Screw Plate Fixation Research Articles

Is casting superior to plate fixation in metacarpal shaft fractures?

This study aimed to compare the outcomes and conduct a cost analysis between plate screw fixation and conservative treatment. The retrospective study was conducted with 36 patients (32 males, 4 females; mean age: 30.3±13.4 years; range, 16 to 65 years) between May 2019 and July 2023. The patients were divided into two groups: those who underwent surgery with miniplate fixation (n=21) and those who were conservatively managed (n=15). The differences in postoperative shortening and angulation were compared between these groups. Additionally, the patients' postoperative functional scores, complication rates, examination findings, and cost analyses were compared. The per-patient cost in the surgical group was higher than in the conservatively treated group (€246.96 vs. €45.07; p<0.001). While postoperative shortening and angulation were more pronounced in the nonoperative group, the other clinical parameters and functional scores were improved. The return-to-work time was longer in the nonoperative group due to prolonged immobilization. Nonoperative splint treatment for metacarpal shaft fractures shows better radiological and clinical outcomes than surgery, except for angulation and shortening, which have limited impact on function. Due to higher costs in surgical cases, nonoperative treatment is more cost-effective. Larger, randomized trials are needed to confirm these findings.

Functional and radiological outcomes and complications of bernese periacetabular osteotomy through modified Stoppa approach.

The Smith-Peterson approach and its modifications provide an extensive exposure and allow osteotomies through a single incision. However, the risk of complications increases when the quadrilateral surface, ischial and pubic osteotomy sites cannot be seen. This study aimed to evaluate the surgical characteristics, complications, and functional and radiological outcomes of patients with acetabular dysplasia who underwent Bernese periacetabular osteotomy (PAO) through modified Stoppa approach and plate-screw fixation. The study included 31 patients (41 hips) who had undergone PAO using a modified Stoppa approach. The characteristics of patients and the surgical procedure were described. The lateral centre-edge angle (LCEA) and Tönnis roof angle were evaluated in the radiological outcome evaluation. The modified Harris Hip Score (mHHS) was used to evaluate functional outcome. Furthermore, complications were described. The mean age of the patients was 20.4 ± 9.0 years. Of the 31 patients, 21 underwent unilateral Bernese PAO and 10 underwent bilateral Bernese PAO. The mean follow-up period was 25.1 ± 8.8 months. Postoperatively, the mean mHHS improved significantly (68.8 ± 9.4 vs. 88.8 ± 10.0, p < 0.001). Postoperatively, the mean LCEA and Tönnis roof angle improved significantly (17.7 ± 6.0 vs. 42.2 ± 4.8, p < 0.001 for LCEA and 18.3 ± 5.5 vs. 8.0 ± 2.2, p < 0.001 for Tönnis roof angle). There was no significant correlation between preoperative to postoperative improvement in LCEA or Tönnis roof angle and improvement and mHHS (p > 0.005). 5 complications were identified: 1 transient sciatic nerve palsy, 1 external iliac vein injury, 1 infection, and 2 screw irritations of acetabulum. Performing Bernese PAO through a modified Stoppa approach with plate-screw fixation results in acceptable complication rates, immediate early weight-bearing opportunity, and improved functional and radiological outcomes in patients with acetabular dysplasia.

