Plate Removal Research Articles

Review of Calcaneal Osteotomies Fixed With a Calcaneal Slide Plate.

The calcaneal slide osteotomy is a common procedure used for the surgical correction of heel varus and valgus deformities. A variety of fixation methods exist including screws and plates. The literature shows a high rate of hardware prominence with screws leading to subsequent removal of hardware. Few studies have examined the use of plates for fixation of a calcaneal osteotomy. The purpose of this study was to assess outcomes following fixation of a calcaneal osteotomy with a calcaneal slide plate. This is a retrospective consecutive case series of all patients who underwent either a medial or lateral calcaneal slide osteotomy using the specialized calcaneal slide plate between September 2013 and December 2018 by a single surgeon. The primary outcome measures were the rate of hardware removal, healing of the calcaneal osteotomy, and any associated complications such as infection or incision healing delays. Patient baseline demographics and procedure-related data were recorded. The minimum follow-up was 4 months. A total of 81 procedures were performed using this calcaneal slide plate. All of the patients had one or more additional procedures at the same time as the calcaneal osteotomy. All of the calcaneal osteotomies healed without displacement. Only 1 patient (1.2%) returned to the operating room and had removal of the calcaneal slide plate, which was after osteotomy union for an infected wound. There were no cases of hardware failure or removal due to it being symptomatic. A specialized calcaneal slide plate was an effective fixation device for both medial and lateral calcaneal slide osteotomies for a variety of foot and ankle conditions. The union rate was 100% and none of the patients had hardware symptoms, which is an improvement on published reports of symptomatic hardware after calcaneal slide osteotomy. Level IV, retrospective case series.

Influence de l’augmentation de la pente tibiale sur l’état du ligament croisé antérieur après ostéotomie tibiale d’ouverture de valgisation dans une population de genou à ligament croisé antérieur intact

PurposeThe purpose of this study was to clarify the relationship between posterior tibial slope angle (PTSA) and anterior cruciate ligament (ACL) status in medial open wedge high tibial osteotomy (OWHTO). Our hypothesis was that even though OWHTO may improve anteroposterior laxity of the knee, an increase in PTSA after OWHTO would be associated with ACL degeneration. MethodsSeventy-five patients treated with OWHTO were retrospectively analyzed. PTSA were evaluated radiographically pre- and postoperatively. The ACL was evaluated during the index arthroscopy at the time of OWHTO and a second-look arthroscopy during the plate removal, and scored from 1 (normal ACL) to 4 (complete tear). An anterior tibial translation (ATT) test was performed. ResultsThe mean time period from the index to second-look arthroscopy was 15.0±4.4 months. PTSA significantly increased from 5.3±3.4° preoperatively to 7.5±4.0° postoperatively (p<0.001). The average ACL score significantly increased from 1.9±0.5 at the index arthroscopy to 2.2±0.5 at the second-look arthroscopy (p=0.0025). The average ATT on the operated side significantly decreased from 7.1±2.6mm preoperatively to 5.3±2.3mm at the second look arthroscopy (p<0.0001). There was a significant positive correlation between the increase in PTSA and the change of ACL grade (Correlation coefficient (r)=0.221, p<0.05). ConclusionEven though OWHTO reduces anteroposterior knee laxity, an increase in PTSA is associated with ACL degeneration. It is important for the surgeon to avoid an increase in PTSA during the procedure to prevent ACL degeneration after OWHTO. Level of EvidenceIV, therapeutic retrospective case series.

Functional flow cytometry of monocytes for routine diagnosis of innate primary immunodeficiencies

Functional flow cytometry of monocytes for routine diagnosis of innate primary immunodeficiencies

