Pre-contoured Plate Research Articles

A novel anatomically pre-contoured side-specific titanium plate versus the reconstruction plate for quadrilateral plate fractures of the acetabulum: a propensity-matched cohort study

BackgroundSurgical treatment of acetabular fractures involving a quadrilateral plate is a challenge to orthopedic surgeons. We have developed a novel fixation technique using a specially shaped reconstruction plate combined with several buttress screws of a quadrilateral plate which was also called a dynamic anterior plate-screw system for quadrilateral plate (DAPSQ) to treat acetabular fractures involving quadrilateral plate since 2005 (RP group). And the long-term follow-up results have confirmed the effectiveness and safety of this technique. After 2016, standardized titanium plate (STP group) of DAPSQ have been designed and applied. The aim of the study was to compare the clinical efficacy of anatomical plate and the reconstruction plate of DAPSQ in the treatment of quadrilateral plate fractures.MethodsWe led a propensity-matched cohort study of quadrilateral plate fractures. Twenty-two patients were included in the STP group during the inclusion period (2016–2018) and were matched to 22 cases in our database of the RP group (2008–2016). The primary outcome measures were the quality of reduction and functional outcomes. Intraoperative conditions were also compared.ResultsOf these 22 consecutive patients in the STP group, the mean age was 46.7 years and the most common fracture pattern was a both-column fracture (12 cases, 54.5%) according to Letournel-Judet classification. The mean follow-up period was 23.1 months (range 12–37). There were no significant differences between the two groups with regard to the quality of reduction using the Matta radiological criteria and functional outcomes evaluated by the modified Merle d’Aubigné score (P > 0.05). Compared with the RP group, the STP group had a shorter operation time (245.1 min vs. 286.8 min, P = 0.020), less intraoperative blood loss (1136.4 mL vs. 1777.3 mL, P = 0.014), and transfusion (780.9 vs. 1256.8 mL, P = 0.035). The complication rate was 18.2% in the STP group, and there was no significant difference compared with the RP group (36.4%) (P > 0.05). None of the cases in the two groups had quadrilateral screws entering the hip or implant failure.ConclusionsThe fixation of standardized titanium plate in quadrilateral plate fractures showed a similar result to the reconstruction plate, in terms of quality of reduction and functional outcome. The standardized titanium plate of DAPSQ has the advantages of a short operation time, less intraoperative bleeding, and blood transfusion, and it is worth further promotion and research.

Clinical and functional outcomes of pre-contoured plate fixation in displaced intraarticular calcaneum fracture

<p class="abstract"><strong>Background:</strong> We evaluated the clinical and functional outcome of intra-articular calcaneal fractures treated with pre-contoured plating. The functional outcome was measured by the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system.</p><p class="abstract"><strong>Methods:</strong> Twenty-five adult patients with displaced intra-articular calcaneus fractures, treated with by open reduction and internal fixation using pre-contoured plates, and those who were available for follow up were evaluated for the outcomes such as operative procedure, anatomical reduction, postoperative hospital stays early mobilization and functional outcome postoperatively. Follow-up was at three, six and twelve months radiological and clinical union were also considered.<strong></strong></p><p class="abstract"><strong>Results:</strong> Twenty-five adult patients presented with calcaneal fractures were operated during the study period. The mean time for union of fracture was 12.5±1.8 weeks. When we assessed the functional outcome in those patients who had radiological and clinical union using AOFAS score, we found that 16 out of 23 (64%) had good results with mean AOFAS score of 83.5±2.0 and 7/25 (28%) had fair results with mean score of 73.3±1.3, and 2/25 (8%) had poor results with mean score of 54.0±8.5. In 2 out of 16 (12.5%) patients, with good AOFAS scores, implants were removed after one and a half year from the day of surgery after confirming complete union of the fracture.</p><p class="abstract"><strong>Conclusions:</strong> We believe that pre-contoured reconstruction plate fixation for displaced intraarticular calcaneus fracture is excellent in terms of the union of the fracture, attaining anatomical reduction. It gives better outcomes concerning the function and range of movements.</p>

