Reconstruction Plate Fixation Research Articles

A new technique for percutaneous screw fixation for treating FFP IIIa and IIIb fragility fractures of the pelvis

To determine the presence of a consistent osseous corridor from the lateral-posterior aspect of the anterior inferior iliac spine to the sacral wing that could be used for safe trans percutaneous screw fixation for pelvic fragility fractures of the iliac wing and fracture dislocations of the sacroiliac joint (FFP types IIIa and IIIb). Computed tomography (CT) scans were obtained from 100 patients and imported to Mimics software for 3D reconstruction. Then, a cylinder was drawn to imitate the modified LC-II screw and adjusted to a maximum radius and length to obtain the feasible region. Thirteen parameters of the osseous corridor of the modified LC-II screw were measured. Differences between sex groups were compared, and significant statistical correlations were carefully studied to determine potentially important clinical relationships. The records of patients with FFP type IIIa and IIIb fragility fractures of the pelvis were extracted from our hospital. Patients who underwent modified LC-II screw fixation, LC-II screw fixation or reconstruction plate fixation were included. Patients’ operative characteristics and complications were recorded at follow-up. Fracture reduction quality was assessed using the Matta standard. Functional outcomes were evaluated using the Majeed grading system. The mean maximum diameters of the osseous corridors of the modified LC-II screw in males and females were 12.73 and 10.83 mm, respectively. The mean maximum lengths of the osseous corridors of the modified LC-II screw in males and females were 96.37 and 93.37 mm, respectively. In the treatment of patients with FFP IIIa and FFP IIIb fractures, the group of treatment by the modified LC-II screws fixation was shown significantly shorter operative time and fewer intraoperative blood loss in comparison to that by the reconstruction plates. In the present study, all the males and females had a complete osseous corridor of the modified LC-II screw. The clinical results of the patients who were treated with modified LC-II screw fixation suggest that the novel method has a good preliminary outcome.

Comparison of 2 different fixation techniques of comminuted acetabular quadrilateral surface fractures using square bracket-shaped tubular plate or interfragmentary screws in addition to supra/infrapectineal plate fixation: An observational study.

The management of comminuted quadrilateral fractures remains challenging, and treatment options are constantly evolving. The purpose of the present study was to examine the outcomes of 2 different fixation techniques in the management of comminuted quadrilateral fractures. Twenty-two patients with comminuted quadrilateral acetabular fractures were surgically treated with interfragmentary lag screw (group 1) and square bracket-shaped tubular (SBST) plate technique (group 2), in addition to suprapectineal and infrapectineal pelvic reconstruction plate fixation between January 2016 and July 2019 at our clinic. 2 years follow-up control data of each group were compared in terms of radiological and functional results, and complications. According to the functional score comparison, the mean Merle d'Aubigne Postel scoring system (MAP) score was 15.2/15.6 (P = .632), and the mean Harris hip scoring (HHS) system score was 74.65/77.3 (P = .664) in groups 1 and 2, respectively. Radiological comparison was performed according to matta radiological criteria (MRC), and 2 excellent, 6 good, 2 poor, 4 excellent, 4 good, and 4 poor radiological results were observed in groups 1 and 2, respectively. intraarticular screw penetration was detected in 3 patients in group 1, while there was no articular implant penetration in group 2 (P = .001). We believe that satisfactory results can be obtained with the SBST plate technique, offering functional and clinical outcomes that are similar to those of the interfragmentary screw technique. The SBST plate technique is superior in terms of avoiding intraarticular screw penetration and related revision surgery.

Comparative study of CAD/CAM reconstruction and miniplates for patient-specific fixation in LCL-type mandibular reconstruction.