Influence of thermal properties on residual stresses in SLM of aerospace alloys

PurposeResidual stresses are induced during selective laser melting (SLM) because of rapid melting, solidification and build plate removal. This paper aims to examine the thermal cycle, residual stresses and part distortions for selected aerospace materials (i.e. Ti-6Al-4V, stainless steel 316L and Invar 36) using a thermo-mechanical finite element model. The numerical results are validated and compared to experimental data.Design/methodology/approachThe model predicts the residual stress and part distortion after build plate removal. The residual stress field is validated using X-ray diffraction method and the part distortion is validated using dimensional measurements.FindingsThe trends found in the numerical results agree with those found experimentally. Invar 36 had the lowest tensile residual stresses because of its lowest coefficient of thermal expansion. The residual stresses of stainless steel 316L were lower than those of Ti-6Al-4V because of its high thermal diffusivity.Research limitations/implicationsThe model predicts residual stresses at the optimal SLM process parameters. However, using any other process conditions could cause void formation and/or alloying element vaporization, which would require the inclusion of melt pool physics in the model.Originality/valueThe paper explains the influence of the coefficient of thermal expansion and thermal diffusivity on the induced thermal stresses using experimental and numerical results. The methodology can be used to predict the part distortions and residual stresses in complex designs of any of the three materials under optimal SLM process parameters.

Palmar angular stable plate fixation of nonunions and comminuted fractures of the scaphoid

Stabilization of comminuted fractures and nonunions of the scaphoid with an angular stable low-profile scaphoid plate. Scaphoid nonunions with alarge palmar defect, second and third surgical procedure after previous stabilization by headless compression screw (HCS). Comminuted fractures of the scaphoid that cannot be sufficiently stabilized by screws. Radio- and midcarpal osteoarthritis, small proximal pole fragments, fragmentation of the proximal pole. The scaphoid is accessed by apalmar approach. After correcting the DISI (dorsal intercalated segment instability) deformity of the lunate and humpback deformity of the scaphoid, the reduction is secured by temporary Kirschner wires. The nonunion is debrided and the bone defect filled with cancellous bone graft. Subsequently the scaphoid plate and the angular stable screw are positioned in the order to place three screws in the proximal and distal fragment of the scaphoid. Comminuted fractures of the scaphoid are fixated by temporary Kirschner wires, then the plate is positioned in the same way as nonunions. Comminuted fractures and nonunions of the scaphoid are immobilized by abelow-elbow cast or thermoplastic splint with inclusion of the thumb for 8weeks. No heavy work, high-risk or contact sport activities for 12weeks. Plate removal is recommended after 6months or after bony healing. By stabilizing scaphoid nonunions with a plate, high union rates with good clinical outcome can be achieved if the indication is correct.

Mechanical testing setups affect spine segment fracture outcomes

The purpose of the work presented here was to establish an experimental testing configuration that would generate a bending compression fracture in a laboratory setting. To this end, we designed and fabricated a fixture to accommodate a three level spine segment and to be able to perform mechanical testing by applying an off-centric compressive loading to create a flexion-type motion. Forces and moments occurring during testing were measured with a six-channel load cell. The initial testing configuration (Fixture A) included plates connected to the superior potted vertebral body and to the ball-socket joint of the testing system ram. Surprisingly, while all cadaveric specimens underwent a similar off-centric compressive loading, most of the specimens showed extension outcomes as opposed to the intended pure-flexion motion. The extension was due to fixture size and weight; by applying an off-centric load directly on the top plate, unintended large shear forces were generated. To resolve the issue, several modifications were made to the original fixture configuration. These modifications included the removal of the superior plates and the implementation of wedges at the superior surface of the fixture (Fixture B). A synthetic sample was used during this modification phase to minimize the number of cadaveric specimens while optimizing the process. The best outcomes were consistently observed when a 15°-wedge was used to provide flexion-type loading. Cadaveric specimens were then experimentally tested to fracture using the modified testing configuration (Fixture B). A comparison between both fixtures, A and B, revealed that almost all biomechanical parameters, including force, moment, and displacement data, were affected by the testing setup. These results suggest that fixture design and implementation for testing is of extreme importance, and can influence the fracture properties and affect the intended motion.