Outcome of fixation of acromioclavicular joint dislocation type-iii with clavicular hook plate

Introduction: Acromioclavicular (AC) joint dislocation is one of the most common shoulder injuries accounting for approximately 9-12% of all shoulder girdle injuries. Rockwood classification of AC joint dislocation is the most widely accepted classification system which classifies the injury into six types. Surgical management with open reduction and fixation with clavicular hook plate without the repair of coracoclavicular ligament has proved to be one of the best treatment options for Type III AC joint dislocations.
 Methods: Twenty-three patients with Rockwood Type III AC joint dislocation were included in the study. Open reduction was done and the fixation was done with the clavicular hook plate. The functional outcomes were assessed before and two months after the implant was removed using the Constant- Murley Score.
 Results: A total of 23 patients were included in the study with the mean age of 30.74 years. The plates were removed on an average of 6.43 months and mean follow up was 8.83 months. The functional outcome was assessed using the Constant- Murley Shoulder score. The pain scores were significantly better after the implant removal was done (p= 0.007). The final mean constant score was 74.6 ± 4.11 before removal and 93.91 ± 2.71 after implant removal and all the 23 patient had excellent result (>90 points).
 Conclusions: The pre-contoured clavicular hook plate has proved to be a good implant option in the fixation of Rockwood Type III AC joint dislocation without the need of any ligamentous repair

ORIF in middle third clavicle fractures: Resumption of occupation and patient satisfaction

Introduction: Conservatively treated displaced clavicle fractures have a non-union rate of 15% and unsatisfactory patient-reported outcomes in 1/3rd of the patients. ORIF with pre-contoured plate gives better functional outcome but is associated with wound and hardware-related complications in 9% to 64% of cases.Purpose: To evaluate patient satisfaction in terms of function, activities of daily living and return to occupation following ORIF with plating for fractures of midshaft clavicle.Methodology: Patients underwent ORIF for midshaft clavicle fracture with pre-contoured clavicle plate using the direct superior approach to clavicle, followed by 4 weeks of sling with gentle range of motion exercises. Resumption of daily activities was allowed after 4 weeks as tolerated by the patient. Patients were evaluated using the Oxford Shoulder Score, shoulder and pectoral girdle range of motion and a general questionnaire to determine the satisfaction of patients with the procedure, at 6 months post-surgery.Result: Of the 17 patients that underwent ORIF for midshaft clavicle fracture, 16 patients (94%) had returned to their original occupation with 1 patient requiring assistance in performing overhead tasks. 1 patient was unable to return to occupation due to associated non-union of a tibia fracture. 15 patients (88%) reported that they were satisfied with the outcome of the surgery.Conclusion: Treatment of midshaft clavicle fractures with ORIF gives good functional outcome and is associated with a high patient satisfaction rate in terms of return to their pre-fracture activity levels for daily living and occupation.

Usability evaluation of 3D user interface for virtual planning of bone fixation plate placement

Abstract Universal pre-contoured plates are commonly used for internal fixation of bone fracture. Optimal plate placement can be determined through visual inspection of the relative position between the plate and the fractured bone as displayed on x-rays. While computer-assisted approaches have been developed to enable the manipulation of 3D models of the bone and the plate in virtual environments, as the 3D models are usually maneuvered using a 2D mouse with the virtual trackball paradigm, the process is counter-intuitive and could hamper system usability. An intuitive 3D haptic device was therefore employed to develop a virtual training system for fixation plate placement. A four-session study over two weeks were conducted with 15 subjects to evaluate the usability of the system, with 2D mouse and 3D haptic device employed as user interface. The effect of force feedback was also studied. A questionnaire was administered at the end of the study to assess user satisfaction towards the usability of the two input devices. User performance of virtual plate placement using a 3D haptic device was found to be superior to that using a 2D mouse, in terms of completion time and accuracy. The performance with and without force feedback was not significantly different. Preference toward 3D haptic device was reflected from the responses to the usability questionnaire. In conclusion, employing a 3D input device as user interface can potentially facilitate virtual planning of bone fixation plate placement.

