Plate Fracture Research Articles

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.

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.

Comparison of treatment results of femoral shaft fracture with two methods of intramedullary nail (IMN) and plate

BackgroundFracture of the femur is one of the most common fractures that, if not stabilized and treated properly, may lead to severe disability, impairment of the individual’s efficiency, and numerous complications. This study aimed to evaluate the treatment results of femoral shaft fracture with two methods intramedullary nail (IMN) and Plate.Materials and methodsIn this cross-sectional study, 60 patients with femoral bone fractures were admitted to Imam Khomeini Hospital in Jiroft in 2020 and were treated for at least one year after discharge. They were divided into two treatment groups - Plate fracture fixation (n = 30) and IMN fracture fixation (n = 30). Data were collected using a researcher-made checklist including patient demographics and treatment outcomes. The collected data were analyzed using SPSS-v 26 statistical software and descriptive and inferential statistical tests at a significance level of p < 0.05.ResultsPatients in the Plate treatment group were generally older (50–60 years) compared to the IMN treatment group (30–40 years), and there were more men than women in both groups. Only 10% of patients in each group developed superficial infections after surgery. There were more cases of deep infections in the Plate group, but it was not statistically significant. The IMN group had fewer cases of malignancy and claudication compared to the Plate group. Patients in the IMN group also returned to functional activities faster than those in the Plate group, which was a statistically significant difference.ConclusionConsidering that deep infection, non-union, malunion, claudication, and ability to return to functional activities in the group using nails treated was less than the group treated with plates, the treatment method of femoral fracture using IMN is the preferred treatment method.

Supra-pectineal quadrilateral buttress plating versus infra-pectineal plating in the management of quadrilateral plate fractures: A randomized controlled trial.

Management of quadrilateral plate fractures is technically demanding and requires specific fixation techniques. Infra-pectineal plating is the gold standard method of fixation. However, we recorded a high incidence of medial wall displacement and reoperations. Therefore, the aim of our study was to identify whether supra-pectineal quadrilateral buttress plating provides much more rigid fixation with a better functional and radiological outcome or not. The authors conducted this prospective, randomized control, single-blinded study at a level 1 single trauma centre. Between March 2022 and June 2023, 34 patients with quadrilateral plate fractures had anterior fixation, either via the anatomical QLP (17 cases) or infra-pectineal plating (17 cases) (Groups A and B, respectively). The radiological and clinical outcomes, as well as residual medial wall displacement, were the primary outcomes. The mean follow-up was 14.47months in group A and 15.24months in group B. In group A, the mean operative time (p = 0.02) was shorter, and the mean blood loss (p < 0.001) was significantly lower. However last follow-up showed no statistically significant differences as regards residual medial wall displacement (p = 1.0), final radiological (p = 0.86), and clinical outcomes (p = 1.0). Authors concluded that the anatomical QLP made it easier to reduce and fix acetabular fractures with a displaced medial wall. This was done by using multidirectional screws in the posterior column through its infra-pectineal extension and a strong screw purchase aimed at the posterior column through its supra-pectineal part. The two groups were similar in terms of final radiological and clinical outcomes, as well as residual medial wall displacement rates. However, the QLP had less morbidity than the classic infra-pectineal plating (shorter operation time and less blood loss).

Visual Anomaly Detection via CNN-BiLSTM Network with Knit Feature Sequence for Floating-Yarn Stacking during the High-Speed Sweater Knitting Process