Minimally invasive single locking plate combined with multiple planar screw internal fixation for pilon fracture

Objective To investigate the clinical effect of minimally invasive single locking plate combined with multiplanar screw internal fixation on pilon fracture of distal tibia. Methods A retrospective case control study was conducted to analyze the clinical data of 51 patients with pilon fracture involving distal tibial articular surface admitted to 81th Group Military Hospital of the Army from January 2013 to August 2017. Among the patients, 20 patients including 15 males and five females, aged (37.5±9.9)years were treated with closed traction reduction or open joint reduction through minimally invasive incision and single main locking plate combined with multiplanar screw placement (study group). There were 13 patients with type II and seven patients with type III according to Ru edi-Allgwer classification of fracture. In addition, 31 patients were treated with open reduction and multi-plate internal fixation (control group), including 25 males and six females, aged (43.4±11.3) years. There were 20 patients with type II and 11 with type III according to Ru edi-Allgwer classification. The operation time, fracture healing time, postoperative complications were compared between the two groups. Burwell-Charnley imaging evaluation criteria were used to assess the quality of fracture reduction. At the last follow-up, ankle function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot functional score. Results All 51 patients were followed up for 6-24 months, with an average of 16 months. The operation time was (82.5±19.2)minutes in the study group and (127.7±40.8)minutes in the control group (P 0.05). Local skin necrosis (not above the plate) occurred in two patients in the study group and in three patients in the control group, with the wounds being healed within 3 months after dressing change and vacuum sealing drainage (VSD). In the control group, one patient had severe infection and recovered after treatment of steel plate removal, debridement and irrigation, and external fixator fixation. Three patients in the control group had skin necrosis resulting in plate exposure, who received transferred skin flaps to cover the wound. The incidence of postoperative complications were 10% (2/20) and 23% in the study group and the control group, respectively (7/31)(P>0.05), with the incidence of severe complications for 0 and 13% (4/31)(P 0.05). At the last follow-up, AOFAS ankle-hind foot function scores were excellent in 12 patients, good in five patients, fair in two patients and poor in one patient in the study group with excellence rate of 85%, while the scores were excellent in 20 patients, good in six patients, fair in three patients and poor in two patients in the control group, with excellence rate of 84% (P>0.05). Conclusion For pilon fracture of distal tibia, both minimally invasive single locking plate combined with multi-plate screw internal fixation and open reduction combined with multi-plate internal fixation have good reduction effect and satisfactory recovery of ankle function, but the former can significantly shorten the operation time and reduce the incidence of serious complications after operation. Key words: Tibial fractures; Fracture fixation, internal; Pilon fractures

Esophageal Perforation after Anterior Cervical Spine Surgery

Study DesignRetrospective case analyses.PurposeTo investigate the causes, diagnosis, and management of esophageal perforation, depending on the time of diagnosis.Overview of LiteratureTo date, few studies have addressed these issues.MethodsA total of seven patients were included in this study. The patients were classified into three groups based on esophageal perforation diagnosis time: intraoperative (diagnosed during surgery), perioperative (diagnosed within 30 days postoperatively), and delayed (diagnosed >30 days postoperatively) groups.ResultsIn the intraoperative group (N=2), infectious spondylitis was the main cause of esophageal perforation. Anterior plate and screw removal, followed by posterior instrumentation, was performed. The injured esophagus was managed by omentum flap repair in one patient and primary repair in one patient. In the perioperative group (N=2), revision surgery for infection and metal failure were the main causes of esophageal perforation. In both cases, food residue was drained on the third postoperative day. The injured esophagus was managed conservatively. In the delayed group (N=3), chronic irritation caused by metal failure was the main cause of esophageal perforation. In all patients, there was no associated infection. The anterior instrumentation was removed, and the two patients were treated by primary repair, and one patient was treated using sternocleidomastoid muscle flap. One patient in intraoperative group died of sepsis.Conclusions The main cause of intraoperative esophageal perforation was esophageal adhesions because of infectious spondylitis. However, perioperative and delayed esophageal perforations were caused by chronic irritation because of metal failure. Anterior plate and screw removal was necessary, and posterior instrumentation and fusion may be considered, depending on the fusion status.