Supplementation of Lateral Locked Plating for Distal Femur Fractures: A Biomechanical Study

To investigate the biomechanical properties of a lateral locked plate alone or in combination with a supplemental medial plate or an intramedullary nail (IMN). Intra-articular distal femur fractures with metaphyseal comminution (OTA/AO 33-C) were simulated with a standardized model in 28 synthetic femora and divided into 4 groups. Group I was instrumented with a 4.5-mm lateral locked distal femoral plate alone, group II with a lateral locked plate plus a low-profile precontoured 3.5-mm medial distal tibial plate, group III with a lateral locked plate plus a medial 3.5-mm reconstruction plate, and group IV with a lateral locked plate plus a retrograde IMN. Specimens were then axially loaded and cycled to failure or runout. Outcomes of interest were baseline stiffness, survivability, and cycles to failure. Groups III and IV have a significantly higher baseline stiffness (P < 0.001) when compared with groups I and II. Furthermore, groups III and IV had a higher max load to failure (P < 0.01) when compared with groups I and II. The survivability in groups III and IV was 71% and 100%, respectively, while no specimens in group I or II survived maximum loading. There was no significant difference between group III and IV regarding stiffness, survivability, and cycles to failure. When considering fixation for intra-articular distal femur fractures with metaphyseal comminution (OTA/AO 33-C), we found that supplementation of a lateral locked plate with a medial plate or an IMN to be biomechanically superior to lateral locked plating alone regarding stiffness, survivability, and cycles to failure. A low-profile precontoured plate did not add significantly to the construct stiffness in this study.

Anatomy of clavicle in the Indian population and its applicability in pre-contoured plating.

Fractures of the clavicle are traditionally treated non-operatively, but with the increase of high-energy trauma, there has been an increase in the operative management of these fractures. Controversy exists on the type of fixation for middle third clavicle fractures. The anatomically pre-contoured plates are low-profile mechanically sound plates which do not cause much soft tissue irritation. To characterise the clavicular morphology through computerised tomography and determine the applicability of pre-contoured plates for our population. In this study, the mean total length was 145.31mm and the apex of superior clavicle bow was located 38.15mm from the acromial end, thereby giving a zone of 107.16mm for plating. In the 107.16mm of platable zone, the zone of ideal fracture location was 43.16mm. Superior anterior plates had a good fit in 89.3% of the CT subset, whereas superior plates had a good fit in only 71.6% of the population. Superior anterior pre-contoured clavicle plates have approximately 98% good to fair compatibility for clavicles in the South Indian population without any need for further intra-operative moulding.

Elbow Arthrodesis Using a Medially Positioned Plate in 6 Dogs.

The aim of this study was to report the surgical technique, associated complications and clinical outcome of elbow arthrodesis using a medially positioned plate. This was a retrospective case series. Six cases met the inclusion criteria. In all cases, the elbow was approached medially without the requirement for ulnar osteotomy. A non-locking 2.7/3.5- mm pre-contoured elbow arthrodesis plate was applied in 5/6 cases and a 2.0-mm String of Pearls plate applied in one case. The mean angle of arthrodesis was 118° (range: 113-130°). One major intraoperative complication occurred. Three minor and 3 major postoperative complications occurred. Postoperative imaging was available for 5/6 cases. Complete arthrodesis was confirmed by imaging in 4/5 cases, partial progression of arthrodesis was documented in 1/5 cases and no further images were deemed necessary. Postoperative Liverpool Osteoarthritis in Dogs score was available for two cases with scores of 20/52 and 10/52, respectively. Subjective outcomes in the remaining three cases were rated as acceptable more than 1 year postoperatively. Positioning the plate medially for elbow arthrodesis simplified the surgical approach, could be performed with a pre-contoured plate and allowed successful revision of an arthrodesis previously stabilized with a caudally positioned plate. The cases in this series had acceptable outcomes despite a high risk of complications.