Surgical Costs Associated with Tibiotalar Fusion

Category: Ankle Arthritis; Ankle Introduction/Purpose: There is growing focus on the surgical costs related to common orthopedic procedures. In this investigation, we studied the costs associated with tibiotalar arthrodesis by comparing different surgical constructs (screws-alone vs. plate-screw fixation). Methods: Patients were retrospectively identified who had undergone primary fusion of the tibiotalar joint based on CPT codes from 2014 to 2020. Utilizing the Value Driven Outcome (VDO) tool implemented at our institution, we conducted an evaluation of both total direct costs and facility-related expenses. The VDO tool encompasses a comprehensive item-level database capable of capturing detailed cost information, which is subsequently presented as relative mean data. Adjustments were made to cost variables to reflect 2022 US dollars, and comparative analysis of costs in relation to treatment groups and other exposure variables was performed using generalized linear models to yield cost ratios along with 95% confidence intervals (CIs). Results: Our cohort consisted of 263 patients who underwent primary ankle fusion procedures done by one of four fellowship-trained orthopedic foot and ankle surgeons. There were no differences in demographic data or total OR time based on surgical construct (screws-alone N =229, plate-screws N =34). Total direct cost for plate-screw constructs were 72% higher than screws alone (ratio in cost =1.72, 95% CI 1.49~2.03, p&lt; 0.001). There was no significant difference in regression analysis between plate-screw vs screws-alone for facility cost (ratio in cost =1.14, 95% CI: 0.99~1.34, p=0.10). For all fusion constructs, every 1 hour increase in total OR time increases total direct costs by 28% (ratio in cost =1.28, 95% CI 1.18~1.40, p&lt; 0.001). Conclusion: Enhancing the cost-effectiveness of orthopedic care remains an important objective. Our investigation suggests that screw-only constructs, compared to plate-screw constructs, can notably lower overall total costs by 72%. Many variables are considered when selecting surgical constructs for ankle arthrodesis. When clinically appropriate, screw-only ankle arthrodesis constructs could be considered if there is a need to reduce overall total costs.

Finite element analysis of anatomic plate fixation for proximal clavicular fractures

To explore establishment and finite element analysis of personalized proximal clavicular anatomical plate screw fixation model. A 40-year-old male healthy volunteer was selected and the finite element analysis modules of 3D reconstruction software Mimics 15.01, Hypermesh 2019 and Abaqus 2020 were used. The finite element model of anatomic plate at the proximal clavicle was established, and a vertical load of 250 N was applied to the distal end of long axis of clavicle about 15 mm, then the overall structure, plate and screw displacement cloud image, Mises stress distribution were observed. The displacement distribution of the overall structure shows the maximum displacement was distributed on the distal clavicle. Under the four conditions of normal upper limb weight, longitudinal clavicle fracture, oblique fracture and shoulder impact violence during fall, longitudinal clavicle fracture and oblique fracture, the maximum displacement were 1.04 mm, 1.03 mm, 1.35 mm and 1.33 mm, respectively. The displacement cloud map of titanium alloy steel plate showed the largest displacement was distributed near the distal clavicular bone, and the maximum displacement were 0.89 mm, 0.88 mm, 1.10 mm and 1.09 mm, respectively. The displacement cloud map of titanium alloy screw showed the largest displacement was distributed at the root of the distal screw, and the maximum displacement were 0.88 mm, 0.87 mm, 1.08 mm and 1.06 mm, respectively. Mises stress distribution showed the maximum stress was mainly distributed on titanium alloy plates and screws, and the stress on the clavicle was very small. Mises stress distribution cloud showed the maximum Mises stress was distributed at the second row of screw holes near the clavicle, and the maximum Mises stress were 673.1, 678.1, 648.5, 654.4 MPa, respectively. The maximum stresses of titanium alloy screws were 414.5, 417.4, 415.8 and 419.7 MPa, respectively. The biomechanical changes of personalized proximal clavicular anatomical plates are demonstrated by using 3D finite element method to provide biomechanical data for personalized proximal clavicular anatomical plates.

Comparative Assessment of Functional Recovery Following Dynamic Hip Screw Plate versus Proximal Femoral Nail Fixation in the Management of Unstable Trochanteric Fractures of the Femur

Abstract Background: Unstable trochanteric fractures include posteromedial comminution, reverse oblique pattern, lateral wall fracture and subtrochanteric extension. Unstable trochanteric fractures usually can be treated by anatomical reduction with the use of a sliding hip screw or cephalomedullary nail. DHS is cost-effective and user-friendly whereas PFN, though biomechanically superior, is a relatively new entrant. Thus this comparative study helped us to understand the management of unstable trochanteric fractures in terms of surgical technique and evaluate the functional outcomes after fixation with PFN and DHS. Aims and Objectives: To compare the functional outcome, safety and effectiveness of dynamic hip screw plate (DHS) and proximal femoral nail (PFN) fixation in the management of unstable trochanteric fractures of femur. Materials and Methods: The study was an observational longitudinal follow up comparative study. 50 adult patients of age group 40 to 80 years having unstable trochanteric fractures of femur treated with either DHS plate or PFN were included in the study. 27 such patients were operated with DHS whereas 23 patients were operated with PFN. Modified Harris hip score, duration of hospitalisation, presence or absence of abduction lurch, intraoperative blood loss and procedure time and time to independent mobility were compared between the two groups during postoperative follow up. Results: Patients treated with PFN had better outcome than DHS in terms of shorter duration of hospitalisation, early mobilization in terms of early pain-free full weight bearing, lesser intraoperative blood loss, shorter procedure time and better functional result on the basis of modified Harris hip score at final follow up. But, PFN fixation was associated with more abduction lurch compared to DHS. Conclusion: Thus, PFN proved to be a better implant than DHS in the management of unstable trochanteric fractures of femur.