Stability of the chin after advancement genioplasty using absorbable plate and screws with template devices

PurposeThe purpose of this study was to compare the stability of the chin between absorbable plate and screws with a template device and titanium plate after advancement genioplasty in class II patients. Patients and methodsThe subjects consisted of 22 Japanese class II patients who underwent genioplasty advancement in combination with bi-maxillary surgery. After genioplasty horizontal osteotomy, the template plate and screws were fixed at the central region of the chin temporarily. Then, two absorbable bi-cortical screws (uncalcined and unsintered hydroxyapatite and poly-l-lactic acid: uHA/PLLA) were used and fixed bilaterally. After removal of the template plate and screws, one absorbable plate and screws were added to fix the segment in the advancement genioplasty (n = 14). The remaining 8 patients underwent genioplasty advancement surgery with the conventional titanium plate.For all patients, lateral cephalograms were obtained pre- and immediately after surgery and at 1 year after surgery. Change in the Pogonion (Pog) and Menton (Me) points and the corresponding soft tissue points (PogS and MeS) were evaluated. ResultsAlthough there were no significant differences in the change from before to immediately after surgery between the absorbable and titanium groups, there were significant differences in the Pog (Y) (P = 0.0379) and PogS (Y) (P = 0.0379) from immediately after surgery to after 1 year between both groups. ConclusionThis study shows that predicted advancement of the chin in the absorbable group could be achieved by using a template and screws, and likewise in the titanium group. However, this study suggested that vertical relapse to the inferior site or resorption at the antero-superior edge of the segment could occur in the absorbable group.

Locking Versus Non-Locking Plate Fixation in the Management of Maxillofacial Fractures : A Prospective Comparative Study

Introduction Various methods of fixation have been advocated for the treatment of maxillofacial fractures. A new type of plating system, initially developed by Raveh et al. is locking plate/screw system. This system has various advantages over conventional non locking plating system like better stability, ease of plate adaptation, early restoration of function, internal locking system which decreases the chance of screw loosening and infection. Objectives A comparative evaluation of locking plates system versus conventional miniplates in maxillofacial fractures. Method Twenty patients presenting with maxillofacial fractures were treated with locking plates and conventional non locking plates in two years from 2014 to 2016. Ten patients were treated with locking plate system in group A and 10 patients with conventional non locking plates in group B. Patients were evaluated on clinical and radiographic parameters during three months follow up. Results Postoperative outcomes for both groups were extremely favorable with a relatively small number of complications. There was no case of postoperative wound dehiscence, infection, damage to tooth roots, plate exposure and plate removal, malunion and any other complication in both the groups. Postoperative occlusion disturbance was seen in 20% cases in both group A as well as group B in mandible fractures. In maxillary fractures postoperative occlusion disturbance was seen in one case (20%) in group B. Conclusion This study concluded that despite the significant theoretical advantages of locking system seen in biomechanical studies, no statistical significant results were found between these two systems. The postoperative outcomes for both groups were almost similar with a relatively small number of complications.

Modified Le Fort I step osteotomy for improvement of paranasal flatness in maxillary deficiency: Technical note and series of 24 cases

IntroductionTo describe a modified Le Fort I step osteotomy for the improvement of paranasal flatness in maxillary deficiency and to evaluate postoperative complications as well as post-treatment relapse. Patients and MethodsIn this retrospective case series study, clinical data of all patients with maxillary deficiency associated with a Class III malocclusion who underwent a modified Le Fort I step osteotomy were reviewed. The primary and secondary outcome variables were, respectively, the improvement of paranasal flatness as evaluated by the clinical analysis of the cheekbone-nasal base-lip contour (CP-Nb-LC), and postoperative complications as well as post-treatment relapse. Other variables included age, gender, and additional surgical procedures. Descriptive statistics were performed. ResultsThe sample was composed of 24 patients. Paranasal flatness was corrected with the reestablishment of an harmonious convex cheekbone-nasal base-lip contour in all patients, who were satisfied with the esthetic result. Two patients (8%) had discomfort associated with the paranasal plates. One of these also had a unilateral nasolacrimal duct dysfunction with occasional bothersome epiphora that resolved after plate removal. Two patients (8%) had maxillary sinusitis that resolved rapidly following medical treatment. One patient (4%) had persistent minor infraorbital nerve hypoesthesia. No occlusal relapse or pseudarthrosis occurred. ConclusionThe modified Le Fort I step osteotomy approach is a valuable method for the improvement of paranasal flatness in maxillary deficiency.