Chirurgie virtuelle assistée par ordinateur et impression 3D de plaques individualisées pré-chantournées dans les fractures acétabulaires des deux colonnes

IntroductionWith the rapid development of three-dimensional (3D) printing and computer technology, adopting computer-assisted virtual surgical procedures and 3D printing of patient-specific pre-contoured plates can greatly reduce surgical invasiveness and operative time and simplify the procedure. HypothesisUse of computer-assisted virtual surgical procedures and 3D printing of patient-specific pre-contoured plates reduce the operative time and blood loss in bi-columnar acetabular fracture fixation. MethodsA retrospective analysis was performed for 52 bi-columnar acetabular fracture cases treated surgically in our department from January 2013 to January 2017. According to the patients’ willingness to accept 3D printing services, 52 patients were divided into groups A and B. In group A (28 patients), computer-assisted virtual surgical procedures and 3D printing of patient-specific pre-contoured plates were adopted. In group B (24 patients), the conventional method was adopted. Fracture type, operative blood loss, surgical time, complications, radiographic quality of reduction, and hip function were compared between groups. All patients were operated by the same surgeon. ResultsThe real surgical procedure of all patients in group A was almost identical to the preoperative virtual operation. Operative time and intra-operative blood loss were significantly reduced in group A than in group B (P<0.05), while the postoperative fracture reduction quality and hip function obtained slightly higher levels of satisfaction in group A. ConclusionsComputer-assisted virtual surgical procedures, 3D printing technology and patient-specific pre-contoured plates can reduce the operative time and blood loss with less surgical invasiveness and ensure completely satisfactory clinical outcomes. However, promotion of this technology requires additional work. Level of evidenceIII, therapeutic study.

Application of computer-assisted virtual surgical procedures and three-dimensional printing of patient-specific pre-contoured plates in bicolumnar acetabular fracture fixation

IntroductionWith the rapid development of three-dimensional (3D) printing and computer technology, adopting computer-assisted virtual surgical procedures and 3D printing of patient-specific pre-contoured plates can greatly reduce surgical invasiveness and operative time and simplify the procedure. HypothesisUse of computer-assisted virtual surgical procedures and 3D printing of patient-specific pre-contoured plates reduce the operative time and blood loss in bicolumnar acetabular fracture fixation. MethodsA retrospective analysis was performed for 52 bicolumnar acetabular fracture cases treated surgically in our department from January 2013 to January 2017. According to the patients’ willingness to accept 3D printing services, 52 patients were divided into groups A and B. In group A (28 patients), computer-assisted virtual surgical procedures and 3D printing of patient-specific pre-contoured plates were adopted. In group B (24 patients), the conventional method was adopted. Fracture type, operative blood loss, surgical time, complications, radiographic quality of reduction, and hip function were compared between groups. All patients were operated by the same surgeon. ResultsThe real surgical procedure of all patients in group A was almost identical to the preoperative virtual operation. Operative time and intraoperative blood loss were significantly reduced in group A than in group B (p<0.05), while the postoperative fracture reduction quality and hip function obtained slightly higher levels of satisfaction in group A. ConclusionsComputer-assisted virtual surgical procedures, 3D printing technology and patient-specific pre-contoured plates can reduce the operative time and blood loss with less surgical invasiveness and ensure completely satisfactory clinical outcomes. However, promotion of this technology requires additional work. Level of evidenceIII, therapeutic study.

What’s New in Orthopaedic Trauma

What’s New in Orthopaedic Trauma

To evaluate intraoperative technical difficulties during PHILOS plating for treatment of displaced proximal humerus fractures

Background: This is a Prospective study carried out at Department of Orthopaedics & traumatology, Amaltas Institute of Medical Sciences, Dewas, M.P. in 30 patients of proximal humerus fracture were attended in casualty and OPD and were admitted.Result: Most of the injuries caused by was road traffic accident. In our study, patients with two part fracture had better functional outcome as compared to patients with three and four part fracture.Conclusion: The internal fixation with the PHILOS plate seems to be a reliable option in the operative treatment of upper end humeral fractures, especially in osteoporotic bone. It allows secure fracture fixation and quick shoulder mobilization. PHILOS plates are pre-shaped & pre-contoured plates to match proximal humeral anatomy with multiple proximal locking screw placement options has made fixation of complex fractures easy. It provides rigid fixation, enhanced axial & angular stability & allows early mobilization of the shoulder without compromising fracture union.