Is headless screw a valid alternative for the fixation of Chevron olecranon osteotomy? A biomechanical comparison of 4 fixation methods

BackgroundChevron osteotomy is a popular technique for repairing complex distal humerus intraarticular fractures. However, re-fixation presents challenges like hardware prominence and soft tissue damage. Headless cannulated screws are gaining popularity for fixation due to better bone purchase and less irritation. This study aims to compare different fixation strategies with headless screws for chevron osteotomy fixation. MethodsThis study utilized 32 polyurethane foam ulna specimens for biomechanical testing. The Chevron osteotomy was performed with an oscillating saw for all specimens. Four different techniques were used for re-fixation: modified tension band wire fixation, plate-screw fixation, cannulated screw fixation, and headless cannulated screw fixation. The constructs were mounted to the testing machine, simulating the elbow in 90 degrees of flexion. All specimens were tested under axial traction. Displacements at 350N and 500N and loads at the failure were recorded. ResultsAt the load of the implant failure, headless cannulated screw fixation revealed higher force values when compared to the other constructs, and modified tension band wire fixation showed lower force values compared to the other three groups (p < 0.001). The headless cannulated screw fixation group showed no significant differences in osteotomy displacements when tested to a 350N load. There were no significant differences in displacements at a 500N load between the four groups (p = 0.275). ConclusionThis study suggests that headless cannulated screw fixation is a viable and effective option for Chevron osteotomies. Headless cannulated screw fixation makes it a promising alternative to traditional fixation methods. This technique may be a more reliable fixation technique during daily activities and moderate elbow motions, indicating that it has the potential to succeed.

Comparative Biomechanical Study of Fragment-Specific Plates and Headless Screws for Radial Styloid and Lunate Facet Fixation in Distal Radius Fracture Evaluated in a Synthetic Composite

To evaluate the compressive stiffness (ability to resist compression under an applied load) of fragment-specific plate and headless screw fixation for radial styloid and volar lunate facet fractures in a synthetic composite distal radius. A simulated radial styloid fracture (AO type B1.1) and simulated volar lunate facet fracture (AO type B3.3) were created in synthetic composite distal radii and fixed with a fragment-specific plate (FSP) using a radial styloid or lunate facet plate or with two- or three-headless screws (2HS, 3HS), creating 6 fixation models: B1.1/FSP, B1.1/2HS, B1.1/3HS, B3.3/FSP, B3.3/2HS, and B3.3/3HS. Compressive stiffness of fixation constructs under initial static load, cyclic load, and final static load was investigated. Nonaxial loadings, including shearing and rotation, were not evaluated. Regarding AO type B1.1, the mean stiffness of the B1.1/FSP construct was not significantly different from the intact radius, and the mean stiffness was greatest in the B1.1/3HS and lowest in the B1.1/2HS construct. For AO type B3.3, the mean stiffness of the B3.3/3HS construct was not significantly different from the intact radius, and the mean stiffness of the B3.3/FSP and B3.3/2HS construct was greatest and lowest, respectively. Minimal differences in stiffness between initial and final static loads confirmed that there was no evidence of failure implant under cyclic compressive loads. Fragment-specific plates and two- or three-headless screw fixation maintained mechanical stability through compressive cyclic loading for radial styloid and volar lunate facet fractures. The FSPs and three-headless screws fixations provided superior stiffness over the two-headless screws fixation. There was no articular fracture failure in all fixation constructs with initial static compression, cyclic loading, and final compression. Fragment-specific plates and headless screws can both be considered as adequate fixation for radial styloid and volar lunate facet fractures.

Posterolateral Locked Plate and Percutaneous Medial Screw Fixation for Distal Humerus Fractures in Elderly.

