Reconstruction Plate Group Research Articles

Comparison of reconstruction plates and miniplates in mandibular defect reconstruction with free iliac flap.

Given the increasing demand for precise and reliable reconstructive techniques in maxillofacial surgery, we try to offer valuable insights for clinicians in selecting optimal fixation methods. Patients were categorized into miniplate and reconstruction plate groups for accuracy and bone healing comparison. We measured gonial angle, intercondylar, intergonial and anterior-posterior distance for general accuracy and distance of segmental endpoint to the sagittal plane for partial accuracy. The bone healing rate of the two groups was compared with CT images at 3, 6 and 12 months after operation. Considering directional indicators, the miniplate group exhibited a wider intercondylar distance than the reconstruction plate group (p = 0.029). At 6 months postoperatively, the miniplate group demonstrated a higher bone healing rate compared to the reconstruction plate group, with no significant differences at other time points. Over a nearly 5-year review, mandibular reconstruction with vascularized iliac bone flaps showed that reconstruction plates better maintained condylar position accuracy, while miniplates had superior bone healing rates at 6 months. No significant differences were found in other accuracy indices between the two plates. Clinicians' selection of fixation plates frequently depends on personal preference rather than evidence-based criteria. This study compares the precision and postoperative osseous healing outcomes of miniplates and reconstruction plates to provide a more scientifically grounded basis for clinical decision-making.

Comparison of Eight-plate with Reconstruction-plate in Temporary Hemiepiphysiodesis ‎to Correct the Idiopathic Genu Valgum ‎in Pediatrics.

High cost of eight-plate makes it unavailable in many countries; therefore, ‎developing an ‎alternative device for temporary hemiepiphysiodesis of knee deformities in ‎pediatrics ‎is valuable. In this study, we compared the outcome of the eight-plate with the ‎reconstruction-plate in this setting. In this retrospective study, 109 skeletally immature patients (212 physes) who underwent temporary hemiepiphysiodesis to correct idiopathic genu valgum were included. The eight-plate and reconstruction-plate were used in 47 patients (90 physes) and 62 patients (122 physes), respectively. Outcome measures were the valgus angle, medial proximal tibial angle (MPTA), the lateral distal femoral angle (LDFA), the joint-line convergence angle (JLCA), and lower limb mechanical axis (LLMA). The baseline characteristics of the patients were comparable between the two plate groups. The mean follow-up of the patients was 32.9 ± 15.1 months. The mean MPTA change was 2.7 ± 3.7º in the eight-plate group and 2.1 ± 3.4º in the reconstruction-plate group (P=0.2). The mean LDFA improvement was 8 ± 3.7º in the eight-plate group and 7.9 ± 3.5º in the reconstruction-plate group (P=0.61). The mean valgus correction was 10.7 ± 4.4º in the eight-plate group and 10.4 ± 4.6º in the reconstruction-plate group (P=0.74). Moreover, the mean change of JLCA was 0.7 ± 1.3º in the eight-plate group and 0.8 ± 1.3º in the reconstruction-plate group (P=0.58). The postoperative LLMA was comparable between the two study groups as well. In total, five postoperative complications were recorded in this series, which included one case of ‎screw loosening in each group, two cases of overcorrection, and one screw breakage in the ‎reconstruction-plate group. The radiologic results and complications of the reconstruction-plate are comparable with the eight-plate. Therefore, it can be safely and efficiently used in hemiepiphysiodesis to correct idiopathic genu valgum.