In order to meet the current expanding market demand for knitwear, high-speed automatic knitting machines with “one-line knit to shape” capability are widely used. However, the frequent emergence of floating-yarn stacking anomalies during the high-speed knitting process will seriously hinder the normal reciprocating motion of the needles and cause a catastrophic fracture of the whole machine needle plate, greatly affecting the efficiency of the knitting machines. To overcome the limitations of the existing physical-probe detection method, in this work, we propose a visual floating-yarn anomaly recognition framework based on a CNN-BiLSTM network with the knit feature sequence (CNN-BiLSTM-KFS), which is a unique sequence of knitting yarn positions depending on the knitting status. The sequence of knitting characteristics contains the head speed, the number of rows, and the head movements of the automatic knitting machine, enabling the model to achieve more accurate and efficient floating-yarn identification in complex knitting structures by utilizing contextual information from knitting programs. Compared to the traditional probe inspection method, the framework is highly versatile as it does not need to be adjusted to the specifics of the automatic knitting machine during the production process. The recognition model is trained at the design and sampling stages, and the resulting model can be applied to different automatic knitting machines to recognize floating yarns occurring in various knitting structures. The experimental results show that the improved network spends 75% less time than the probe-based detection, has a higher overall average detection accuracy of 93% compared to the original network, and responds faster to floating yarn anomalies. The as-proposed CNN-BiLSTM-KFS floating-yarn visual detection method not only enhances the reliability of floating-yarn anomaly detection, but also reduces the time and cost required for production adjustments. The results of this study will bring significant improvements in the field of automatic floating-yarn detection and have the potential to promote the application of smart technologies in the knitting industry.

7999 Tumor Induced Osteomalacia Caused By Glomangiopericytoma

Abstract Disclosure: N. Kabir: None. E. Campbell: None. S. Singh: None. Introduction: Tumor induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused primarily by FGF-23 secreting tumors. Excessive production of FGF23 causes hypophosphatemia, decreased phosphate resorption in the gut, increased renal phosphate wasting, and decreased activation of Vitamin D. This leads to decreased bone density, bone pain, proximal muscle weakness, impaired gait, and recurrent fractures. Case Presentation: 44 year old male with a history of recurrent insufficiency fractures and weakness. At the time of evaluation, he reported fracture of tibial growth plate, sacral fracture, and metatarsal stress fracture. Other symptoms included bone pain, fatigue, muscle weakness, and intercostal muscle spasms with exertion. His pain was debilitating, requiring crutches to ambulate. Available labs at that time were significant for hypophosphatemia (1.3 mg/dL), elevated ALP (160 U/L), low 25OH-vitamin D (26 ng/mL), and normal calcium (8.7 mg/dL). Urine studies demonstrated phosphaturia (fractional excretion of phosphate, 62.4%). FGF23 level resulted at the upper limit of normal (210 RU/mL). Pending further evaluation, burosumab was started. Further work up included a 68Ga-PET-DOTATATE scan revealing a somatostatin receptor expressing soft tissue mass in the left sphenoid sinus and posterior left ethmoid sinus. The scan also demonstrated impending bilateral femur fractures, prior rib fractures, and sacral insufficiency fractures. Based on these findings, he was admitted to the hospital and underwent prophylactic, intramedullary nail fixation of his bilateral femur fractures. He underwent resection of skull base tumor with the final pathology revealing a sinonasal glomangiopericytoma. Immunohistochemical stain was positive for CD99 and cyclin D1, and focally positive for SMA, consistent with histopathologic diagnosis. Patient required prolonged inpatient rehabilitation to recover independent ambulation. Discussion: Sinonasal glomangiopericytoma (SNGP) is a mesenchymal tumor that accounts for &amp;lt;0.5% of all nasal and sinus tumors. TIO due to SNGP is extremely rare, with only a few cases reported since the 1990s. As seen with our patient, TIO from SNGP rarely presents with sinonasal symptoms, and can often be overlooked. Our patient hadb significant progression of disease and disability due to numerous delays in diagnosis and management. Definitive cure for TIO can be achieved with complete surgical resection of the tumor, but failure to diagnose in a timely manner can result in decline in quality of life. Our takeaway from this case is that providers should obtain FGF23 levels, especially in the setting of hypophosphatemia and phosphaturia, to complete the work up for osteomalacia. Presentation: 6/1/2024