Miniplates offer superior clinical handling and facilitate postoperative removal after mandibular reconstruction but unfavorable load distribution under high stress has been shown. This study aimed to compare the clinical outcome of patient-specific 3D-printed (PS-3D) titanium miniplate with reconstruction plate fixation in three-segmental LCL-type reconstructions for the first time. Patients undergoing three-segmental LCL-type mandibular reconstruction after malignant tumor resection between April 2017 and July 2023 were analyzed in a retrospective single-center study. Inclusion criteria were primary reconstruction using a fibula free flap and PS-3D titanium mini- or reconstruction plate fixation. Complication rates were recorded and analyzed within 6 months after surgery using the N - 1 Chi2- and unequal variance t-test. 38 patients (10 females, 28 males; mean age 61.4 ± 7.6 years) met the inclusion criteria. In 14 patients (36.8%) miniplates were used in the anterior region. Rates of fixation failure, plate exposure, incomplete osseous union, wound infection, soft tissue, and overall complications did not differ significantly between the two plate systems. Complication rates did not differ significantly between PS-3D mini- and reconstruction plates in three-segmental LCL-type mandibular reconstructions. Given their advantages in clinical handling and postoperative removal, PS-3D miniplates can be a viable alternative also in larger mandibular reconstructions.

Comparison of two surgical interventions for advanced stages pubis and pubic symphysis tuberculosis in adults: A retrospective study of 33 cases

PurposeTo compare the clinical efficacy of two surgical interventions in treating advanced stages TB of the pubis and pubic symphysis. MethodsBetween June 2010 and January 2020, 33 cases of the advanced pubis and pubic symphysis TB were treated with a one-stage debridement procedure (debridement only group, n = 15) or a one-stage debridement with bone grafting and plate fixation procedure (debridement + plating group, n = 18). The visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), operation time, intraoperative blood loss, complications, time of bone graft fusion, and improvement in the mental component summary (MCS) and physical component summary (PCS) of Short Form-36 (SF-36) were compared and analyzed. ResultsAll patients were followed for 24.9 (SD 1.6) months. All patients were completely cured of the pubis and pubic symphysis TB with no recurrence. There were no significant differences (P >0.05) between the two groups in terms of age, follow-up period and intraoperative blood loss. The post-operative VAS scores, ESR and CRP levels, PCS and MCS scores of two groups significantly improved compared to pre-therapy. The mean operation time in debridement + plating group was 140.9 (43.2) min, which was significantly longer than in debridement only group [94.9(21.8) min, P < 0.01]. The final follow-up (FFU) indices of the VAS score in debridement only group were higher than those in debridement + plating group [1.9 (0.8) vs 1.3 (0.5), P=0.012]. A satisfactory average bony fusion time of 12.2 (3.3) months was achieved in debridement + plating group . ConclusionsA one-stage debridement, bone grafting, and reconstruction plate fixation procedure achieved reconstruction of the integrity and stability of the pelvic ring, pain relief, and rapid cure of bone TB. This procedure is a safe and effective treatment option for advanced pubis and pubic symphysis TB.

Percutaneous Fixation for Traumatic Symphysis Pubis Disruption-Are the Results Superior Compared to Open Techniques? A Systematic Review and Meta-Analysis of Clinical and Biomechanical Outcomes.