Examining the novel use of continuous compression implants in clavicle reconstruction: A biomechanical study

BackgroundCurrent implants for clavicle fractures are known to cause poor cosmesis and irritation, which may require implant removal. Low-profile shape-memory staples provide an attractive alternative, but their biomechanical utility in clavicle reconstruction is unknown. We hypothesized that shape-memory reconstructions would be more compliant compared to traditional constructs but would also outperform conventional plates during cyclic loading to failure. MethodsThis study was performed with 36 synthetic clavicles and 12 matched pairs of cadaveric specimens. The synthetic study tested four reconstructions: a single superiorly placed staple (n = 6), a single anteroinferiorly-placed staple (n = 6), a 3.5 mm reconstruction plate (n = 12), and two orthogonally placed staples (n = 12). The cadaveric study tested three constructs: reconstruction plate (n = 8), two orthogonal staples (n = 8), and a 2.7 mm reconstruction plate combined with a superior staple (n = 8). Non-destructive 4-point bending, compression, and torsion assays were performed prior to destructive cantilever bending and cyclic torsion tests. FindingsThe single staple and double staple groups demonstrated significantly decreased resistance to bending (p < 0.001) and torsion (p ≤ 0.027) when compared to reconstruction plate groups. The double staple group sustained significantly fewer cycles to failure than the reconstruction plate group in cyclic torsional tests (p = 0.012). The synthetic models produced higher stiffness and failure mechanisms that were completely different from cadaveric specimens. InterpretationShape memory alloy implants provided inadequate stiffness for clavicle fixation but may have utility in other orthopaedic applications when used as a supplementary compression device in conjunction with traditional plated constructs. Synthetic bones have limited capacity for modeling fragility fractures.

Comparison of three methods of Müller type C2 and C3 distal femoral fracture repair.

BackgroundWe compared the outcomes of three fixation techniques for Müller type C2 and C3 distal femoral fractures.MethodsWe retrospectively analyzed patients undergoing internal fixation for Müller type C2 and C3 distal femoral fractures via locking plate (Group A), lateral locking condylar plate and medial contoured reconstruction plate (Group B), and lateral locking condylar plate and anterior reconstruction plate (Group C). Knee joint functional recovery and functional outcomes were evaluated 12 months postoperatively.ResultsPatients included 34 men and 24 women aged 25 to 74 years (mean, 50.3 ± 10.73 years). Operating times were longest in Group B and similar in Groups A and C. Bleeding volume in Group A was smaller than in Group B and similar to that of Group C. Functional outcomes were excellent in 18 (31%) fractures, good in 24 (41%), moderate in 11 (19%), and poor in 5 (9%). Good-to-excellent results were achieved in 56%, 82%, and 83% of patients (Groups A, B, and C, respectively). Groups B and C's outcomes were superior to Group A's outcomes. No significant difference in postoperative complications between the groups existed.ConclusionLateral locking condylar and anterior reconstruction plating was useful for complex type C distal femoral fractures.

Clinical outcome and operative cost comparison: Locked compression plate versus reconstruction plate in midshaft clavicle fractures.

The aim of this study was to compare the clinical outcomes and operative cost of a locked compression plate (LCP) and a nonlocked reconstruction plate in the treatment of displaced midshaft clavicle fracture. From January 2013 till March 2018, a total of 55 patients with acute unilateral closed midshaft clavicle fracture were treated with either a 3.5-mm pre-contoured LCP [32 patients; 25 men and 7 women; mean age: 35 years (range: 19-63 years)] or a 3.5-mm nonlocked reconstruction plate [23 patients; 20 men and 3 women; mean age: 31.4 years (range: 17-61 years)]. The clinical outcomes in terms of fracture union, Quick Disability of Arm, Shoulder and Hand (DASH) score, implant irritation, failure rate, and reoperation rate were evaluated retrospectively. The patient billing records were reviewed to obtain primary operation, reoperation, and total operative cost for midshaft clavicle fracture. These values were analyzed and converted from Malaysia Ringgit (RM) to United States Dollar (USD) at the exchange rate of RM 1 to USD 0.24. All patients were followed up for at least one-year duration. The mean time to fracture union, implant irritation, implant failure, and reoperation rate showed no significant difference between the two groups of patients. The mean Quick DASH score was significantly better in the reconstruction plate group with 13 points compared with 28 points in the LCP group (p=0.003). In terms of total operative cost, the LCP group recorded a cost of USD 391 higher than the reconstruction plate group (p<0.001). The 3.5-mm reconstruction plate achieved not only satisfactory clinical outcomes but was also more cost-effective than the LCP in the treatment of displaced midshaft clavicle fractures. Level III, Therapeutic study.