9379 From Diagnosis To Treatment: A Comprehensive Approach To Pregnancy-Related Osteoporosis With Teriparatide

Abstract Disclosure: C. Hubers: None. M. Renzu: None. V. Mehta: None. A. Manzoor Qazi: None. A.M. Satei: None. D.K. Yerasuri: None. Introduction: Pregnancy and lactation related osteoporosis (PLO) is a rare but serious condition with significant consequences for maternal and fetal health. Teriparatide's efficacy in treating this condition is promising, particularly given concerns about bisphosphonate use in this population. Clinical Case: A 26-year-old white female sought evaluation for concerns arising after her first pregnancy. Following delivery via Cesarean section, she experienced acute back pain, instability while walking and frequent falls. A subsequent bone scan showed superior end plate fractures of T9, T11, T12, and L1, while an MRI of the lumbosacral spine showed mild acute to subacute compression deformities involving the superior endplates of the L2-L5 vertebral bodies. Despite having Factor V Leiden disease, her medical history is unremarkable for significant chronic conditions or comorbidities affecting bone health. Bone density scans revealed a Z-score of -2.4 in the lumbar spine and -1.6 in the total hip, with a femoral neck Z-score of -1.3. Her lumbar spine T-score was reported as -2.8, reflecting significant bone mineral density (BMD) loss with a BMI of 20.67. She underwent thorough testing to rule out other potential contributory conditions, such as celiac disease and hemochromatosis, but was eventually diagnosed with PLO. Treatment was initiated with teriparatide, administered as a daily 20 µg subcutaneous injection. The patient demonstrated an excellent response, with marked improvements in pain and enhanced ability to perform daily activities. After treatment with teriparatide, the patient’s c-telopeptide also improved. Discussion: PLO is a very rare manifestation of osteoporosis, mainly affecting women with lower BMI and advanced age. The etiology involves hormonal changes, increased calcium demands during pregnancy and lactation, and decreased BMD. Our patient's history and clinical course highlight a compelling instance of PLO, likely attributed to decreased estrogen exposure secondary to amenorrhea and breastfeeding, resulting in increased bone turnover. While bisphosphonates are often recommended for PLO, concerns about safety in pregnant and lactating women underscore the need for alternative treatments like teriparatide. Potential effects on gestational age, neonatal birth weight, and neonatal calcium levels have been observed in newborns with maternal exposure to bisphosphonates. Teriparatide is a synthetic form of parathyroid hormone that works primarily by stimulating osteoblast activity, leading to increased bone formation and BMD. It also enhances calcium and phosphate absorption in the kidneys and intestines, further contributing to its bone-building effects. Our patient's response to teriparatide emphasizes its potential as a safer option in managing PLO, warranting further research to establish comprehensive management guidelines. Presentation: 6/3/2024

Quantifying Distal Deltoid Disruption With Linear versus Curvilinear Plating of Proximal Humerus Fractures: A Cadaveric Study

BACKGROUND: Plate fixation of proximal humeral fractures is usually associated with some degree of distal deltoid dissection. The purpose of this study was to quantify deltoid release with standard linear versus curvilinear plates used in the repair of proximal humeral fractures. METHODS: Seven nonpaired, fresh-frozen, clavicle-to-fingertip cadaveric shoulders met the inclusion criteria for this study. Four different proximal humerus implants were tested. One of these plates was curvilinear (89 mm), and the other 3 plates were linear (85, 98, 109 mm in length). Plates were compared based on the amount of deltoid insertion released for proper plate positioning. An analysis of variance with post hoc Tukey tests was conducted to compare mean deltoid disruption across the 3 shortest plate types from each manufacturer. A linear regression analysis was conducted to analyze the effect of plate length on mean deltoid release. RESULTS: The mean deltoid insertion length was 39.6 ± 8.6 mm (n = 7). The curvilinear plate (89 mm) required the least amount of average deltoid release at 4.1 ± 4.5 mm, or 12.1% of the deltoid insertion. Independent analysis of variance, including the 3 shortest plates from each manufacturer, found a significant effect of which plate was used on the amount of deltoid disruption that resulted (F(2, 18) = 18.0, P &lt; 0.001, ω = 0.6). A linear regression including all 4 plates demonstrated a statistically significant direct relationship between the plate length and the mean deltoid released (y = 0.6x − 43.8, r2 = 4). CONCLUSION: This study demonstrates that proximal humerus plate length has a direct relationship with the amount of deltoid released during plating. Although deltoid disruption is length dependent, plate shape (curvilinear vs. linear) could also be contributory. When comparing a curvilinear and a linear plate of similar lengths, the curvilinear plate resulted in less mean deltoid release.