Open reduction and reconstruction plate and screws fixation (RPSF) is considered the gold standard for the treatment of traumatic symphysis pubis diastasis (SPD). Percutaneous cannulated screw fixation (PCSF) has recently gained popularity as it may reduce operative time and morbidity. The current systematic review aims to compare the clinical and radiological outcomes of PCSF and RPSF in traumatic SPD and analyze the biomechanical effectiveness of PCSF. The Medline, Scopus, and Cochrane databases were searched until February 2023. The primary outcomes were the incidence of implant failure and revision surgery and the amount of displacement of symphysis pubis. Secondary outcomes were the intraoperative blood loss, the scar length, the operative time, the wound infection, and the patients' functional improvement. Six clinical trial studies with a total of 184 patients and nine biomechanical studies were included. There was no significant difference between the two groups regarding the incidence of implant failure, the prevalence of revision surgery, and the amount of postoperative loss of reduction (p > 0.05 for all outcomes). The intraoperative blood loss (14.9 ± 4.2 mL for PCSF versus 162.7 ± 47.6 mL for PCSF, p < 0.001) and the incision length (1.7 ± 0.9 mL for PCSF versus 8 ± 1.4 mL for PCSF, p < 0.001) were significantly lower after PCSF. The mean operative time was 37 ± 19.1 min for PCSF and 68.9 ± 13.6 min for RPSF (p < 0.001). The infection rate was less frequent in the PCSF group (3% for PCSF versus 14.3% for RPSF, p = 0.01). One clinical trial reported better functional recovery after PCSF. In all biomechanical studies, the threshold for implant failure was beyond the applied forces corresponding to daily activities. PCSF for traumatic SPD is associated with less operative time, less blood loss, and a lower infection rate when compared to conventional plate techniques without increasing the incidence of postoperative fixation failure and revision surgery. Moreover, PCSF has been proven to be biomechanically sufficient for stabilization. Therefore, it should be considered an efficient and viable alternative for the reconstruction of SPD when closed reduction can be adequately achieved.

Safety and Efficacy of Combined Imbrication Axle Reconstruction and Z-Type Titanium Plate Fixation for Hinge Fracture Displacement During Open-Door Laminoplasty.

Open-door laminoplasty is a classical decompression method used to treat cervical spondylotic myelopathy. However, hinge fracture displacement (HFD) is a common occurrence during this procedure. The current study aimed to investigate the safety and efficacy of a combined imbrication axle reconstruction and Z-type titanium plate fixation method for HFD during open-door laminoplasty. In total, 617 patients with cervical spondylotic myelopathy who underwent C3-C7 open-door laminoplasty from March 2015 to October 2018 were included in this retrospective study. Overall, 73 patients developed HFD during surgery. Of these, 43 underwent combined imbrication axle reconstruction and Z-type titanium plate fixation (IRZF group) and 30 underwent traditional titanium plate fixation (TF group). Data such as the operative time, intraoperative blood loss volume, and distribution of fractured hinges were recorded. Both groups were compared in terms of improvement in neurologic function, cervical curvature index, hinge fusion rate, incidence of C5 palsy, severity of axial symptoms, and development of complications. The operative time and intraoperative blood loss were slightly higher in the IRZF group than in the TF group; however, the differences were not significant (p > 0.05). Furthermore, there was no significant difference between the groups in terms of the number of fractured segments and the distribution of fractured hinges (p > 0.05). The cervical curvature index did not decline in the two groups (p > 0.05). The IRZF group had a higher hinge fusion rate than the TF group at 3 (79.6 vs. 57.1%) and 12 (93.9 vs. 74.3%) months postoperatively (p < 0.05). There was no significant difference in the incidence of C5 palsy between the two groups (9.3 vs. 6.7%; p > 0.05). However, the TF group had more severe axial symptoms than the IRZF group (p < 0.05). The neurologic function of the two groups increased postoperatively as per the Japanese Orthopaedic Association scoring system (p < 0.05). Nevertheless, there was no significant difference in terms of neurologic function at any observational time point (p > 0.05). One patient in the TF group with hinge nonunion underwent laminectomy due to lamina displacement into the spinal canal and nerve root compression. In patients with HFD, IRZF facilitates a more intimate contact between the lamina and the lateral mass and, therefore, achieves fractured hinge fusion without additional surgical trauma. This technical improvement can significantly promote neurologic recovery, decrease the severity of axial symptoms, and prevent the development of spinal cord or nerve root recompression.

Surgical treatment of severe medication-related osteonecrosis of the jaw.

