Plate Fixation Research Articles

Is intercalary frozen autograft augmented with intramedullary cement and bridging plates fixation a durable reconstruction?

AimsWe analysed the survival, complications, and function of frozen autograft augmented with intramedullary cement and bridging plates fixation for intercalary bone defect reconstruction in primary bone sarcomas.Patients and MethodsA retrospective cohort study was conducted on 72 patients with primary bone sarcomas (34 males, 38 females) between January 2016 and June 2023. The average age was 22.0 ± 13.6 years (6 to 61 years) and the pathological type included osteosarcoma (55), followed by adamantinoma (5), Ewing’s sarcoma (4), undifferentiated pleomorphic sarcoma (4), chondrosarcoma (3), and malignant tenosynovial giant cell tumor (1). The oncological outcomes included local control, metastasis, progression-free survival and overall survival. The functional outcomes were evaluated by the Musculoskeletal Tumor Society Score (MSTS-93), the Toronto Extremity Salvage Score (TESS), and the motion of the joint.ResultsThe mean follow-up time was 50.0 ± 27.4 months (12 to 99 months). 10 patients died of the disease, 9 patients were alive with disease and 53 patients were alive with no evidence of disease. The average 5-year overall survival of autograft was 85.8% (95% CI, 72.1-93.1%). The average MSTS-93 score was 96% ( 67–100%) and the average TESS score was 98% (74–100%). Twenty-four patients (33.3%) had at least one complication in the follow-up period. The most common complications were nonunion (9.7%, 7/72) and local recurrence (9.7%, 7/72), followed by leg length discrepancy (6.9%, 5/72), infection (5.6%, 4/72), implant failure (4.2%, 3/72), delayed union (2.8%, 2/72), and graft fractures (1.4%, 1/72). Tumor site was an independent risk factor for bone nonunion (OR, 22.23; p = 0.006).ConclusionsWe presented a large technique series for preventing autograft-related complications (especially for autograft fractures) of intercalary frozen autograft reconstruction. This method showed promising functional outcomes and provided durable reconstruction.Level of evidencelevel IV therapeutic study.

Surgical treatment options of displaced midshaft fractures of the clavicle in young adults: plate fixation versus intramedullary nailing

Background: This study aimed to compare the outcomes and complications of active young adults undergoing open reduction and plate fixation (ORPF) and intramedullary nailing (IMN) for displaced midshaft clavicle fractures (MCFs). Methods: A retrospective review was performed on all patients undergoing ORPF and IMN of complete MCFs at a single center between 2018 and 2022. Patients who were younger than 60 years with radiographic follow-up until union were included in the study. The mean age of the patients was 33.1 years. Outcome measures were achievement of union, time to healing, residual deformity, complications, and need for additional procedures.Results: Of 39 patients, 29 underwent ORPF and 10 underwent IMN. Plate fixation provided faster functional recovery in the first 6 months, but no difference was observed after 1 year. All fractures in the IMN group healed (100%), compared to 90% in the ORPF group (P=0.08). Mean time to union was 21±8.9 weeks and was significantly different between the two groups (P<0.01), with the ORPF group averaging 23.1 weeks and the IMN group 20.8 weeks. Nonunion rates were higher in the ORPF group (10.3%) than in the IMN group (0.0%), but the difference was not significant (P=0.10).Conclusions: Both methods restored patients to their pre-injury functional levels. However, IMN, with its higher healing rate, fewer required revision surgeries, and lower incisional numbness, appears to be the preferred method for treating MSFs without comminution in young adults.Level of evidence: III.

Mandibular Fractures in Edentulous Patients with Bone Atrophy and Osseointegrated Dental Implants: Therapeutic Management in a Case Series

Background and Objectives: This research describes the management of mandibular fractures in edentulous patients with atrophic mandibles and implant-retained overdentures, exploring etiologies and treatment options. Materials and Methods: A retrospective study (January 2010–December 2023) was conducted on six patients from two hospitals (Hospital Gregorio Marañón y Hospital La Paz, Madrid). The data collected included fracture etiology, treatment type, and complications. Results: All six patients were women, with a mean age of 76.33 years. The most common cause of fracture was peri-implantitis (50%). Surgical treatment (open reduction and internal fixation) was performed in five patients, with different surgical approaches and fixation methods. One patient, due to multiple comorbidities, received conservative treatment. Complications occurred in 50% of cases, including delayed healing and hypoesthesia. The average hospital stay was four days, with a mean follow-up of 34 months. Conclusions: Mandibular fractures in these patients are rare. Surgical treatment using rigid fixation plates is recommended. The rational use of bone grafting should be taken into account. Treatment depends on fracture type, patient condition, and surgeon experience.