Novel implant design for comminuted posterior wall acetabular fractures.

In recent years, the medical community has witnessed a notable increase in high-energy traumatic injuries, leading to a surge in complex fracture patterns that challenge existing treatment methodologies. Among these, the posterior approach to acetabular fractures stands out for offering direct visualization of the retro-acetabular surface, with current fixation methods relying on 3.5mm low-profile reconstruction plates and various other implants. Despite the effectiveness of these methods, there is a burgeoning demand for a singular, adaptable implant that not only streamlines the surgical process but also optimizes patient outcomes. In an innovative approach to address this need, three-dimensional (3D) models of the posterior acetabular wall were meticulously crafted using AutoCAD® software. The chosen material for the implant was 316L surgical steel for its durability and strength. The design of the implant featured a low-profile mesh structure, which was instrumental in facilitating osteosynthesis. This design allowed for the placement of screws of varying lengths in multiple directions, ensuring the initial reconstruction of the joint in an anatomical position without hindering the placement of the definitive implant. The primary objective was to secure the fixation and stabilization of the fracture by specifically targeting the smaller bone fragments. A comparative analysis was then conducted between this novel plate and a conventional 316L surgical steel, seven-hole, 3.5mm reconstruction plate through finite element analysis. The comparative analysis unveiled that both plates demonstrated comparable deformation capacities, with no significant differences in load-bearing capabilities observed. This finding suggests that the innovative plate can match the performance of traditional plates used in such surgeries. The finite element analysis revealed that the newly developed anatomical plate for posterior wall acetabular fractures meets the necessary physical and mechanical criteria for permanent implementation in patients with these fractures. This breakthrough represents a promising advancement that could simplify surgical procedures and potentially elevate patient outcomes. This study is classified as a Level II, diagnostic study.

Clinical and radiographic results of internal fixation of quadrilateral plate fractures of acetabulum.

Quadrilateral plate (QLP) is a relatively thin bony structure located below the pelvic brim proximal to the hip joint, so management of its fractures is challenging. Evaluation of the functional and radiological outcomes of internal fixation of quadrilateral plate acetabular fractures; comparison of two methods of fracture fixation. A prospective multicentric study including 30 patients who underwent open reduction and internal fixation of QLP fractures through modified Stoppa approach. Patients were divided into two groups according to the method of fixation (anatomical QLP plate vs suprapectineal and infrapectineal plates). Post-operative quality of reduction was evaluated using Matta score. Radiographical assessment according Matta's grading criteria and clinical outcome assessment using the Harris Hip Score (HHS) were repeated at follow-up and at one year to assess displacement. Mean age of patients was 34.9 ± 12.1years. After one year follow-up, clinically mean HHS was 88. ± 5.74. Radiologically post-operative reduction quality was anatomical in 21 (70%) patients, satisfactory in eight (26.7%) patients and unsatisfactory in one (3.3%) patient. Matta's grading at the last follow-up was excellent in 21 (70%) patients, good in six (20%), fair in two (6.7%) patients and poor in one (3.3%) patient. No significant difference was recorded between the two groups in terms of radiographical and clinical results and rate of complications. Accurate reduction of quadrilateral plate fracture with secure fixation through modified Stoppa approach provides good and reproducible outcomes with few complications regardless the type of the implant.