This study aimed to summarize the clinical outcomes of surgical treatment for severe medication-related osteonecrosis of the jaw (MRONJ, stages 2 and 3). A retrospective cohort study was conducted to review the patients with severe MRONJ from July 2013 to May 2021. All patients were treated surgically. The characteristics and clinical variables were recorded and analyzed. A total of 104 patients (123 MRONJ lesions) were included, including 42 males and 62 females, aged 64.6±9.1 years. The primary disease was malignant in 91 cases and benign in 13 cases. Forty-three cases (35.0%) were stage 2 lesions, and 80 (65.0%) were stage 3 lesions. Thirty-nine (31.7%) lesions were located in the maxilla, and 84 (68.3%) lesions were located in the mandible. The most commonly used bisphosphonates were zoledronic acid (n=89; 85.6%), followed by alendronate (n=10; 9.6%), and pamidronate (n=10; 9.6%). Antiangiogenic agents were administered in 62 (59.6%) patients. The mean duration of bisphosphonate therapy was 34.7±25.8 months, and the mean duration of drug holiday was 10.1±10.7 months. All operations were performed under general anesthesia. For stage 2 lesions, debridement and saucerization were performed to completely resect the lesions, and the wounds were closed without tension through local mucoperiosteum flaps. For stage 3 lesions, after the lesions were completely resected, the bone defect was covered by reconstruction plate fixation and ipsilateral submandibular gland translocation, iodoform gauze, and buccal fat pad accordingly. The follow-up period ranged from 3 months to 6 years; 81.3% (100/123) of the lesions reached mucosal healing at the last follow-up, whereas wound infection and dehiscence occurred in 18.7% (23/123) of the lesions postoperatively. Severe MRONJ lesions could be surgically treated to achieve mucosal healing. Vascularized flap reconstruction could be considered if the patient's general condition could tolerate it.

Mini-plate versus Reconstruction Plate: A Comparative Analysis of Complications in Free Fibula Osteocutaneous Flaps for Oral Cancer

Background: Advanced Oral cancers require segmental mandibulectomy, which ideally requires fibula flap reconstruction. Mini-plates or reconstruction plates are used for fibula fixation as per the surgeon’s preference, but the complication rates of each have hardly been studied. The purpose of this study was to find the incidence of plate-related complications, the factors attributing to it, and the difference in complication rates between mini-plate and reconstruction plate for fibula flap fixation exclusively in oral cancer patients who underwent segmental mandibulectomy as part of ablative surgery. Materials and Methods: The study was a retrospective observational study of oral cancer patients who underwent free fibula osteocutaneous flap reconstruction for mandibulectomy defects from November 2010 to November 2020 at a tertiary cancer center in India. Statistical Methods: Chi-square test, Fisher’s exact test. Results: Thirty-nine patients were included in the study and the mean follow-up period was 31 months. Seventeen of them had mini-plate fixation, 16 had reconstruction plate fixation and in two patients, both were used. About 25.64% of patients had complications. In the mini-plate group, 11.7% of patients had complications whereas 44.4% had complications in the recon plate group. 9/32 patients who took adjuvant treatment had complications, and in this subset of patients, there was a significant difference in the incidence of complications between the mini and recon plate groups (P = 0.03). Conclusion: Mini-plates are associated with less complications while used for fixation in microvascular fibula osteocutaneous flaps in oral cavity malignancy who are potential candidates for adjuvant treatment.

Towards mechanobiologically optimized mandible reconstruction: CAD/CAM miniplates vs. reconstruction plates for fibula free flap fixation: A finite element study.