Plate removal without loss of correction after open-wedge high tibial osteotomy is possible when posterior cortex bone union reaches osteotomy gap center even in incompletely filled gaps.

The study aimed to evaluate the optimal timing for plate removal after open-wedge high tibial osteotomy (OWHTO) without loss of correction and to investigate risk factors for loss of correction after plate removal. The study presents the hypothesis that plate removal without loss of correction was possible when gap filling reached zone 2 (25-50%) on anteroposterior radiographs. Ninety-one patients (101 knees) who underwent OWHTO using the TomoFix® plate were enrolled. Plate removal was performed at an average 16.4 ± 5.4months after OWHTO. Clinical evaluation included plate-related symptoms, the Japanese Orthopedic Association Knee Score (JOA score), and Oxford Knee Score (OKS). Radiological outcomes, including the hip-knee-ankle angle (HKA), weight-bearing line ratio (WBLR), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS), were evaluated preoperatively, at plate removal and at 1year after plate removal. Computed tomography (CT) was performed at plate removal to evaluate the flange bone union, progression rates of gap filling, and posterior cortex bone union. In addition, the risk factors for loss of correction after plate removal were evaluated. At plate removal, 63 (62.4%) knees had plate-related symptoms (mild, 56 knees; moderate, 7 knees; severe, 0). After plate removal, the JOA score did not change, whereas OKS further improved; six knees developed loss of correction. On CT evaluation at plate removal, the flange bone union was achieved in all cases; the progression rates of gap filling and posterior cortex bone union were 47.0% ± 16.6% and 62.8% ± 16.5%, respectively. A posterior cortex union rate of < 43.3% was the only predictor for loss of correction after plate removal (odds ratio: 1.38, P < 0.01). Plate removal without loss of correction after OWHTO was possible when bone union of the posterior cortex reached the center of the osteotomy gap even in incompletely filled gaps. Therapeutic case series, Level IV.

Effect of increased posterior tibial slope on the anterior cruciate ligament status in medial open wedge high tibial osteotomy in an uninjured ACL population

PurposeThe purpose of this study was to clarify the relationship between posterior tibial slope angle (PTSA) and anterior cruciate ligament (ACL) status in medial open wedge high tibial osteotomy (OWHTO). Our hypothesis was that even though OWHTO may improve anteroposterior laxity of the knee, an increase in PTSA after OWHTO would be associated with ACL degeneration. MethodsSeventy-five patients treated with OWHTO were retrospectively analyzed. PTSA were evaluated radiographically pre- and postoperatively. The ACL was evaluated during the index arthroscopy at the time of OWHTO and a second-look arthroscopy during the plate removal, and scored from 1 (normal ACL) to 4 (complete tear). An anterior tibial translation (ATT) test was performed. ResultsThe mean time period from the index to second-look arthroscopy was 15.0±4.4months. PTSA significantly increased from 5.3±3.4° preoperatively to 7.5±4.0° postoperatively (p<0.001). The average ACL score significantly increased from 1.9±0.5 at the index arthroscopy to 2.2±0.5 at the second-look arthroscopy (p=0.0025). The average ATT on the operated side significantly decreased from 7.1±2.6mm preoperatively to 5.3±2.3mm at the second-look arthroscopy (p<0.0001). There was a significant positive correlation between the increase in PTSA and the change of ACL grade [correlation coefficient (r)=0.221, p<0.05]. ConclusionEven though OWHTO reduces anteroposterior knee laxity, an increase in PTSA is associated with ACL degeneration. It is important for the surgeon to avoid an increase in PTSA during the intervention to prevent ACL degeneration after OWHTO. Level of evidenceIV, therapeutic retrospective case series.