Characterization of coal permeability considering fracture shape—Using the MP-Otsu threshold segmentation algorithm

Coal seepage simulation based on digital images is capable of visualizing the three-dimensional seepage process and providing permeability data. However, Otsu's conventional thresholding algorithm is prone to image mis-segmentation for extracting pores and fractures, which makes the reconstructed model unable to reestablish the coal structure truly. The present work first explains the failure mechanism of the conventional Otsu algorithm for image segmentation based on computed tomography (CT) images of coal. Three weighting factors, including the slope of the mineral content fitting curve against the Otsu threshold and the approximate proportion of the target in the image, are introduced to enhance the accuracy of the threshold relation. In continuing, the MP-Otsu thresholding algorithm is proposed. Finally, the 3D fracture model of the coal is reconstructed from the CT image via the MP-Otsu thresholding algorithm. Focusing on the shape of the model, the permeability is then calculated on the basis of the pipe flow model and the parallel plate model. The contribution of fractures with various radii in the pipe model and different apertures in the parallel plate model is appropriately incorporated into the permeability evaluation. The obtained results reveal that the presence of mineral components and the low porosity of coal are the chief reasons for the failure of the conventional Otsu algorithm in the digital image segmentation of coal. The porosities calculated by the improved MP-Otsu algorithm are predicted to be 7.13 %-72.03 % lower than those of the Otsu’s method, which effectively improves the over-segmentation of fractures by Otsu and could accurately extract fractures in images. The permeability model, considering the fracture shape, gives results similar to the simulation results, and parallel plate fractures remarkably affect the permeability of the coal body. In particular, fractures with radius R > 7 μm and apertures b > 50 μm account for more than 90 % of the permeability and thus play a key role in the seepage process.

Evaluation of functional outcome using dual plating in treatment of intraarticular distal humerus fractures in adults.

Of all the humerus fractures in adults, 30% are of the distal end of the bone. The dual plate is strong biomechanically. The current study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, between July 1, 2019 to July 1, 2021 to study the role of dual plating in intra-articular distal humerus fractures. Included were 20 adult patients, all with intra articular fracture of the distal humerus and treated and evaluated by open reduction and internal fixation technique using dual locking plating. Clinically the final results were assessed using the Mayo Elbow Performance Score (MEPS). The final results were observed to be excellent in 12 (60 %), good in 6 (30%), fair in 2 (10 %) patients, with no poor results recorded. One patient had transient ulnar neuropraxia which recovered spontaneously after six weeks and one patient developed superficial skin infection which responded to antibiotic treatment. The mean of MEPS was significantly higher after six months and one year than that after two weeks, two months, and four months of operation.

Efficacy of Nasal Septal Complex in the Endoscopic Reconstruction of Medial Orbital Wall.

The aim of this study is to investigate the efficacy of nasal septal complex reconstructing the medial orbital wall under some specific circumstances. The authors performed a study that included 10 patients who underwent isolated medial orbital wall fracture (blow-out fracture). All the reconstruction surgery of the patient included in this study fixed defect of medial orbital wall using autologous nasal septal complex (composed of nasal septal cartilage and perpendicular plate of ethmoid). The authors observed postoperative improvements of diplopia or ocular motility disorders of the affected orbit. The surgeries had gained satisfactory results, and without severe postoperative complications. After long-term follow-up, postoperative CT indicated the implant-covered defect of medial orbital wall, and there's no incarceration of the medial rectus. Meanwhile, the authors found there is no crack in the implant, and the surgery using nasal septal complex achieved premorbid orbital form. Autologous nasal septal complex provides a better complement to endoscopic reconstruction of medial orbital wall; this strategy allows nasal septum to reconstruct isolated medial orbital wall defects of various degrees, such as nasal septum fracture and dysplasia of perpendicular plate of ethmoid.

