-79 (Group 1) with 80 and above (Group 2). This study included sixty-one patients who underwent using locking compression plate for proximal humeral fractures between April 2016 and November 2021. The patients were divided into two groups. The neck shaft angle (NSA) was checked at immediately after surgery, at 1month and the final follow-up visit. The NSA changes in the two groups were compared using the independent t-test. In addition, multiple regression analysis was used to find out which factors affect NSA changes. In group 1, the mean difference between NSA immediately after surgery and 1month after surgery was 2.74°, and group 2 was 2.89°. In group 1, the mean difference in NSA for 1month after surgery and at the last follow-up was 1.43°, and group 2 was 1.75°. No significant difference was observed in the NSA changes between two groups (p = 0.59, 0.173). Bone marrow density and four-part fracture type were significant difference in NSA changes (p = 0.003, 0.035). The disabilities of the arm, shoulder and hand scale (DASH scale), age, medical support, diabetes and three-part fracture type were no significant in NSA changes. Using locking compression plate without structural bone grafting is a good option in elderly patients over 80years old and can help achieve radiological results similar to patients which age group of 67-79.

Delayed open surgery for distal radius epiphyseal plate fracture in children

ObjectivesThis study assessed the feasibility of open surgery and determined outcome predictors for late management of epiphyseal plate fracture of the distal radius in children. MethodsThis retrospective study included 25 patients (22 male, 3 female) who underwent open surgery for late management of epiphyseal plate fracture of the distal radius. Wrist function was evaluated on Cooney score. Potential predictors comprised age, gender, fracture type, days after injury (DAI), degree of violence (DOV), and dorsal angulation before surgery (DABS). ResultsOverall, wrist function after surgery was classified as excellent for 16 patients (64%), good for 6 (24%), and fair for 3 (12%). The rate of excellent wrist function was 86.7% (13/15) in children older than 10 years but only 40% (4/10) for those aged under 10 years (p = 0.0280). Cooney score correlated positively with age, but there was no correlation with gender, fracture type, DAI, DOV or DABS. ConclusionOpen reduction surgery for late management of distal radius epiphyseal fracture yielded good results in patients aged over 10 years. Level of evidenceIII.

Unstable distal radius fractures fixation with a 2.4 mm volar variable-angle locking plate: radiological and functional assessment

Background: The main objective of this observational study was to evaluate the functional and radiological outcome of variable angle volar plates in intra-articular distal end radius fractures. Methods: Patients with distal end radius fractures (AO type 3C) treated operatively between Jan 2020 and Dec 2020 and then followed up for at least 12 months. A total of 32 patients (11 men and 21 women) with a mean age of 51.9 years were included in the study. The functional outcome was assessed by using modified Mayo wrist score (MMWS), disabilities of the arm, shoulder, and hand (DASH) score, wrist range of motion (ROM) and grip strength relative to the uninjured side and radiological assessment of radial height, volar tilt, and radial inclination. Results: MMWS and DASH scores improved postoperatively over time. Signs of radiographic union started around 12 weeks after surgery. The most common complication observed was finger and wrist stiffness, which was resolved with active wrist and finger movements. Non-union or hardware-related complications/ late complications such as tendon irritation/attrition were not observed with variable angle volar locking plates. Conclusions: Distal end radius fracture fixation with variable angle plate gives favourable radiological and clinical outcomes. These results can be owed to features such as low profile, variable locking, anatomical design and implant biomechanics. The surgeon determined angulation of the distal row of screw fixation may decrease the incidence of joint penetration and improve fixation of radial styloid and lunate facet stability.

Evaluation of Fixation of Fracture Shaft of Radius Ulna without Tourniquet

Background: Plate fixation is the mainstay of care for distal forearm shaft fractures in adults. By and large, volar or dorsal plating is used for radial shaft fractures. The radius's lateral surface offers an equal and constantly curved region for inserting a plate. The radial bow may be readily evaluated and restored after surgery. A prospective investigation was performed to examine the result of lateral plating of radius shaft fractures. Objective: In this study our main goal is to evaluate the treatment outcome of fixation of fracture shaft of radius ulna. Method: The research was conducted at tertiary medical hospital and district general hospital, Dinajpur included 100 patients. Several of them had broken both of their forearm bones, while others had broken only the radial shaft. Within 36 hours of damage, all patients were fixed with a 3.5 mm restricted contact dynamic compression plate or locking compression plate on the lateral surface of the radius. Typical procedure was used to repair the ulna. Results: During the study, majority were belong to 32-40 years age group, 36%. Followed by 20% were belong to 41-50 years age group, 11% belong to 20-31 years age group. In addition to that, 80% were male. 75% had fractured both of their forearm bones. Followed by 70% had closed fractured type, 35% had motor vehicle accident and lastly 85% had middle third radial shaft. Union was assessed by gradual disappearance of the fracture line and/or development of bridging callus at the fracture site. After getting treatment, 89% patients had excellent results, 8% had satisfactory and 1% had unsatisfactory result. There was 1% failure (nonunion). Conclusion: As compared to conventional methods, radial lateral plating holds promise as a viable option. Longitudinal studies with larger patient groups and study criteria are needed to confirm the potential advantages and validate our results.