Comparison of three internal fixation methods for distal femoral fractures of Müller types C2 and C3

Objective To compare 3 internal fixation methods for the treatment of distal femoral fractures of Muller types C2 and C3. Methods The clinical data of 58 patients were retrospectively analyzed who had been treated for distal femoral fractures of Muller types C2 and C3 at Department of Orthopaedic Trauma, Ningbo No. 6 Hospital from February 2013 to February 2017. They were divided into 3 groups according to the internal fixation method they had used. In the single incision locking plate group (group A) of 21 cases, there were 13 males and 8 females with an age of 50.6 years±12.9 years. In the double-incision locking plate combined with reconstruction plate group (group B) of 18 cases, there were 11 males and 7 females with an age of 53.5 years±13.0 years. In the single incision locking plate combined with reconstruction plate group(group C) of 19 cases, there were 10 males and 9 females with an age of 48.1 years±12.2 years. The 3 groups were compared in terms of operation time, intraoperative blood loss, intraoperative C-arm fluoroscopy, fracture healing time, incidence of postoperative complications, range of motion of the knee and knee functional recovery. Results The 3 groups were compatible because there were no significant differences between them in their preoperative general data (P>0.05). There were no significant differences between groups in the frequency of C-arm fluoroscopy, follow-up time, or incidence of postoperative complications (P>0.05). The operation time in groups A and C (96.7 min±16.4 min and 101.9 min±16.5 min) and intraoperative blood loss for groups A and C (237.8 mL±47.5 mL and 253.6 mL±46.6 mL) were significantly less than in group B (114.9 min±20.1 min and 290.1 mL±60.9 mL) (P<0.05); the fracture healing time for groups B and C (6.9 months±1.6 months and 6.6 months±1.7 months) was significantly shorter than for group A (8.4 months±1.9 months) (P<0.05); the ranges of knee motion 12 months after operation in groups B and C (91.7°±16.7° and 90.9°±14.4°) were significantly larger than that in group A (78.8°±14.4°) (P<0.05); the excellent and good rates of knee function 12 months after operation in groups B and C [77.8% (14/18) and 73.7% (14/19)] were significantly higher than that in group A [57.1%(12/21)] (P<0.05). Conclusion In the treatment of distal femoral fractures of Muller types C2 and C3, application of lateral locking plate and additional anterior locking reconstruction plate via the anterolateral incision at the distal femur can achieve rigid fixation without much damage to the surrounding soft tissues and lead to fine functional recovery of the knee joint because it has the advantages of single incision locking plate and double incision medial and lateral locking plates. Key words: Femoral fractures; Fracture fixation, internal; Bone plates; Surgical approach

The effect of fixation plate use on bone healing during the reconstruction of mandibular defects.

ObjectivesThis study sought to compare efficiency results between the use of a customized implant (CI) and a reconstruction plate (RP) in mandibular defect reconstruction in an animal model.Materials and MethodsFifteen rabbits underwent surgery to create a defect in the right side of the mandible and were randomly divided into two groups. For reconstruction of the mandibular defect, the RP group (n=5) received five-hole mini-plates without bone grafting and the CI group (n=10) received fabricated CIs based on the cone-beam computed tomography (CBCT) data taken preoperatively. The CI group was further divided into two subgroups depending on the time of CBCT performance preoperatively, as follows: a six-week CI (6WCI) group (n=5) and a one-week CI (1WCI) group (n=5). Daily food intake amount (DFIA) was measured to assess the recovery rate. Radiographic images were acquired to evaluate screw quantity. CBCT and histological examination were performed in the CI subgroup after sacrifice.ResultsThe 1WCI group showed the highest value in peak average recovery rate and the fastest average recovery rate. In terms of reaching a 50% recovery rate, the 1WCI group required the least number of days as compared with the other groups (2.6±1.3 days), while the RP group required the least number of days to reach an 80% recovery rate (7.8±2.2 days). The 1WCI group showed the highest percentage of intact screws (94.3%). New bone formation was observed in the CI group during histological examination.ConclusionRabbits with mandibular defects treated with CI showed higher and faster recovery rates and more favorable screw status as compared with those treated with a five-hole mini-plate without bone graft.