Early locking plate removal following open reduction and internal fixation of proximal humeral fractures could prevent secondary implant-related complications

IntroductionProximal humeral fracture is a common cause of morbidity in the elderly and poses a challenge for the orthopedic surgeon. Open reduction and internal fixation (ORIF) with a locking plate is associated with high rate of secondary implant-related complications (IRC). Early implant removal could potentially reduce the risk of IRC and further improve the outcome in relatively asymptomatic patients. The purpose of this study was to evaluate the clinical and radiologic outcomes following implant removal. MethodsA total of 56 patients with an average age of 63 ± 13 years and a mean follow-up of 29 months were evaluated retrospectively following removal of a locking plate in the proximal humerus. Postoperative functional outcomes were evaluated with the Constant-Score, Subjective shoulder value and Quick-DASH score. ResultsEarly implant removal resulted in high functional outcomes with 96% of the patients reporting an improvement of their shoulder function following implant removal. No intraoperative complications were reported. Avascular necrosis (AVN) of the humeral head occurred in 12.5% of the patients, but no secondary screw cut-out was reported. ConclusionEarly implant removal might be a safe option to avoid secondary IRC with significant subjective functional improvement also in asymptomatic patients. Although early implant removal cannot reverse the process of AVN, it could potentially prevent secondary IRC and subsequent glenohumeral cartilage destruction.

Experience with Anterior Maxillary Osteotomy Techniques: A Prospective Study of 20 Cases.

This prospective study aimed at studying the complications associated with different techniques of anterior segmental maxillary osteotomy. The study was conducted on 20 cases diagnosed with anteriorly prognathic maxilla with class 1 molar relation. The patients were followed up for a period of at least 1year. The clinical and demographic data along with the intraoperative and postoperative complications associated with different treatment techniques were recorded. In five cases, Wassmund technique was followed with average time span of 32min. Wunderer and Cupar technique took average time span of 23min. Two patients presented with four non-vital teeth in a follow-up period of 1year and one patient treated with Cupar's technique had complication of palatal tear. Only one patient reported with relapse in a follow-up period and none of the patients had any complication associated with hemorrhage, neurosensory alteration or requiring plate removal. The findings of our study recommend ASMO as treatment modality of choice in patients with bimaxillary and/or dentoalveolar protrusion with Cupar's technique providing more ease of operation.

Plate Fixation for Unstable Displaced Distal Radius Fractures in Children.

Background Distal radius fractures in children are normally treated by plaster immobilization. For displaced unstable distal radius fractures, closed reduction and Kirschner wire (k-wire) fixation can be performed. Disadvantages of k-wire fixation are the need for postoperative plaster treatment for several weeks, which may induce stiffness, and the risks of complications such as tendon irritation and pin-track infections. More invasive volar plate fixation is less popular, although this allows for direct mobilization and enhances anatomical reduction. Purpose To present the functional outcomes of pediatric patients treated with volar plate fixation for unstable displaced distal radius fractures. Patients and Methods A retrospective cohort study of all consecutive pediatric patients between September 2010 and July 2017 was performed. A total of 26 patients with a median age of 12.5 years were included. The primary objective was functional outcome determined by the Patient-Rated Wrist Evaluation (PRWE) questionnaire. Secondary objectives were range of motion, grip strength, radiological parameters, complications, and incidence of plate removal. Results Median PRWE score was 3 after a median follow-up of 29 months. Range of motion and grip strength did not differ significantly between the injured and uninjured wrists. No wound infections were found. Plate removal was performed in 15 patients (58%). Conclusion Volar plate fixation for unstable displaced distal radius fractures in children provides good functional and radiological outcomes with minor complications. Level of evidence This is a Level IV cohort study.

Plate removal following orthognathic surgery

Background: Titanium plates are used in orthognathic surgery for over 40 years. Routine removal of titanium plates is not recommended. However, some plate-related complications may occur and some plates have to be removed.