Functional results of clavicle fractures in adults treated by open reduction and internal fixation using superior precontoured plate

Background: Observe results of open reduction and internal fixation of fractures of the clavicle in adults using pre-contoured superior clavicle locking plate.Methods: This study was prospective study carried out in the Govt Medical college Hospital Baramullah Kashmir Department of Orthopaedics from June 2014 to September 2016. A total of 25 patients with fresh fractures were treated with ORIF with a pre-contoured superior clavicle locking plate.Results: The mean age of patient was 30.08 years, males (64%), right clavicle frequently fractured (52%) Robinson type 2B1 configuraion. (44%) sustained their injury due to a road traffic accident. The average 6 month Quick DASH score was 0.82, whereas the mean constant score was 94.8 at final follow-up. The complications were superficial wound infection in (4%), mechanical pull-out of the plate in (8%), numbness below the incision area in (12%), symptomatic hardware in (4%), and non-union in (4%).Conclusions: There has been a resurgence of interest in operative treatment for fractures that are displaced, comminuted, or that display significant shortening. Operative treatment is beneficial to only a subset of patients, in whom functional expectations and fracture characteristics have both been taken into account before taking the final decision.

Precontoured buttress plate vs reconstruction plate for acetabulum posterior wall fractures: A biomechanical study.

BACKGROUNDThe purpose of open reduction and internal fixation of acetabulum posterior wall fractures is to restore anatomical structure and stability of the hip joint, in order to start weight bearing as soon as possible and prevent hip arthrosis; restoration of the anatomy should preserve function of the joint as well. Although “special shaped precontoured plates” have been developed in recent years for surgical treatment of this region, studies comparing the traditional plates with the newly designed precontoured plates are lacking.AIMTo evaluate the biomechanical properties of precontoured anatomic buttress and conventional curved reconstruction plates (CCRPs) for posterior wall acetabulum fracture treatment.METHODSTwelve pelvis models were created for testing plate treatment of fracture in the posterior wall of the acetabulum. These 12 pelvis models were used to create 24 hemipelvis models (experimental) by cutting from the sagittal plane and passing over the center of gravity, after which the posterior wall acetabular fractures (of similar type and size) were created. In these experimental models, the right acetabulum was fixed with a 5-hole CCRP, while the left was fixed with a precontoured anatomic buttress plate (PABP). Samples were placed through the test device and were subjected to static load testing, with a constant testing velocity of 2 mm/min until the load reached 2.3 kN or the acetabular fixation failed. Dynamic tests were also performed with sinusoidal wave load, with a maximal load of 2.3 kN and a load ratio of 0.1.RESULTSThe average stiffness values were 460.83 ± 95.47 N/mm for the PABP and 291.99 ± 118.58 N/mm for the 5-hole CCRP. The precontoured anatomic acetabulum buttress plates had significantly higher rigidity than the CCRPs (P = 0.022). There was a statistically significant difference between the unloaded and 2.3 kN-loaded values of AL (posterosuperior fracture line vertical to the ground surface) and CL (posteroinferior fracture line vertical to the ground surface) parameters for both the PABPs and the 5-hole CCRPs (P = 0.036 and P = 0.045, respectively). According to the static tests, the amount of total displacement was significantly less in the PABPs than in the CCRPs. Comparative analysis of the displacement in the BL (posterior wall fracture line horizontal to the ground) parameter yielded no statistically significant differences between the PABP and the 5-hole CCRPs (P = 0.261).CONCLUSIONPABP provides more stable fixation in acetabulum posterior wall fractures than 5-hole CCRP, allowing for proximal or distal fracture line screw application without reshaping.