Case series study and finite element analysis of a new cervicothoracic fixation device

ObjectiveTo introduce a specialized device designed for the fixation of the cervical-thoracic spine and describe its surgical installation, finite element analysis, and clinical outcomes.MethodsA finite element model of the C6-T1 segment was developed and validated, and simulations of subtotal resection of anterior cervical vertebrae, artificial vertebrae placement, and titanium plate fixation were performed. The model was subjected to a 75 N load to simulate the weight of the head and a 1 N·m force to simulate flexion, lateral bending, and axial rotation. The analysis focused on range of motion, total stress, stress in the artificial vertebrae, and stress in the device. The clinical outcomes were evaluated in a retrospective case series of 140 patients with cervical spine fractures.ResultsUnder the same loading conditions, the maximum stresses on specialized anatomical and biomechanical devices for the fixation of the cervicothoracic segment of the spine during neutral, forwards flexion, backwards extension, left lateral bending, right lateral bending, left rotation, right rotation and other working conditions were 25.097 MPa, 149.480 MPa, 64.150 MPa, 67.804 MPa, 72.754 MPa, and 117.98 MPa, respectively. And, the maximum ROMs were 2.230 mm, 5.585 mm, 4.682 mm, 3.184 mm, 3.061 mm, 4.451 mm, and 4.645 mm. Compared with those in the preoperative period, the patients’ CL, OPCL, UCL, LCL, UROM, LROM, VAS score, NDI score, JOA score, intervertebral space height at the injured segment, cervical anterior kyphosis angle, Cobb angle, vertebral displacement, ASIA grade, fracture classification, and vertebral displacement improved (P < 0.05). Sixty-two patients had dysphagia, and 3 patients experienced leakage of cerebrospinal fluid.ConclusionThe design of the new cervicothoracic internal fixation device conforms to the anatomical structure of the cervicothoracic spine, which can provide immediate stability, better screw placement and adequate bone grafting, and reduce the risk of complications. Despite some disadvantages, it is a good device for segmental fixation of the cervical and thoracic spine.

Comparative Outcomes of Percutaneous K-Wires Versus Plate Fixation in the Treatment of Distal Radius Fractures: A Focus on Stability in Osteoporotic Patients and Both-Bone Distal End Fractures.

Background Distal radius fractures (DRFs) are commonly treated with percutaneous K-wire or plate fixation. The relative efficacy and stability of these methods, particularly in osteoporotic patients and in cases involving both distal radius and ulna fractures, remain subjects of clinical debate. Objective This study aims to compare the outcomes of percutaneous K-wire fixation versus plate fixation in patients with distal end radius fractures, focusing on postoperative stability in osteoporotic conditions and both-bone distal end fractures. Methods A total of 50 patients were retrospectively analysed and divided into two groups: 25 underwent percutaneous K-wire fixation, and 25 underwent plate fixation. Outcomes measured included bone healing time, complication rates, functional recovery using the DASH score, and radiological outcomes through standard X-ray imaging. Results Preliminary data suggest that plate fixation offers better stability, especially in osteoporotic patients and cases with both-bone involvement. Complications with K-wire fixation were more frequent in these subgroups. Conclusion Plate fixation may provide superior stability and functional outcomes in treating DRFs, particularly in complex cases involving osteoporosis or bone injuries. Further research with larger sample sizes and prospective design is recommended.