Capitolunate Arthrodesis versus Four-corner Arthrodesis in Scaphoin Nonunion Advanced Collapsed Wrist Treatment

Objective To evaluate the outcomes of scaphoidectomy and capitolunate arthrodesis versus four-corner arthrodesis in patients with stage III scaphoid nonunion advanced collapse (SNAC) wrists. Methods We reviewed retrospectively all of the consecutive patients surgically treated in our center between 2007 and 2015, including 20 patients in the four-corner arthrodesis group and 11 patients in the capitolunate group. The mean follow-up time was of 47 months. The follow-up evaluation included wrist range of motion (ROM), grip strength, visual analogue scale (VAS), the disabilities of the arm, shoulder, and hand (DASH) questionnaire, and the Mayo wrist scale (MWS). Postoperative complications and the radiographic evaluation were also assessed. Results There was no statistical difference in flexion, radial deviation, ulnar deviation, grip strength, VAS, DASH or MWS scores. There was a statistically significant increase (6°) in extension in capitolunate arthrodesis versus four-corner arthrodesis, possibly without clinical relevance. There were two nonunions in the four-corner group, and none in the capitolunate group. None of the patients in the capitolunate group required screw removal. One patient in the four-corner group required dorsal plate removal. One patient in each group required conversion to total arthrodesis. Conclusions Capitolunate arthrodesis shows similar results in wrist ROM, grip strength and patient-reported outcomes when compared with four-corner arthrodesis at an average follow-up period of 4 years. We did not have any pisotriquetral arthritis in the capitolunate arthrodesis group, despite not removing the triquetrum in any of patients of this group. Type of study/level of evidence Therapeutic III.

Successive complications after anterior cervical fixation: pharyngoesophageal diverticulum, fistulization, and cervical spondylitis by Streptococcus milleri \u2013 case report and literature review

IntroductionPharyngoesophageal diverticulum is an uncommon complication after anterior cervical discectomy and fusion surgery.Case presentationOur patient was a 48-year-old woman with two previous cervical surgeries with fixation of C4-C5 and C5-C6, the last one in 2003. Two years after surgery, she presented with arthralgia, arthritis, chills, and fluctuating rash. In 2007, she presented with dysphagia, halitosis, and sputum production. She was diagnosed with a pharyngoesophageal diverticulum with a fistula to C6 vertebra and secondary spondylitis. She was taken for open surgery with removal of screws and plates, cricopharyngeal myotomy, and esophageal repair. Streptococcus milleri grew in tissue and osteosynthetic material. She received 4 months of amoxicillin and probenecid and had a complete recovery. Since 1991, 19 similar cases have been reported with one fatality. To our knowledge, this is the first reported case of diverticulum complicated with fistula and secondary spondylitis.ConclusionsIn patients with a history of anterior cervical discectomy and fusion complaining of dysphagia, even years after surgery, it is mandatory to perform an esophagogram. This symptom was referred to in 88% of the cases reported in the literature.

Biomechanical Evaluation of Dual Plate Configurations for Femoral Shaft Fracture Fixation

Aim This study aimed at comparing the mechanical properties of conventional and locking dual plates in adjacent and orthogonal orientations for the surgical fixation of transverse femoral shaft fractures. It also assessed the failure mechanics after dual adjacent and orthogonal locking plate removal. Methods Thirty-two composite femurs were transversally osteotomized and randomly assigned for fixation with either dual locking or compression plates in an adjacent or orthogonal configuration. Sixteen specimens were preloaded axially to 20 N and single-leg stance loads were simulated. The remaining sixteen constructs were subjected to torsional loads of 10 Nm at a rate of 10 Nm/s in external and internal rotation of the femoral head in relation to the knee. Overall combined rotational stiffness was calculated. Eight different specimens with no osteotomy underwent the same experiments after dual locked plate removal and were tested to failure in combined eccentric axial and torsional modes. Data were statistically processed using a two-tailed t-test and one-way analysis of variance for the comparison of means between two or more groups, respectively. Results Orthogonal constructs were statistically stiffer in axial loading compared to their adjacent counterparts in both conventional and locking configurations (p<0.001). Dual locking plates provided higher torsional stiffness than conventional ones within each plate orientation (p<0.01). Neither axial/torsional strength nor failure loads differed between constructs that had adjacent or orthogonal dual locking plates instrumented and then removed (p>0.05). Conclusions In both orthogonal and adjacent orientations, double locking plates provide higher stability than their dual conventional counterparts. Orthogonal dual plate configuration is more stable and biomechanically superior to dual adjacent plating for constructs fixed with either standard compression or locking plates.