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.

Biomechanical comparison between solid and cannulated intramedullary devices for midshaft clavicle fixation

BackgroundA method of closed reduction and internal fixation with cannulated screws was proposed as a surgical treatment of midshaft clavicle fractures. However, there are no mechanical studies about the cannulated screw used in the fixation of midshaft clavicle fracture. We conducted this study to compare the construct bending stiffness of a fixation midshaft clavicle fracture with a Knowles pin, cannulated screw and reconstruction plate. In addition, purchase lengths of both intramedullary devices were measured.MethodsAfter transverse osteotomy over the midpoint for fracture simulation, eighteen synthetic clavicles were assigned to 3 groups and fixed with reconstruction plate, Knowles pin or cannulated screw. Purchase length was defined as the engaged length of the intramedullary portion of the two intramedullary devices Stiffness, yield load and maximum load of the cantilever bending test were calculated of each tested synthetic bones.ResultsThe Knowles pin group had a significantly longer average intramedullary purchase length compared with that of the cannulated screw group. The construct stiffness in the reconstruction plate group (5.6 ± 0.9 N/mm) was higher than that of the intramedullary devices; the Knowles pin group (3.1 ± 0.6 N/mm) provided a greater construct stiffness than did the cannulated screw group (1.7 ± 0.4 N/mm) (p = 0.007). The cannulated screw group had the lowest yield and maximum load compared with the reconstruction plate and Knowles pin groups. Both the reconstruction plate and Knowles pin failed at the implant-bone interface. However, the cannulated screw group failed at the osteotomy site with broken implants.ConclusionThis study suggests that fixation of midshaft clavicle fractures with cannulated screws may lead to early failure due to inadequate mechanical strength. Ideal intramedullary clavicle devices should supply adequate intramedullary purchase lengths and mechanical strength.

Comparative analysis of functional outcome of anatomical precontoured locking plate versus reconstruction plate in the management of displaced midshaft clavicular fractures

For the fixation of displaced midshaft clavicular fractures, different plates are available, each with its specific pros and cons. The ideal plating choice remains subject to ongoing discussion. Reconstruction plates are cheap and easily bendable, but their strength and stability have been questioned. The anatomical precontoured locking plates provide better stability and strength compared with the reconstruction plate. We have analyzed both prospectively and retrospectively 55 cases of displaced midshaft clavicular fractures treated surgically using precontoured anatomical locking plate (24 cases) or reconstruction plate (31 cases) for patients admitted in our institute between January 2011 and December 2017. The clinical and radiological outcomes between the reconstruction plate and precontoured anatomical locking plate were compared using Quick Disability of the Arm, Shoulder and Hand (DASH) score and plain radiographs, respectively. The mean time to union was 16.3 weeks in the reconstruction plate group compared with 13.4 weeks in the precontoured locking plate group. The mean score in Quick DASH was 32.65 in the reconstruction group and 25.44 points in the precontoured locking plate group. We had complications such as hypertrophic scar, painful shoulder, and restricted range of motion in both the groups, whereas screw cutout and plate failure were noted only in the reconstruction plate group, which needed implant removal. The mean follow-up period was 16.44 months (14-31 months). The removal of implant was carried out in three patients in the reconstruction group. None of the group had nonunion. Surgical management of fresh middle third clavicle fractures with anatomical precontoured locking plate provided stable fixation, faster union, and better functional outcome compared with the reconstruction plating. Anatomical plate had the advantage of less soft tissue stripping, and there is less need for lag screw fixation of the plate for fracture stability as precontoured plate itself provides a rigid construct.