Efficacy and safety of volar locking plate versus cast immobilization for distal radius fractures: a systematic review and meta-analysis of randomized controlled trials

Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs), yet their efficacy compared to cast immobilization remains debated. This meta-analysis aimed to compare VLPs versus cast immobilization for DRFs across various follow-up durations. Randomized controlled trials reporting patient-reported functional scores, wrist range of motion (ROM), radiological assessments, and complications were included. Meta-analysis was performed for 6-week, 3-month, 6-month, 12-month, and &gt;12-month follow-ups. Subgroup analysis stratified studies by age group, ≥ 60 years and &lt; 60 years. VLPs showed significantly lower Disabilities of the Arm, Shoulder, and Hand (DASH) scores at 6 weeks (p &lt; 0.001), 3 months (p &lt; 0.001), 12 months (p = 0.012), and &gt; 12 months (p &lt; 0.001), and lower PRWE scores at 6 weeks (p &lt; 0.001), 3 months (p = 0.048), and &gt;12 months (p = 0.032). Wrist ROM favored VLPs at 6 weeks (p &lt; 0.05), with higher flexion and supination at 3 months (p = 0.027) and 12 months (p = 0.003). Radiologically, VLPs showed improved parameters at 3- and 12-month follow-up. Overall complications did not significantly differ. Subgroup analysis in patients &lt; 60 years generally supported these findings, while in patients ≥ 60 years, radiological outcomes aligned, yet only lower DASH scores were observed with VLPs at 3 months (p &lt; 0.001). VLPs may offer superior clinical, functional, and radiological outcomes compared to cast immobilization at 3- and 12-month follow-up for patients &lt; 60 years, with comparable safety profiles. For patients ≥ 60 years, VLPs may yield better radiological outcomes at 3- and 12-month follow-up, though clinical benefits remain uncertain.

Single-Plate versus Dual-Plate Utilization for Treatment of Humeral Shaft Fractures: A Retrospective Clinical Series

Objectives Dual plating is the current standard of care for displaced distal humerus fractures and even some metadiaphyseal humeral fractures. Single plate fixation is the current standard of care for humeral shaft fractures when performing open reduction and internal fixation (ORIF). A role may exist for dual plating of humeral shaft fractures. This study aims to compare clinical outcomes of single versus dual-plating when performing ORIF procedures on humeral shaft fractures. Methods A retrospective study of 143 patients (81 females, 62 males; mean age 47.3) who sustained humeral shaft fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (OTA/AO) type 12A, B, and C) and received either dual or single plating via ORIF between March 2010 and May 2022. Of the 143 patients, 79 (55%) received single plating, while 64 (45%) received dual plating. To account for possible confounders, we collected data on patient characteristics, mechanism of injury, and intra-surgical variables. Primary outcome measurements compared radiographical x-ray imaging (3-months, 6-months, and 12-months), complications, and visual analog scale (VAS) score. Results There was no statistically significant difference between VAS scores, union rates, post operative radial nerve injury, infections, or hardware failure for primary surgical outcomes. Patients were allowed to bear weight as tolerated more quickly in the dual-plating group. An association was observed between the usage of dual plates and osteoporosis. Conclusion In conclusion, we found dual-plate fixation for ORIF of humerus fractures to be not statistically significantly different compared to single plate fixation. Dual-plating has satisfactory radiograph and clinical outcomes compared to conventional single-plate fixation. While we are not advocating for the routine use of dual-plating, the results of our study suggest that the use of dual-plating produces similar outcomes when compared to single-plating for ORIF of a humerus shaft fracture.

Functional Outcome of Volar Barton Fracture of Distal End Radius Undergoing Plating

Background: Volar Barton fractures of the distal radius are complex intra-articular injuries that often require surgical intervention for optimal functional recovery. Volar plating is commonly used to achieve stable fixation and early mobilization.Objective: This study aimed to evaluate the functional outcomes and complications in patients with volar Barton fractures of the distal radius treated with volar plating.Methods: This prospective study was conducted from March 2023 to March 2024, including 60 patients aged 18-60 years with AO/ASIF type B3 volar Barton fractures. All patients underwent open reduction internal fixation (ORIF) using a volar locking plate through a modified Henry approach. Postoperative assessments were performed at six months using Gartland and Werley’s wrist score. Data analysis was conducted using SPSS 25, with one-way ANOVA applied to evaluate associations between variables, considering a p-value &lt; 0.05 as significant.Results: The average age was 34.43 ± 12.34 years. Excellent functional outcomes were achieved in 61.7% of patients, good in 30%, fair in 6.7%, and poor in 1.7%. Complications were minimal, with 95% of patients reporting none, 3.3% experiencing wound infections, and 1.7% reporting wrist stiffness.Conclusion: Volar plating for volar Barton fractures showed excellent to good functional outcomes in most patients, with minimal complications. Further studies with larger populations are recommended.