Middle third clavicular fractures fixed with precontoured locking compression plate or reconstruction plate: comparison of outcomes and complications

Background: Fractures of the clavicle account for 2.6% to 4% of all fractures. Operative management of displaced fractures of the midshaft clavicle is preferred due to better outcomes. Various plates are used for fixation of these fractures, which include reconstruction plates, dynamic compression plates, and precontoured locking plates. Very few studies have documented whether the proposed benefits of precontoured plates are realized in a clinical setting. In this study, we compared the outcomes and complications of displaced midshaft clavicular fractures fixed using precontoured and reconstruction plates. Methods: Patients with Robinson Type 2B fractures of the clavicle treated using reconstruction plates (46 patients) or precontoured plates (68 patients) were included in the study. Parameters such as duration of surgery, functional outcome at 6 mo, and occurrence of complications, such as nonunion, infection, hardware prominence, and overall reoperation rates, were compared between the two groups. Results: There was no significant difference in functional outcomes between the reconstruction plate group and precontoured plate group (Constant score: 85.23 vs. 86.75, respectively). However significantly higher rate of hardware prominence (32.6% vs. 7.3%, respectively), implant removal (15.2% vs. 2.9%, respectively), and reoperation (19.5% vs. 4.4%, respectively) was found with reconstruction plates compared to precontoured plates. Conclusions: The treatment of displaced midshaft clavicular fractures with either reconstruction plates or precontoured plates offers a return to excellent shoulder function. However, a significant decrease in duration of surgery, hardware prominence, and reoperation rate was seen with precontoured plates.

Plate Osteosynthesis versus conservative treatment in middle third shaft fractures of clavicle: A comparative study

Objectives: Mid shaft clavicle fractures have traditionally been treated by conservative means with good outcome. ORIF with plating is an upcoming option to improve outcome further. Aim of this study is to compare the outcome of open reduction and internal fixation with conservative treatment. Methods: The study was done at the tertiary care trauma centre of Krishna institute of medical sciences, karad, Maharashtra between January 2018 to January 2019. The study was conducted over a period of one year, with 40 closed mid shaft clavicle fractures included. Half of the patients were operated using AO pre-contoured plate. The functional outcome was evaluated by the Constant and Murley score at the end of 3 months from injury. The fracture union time and associated problems were also compared. Results: In the operative group, 20 patients (76%) had excellent functional outcome. In the operated group, 2 patients (8%) had hypertrophic skin scar and in 2 patients (8%) plate prominence occurred. 1 patient (4%), plate loosening occurred. In 2 patients (8%), delayed union occurred which went for malunion and in 1 patient (4%), plate breakage occurred. In the non-operative group, 3 patients (15%) had good functional outcome, 7 patients (35%) had fair functional outcome and 10 patients (50%) had poor functional outcome. Conclusion: In this study, early primary plate fixation of mid shaft clavicular fractures results in improved patient-oriented outcomes, improved surgeon-oriented outcomes, earlier return to function and decreased rates of non-union and malunion.

A single centre experience of pre-contoured clavicle plates by an anterior approach

AimIn recent years there has been increasing evidence that comminuted and shortened clavicle fractures should be treated surgically. The aim of this study was to assess the outcome of patients who had their clavicle fracture fixed using a pre-contoured, clavicle specific plate from an anterior approach. MethodA retrospective analysis was carried out of all patients treated with pre-contoured clavicle plates from an anterior approach between May 2014 and June 2016.Medical records were analysed, and a phone survey was carried out to assess patient function and note any complications. ResultsThirty-five eligible patients were identified. Post-operative complications included: 3 patients experienced altered sensation of the anterior chest wall, 2 suture granulomas, 1 incidence of prominent metalwork. In addition, 2 patients suffered peri-implant fractures due to secondary trauma after union. Patients who had Open Reduction and Internal Fixation (ORIF) for acute fractures had a mean qDASH of 8.93 and those who had a ORIF and bone grafting for non-union had an mean qDASH of 34.38. ConclusionAlthough there are 6 complications listed for 33 procedures, these would be considered minor. Patients appear to do better if treated for an acute fracture. Anterior approach for clavicle ORIF using an anatomically shaped pre-contoured plate appears to be a safe and effective procedure.

Intraoperative Assessment of Coronal Alignment in Distal Femur Fracture Fixation: Technical Trick.