Background: A high incidence of ulnar nerve-related complications has been reported in open reduction and internal fixation for distal humerus fractures (DHFs). To minimise ulnar nerve damage, we used a percutaneous medial screw combined with a posterolateral plate in the elderly. The aim of this study was to evaluate the postoperative complications and functional outcomes of this method. Methods: Data from patients aged over 65 who underwent this surgical procedure for DHFs at a single Level I trauma centre from 2013 to 2021 were extracted. Postoperative complications, reoperations, mean range of motion, Mayo Elbow Performance Index (MEPI) scores and Hand20 scores were retrospectively evaluated. All patients in this study received postoperative rehabilitation by hand therapists at our hospital. Results: We identified 28 patients treated with this method. The mean follow-up period was 8.6 ± 3.7 months. The median intraoperative time was 125 minutes (interquartile range: 105-157 minutes). None of the patients developed ulnar nerve neuropathy, but one patient (3.7%) experienced radial nerve dysfunction. Two patients (7.4%) had nonunion. Implant failure occurred in three patients (11.1%) due to migration of the medial screw. One patient (3.7%) amongst them underwent reoperation. The mean flexion to extension arc was 97 ± 18°, 116 ± 19°, and 116 ± 19° at 1-, 3- and 6-month follow-ups, respectively. According to the MEPI, 20 patients achieved excellent results, seven patients achieved good results and one patient achieved a fair result at the last follow-up. The median Hand20 score was 4.3 (interquartile range: 2.1-14.0) at the 6-month follow-up. Conclusions: The posterolateral plate and medial screw method showed good functional outcomes and few nerve-related complications. This modified method might be a better option for DHFs in elderly patients. Level of Evidence: Level IV (Therapeutic).

Intramedullary Screw versus Locking Plate Fixation for Traumatic Displaced Proximal Fifth Metatarsal Fractures: A Systematic Review.

Background/Objectives: Intramedullary screw fixation (IMS) and locking plate fixation (LPF) are currently recommended treatments for proximal fifth metatarsal fractures (PFMF). However, treating comminuted or small displaced avulsion PFMF with IMS poses challenges due to complications. A novel alternative fixation method, the locking compression plate for distal ulna hook plate fixation (LPF), has been introduced recently for distal ulna fractures and has shown improved clinical results. This scoping review aims to assess whether LPF yields superior outcomes, such as postoperative AOFAS scores and rate of postoperative complications, compared to IMS in PFMF treatment. Methods: This review included randomized controlled trials (RCTs), prospective cohort studies, retrospective cohort studies, or case series involving patients with PFMF who underwent plate fixation or screw fixation. The primary outcome was the postoperative American Orthopedic Foot and Ankle Society (AOFAS) score. Studies were sourced from databases including PubMed, Embase, and Scopus, with the search conducted up to February 2024. The Systematic Review protocol was registered in the CRD PROSPERO database (CRD42024532593). Results: Ten studies were included, comprising 3 cohort studies, 1 case-control study, and 6 case series, with a total of 309 patients (158 with LPF and 142 with IMS). The postoperative AOFAS scores showed no significant difference between LPF and IMS in treating PFMF. However, LPF demonstrated efficient surgical procedures and enhanced functional outcomes. Complications were minimal in both groups, with no significant difference in the rate of postoperative complications. Conclusions: Although there was no significant difference in AOFAS scores between LPF and IMS, LPF demonstrated efficient surgical procedures and enhanced functional outcomes, making it a reasonable alternative method for PFMF. Effective shared decision-making (SDM) with patients becomes paramount in choosing the optimal surgical approach. In the surgical landscape, thoughtful deliberation, patient engagement, and adherence to biomechanical principles are crucial for achieving successful outcomes in the treatment of PFMF.

Functional and Radiological Outcomes of Miniature Plate Osteosynthesis in Metacarpal and Phalangeal Fractures of Hand: A Prospective Study.