Outcome Comparison of Multidirectional Locked Nailing and Plating for Distal Tibial Fractures: A Comparative Analytical Study

Introduction: This comparative analytical study explores the functional outcomes of treating distal tibial fractures using multidirectional locked nailing and plating. Distal tibia fractures, resulting from high-energy trauma, pose challenges due to soft tissue damage, infection risks, and potential unfavorable outcomes. Our study seeks to evaluate and contrast the functional results of treating distal tibial fractures using multidirectional locked nailing versus plating techniques. Materials and Methods: Conducted at Saveetha Medical College and Hospital from August 2022 to October 2023, the study involved 20 cases meeting specific criteria. Adult patients (18-70 years) with closed fractures and grade I compound fractures of distal tibia (AO type 43-A1, 43-A2, and 43-A3) were included. The cases were evenly divided between multidirectional locked nailing and plating groups. Subsequent evaluations, comprising both radiographic and clinical analyses, were performed at 6, 12, and 24-week intervals. Results: The study encompassed various parameters, including age distribution, causes of fractures, weight-bearing protocols, and joint movements. Multidirectional locked nailing demonstrated a shorter fracture union time, promoting earlier weight-bearing and functional exercises. Ankle and knee scores in this group indicated successful joint function restoration but with a higher malunion rate. Plating exhibited a lower malunion rate but a prolonged time to union. Complications, including superficial infections and wound dehiscence, were observed, emphasizing the importance of postoperative monitoring. Despite challenges, the plate group achieved satisfactory functional outcomes, highlighting fair to good ankle scores and full knee movement in all cases. Conclusion: In conclusion, the study underscores the distinctive advantages and considerations of each treatment approach. Multidirectional locked nailing facilitates faster union and joint function restoration but carries a higher malunion risk. Plating, with a lower malunion rate, requires meticulous postoperative care. The choice between the two methods should be individualized, considering patient-specific factors, fracture characteristics, and the surgeon's expertise. This research contributes valuable insights for informed decision-making in distal tibia fracture treatment.

Outcomes of osteoarticular ulna allograft for the reconstruction of proximal ulna tumour.

The ulna is an extremely rare location for primary bone tumours of the elbow in paediatrics. Although several reconstruction options are available, the optimal reconstruction method is still unknown due to the rarity of proximal ulna tumours. In this study, we report the outcomes of osteoarticular ulna allograft for the reconstruction of proximal ulna tumours. Medical profiles of 13 patients, who between March 2004 and November 2021 underwent osteoarticular ulna allograft reconstruction after the resection of the proximal ulna tumour, were retrospectively reviewed. The outcomes were measured clinically by the assessment of elbow range of motion (ROM), stability, and function, and radiologically by the assessment of allograft-host junction union, recurrence, and joint degeneration. The elbow function was assessed objectively by the Musculoskeletal Tumor Society (MSTS) score and subjectively by the Toronto Extremity Salvage Score (TESS) and Mayo Elbow Performance Score (MEPS) questionnaire. The mean follow-up of patients was 60.3 months (SD 28.5). The mean elbow flexion-extension ROM was 95.8° (SD 21). The mean MSTS of the patients was 84.4 (SD 8.2), the mean TESS was 83.8 (SD 6.7), and the mean MEPS was 79.2 (SD 11.5). All the patients had radiological union at the osteotomy site. Symptomatic osteoarthritic change was observed in three patients (23%), one of whom ended up with elbow joint fusion. Two patients (15.4%) had recurrence during the follow-up period. Surgical complications included two allograft fractures, two plate fractures, three medial instabilities, and two infections. Osteoarticular ulna allograft reconstruction provides acceptable functional outcomes. Despite a high rate of complications, it is still a valuable reconstruction method, particularly in skeletally immature patients who need their distal humerus physis for the rest of hand growth.