Due to their advantages in applicability, patient-specific (CAD/CAM) reconstruction plates are increasingly used in fibula free flap mandible reconstruction. In addition, recently, CAD/CAM miniplates, with further advantages in postoperative management, have been introduced. However, biomechanical conditions induced by CAD/CAM systems remain partially unknown. This study aimed to evaluate the primary fixation stability of CAD/CAM fixators. For a patient-specific scenario, the biomechanical conditions induced in a one segmental fibula free flap stabilized using either a CAD/CAM reconstruction plate or CAD/CAM miniplates were determined using finite element analysis. The main output parameters were the strains between intersegmental bone surfaces and stresses in the fixation systems due to different biting scenarios. CAD/CAM miniplates resulted in higher mechanical strains in the mesial interosseous gap, whereas CAD/CAM reconstruction plate fixation resulted in higher strains in the distal interosseous gap. For all investigated fixation systems, stresses in the fixation systems were below the material yield stress and thus material failure would not be expected. While the use of CAD/CAM miniplates resulted in strain values considered adequate to promote bone healing in the mesial interosseous gap, in the distal interosseous gap CAD/CAM reconstruction plate fixation might result in more beneficial tissue straining. A mechanical failure of the fixation systems would not be expected.

Simultaneous reduction and fixation using an anatomical suprapectineal quadrilateral surface plate through modified Stoppa approach in superomedially displaced acetabular fractures

Treatment of superomedially displaced acetabular fractures including a quadrilateral surface (QLS) is challenging. We present a surgical technique using an anatomical suprapectineal QLS plate through the modified Stoppa approach and report the availability of this plate to treat this fracture type along with the surgical outcomes. Sixteen consecutive patients (14 men and 2 women) who underwent surgical treatment using an anatomical suprapectineal QLS plate through a modified Stoppa approach for superomedially displaced acetabular fractures between June 2018 and June 2020, were enrolled retrospectively. These fractures included 11 both-column fractures and 5 anterior-column and posterior hemitransverse fractures, which were confirmed on preoperative 3-dimensional computed tomography. Surgical outcomes were clinically assessed using the Postel Merle d’Aubigné (PMA) score and visual analog scale (VAS) score at the final follow-up, and radiological evaluations were performed immediately after the operation and at the final follow-up. For comparative analysis, 23 patients who underwent internal fixation with the conventional reconstruction plate through modified ilioinguinal approach between February 2010 and May 2018, were selected. This control group was composed of 18 both-column fractures and 5 anterior-column and posterior hemitransverse fractures. The follow-up period was at least 1 year in all patients. The mean operation time and blood loss was 109 min, and 853 ml, respectively, whereas 236 min, and 1843 ml in control group. Anatomical reduction was achieved in 14 (87.5%) patients, while imperfect reduction was achieved in the remaining 2 patients. At the final follow-up, radiographic grades were excellent, fair, and poor in 14 patients (87.5%), one, and one, respectively. The mean PMA score was 16.1 (range 13–18) and the mean VAS score was 1.0 (range 0–3). No secondary reduction loss or implant loosening was observed. However, 2 patients underwent conversion to total hip arthroplasty (THA) due to post-traumatic arthritis and subsequent joint pain. No other complications were observed. In the comparative analysis, radiological outcome showed a significant relationship with the conversion to THA (p = 0.013). Shorter operation time and less blood loss were significantly observed in the QLS plate fixation group through the modified Stoppa approach compared with the conventional reconstruction plate fixation group through modified ilioinguinal approach (p < 0.001, respectively). Simultaneous reduction and fixation using an anatomical suprapectineal QLS plate through the modified Stoppa approach may be a viable technique in superomedially displaced acetabular fractures along with shorter operation time and less blood loss.

A novel anatomical self-locking plate fixation for both-column acetabular fractures

PurposeTo compare the stability of the posterior anatomic self-locking plate (PASP) with two types of popular reconstruction plate fixation, i.e. double reconstruction plate (DRP) and cross reconstruction plate (CRP), and to explore the influence of sitting and turning right/left on implants. MethodsPASP, DRP and CRP were assembled on a finite element model of both-column fractures of the left acetabulum. A load of 600 N and a torque of 8 N·m were loaded on the S1 vertebral body to detect the change of stress and displacement when sitting and turning right/left. ResultsThe peak stress and displacement of the three kinds of fixation methods under all loading conditions were CRP > DRP > PASP. The peak stress and displacement of PASP are 313.5 MPa and 1.15 mm respectively when turning right; and the minimal was 234.0 Mpa and 0.619 mm when turning left. ConclusionPASP can provide higher stability than DRP and CRP for both-column acetabular fractures. The rational movement after posterior DRP and PASP fixation for acetabular fracture is to turn to the ipsilateral side, which can avoid implant failure.