Supracondylar femur fractures represent a challenging and common injury treated by many orthopedic surgeons. An array of surgical fixation options has been developed to help the treating surgeon restore normal anatomic alignment of these fractures, and lateral precontoured condylar femoral locking plates have become a common implant for most surgeons in treating these fractures. Although these precontoured plates provide significant benefit to the treating physician in regards to gaining appropriate bony fixation, common technical errors that may lead to malalignment when using these plates have been described. Avoiding these errors will help improve patient outcomes. Here, we describe a novel, inexpensive, and universally available technique that may aid the treating surgeon in restoring coronal alignment when treating distal femur fractures.

Comparison of 4 different techniques in first metatarsophalangeal joint arthrodesis.

The aim of this study was to evaluate outcomes and fusion rates of 4 different methods of first metatarsophalangeal joint (MTPJ) arthrodesis. We performed a retrospective analysis of first MTPJ fusion using Bold® and Acutrak® compression screws, universal 1/3 tubular plate and Hallu®-S non-locking plate in 6 hospitals in Dublin over 4years. A cohort of 300 patients (351 feet) was operated on by 3 feet and ankle fellowship trained orthopaedic surgeons (PK, MMS, JVMcK) over 4years. Mean age was 62.4years. There were 261 females and 39 males. One hundred three patients had a fusion of first MTPJ using two Acutrak® screws and 90 with two Bold® screws. Sixty-five were fused with the Hallu-S® plate and 42 with the universal 1/3 tubular plate. Patients were evaluated clinically and radiographically at 6weeks, 3months and 12months. Functional outcome scores performed using Manchester-Oxford Foot Questionnaire (MOXFQ). Failure rate in those fused with the Hallu®-S plate was 0%, Acutrak® screws 2.4%, Bold® screws 9.5% and universal 1/3 tubular plate 12.5% (p > 0.12). All treatment groups demonstrated significantly reduced MOXFQ scores (p value < 0.05). In this retrospective study for first MTPJ fusion, a low profile, pre-contoured plate in combination with a screw mode had the best results with no failure rates and improved MOXFQ scores. IV, retrospective study.

The first 100 patients treated with a new anatomical pre-contoured locking plate for clavicular midshaft fractures

BackgroundPre-contoured locking plates were recently introduced in the management of clavicular midshaft fractures. These plates may offer advantages such as no necessity for intraoperative bending and reduced plate irritation. The purpose of this study was to review the clinical and radiographical outcome of the first 100 patients treated with a new anatomical pre-contoured locking plate.MethodsIn a retrospective single-center study, 100 consecutive patients (16 female, 84 male) with a median age of 40 years (range 15–82) who underwent surgery for clavicular midshaft fractures with a VariAx locking plate (Stryker Corporation Kalmazoo, MI, USA) between March 2012 and January 2016 were included. Postoperative follow-up was performed until union was clinically and radiographically achieved. Fracture type, surgical time, intraoperative need for contouring the plate, further surgery such as revision or hardware removal and complications were recorded.ResultsOne-hundred patients with a dislocated midshaft clavicular fracture with a mean follow-up of 21.9 months (standard deviation 13.2) were included. Ninety-three patients reported normal shoulder function at latest follow-up. Median surgical time was 75.5 min (range, 35–179). In three patients, intraoperative bending of the plate was necessary. In two patients, plates designed for the other side were implanted. Five patients needed revision surgery: One patient with wound healing problems, one patient with a re-fracture after early (13 months) hardware removal and minor trauma, one patient with postoperative shoulder stiffness and two patients with failed osteosynthesis because of surgical implantation fault. One asymptomatic nonunion without further treatment was observed. In 30 patients, the plate was removed after a mean of 17.5 months (SD 4.2) because of subjective plate discomfort.ConclusionsWith this new pre-contoured locking plate, good to excellent intraoperative fit to the anatomical shape of the clavicle can be achieved. The implant seems to be reliable regarding handling and complications. Clinical and radiological results are comparable to results reported in the literature. Hardware removal rate is comparable to other studies with a pre-contoured plate and lower compared to non-pre-contoured.