Pre-contoured locking plates vs. conventional reconstruction plates in AO type C distal humerus fractures: A prospective randomized study

Background: Reconstruction plates have been used from a long time for fixation of distal humerus fractures. Locking plates are increasingly used now-a-days. The aim of this study is to compare the radiological and functional outcome of AO Type C distal humerus fracture treated with pre-contoured locking plates and conventional reconstruction plates. Material and Methods: A total of 25 patients of AO type C distal humerus fracture were enrolled for the study during 2016- 2018. Out of 25 patients, 14 were treated using locking plates and 11 were treated using reconstruction plates. Patients were followed up at 2 weeks, 6 weeks, 3 months, 6 months and 12 months post operatively. Radiological assessment was done by follow-up X-rays at 3, 6 and 12 months. Mayo Elbow Performance Score was used for assessment of functional outcome at 3, 6 and 12 months post-operatively. Results: The mean duration of surgery and hospital stay was similar in both the groups. The mean Range of motion and MEPS score was significantly higher in locking plate group as compared to conventional reconstruction plates at 3 months post operatively. However both of them were similar at 6 months and 12 months post operatively. 93% union rate in locking plate group and 9% union rate in reconstruction plate group were seen at the end of 12 months follow-up. Excellent and/or good results were obtained in 93% in locking plate group which is significantly higher than reconstruction plate group in which only 82% patients had excellent and/ or good results. Conclusion: Locking plates has advantage over reconstruction plates in early mobility and greater functional outcome.

Comparison of reconstruction plate versus locking compression plate in short-term therapeutic effects for comminuted fracture of midshaft clavicle in the aged

Objective To compare the short-term therapeutic effects of reconstruction plate versus locking compression plate in the treatment of comminuted fracture of midshaft clavicle in the aged patients. Methods A retrospective analysis was performed of the 64 aged patients who had been treated from March 2009 to April 2015 for comminuted fracture of midshaft clavicle with reconstruction plate or locking compression plate. They were divided into 2 groups according to their treatment methods. There were 30 patients in the reconstruction plate group, 14 males and 16 females with an average age of 67.9±5.6 years; there were 34 patients in the locking compression plate group, 15 males and 19 females with an average age of 67.1±5.3 years. The 2 groups were compared in terms of operation time, blood loss, fracture healing time, internal fixation failure and shoulder functional recovery. Results The reconstruction plate and locking compression plate groups were followed up for 13.2±3.2 and 12.4±2.9 months, respectively. For the 2 groups, respectively, the average operation time was 62.2±10.7 min and 58.1±11.4 min, the average amount of blood loss during operation 35.2±10.7 mL and 30.4±9.6 mL, the average fracture healing time 4.7±0.7 months and 4.5±0.7 months, and the excellent to good rate of shoulder function 86.7%(26/30) and 91.2%(31/34), showing no significant difference between the 2 groups (all P>0.05). Five cases (16.7%) reported plate breakage, screw loosening or delayed union due to fixation failure in the reconstruction plate group but none reported fixation failure in the locking compression plate group, showing a significant difference (P 0.05). Conclusion Since locking compression plate may lead to a lower incidence of fixation failure compared with reconstruction plate, it is recommendable for elderly patients with comminuted fracture of midshaft clavicle. Key words: Clavicle; Fractures, bone; Fracture fixation, internal; Bone plates; Aged

Biomechanical comparison of plate and screw fixation in anterior pelvic ring fractures with low bone mineral density

IntroductionOsteosynthesis of anterior pubic ramus fractures can be challenging, especially in poor bone quality. The aim of the present study was to compare plate and retrograde endomedullary screw fixation of the superior pubic ramus with low bone mineral density (BMD). Materials and methodsTwelve human cadaveric hemi-pelvises were analyzed in a matched pair study design. BMD of the specimens was 35±30mgHA/cm3, as measured in the fifth lumbar vertebra. A simulated two-fragment superior pubic ramus fracture model was fixed with either a 7.3-mm cannulated retrograde screw (Group 1) or a 10-hole 3.5-mm reconstruction plate (Group 2). Cyclic progressively increasing axial loading was applied through the acetabulum. Relative interfragmentary movements were captured using an optical motion tracking system. ResultsInitial axial construct stiffness was 424±116.1N/mm in Group 1 and 464±69.7N/mm in Group 2, with no significant difference (p=0.345). Displacement and gap angle at the fracture site during cyclic loading were significantly higher in Group 1 compared to Group 2. Cycles to failure, based on clinically relevant criteria, were significantly lower in Group 1 (3469±1837) compared to Group 2 (10,226±3295) (p=0.028). Failure mode in Group 1 was characterized by screw cutting through the cancellous bone. In Group 2 the specimens exclusively failed by plate bending. ConclusionsFrom biomechanical point of view, pubic ramus stabilization with plate osteosynthesis is superior compared to a single retrograde screw fixation in osteoporotic bone. However, the extensive surgical approach needed for plating must be considered.