Risk factors for reconstruction plate exposure after surgery in oral cancer patients. A retrospective cohort study.

The aim of this study was to elaborate risk factors for reconstruction plate exposure after wide excision in oral cancer patients, and to find out the most effective treatment. We include patients who underwent ablative surgery for oral cancer and reconstruction plate fixation from the year 2010 to 2016, separate them into two groups according to whether the hardware was exposed, compare risk factors including age, tumor site, staging, comorbidities, and previous treatment between the two groups. The treatment course and outcome were also recorded. In total, 75 patients received reconstruction plate fixation after ablative surgery. Bone plate exposure was found in 26 cases (34.6%). The size of the bone defect and the thickness of soft tissue covering the plate were significant risk factors for plate exposure. In 21 patients (72.4%), the bone plate was removed. Conservative treatment was not effective. Removal of bone plate and debridement in one single surgery had a success rate of 81%. In this study, skin thickness less than 1.5mm over the reconstruction plate and bone defect size larger than 8.4cm were the two significant risk factors for bone plate exposure. Although a standardized treatment algorithm is lacking, surgical debridement with removal of the bone plate result in complete soft tissue healing in most patients and should be the treatment of choice. Patients with larger bone defect and thinner covering soft tissue bear more risk for exposure. The most effective treatment is to remove the hardware.

Comparative Study of Miniplate vs Reconstruction Plate in the Management of Bilateral Parasymphysis Mandible Fracture: FEM Analysis.

The present study compared the stability of fracture fragments in the management of bilateral parasymphysis mandible fracture with Miniplate fixation and Reconstruction plate fixation using finite element analysis. 3D FE Mandible model was created using CT scanner. Two bilateral parasymphysis mandible fracture models were created. Model 1 was fixed with Miniplates, and Model 2 was fixed with Reconstruction plate. Loading forces of 120N at molar region and 62.5N at incisor region were applied. These two models were imported to ANSY'S Workbench Software. Miniplate fixation model showed comparatively reduced gap between fragments than Reconstruction plate. But the gap values of both the models were within the physiologic limit of healing under this specific loading. Analytically Miniplates were superior to Reconstruction plate in the management of bilateral parasymphysis fracture. Analytically Miniplates are superior to Reconstruction plate in the management of bilateral parasymphysis fracture. As the masticatory forces were reduced during fracture healing period, both fixations provide satisfactory healing. So both Miniplate and Reconstruction plate can be considered as fixation method for bilateral parasymphysis mandible fracture.

Application of the submandibular gland for management of stage 3 medication-related osteonecrosis of the mandible

Objective: To summarize the clinical outcomes of reconstruction plate fixation combined with submandibular gland translocation (A) or reconstruction plate fixation combined with submental island flap and submandibular gland (B) for mandibular stage-3 medication-related osteonecrosis of the jaw (MRONJ). Methods: The clinical data of the patients with stage-3 mandibular MRONJ treated with one of the above mentioned procedures from September 2014 to December 2020 in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, were retrospectively reviewed. The clinical data included the general data of the patients, the initial mucosal healing rate at the time of 2 weeks postoperatively and follow-up, and the occurrence of complications. Results: A total of 40 patients were treated, including 17 males and 23 females, aged (64.6±8.9) years. Among the patients, 33 were treated with operation A and 7 with operation B. The initial mucosal healing rate was 90% (36/40). Plate fracture occurred in 4 patients. The mean length of the mandibular bony defect was (4.5±1.4) cm (ranged from 2.1 to 8.0 cm). Conclusions: For management of stage-3 mandibular MRONJ, reconstruction plate fixation combined with submandibular gland translocation or with submental island flap and submandibular gland might be one of the effective and reliable options.