Comparison of plate and compression screw in the treatment of hallux rigidus with arthrodesis: a retrospective study

Objectives: Although numerous surgical techniques and fixation methods have been described for the treatment of hallux rigidus (HR) with arthrodesis, consensus on the gold standard treatment has not been reached. The aim of this study is to retrospectively compare the clinical and radiological outcomes of compression screw fixation and plate fixation in the treatment of HR with arthrodesis. Methods: Patients who underwent arthrodesis surgery due to HR between January 2021 and December 2023 at a single center were retrospectively reviewed. Patients who met the inclusion criteria were divided into two groups: those who underwent arthrodesis with plate fixation (PLATE) and those who underwent arthrodesis with compression screw fixation (SCREW). Demographic data including age, gender, affected side, operative time, hallux valgus angle (HVA), dorsiflexion angle, AOFAS scores, and implant irritation data were compared among patients with at least 3 months of follow-up. Results: It was observed that all patients included in the study had successful bone union without any complications. There were no significant differences between the two groups in terms of age, gender, affected side, preoperative HVA, and preoperative AOFAS scores (P=0.970, P=0.426, P=0.694, P=0.216, and P=0.905, respectively). The mean operation time and postoperative AOFAS score were lower in the PLATE group compared to the SCREW group (P=0.006 and P=0.004, respectively). However, in the SCREW group, the dorsiflexion angle and the rate of implant irritation were lower compared to the PLATE group (P=0.016 and P=0.01, respectively). Conclusions: In the surgical treatment of HR, both plate fixation arthrodesis and compression screw arthrodesis are reliable surgical techniques. While plate fixation arthrodesis is a faster and more practical method, arthrodesis with a compression screw results in fewer complaints related to the implant and provides a more functional recovery.

Dynamic Craniotomy With Khanna NuCrani Plates as an Alternative to Craniotomy With Fixed Plates in Traumatic Brain Injury.

Dynamic craniotomy as opposed to a fixed plate craniotomy provides cranial decompression with a controlled outward bone flap movement to accommodate postoperative cerebral swelling and/or hemorrhage. The objective of this study was to evaluate if fixation of the bone flap following a trauma craniotomy with dynamic plates provides any advantage over fixed plates. A review of our clinical series of 25 consecutive adult patients undergoing dynamic craniotomy with the Khanna NuCrani reversibly expandable bone flap fixation plates for the treatment of traumatic brain injury associated with mass lesions including subdural, epidural, and cerebral hematomas was conducted. Postoperative cerebral swelling was encountered in 21 of 25 patients (84%), which was compensated for with outward bone flap movement in all these patients and associated decreased midline shift. Severe brain swelling with outward bone flap movement of 8 mm or more was noted in 40% of the patients. All patients had a normal intracranial pressure after surgery. None of the patients required any reoperations for hematoma evacuation, rescue decompressive craniectomies, cranioplasty, or complications related to wound healing. The bone flap retracted after the resolution of the brain swelling, and none of the patients reported cosmetic symptoms related to bone flap or wound healing. Overall, 84% (21 of 25) of the patients achieved a good outcome. Craniotomy bone flap fixation with dynamic plates is an alternative to craniotomy with fixed plates. The main advantage of dynamic craniotomy over a craniotomy with fixed plates is that it allows for immediate intracranial volume expansion with reversible outward bone flap migration in patients who may develop postoperative worsening brain swelling and/or hemorrhage, with decreased need for repeat surgeries and associated complications.

Retrospective evaluation of perioperative clinical outcomes of diaphyseal femoral fractures repaired with the string-of-pearls locking plate system with adjunctive fixation.

To evaluate outcomes and complication rate of utilizing a string-of-pearls (SOP) plate augmented with adjunctive fixation in the repair of canine femur fractures. Records of canine patients with mid-diaphyseal femoral fractures repaired with the SOP plate and adjunctive fixation were reviewed. Information retrieved from medical records included signalment, patient weight, fracture configuration, repair technique, healing time, and complications based on perioperative radiographic follow-up to clinical union. Forty client-owned dogs met inclusion criteria for this study. Variables analyzed for association with major complications included body weight, fracture configuration, repair technique, and adjunctive fixation. Major complications requiring surgical revision occurred in 8 of 40 fractures. Five cases experienced intramedullary pin migration and were successfully treated with sedated pin removal. The remaining 3 cases involved implant failure via screw shear breakage and required surgical revision of the fixation to achieve a successful outcome. On the basis of a calculated Bonferroni correction, no statistical significance of the tested variables was found in association with major complications; however, significance was limited due to the low statistical power of this study. The use of adjunctive fixation with the SOP locking plate system led to radiographic union without complication in most cases, and no instances of plate breakage were reported. However, implant complications secondary to the adjunctive fixation can occur. Adjunctive fixation used with the SOP plate for repair of canine femur fractures has a high success rate, though pin migration as a complication persists.