Evaluation of shoulder function in clavicular fracture patients after six surgical procedures based on a network meta-analysis

Purpose Using a network meta-analysis approach, our study aims to develop a ranking of the six surgical procedures, that is, Plate, titanium elastic nail (TEN), tension band wire (TBW), hook plate (HP), reconstruction plate (RP) and Knowles pin, by comparing the post-surgery constant shoulder scores in patients with clavicular fracture (CF). Methods A comprehensive search of electronic scientific literature databases was performed to retrieve publications investigating surgical procedures in CF, with the stringent eligible criteria, and clinical experimental studies of high quality and relevance to our area of interest were selected for network meta-analysis. Statistical analyses were conducted using Stata 12.0. Results A total of 19 studies met our inclusion criteria were eventually enrolled into our network meta-analysis, representing 1164 patients who had undergone surgical procedures for CF (TEN group = 240; Plate group = 164; TBW group = 180; RP group = 168; HP group = 245; Knowles pin group = 167). The network meta-analysis results revealed that RP significantly improved constant shoulder score in patients with CF when compared with TEN, and the post-operative constant shoulder scores in patients with CF after Plate, TBW, HP, Knowles pin and TEN were similar with no statistically significant differences. The treatment relative ranking of predictive probabilities of constant shoulder scores in patients with CF after surgery revealed the surface under the cumulative ranking curves (SUCRA) value is the highest in RP. Conclusion The current network meta-analysis suggests that RP may be the optimum surgical treatment among six inventions for patients with CF, and it can improve the shoulder score of patients with CF. Implications for RehabilitationRP improves shoulder joint function after surgical procedure.RP achieves stability with minimal complications after surgery.RP may be the optimum surgical treatment for rehabilitation of patients with CF.

Clinical efficacy of ITS universal locking plate for treatment of comminuted mid-shaft clavicular fracture

Objective To evaluate the clinical efficacy of ITS universal locking plate for treatment of comminuted midshaft clavicle fractures.Methods The clinical data of 74 patients with comminuted mid-shaft claviclar fractures,who were treated from Jan.2008 to Oct.2013,were retrospectively analyzed.The patients included 32 treated with ITS universal locking plate and 42 with reconstruction plate.The operation time,fracture healing time,postoperative Constant-Murly scores and postoperative complications were compared between the two treatment groups.Results Baseline data had no statistical difference between the two groups.The operation was successful in both groups,and the average operation time was(39.5±9.1)min in ITS universal locking plate group and(47.4±10.2)min in reconstruction plate group,showing significant difference(P0.01).No significant differences were found for the mean healing time([13.5±3.0]weeks vs[13.3±3.8]weeks)or the Constant-Murly scores([91.1±3.0]vs[90.2±2.7])between the two groups.There was no delayed union,nonunion,screw loosening,plate fracture or other complications in ITS universal locking plate group;while one patient had postoperative pain in his shoulder and three others reported difficulty in shoulder mobility.In reconstruction plate group,delayed union was reported in 3cases,nonunion in 1case,screw loosening in 3cases,plate fracture in 1case,postoperative shoulder pain in 4cases,and difficulty in shoulder mobility in 2cases.The total postoperative complication rates were significantly different between the two groups(13%vs 33%,P0.05).Conclusion ITS universal locking plate has a satisfactory effect for treatment of comminuted mid-shaft claviclar fractures,and it is superior to the conventional reconstruction plate.