A comparison of miniplate vs reconstruction plates for head and neck fibula free flap reconstruction

Introduction: Various techniques are available for fixation of fibula free flap reconstruction of head and neck defects. Either wider profile reconstruction platesor miniplate (2.0 mm profile) can be used. This is a comparison of outcomes of those patients who had either reconstruction plate vs miniplate fixation for fibular flap reconstruction of the head and neck.

Combined reconstruction plate fixation and submandibular gland translocation for the management of medication-related osteonecrosis of the mandible

The aim of this study was to summarize the clinical outcomes of patients with stage 3 mandibular medication-related osteonecrosis of the jaw (MRONJ) treated using reconstruction plate fixation and ipsilateral submandibular gland translocation after mandibulectomy. The medical records of patients with stage 3 mandibular MRONJ treated using the above surgical method between September 2014 and July 2019 were reviewed. Of a total of 27 patients included in this study, 23 (85.2%) experienced primary wound healing. The remaining four patients developed wound dehiscence and infection within 1 week after the operation. Three of these patients recovered after the plate was removed, and one patient died of the primary cancer. The follow-up period ranged from 3 months to 5 years, with an average of 12.7 months. The 23 patients with primary wound healing had a symmetrical facial appearance, with normal mouth opening and occlusion. Plate fracture occurred in two patients at 1year and 3 years after the operation. Radioisotope scanning in 10 patients showed that the function of the translocated submandibular gland was normal at 6 months after the operation. In summary, for patients with stage 3 MRONJ involving the mandibular angle and/or body, reconstruction plate fixation and submandibular gland translocation after segmental mandibulectomy is an effective treatment method.

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

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 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.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; 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.&lt;/p&gt;

Comparative study of posterior minimally invasive plate and 3D-navigated percutaneous sacroiliac screw internal fixation for treatment of posterior pelvic ring fracture in elderly patients

Objective To compare the clinical efficacy of posterior minimally invasive reconstruction plate and 3D-navigated percutaneous sacroiliac screw fixation of elderly patients with posterior pelvic ring fractures. Methods A retrospective cases control study was performed to analyze the data of 75 elderly patients with posterior pelvic ring fractures admitted from January 2014 to June 2018 in Central Hospital of the PLA. There were 32 males and 43 females, with the age range of 60-83 years (mean, 67.7 years). Twenty-four patients in the plate group were treated by posterior minimally invasive reconstruction plate fixation, and 51 patients in the navigation group were treated by percutaneous sacroiliac screw internal fixation with 3D navigation. The operation time, intraoperative blood loss, X-ray exposure time, complication rate and postoperative visual analogue scale (VAS) were compared between the two groups. Postoperative Matta radiographic criteria was used to assess fracture reduction quality, and Majeed criteria was used to assess pelvic function at the last follow-up. Results All 75 patients were followed up for 6-24 months (mean, 13.5 months). The operation time, intraoperative blood loss and X-ray exposure time in the plate group were (126.1±20.6)minutes, (251.6±50.8)ml, and (15.7±4.4)s, showing significant differences in comparison with the navigation groups [(49.7±17.5)minutes, (22.8±5.1)ml, and (112.8±8.8)s](P 0.05). At day 3, one week, and one month postoperatively, the VAS in the navigation group was (3.3±0.7)points, (3.2±0.7)points, (2.4±0.6)points, better than that in the plate group [(7.2±0.7)points, (6.2±0.8)points and (4.5±0.7)points] (P 0.05). According to the Matta radiographic criteria, the excellent and good rate was 92% in plate group (excellent in 14 cases, good in 8, and fair in 2), and was 82% in the navigation group (excellent in 25 cases, good in 17 and fair in 9). There was no significant difference between the two groups (P>0.05). According to the Majeed criteria at the follow-up, the excellent and good rate was 96% in the plate group (excellent in 15 cases, good in 8 and fair in 1), and was 94% in the navigation group (excellent in 35 cases, good in 13 and fair in 3). The difference between the two groups was not statistically significant (P>0.05). Conclusion For elderly patients with osteoporotic posterior pelvic ring fractures, percutaneous sacroiliac screw fixation under 3D navigation has the advantages of shorter operation time, less bleeding, less radiation dose and less postoperative pain than minimally invasive reconstruction plate internal fixation, and hence deserves clinical application. Key words: Aged; Pelvis; Fracture fixation, internal; Osteoporosis; Surgery, computer aided