Outcome of Locking Plate Fixation Adjunctive to Intramedullary Rodding in Osteogenesis Imperfecta Patients.

An intramedullary rodding is the preferred fixation method in limb stabilization of OI patients. However, the intramedullary rod may not provide adequate fixation and rotational stability, especially in adolescents and adults. The incorporation of adjunctive plate fixation alongside intramedullary rodding has been introduced to enhance this stability, although its complications remain insufficiently understood. The goal of this study was to explore the outcomes of adjunctive plating in conjunction with intramedullary rodding for limb stabilization in OI patients, emphasizing the complications related to the plates during the healing phase and following plate removal. This retrospective study examined 74 limb segments from 45 patients with OI who underwent intramedullary rodding and adjunctive plating from 2008 to 2022. Criteria for inclusion comprised surgical treatment followed by a minimum of 2 years of follow-up or complication before that time point. The need for adjunctive plating arose from inadequate fixation, rotational instability, and persistent cortical gaps with intramedullary rodding alone. Medical records and follow-up radiographs were reviewed to assess the healing of the target lesion and any complications. The study encompassed 30 males and 15 females, ranging in age from 4 to 38 years, with 51 femoral and 23 tibial segments receiving treatment. Union was successfully achieved in 63 cases (85.3%), with an average union time of 14.4 months. Plates were subsequently removed in 62 cases after an average duration of 18.0 months. Before union, 11 revision surgeries were performed in 4 peri-implant fractures, 1 screw pull-out, and 6 failure of union. One sustained peri-implant fracture after the union. Following the removal of plates, complications included 10 refractures at screw sites, 3 progressive angulations at the previously targeted lesions, and 1 osteomyelitis. Kaplan-Meier analysis revealed that half of the refractures occurred within 1.8 years postplate removal. The overall complication showed borderline significance (P=0.056) among age groups. All the plate-related complications occurred at the diaphyseal, unicortical screws. Plate fixation, when used as an adjunct to intramedullary rodding, effectively stabilizes limbs in OI patients when intramedullary rods alone are inadequate. Nevertheless, given the significant risks associated with plate-related complications, adjunctive plating should be employed selectively only in instances where the union is unlikely to be achieved with intramedullary rodding alone. Level IV-case series.

Protected Early Mobilization Using Buddy Taping Versus Splint Immobilization for Fifth Metacarpal Neck Fractures: A Meta-Analysis

Metacarpal fractures are one of the more common fractures of the hand, with the fifth metacarpal neck fractures, commonly referred to as boxer’s fractures, comprising around 20% of all hand fractures. Currently, a variety of surgical treatment methods may be used for management, such as wire or plate fixations. Although these methods provide stable reduction, they are limited by higher costs and their invasive nature. Therefore, boxer's fractures have traditionally been treated conservatively with cast or splint immobilization, with these methods showing good functional outcomes. Recently, however, there have been studies showing similar results with the use of protected early mobilization with the use of soft wraps and buddy taping. This study aims to compare the patient-reported functional outcomes of treating undisplaced fifth metacarpal neck fractures with protected early mobilization using buddy taping versus cast/splint immobilization with the use of the Shortened Disability of the Arm, Shoulder and Hand Score (quickDASH). This study will be conducted with a comprehensive literature search from PubMed, Cochrane Library, Embase, Google Scholar and ScienceDirect from inception to October 2022. All randomized control trials comparing protected early mobilization with buddy taping and cast/splint immobilization of the fifth metacarpal neck fractures will be included.

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.