Study on the efficacy of 3D printing technology combined with customized plates for the treatment of complex tibial plateau fractures

BackgroundAnatomical reduction and stable fixation of complex tibial plateau fractures remain challenging in clinical practice. This study examines the efficacy of using 3D printing technology combined with customized plates for treating these fractures.MethodsWe retrospectively analyzed 22 patients treated with 3D printing and customized plates at the Orthopedic Department of the Central Hospital affiliated with Shenyang Medical College from September 2020 to January 2023. These patients were matched with 22 patients treated with traditional plates with similar baseline characteristics. Patients were divided into an experimental group (3D-printed models and customized plates) and a control group (traditional plates). The control group underwent traditional surgical methods, while the experimental group had a preoperative 3D model and customized plates for surgical planning. We compared baseline characteristics and recorded various indicators, including preoperative preparation time, surgical time, intraoperative blood loss, number of intraoperative fluoroscopies, hospital stay duration, fracture healing time, complications, knee joint range of motion (ROM), Rasmussen anatomical and functional scores, and HSS scores.ResultsAll surgeries were successful with effective follow-up. The experimental group had shorter surgical time, less intraoperative blood loss, and fewer intraoperative fluoroscopies (P < 0.05). At 6 months and 1 year postoperatively, the experimental group had better knee joint HSS scores than the control group. Preoperative preparation time and total hospital stay were shorter in the control group (P < 0.05). There were no significant differences in fracture healing time and follow-up duration between groups. The experimental group showed better knee joint flexion angles (P < 0.05). Rasmussen scores showed no statistical difference between groups (P > 0.05). The incidence of complications was slightly lower in the experimental group but not significantly different.Conclusion3D printing technology combined with customized plates for complex tibial plateau fractures enables precise articular surface reduction, significantly shortens surgical time, and reduces intraoperative blood loss. This method improves knee joint function, offering a more effective treatment option.

Effect of Screw Length in Volar Plating for Intra-articular Distal Radius Fractures: A Biomechanical Study

PurposeThe purpose of this study was to compare the effect of varying screw lengths on load to failure and retention of the dorsal ulnar corner fragment after fixation of comminuted intra-articular distal radius fractures in a cadaveric model. MethodsTwenty-four fresh frozen cadaveric forearms were subjected to a standardized distal radius osteotomy to mimic an intra-articular fracture pattern. Dual X-ray absorptiometry scans were performed to ensure minimal variability in bone density. All fractures were fixed with a volar locking plate and distal locking screws. Three different lengths of distal locking screws were used in each group of eight specimens to simulate the clinical decision of different distal screw lengths. The screw lengths tested were bicortical, 100% of the width of the bone but unicortical, and 75% of the width of the bone and unicortical. All specimens were preconditioned with cyclic axial loading and then axially loaded using matching acrylic resin molds to clinical failure and fragment displacement as detected by a motion analysis system. Retention or loss of the dorsal ulnar corner fragment during loading was recorded as a binary variable. ResultsBetween the three groups, there were no statistically significant differences in precycling stiffness, postcycling stiffness, load at 2 mm displacement of the dorsal ulnar corner, or force at failure. The group with 75% length screws had a significantly higher loss of reduction of the dorsal ulnar corner (86%) compared with the other groups (0%). ConclusionsVarying screw lengths did not affect the stiffness or overall loads to failure of axially loaded specimens. However, the 75% length screws did not reliably secure the dorsal ulnar corner fragments. Although this did not significantly affect the overall load to failure of the construct, displacement of this fragment may have implications for rotation of the forearm through the distal radioulnar joint. Clinical relevanceSurgeons should consider the utilization of full-length unicortical locking screws to ensure adequate fixation of the dorsal ulnar corner. Type of study/level of evidenceBiomechanical study V.