Biomechanical study of different internal fixators and fixation modes for middle 1/3 clavicle fractures

Objective To investigate the effect of different internal fixators and fixation modes on the biomechanical properties of the middle 1/3 clavicle fractures.Methods Twenty-four artificial clavicle samples were prepared and used to simulate middle 1/3 oblique fractures.According to the clinical operative procedures,fractures were fixed respectively with locking plates in superior position,locking plates in anteroinferior position,reconstruction plates in superior position,and reconstruction plates in anteroinferior position.Then,resistance strain gauges were placed on the broken ends of the bone,embedded in polymethylmethacrylate (PMMA) and placed on Instron-8874 servo-hydraulic mechanical testing machine to have compression test,torsion test,and three-point bending test.Results Bending stiffness of control group,anteroinferior locking plate group,anteroinferior reconstruction plate group,superior locking plate group and superior reconstruction plate group was (539.16 ±47.45) N/mm,(1 013.47 ± 121.62) N/mm,(701.06 ± 53.28) N/mm,(360.98 ± 35.37) N/mm and (336.07 ± 18.83) N/mm respectively,with statistical significance in pair comparison among the control,superior,and anterior groups (P ＜ 0.05).In three-point bending test,the deflection limit of these groups was (8.75 ± 0.53) mm,(16.07 ±1.22) mm,(13.08 ±0.52) mm,(15.84±0.48) mm and (12.23 ±0.41) mm respectively.Moreover,the deflection limit of locking plate group and reconstruction plate group showed significant difference (P ＜ 0.05) and both were higher than that in control group (P ＜ 0.05).In torsion test,the mean torsion stiffness of locking plate group and reconstruction plate group was (0.77 ±0.08) Nm/deg and (0.73 ±0.11) Nm/deg in internal rotation and was (0.72 ± 0.07) Nm/deg and (0.75 ± 0.08) Nm/deg in external rotation,without statistically significant difference between groups.Resistor strain value in internal fixation groups lowered when compared to that in control group (P ＜ 0.05) and particularly lower strain value was observed in anteroinferior locking plate group.Conclusions (1) Plate fixation is the preferred method for treatment of clavicle fractures in that the plate can bear large amount of stress,provide a solid support and facilitate early fracture healing.(2) Anteroinferior clavicle plating using a locking plate possesses good biomechanical properties and has advantages of easy operation,low risk,solid fixation,few complications and cosmetic improvement.The technique is worthy of clinical practice. Key words: Clavicle; fracture fixation, internal; Biomechanics

Congenital clavicular pseudarthrosis: Comparison of two treatment methods

Congenital pseudarthrosis of the clavicle is rare and popular surgical options include excision of the non-union, iliac crest bone grafting and stabilisation with either a fully threaded pin or stabilisation with a reconstruction plate. Between 1995 and 2009, ten patients with congenital pseudarthrosis of the clavicle were retrospectively reviewed for outcome of two different forms of surgical management. Five patients had excision of the non-union, iliac crest bone grafting and stabilisation with a fully threaded pin (group A) and the other five patients had excision of the non-union, iliac crest bone grafting and stabilisation with a reconstruction plate (group B). One patient in the second group had bilateral pseudarthrosis. In group A, three patients achieved radiological union at a median of 6months. Two patients failed to unite at the pseudarthrosis and one of them had further surgery with a reconstruction plate in order to achieve union. In group B, all five patients (six clavicles) achieved radiological union at a median of 3months. All patients had painless full range of shoulder movement and were engaging in unrestricted activities. Excision of the pseudarthrosis, autogenous iliac bone grafting and stabilisation with plate achieves union quicker and with lower incidence of complications compared to excision of the pseudarthrosis, autogenous iliac bone grafting and stabilisation with fully threaded pins.