Evaluation of stiffness-matched, 3D-printed, NiTi mandibular graft fixation in an ovine model

BackgroundManually bent, standard-of-care, Ti–6Al–4V, mandibular graft fixation devices are associated with a significant post-operative failure rate. These failures require the patient to endure stressful and expensive re-operation. The approach recommended in this report demonstrates the optimization of graft fixation device mechanical properties via “stiffness-matching” by varying the fixation device’s location, shape, and material composition through simulation of the device’s post-operative performance. This provides information during pre-operative planning that may avoid future device failure. Optimized performance may combine translation of all loading into compression of the bone graft with the adjacent bone segments and elimination or minimization of post-healing interruption of normal stress–strain (loading) trajectories.ResultsThis study reports a sheep mandibular graft model where four animals received virtually optimized, experimental nickel–titanium (NiTi) fixation plates fabricated using laser beam powder bed fusion (LPBF) additive manufacturing (AM). The last animal, our control, received a standard-of-care, manually bent, Ti–6Al–4V (aka Ti64) fixation plate. A 17.5-mm mandibular graft healed completely in all four animals receiving the experimental device. Experimental NiTi-implanted sheep experienced mandibular bone healing and restoration. The Ti64 plate, in the control animal, fractured and dislocated shortly after being implanted.ConclusionThe use of stiffness-matched implants, by means of plate material (NiTi) and geometry (porosity) enhanced bone healing and promoted better load transfer to the healed bone when compared to the bulk Ti64 found in the fixation plate that the Control animal received. The design technique and screw orientation and depth planning improved throughout the study leading to more rapid healing. The large animal model reported here provides data useful for a follow-on clinical trial.Graphical

Treatment of Comminuted Mandibular Angle Fractures Using Champy Technique.

Isolated and noncomminuted mandibular angle fractures are commonly fixed with a single miniplate on the superior border (Champy technique) through an intraoral approach. However, the use of this technique for comminuted mandibular angle fractures has not been reported yet. This article verified that the Champy technique can also be used to treat comminuted mandibular angle fractures. The authors compared the therapeutic effects of using the Champy technique for intraoral fixation of comminuted mandibular angle fractures with or without alveolar bone defect. The dislocated teeth were removed. Iodoform gauze was used in a patient with alveolar bone defects and incomplete closure of soft tissue. A patient with comminuted mandibular angle fractures without alveolar bone defect experienced primary wound healing and good occlusion after surgery. A patient with comminuted mandibular angle fractures accompanied by alveolar bone defect and incomplete closure of soft tissue has an intraoral fistula and bone resorption until 2 months postoperatively. At 6 months postoperatively, the occlusion remained stable and callus healing had been completed. The Champy technique for intraoral single plate fixation is feasible for comminuted mandibular angle fractures. Incomplete closure of soft tissue leads to exposure of the bone marrow cavity, resulting in delayed fracture healing.

Case Report: Osteosynthesis-associated infection with Ochrobactrum intermedium after acetabular fracture

Ochrobactrum intermedium (O. intermedium) is a gram-negative, non-fermenting bacterium closely related to Brucella genus. O. intermedium resembles an emergent human pathogen that has rarely been detected in both immunocompetent and immunodeficient patients. A musculoskeletal infection with O. intermedium has not been described in the literature. We present the first case of an osteosynthesis-associated infection (OAI) with O. intermedium in an 80-year-old female patient after osteosynthesis of an acetabular fracture. The patient was admitted to the emergency department 6 months after osteosynthesis of a posterior column acetabular fracture treated via open reduction and internal plate fixation of the posterior column. The patient demonstrated tenderness, redness and swelling at the insertion site as well as a fistula. The radiological controls showed femoral head necrosis and partial protrusion of the head into the pelvis. The laboratory parameters showed no pathological findings. OAI was assumed and a two-stage revision with implant removal and resection arthroplasty in the first stage and hip arthroplasty in the second stage was performed. All microbiological specimens taken at the osteosynthesis site and the hip joint grew O. intermedium. The pathogen was determined using the matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) method. Antibiotic regime consisted of intravenous (IV) meropenem for two weeks followed by oral ciprofloxacin and cotrimoxazole. Implantation of the hip prosthesis was performed 6 weeks after the index surgery using a cementless revision cup and a cemented stem. Meropenem and vancomycin IV were given for one week followed by ciprofloxacin and doxycycline for another 5 weeks. 24 months after the surgery, the patient is infection free and satisfied with the result. With this case report we would like to increase awareness of possible implant-associated bacterial infections caused by O. intermedium.