Cannulated iliac screw fixation combined with reconstruction plate fixation for Day type II crescent pelvic fractures.

ObjectiveThis study was performed to evaluate the safety and efficacy of a single cannulated iliac screw combined with reconstruction plate fixation for crescent pelvic fractures (Day type II).MethodThirty adult patients (23 men, 7 women) with a mean age of 42.3 years (range, 22–81 years) were retrospectively reviewed. The time interval between the injury and the operation ranged from 3 to 14 days. The duration of screw insertion, the frequency of C-arm X-ray examination, and the intraoperative blood loss volume were recorded. The minimum follow-up was 12 months (mean, 29 months; range, 12–36 months). Radiographic evaluation was performed using the Matta and Tornetta criteria.ResultsAccording to the Matta and Tornetta radiological criteria, the reduction was rated as excellent in 20 patients and good in 10 patients. Based on the Majeed functional evaluation at the follow-up appointment, the outcome was rated as excellent in 28 patients and good in 2 patients.ConclusionThis technique can restrict damage to the surrounding soft tissues, decrease complications, and promote good clinical results.

Efficacy analysis of two surgical treatments for thoracic and lumbar intraspinal tumours

BackgroundSurgery remains the main curative option for the treatment of intraspinal tumour. The purpose of the present study was to analyze the clinical outcomes of laminoplasty with process-lamina complex replantation compared with laminectomy with pedicle screw fixation for intraspinal tumours.MethodsIn our retrospective analysis, 27 patients received tumour resection surgery by laminoplasty with reconstruction plate fixation and 32 patients received laminectomy with pedicle screw fixation. All patients were followed up for at least 1 year. Data, including surgical time, blood loss, volume of drainage, drainage time, hospital stay, complications, and neurological status were compared. In addition, imaging evaluation was also included.ResultsPatients in the laminoplasty group had lower blood loss (laminoplasty group: 281.5 ± 130.2 mL; laminectomy group: 450.0 ± 224.3 mL; p = 0.001), shorter surgical time (laminoplasty group: 141.7 ± 26.2 min, laminectomy group: 175.3 ± 50.4 min; p = 0.003), lower volume of drainage (laminoplasty group: 1578.9 ± 821.7 mL, laminectomy group: 2621.2 ± 1351.0 mL; p = 0.001), shorter drainage time (laminoplasty group: 6.6 ± 2.5 days, laminectomy group: 9.7 ± 1.8 days; p = 0.000), and a shorter hospital stay (laminoplasty group: 16.9 ± 4.9 days, laminectomy group: 21.0 ± 4.4 days; p = 0.002) compared with patients in the laminectomy group. There were significant differences of oswestry dysfunction index (ODI) between the two groups at 12 months postoperatively (p = 0.034). The incidence of secondary spinal stenosis in the laminoplasty group was significantly reduced (p = 0.029).ConclusionsLaminoplasty in intraspinal tumour resection has a lower blood loss and volume of drainage, shorter surgical time and hospital stay as advantages over the standard laminectomy technique. Moreover, laminoplasty can effectively avoid iatrogenic spinal canal stenosis and thus enhancing functional recovery of spinal cord.