Influence of Mandibular Reconstruction on Patients' Health-Related Quality of Life

To evaluate and compare the influence of different types of mandibular reconstruction on health-related quality of life (HR-QoL) of nonrecurrence patients. We recruited 252 patients who underwent mandibular reconstruction between 1994 and 2007 for this cross-sectional study. They were classified into groups based on reconstruction technique: free bone graft (FBG) group, particulate bone cancellous marrow graft (PBCMG) group, reconstruction plate (RP) group, and microvascular free flap group. The University of Washington Head and Neck Quality of Life Questionnaire and 5 supplemental domains regarding the donor sites were used to evaluate and compare HR-QoL among the groups. The outcomes of the University of Washington Head and Neck Quality of Life Questionnaire differed significantly among the groups (P < .0001). The results of the additional donor site domains also differed greatly among the groups (P < .0001). Appearance, chewing, activity, appearance-donor site, and function-donor site were the domains that were most frequently chosen by the patients as the most important issues. Most of the patients rated their HR-QoL as somewhat better compared with their experience the month before they underwent reconstruction. The HR-QoL and overall quality of life (QoL) during the past 7 days were rated as very good in the FBG group and PBCMG group and good in the RP group and microvascular free flap group. HR-QoL of patients in the FBG and PBCMG groups did not differ significantly with regard to any of the domains, and these 2 groups consistently had the highest mean scores. Both groups differed significantly from the RP group, which tended to report the lowest mean scores for the domains.

Biomechanic study of posterior tibial anatomic plate in the treatment of posterior tibial plateau fracture

Objective To investigate the biomechanical properties of the posterior tibial anatomic plate. Methods A total of 25 fresh frozen adult tibial top and matching femur specimens were randomly divided into four groups. One specimen was used as normal control （ N group）, and the remaining 24specimens were with Schatzker Ⅵ tibial plateau fracture and accompanied by rear split and backward fracture displacement. The lateral margin of the tibia was fixed with a L-type plate, and the medial margin was fixed with the same plate after remodeling. The 24 specimens were divided into three groups, eight specimens per group. The posterior margin of the tibia was fixed by posterior tibial anatomic plate （ Group A）, T-type plate （ Group B） or straight reconstruction plate （ Group C）. The strength, stiffness, torsional biomechanics and failure load performance of the plates in each group were evaluated. Results The strength and stiffness of test groups was superior to that of Group N （ P 〉 0.05 ）, and the torsional biomechanics of test groups was close to that of Group N （ P 〉 0.05 ）. The posterior tibial anatomic plate was superior to T-type plate and straight reconstruction plate in aspects of strength, stiffness, torsional biomechanics and failure load performance （ P 〈 0.05 ）. Conclusions Posterior tibial anatomic plate has excellent biomechanical properties, and it is superior to other materials in treating posterior tibial plateau fracture and restoring the stability of the knee. Key words: Tibial fractures; Biomechanics; Posterior tibial anatomic plate

Operative Treatment of Clavicle Midshaft Fractures: Comparison between Reconstruction Plate and Reconstruction Locking Compression Plate

BackgroundTo compare the outcomes of reconstruction plate and reconstruction locking compression plate (LCP) for the treatment of clavicle midshaft fractures.MethodsForty one patients with a clavicle midshaft fracture were treated by internal fixation with a reconstruction plate (19 patients) or reconstruction LCP (22 patients). The clinical and radiological results were evaluated according to the Quick Disability of the Arm, Shoulder, and Hand (DASH) score and plain radiographs.ResultsThe mean time to union was 14.6 weeks in the reconstruction plate group compared to 13.2 weeks in the reconstruction LCP group (p > 0.05). The mean score to Quick DASH was 33.85 points in the reconstruction plate group compared to 34.81 points in the reconstruction LCP group (p > 0.05). The complications in the reconstruction plate were hypertrophic scarring in 2 cases, painful shoulder in 2 cases, limitation of shoulder motion in 2 cases, and screw loosening in 3 cases. In addition, the complications in the reconstruction LCP group was hypertrophic scarring in 4 cases, painful shoulder in 1 case and a limitation of shoulder motion in 1case (p > 0.05).ConclusionsThis study showed radiologically and clinically satisfactory results in both groups. Overall, operative treatment with a Reconstruction plate or reconstruction LCP for clavicle shaft fractures can be used to obtain stable fixation.