Clinical significance for new type of coracoid process fractures associated with acromioclavicular dislocation on CT three-dimensional reconstruction

To observe the computerized tomography (CT) imaging manifestations of coracoid process fractures associated with acromioclavicular(AC) joint dislocation and make classification and summary, and explore a new classification of coracoid process fracture combined with acromioclavicular joint dislocation. The medical records of patients with the acute traumatic coracoid process fractures associated with AC joint dislocation who had undergone surgical management with clavicular hook plate fixation between May 2012 and June 2021 were retrospectively reviewed. Patients with fractures or dislocations of other parts of the ipsilateral upper limb, which affect the treatment and prognosis, or with chronic shoulder diseases on the affected side, which affect the function of the shoulder joint, were excluded. Eighteen patients were enrolled, including 10 males and 8 females, aged from 16 to 54 years old at the time of injury. The causes of injury were fall in 15 cases, traffic accident in 2 cases, and high fall in 1 case. The time from injury to operation ranged from 1 to 7 days. The morphology of coracoid process fracture and its corresponding relationship with scapula were observed on CT three-dimensional reconstruction images, and the reduction of coracoid process fracture was observed. The results were classified according to different manifestations and outcomes. A total of 18 patients with 18 shoulders were included according to the Inclusion and exclusion criteria. Three manifestations of coracoid process fracture associated with acromioclavicular joint dislocation were observed on CT three-dimensional reconstruction images. One case was typeⅠ(avulsion fracture, coracoid process shape remained general intact), and the coracoid process fracture failed to self-reduction after AC joint reduction and fixation;Fifteen patients with type Ⅱ(hinged fracture, in which one side of the coracoid process fracture remained attached to the scapula or was less displaced than the other side of the fracture) had spontaneous reduction after AC joint reduction and fixation, even 7 of them had coracoid process fracture anatomical reduction;In 2 cases of type Ⅲ (translational fracture, coracoid process fracture with approximately parallel profile), coracoid process fracture failed to self-reduce after AC joint reduction and fixation. The new type of coracoid process fractures associated with acromioclavicular dislocation on CT three-dimensional reconstruction provides an overview of the injury involvement of coracoid process fracture associated with AC joint dislocation, better understand of the nature of the disease, and a reference for clinical diagnosis, treatment and prognosis to the surgeon. Based on the fact that most coracoid fractures especially hinged fractures have spontaneous reduction after AC joint reduction and fixation, we believe that simple fixation of the AC joint is feasible and satisfactory for coracoid process fractures with acromioclavicular joint dislocation, and no surgical intervention is required for coracoid process fractures.

Numerical Optimization of Functionally Graded Ti-HAP Material for Tibial Bone Fixation System

Functionally graded materials (FGMs) are heterogeneous composites characterized by outstanding properties. They are built from two or more components with a gradient distribution of chemical composition along a given direction. A promising graded material for biomedical engineering as an implant could be a FGM made of titanium (Ti) and hydroxyapatite (HAP). It would allow us to counteract the difference between the stiffness modulus of pure titanium and bone tissue. Moreover, it can be a good solution to the problem of stress shielding for bone fixation plates made of conventional titanium or steel. The presented paper aims to perform micromechanical modeling and optimization of a functionally Ti-HAP graded plate, followed by numerical analysis of a fractured tibia stabilization system under specific boundary conditions. Finite element analysis was performed using ANSYS Workbench 2021 software. The models of the FGM plate and tibial fixation system were made using the Space Claim tool. The ANSYS software allowed the optimization of the model considered and the selection of the appropriate structural parameters of the FGM Ti-HAP material. In general, the results proved that the osteosynthesis plate built of graded Ti-HAP material resulted in lower bone stress compared to titanium and steel plates. The results obtained confirmed the validity of the design and the possibility to use functionally graded Ti-HAP bone fixation plates.