Low rate of secondary surgery and implant removal following superior, precontoured plating of midshaft clavicle fractures

Background Surgical fixation of midshaft clavicle fractures with a single 3.5 mm superior clavicular plate has been associated with a high rate of hardware removal due to symptomatic hardware. Because of this, dual-plating techniques with lower-profile implants have been proposed. However, dual-plating systems have disadvantages, including increased cost and increased surgical morbidity. The aim of this study was to define the rate of symptomatic hardware removal for all midshaft clavicle fractures. Methods We retrospectively reviewed information on all patients from 2014 to 2018 at a single level 1 trauma institution with surgeries performed by two fellowship-trained orthopedic trauma surgeons. Documented removal of hardware and the reason for removal were recorded. We then contacted all patients at their listed telephone number to confirm the hardware was still in place and to administer patient outcome questionnaires. If patients did not answer, attempts were made to contact them multiple times on multiple days. Those who were not reached but had documented hardware removal were included in the total number of patients with hardware removal. Results The search revealed 158 patients, of whom 89 (61.8%) were included in the study. Average follow up was 4.09 years (range 2.02–6.50 years). Five patients (5.56%) underwent hardware removal. Removal was for symptomatic or irritating hardware in two of these patients (2.22%). Average abbreviated Disability of Arm, Shoulder, and Hand score was 6.27, and average American Society of Shoulder and Elbow Surgeons shoulder score was 93.6. Conclusion In our series, the rate of symptomatic hardware removal was 2.22%, well below reported removal rates. Hardware removal rates for prominent symptomatic superior clavicular plates may be significantly lower than previously reported, and these fractures may be adequately treated with a single, superior plate.

The use of a novel reduction plate in transoral anterior C1-ring osteosynthesis for unstable atlas fractures.

Transoral anterior C1-ring osteosynthesis has been reported as an effective treatment for unstable atlas fracture, which aims to preserve important C1-C2 motion. However, previous studies have shown that the anterior fixation plates used in this technique were not suitable for the anterior anatomy of the atlas and lacked an intraoperative reduction mechanism. This study aims to evaluate the clinical effects of a novel reduction plate used in transoral anterior C1-ring osteosynthesis for unstable atlas fractures. 30 patients with unstable atlas fractures treated by this technique from June 2011 to June 2016 were included in this study. The patients' clinical data and radiographs were reviewed, and the reduction of the fracture, internal fixation placement, and bone fusion were assessed using pre- and postoperative images. The patients' neurological function, rotatory range of motion, and pain levels were evaluated clinically during follow-up. All 30 surgeries were successfully performed, and the average follow-up duration was 23.5 ± 9.5 months (range 9-48 months). One patient suffered atlantoaxial instability during the follow-up and was treated with posterior atlantoaxial fusion. The remaining 29 patients had satisfactory clinical outcomes, with ideal fracture reduction, good screw and plate placement, well-preserved range of motion, neck pain alleviation and solid bone fusion. There were no vascular or neurological complications during the operation or follow-up. The use of this novel reduction plate in transoral anterior C1-ring osteosynthesis is a safe and effective surgical option in the treatment of unstable atlas fractures. This technique offers an immediate intraoperative reduction mechanism, which provides satisfactory fracture reduction, bone fusion, and preservation of C1-C2 motion.

Interfacial microstructure evolution for coordinated deformation of Mg/Al composite plates by asymmetrical rolling with differential temperature rolls

In this work, Mg/Al composite plates with different thickness ratios were prepared by the asymmetrical rolling process with differential temperature rolls and isothermal symmetrical rolling. Microstructural evolution and mechanical properties of matrix and composite materials with different thicknesses were analyzed. Influence of thickness ratios on the coordinated deformability of heterogeneous metals and interface toughness under the action of temperature gradient and shear force was investigated. Results show that the relative deformation rates of matrix and composite materials converge gradually under the influence of work hardening of Mg/Al layer. The Mg layer is mainly DRXed grains and texture intensity gradually weakens with increasing thickness ratio. The Al layer is mostly dominated by subgrains and deformed grains, which have a strong correlation with thickness ratio. Strength and plasticity of composites first increase and then decrease with increasing thickness ratio. Fracture of composite plate occurs in intermetallic compounds (IMCs). Thickness of IMCs has a strong positive correlation with thickness ratio. When the thickness ratio of AZ31B/Al6061 for 5, the relative thickness of IMCs is the largest and the relative bonding strength is the smallest. When the thickness ratio of AZ31B/Al6061 for 3, there is no element aggregation in IMCs, and the comprehensive mechanical properties of composite plate are comparatively better.