Open reduction and plate fixation of fractures of both bones in the forearm in Klippel-Trenaunay-Weber syndrome: a case report

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare disease characterized by vascular malformations, port-wine staining, and soft tissue and bone hypertrophy. Lesions occur in the lower extremities in 95% of cases, whereas only 5% occur in the upper extremities. Several case reports have described the treatment of fractures in the lower extremities in patients with KTWS. However, the risk of massive bleeding, bone deformity, and poor bone quality can lead to suboptimal surgical outcomes. No reports describing the treatment of forearm shaft fractures in KTWS could be found in the English-language literature. Intramedullary nailing is difficult due to the deformed bone and the risk of nonunion. Open reduction and internal fixation (ORIF) should be considered with caution in KTWS patients due to the risks of intraoperative bleeding and wound problems. The authors report that satisfactory results were obtained with ORIF after preoperative vascular embolization in a 60-year-old KTWS patient with fractures in both bones of the forearm.

Management of Neglected Pediatric Monteggia Fracture-Dislocation: A Case Report and Literature Review

Background: Missed or neglected Monteggia lesions are defined as classical fracture-dislocation presenting at least four weeks after injury. This injury in children is often challenging to treat and requires complex methods to achieve optimal results. Case Report: We report a 6-year-old girl with a 2-month-old neglected Bado type-I Monteggia fracture-dislocation. Our patient underwent ulnar osteotomy, bone grafting, and fixation with a semi-tubular plate along with open radial head reduction. Although the patient experienced wound complications at the bone graft harvest site, she achieved an excellent outcome with restored functionality and range of motion (ROM). Conclusion: Neglected Monteggia injuries in pediatric patients demand multifaceted treatment approaches due to their complexity and potential for long-term functional impairment. The absence of a consensus on definitive treatment underscores the importance of early diagnosis and open reduction to enhance long-term outcomes. This case report highlights the effectiveness of ulnar osteotomy, plate fixation, and open radial head reduction in achieving favorable results.

"Navigating the tides of recovery": early vs. delayed osteosynthesis for closed tibia fractures complicated by acute compartment syndrome - an analysis of one hundred and three cases.

In cases of closed tibia fractures with acute compartment syndrome (ACS), there is no established agreement on whether performing internal fixation at the time of closure or after healing of the fasciotomy wounds would affect the likelihood of non-union or infection risk. The study aims to compare fracture union rates, incidence of infection, and overall outcomes between early and delayed definitive fixation. Retrospective analysis of closed tibia fractures (AO/OTA 41, 42) with ACS between 2010 and 2019 with a minimum two years follow-up. The patients were grouped into group-1 (early-definitive fixation group) and group-2 (delayed-definitive fixation group). The patients were further subdivided into - 1A(early-plate osteosynthesis), 1B(early-intramedullary nail fixation), 2A(delayed-plate osteosynthesis), and 2B(delayed-intramedullary nail fixation). Incidence of ACS in closed tibia fractures was 3.85%. Of the 103 patients included, the patients with plate fixation had a significantly higher union rate in the delayed group (100% vs. 91.66%; P = 0.0001). Similarly, among patients with nail fixation, a significantly higher union rate was seen in the delayed group (96.30% vs. 85.19%; P = 0.0016). The overall incidence of infection was 22.3% (23/103). Moreover, infection was higher in the early definitive fixation group (30.16% vs. 10%; P = 0.016). With a lower incidence of infection and higher union rate among the delayed definitive fixation group, we propose to postpone the definitive fixation of closed tibia fractures complicated by ACS till the complete healing of fasciotomy wounds. This allows for adequate soft tissue healing and improvement in the biological environment of fracture, which boosts the chances of successful union and reduces infection risks.

Does endoscopic carpal tunnel release during distal radial fracture fixation improve outcomes? A randomized controlled trial.

This study investigated the functional outcome of prophylactic carpal tunnel release during distal radial fracture fixation. A total of 60 patients undergoing anterior locking plate fixation for a distal radial fracture were randomized into two groups: one having prophylactic endoscopic carpal tunnel release and the other serving as a control. Functional outcomes were assessed using the Patient-Reported Wrist Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, EuroQol 5-Dimension 5-Level questionnaire, Boston Carpal Tunnel Questionnaire, Pain Numerical Rating Scale, grip strength and finger-to-palm distance over a 12-month period. The study found no significant differences in overall functional outcomes or complications between the groups.Level of evidence: I.