There are several operative modes to address hand fractures to gain better anatomical and functional results including external fixator, percutaneous K-wire fixation, lag screw fixation, tension band wiring, intra-medullary nails or wires, and plate-screw fixation. We evaluated the results of plate osteosynthesis in fractures of metacarpals and phalanges in a prospective manner. A total 50 adults (19-60 years) of either sex having 58 fractures managed by miniature plate osteosynthesis and followed for a minimum six months (6-19), including metacarpal and phalangeal fractures (unstable or serial fractures), intra-articular fractures, fracture-dislocation of proximal interphalangeal and distal interphalangeal joints with joint incongruity or subluxation were enrolled while contaminated compound fractures, pathological fractures and cases of reimplantation were excluded from study. Clinical assessment was done using the American Society for Surgery of the Hand (ASSH), total active flexion (TAF), total active range of motion (TAM) score, and the Disabilities of the Arm, Shoulder, and Hand (quick DASH) score while sequential radiographs were done at each follow-up. All the fractures had perfect union clinically as well as radiologically with a mean duration of six weeks while functional outcomes in reference to clinical scores were observed excellent and fair in all cases. None of the cases had any loss of reduction, loosening of the implant, or other major complications. Miniature plate fixation provides enough stability in metacarpal and phalanges fractures, thereby allowing immediate active movements, which leads to excellent functional outcomes and early return to normal activities.

Sustentaculum fracture fixation with lateral plate or medial screw fixation are equivalent

BackgroundFixation of sustentaculum tali fractures is important to maintain the biomechanical function of the subtalar joint. A common method of fixation is securing the sustentacular fragment by way of a laterally based locking plate (LP). A medial approach with a single screw (MS) has been proposed as an alternative method of fixation. MethodsFive pairs of formalin-preserved cadaveric ankles with the subtalar joint and interosseous ligaments intact (“osseous cadavers”) and four pairs of fresh-frozen cadaveric ankles with soft-tissue preserved dissected from mid-tibia down (“soft tissue cadavers”) were used in the study. The left ankle was randomly assigned to one of the two fixation methods (LP or MS), while the right ankle was the opposite. These same steps for fixation were repeated for six synthetic ankle models. All models were loaded with a body mass of 80 kg. Statistical differences between LP and MS stiffness were determined using a paired t-test in cadavers and un-paired t-tests in synthetic ankles. ResultsFor osseous cadaveric ankles, LP demonstrated a mean stiffness of 232.95(SD: 59.96) N/mm, while MS was 239.72(SD:131.09) N/mm (p = 0.9293). For soft tissue cadaveric ankles, LP mean stiffness was 133.58(SD:37.84) N/mm, while MS was 134.88(SD:20.75) N/mm (p = 0.9578). For synthetic ankles, LP mean stiffness was 220.40(SD:81.93) N/mm, while MS was 261.50(SD:100.21) N/mm (p = 0.6116). ConclusionsAcross all three models, there was no significant difference between LP and MS methods. Retrospective observational studies are recommended to assess patient outcomes from each of the methods.

The retropharyngeal reduction plate for atlantoaxial dislocation: a finite element analysis.

Objective: To investigate the biomechanical properties of the retropharyngeal reduction plate by comparing the traditional posterior pedicle screw-rod fixation by finite element analysis. Methods: Two three-dimensional finite element digital models of the retropharyngeal reduction plate and posterior pedicle screw-rod fixation were constructed and validated based on the DICOM (Digital Imaging and Communications in Medicine) data from C1 to C4. The biomechanical finite element analysis values of two internal fixations were measured and calculated under different conditions, including flexion, extension, bending, and rotation. Results: In addition to the backward extension, there was no significant difference in the maximum von Mises stress between the retropharyngeal reduction plate and posterior pedicle screw fixation under other movement conditions. The retropharyngeal reduction plate has a more uniform distribution under different conditions, such as flexion, extension, bending, and rotation. The stress tolerance of the two internal fixations was basically consistent in flexion, extension, left bending, and right bending. Conclusion: The retropharyngeal reduction plate has a relatively good biomechanical stability without obvious stress concentration under different movement conditions. It shows potential as a fixation option for the treatment of atlantoaxial dislocation.

Computational Mechanical Analysis of AO 44A1, 44B1, and 44C1 Fractures with Finite Element Modeling: Evaluation of Screw, Plate, and Kirschner Wire Fixation.

The aim of this study was to create AO 44A1, 44B1, and 44C1 fractures using finite element analysis to determine the stability of Kirschner wire, intramedullary screw, and plate-screw fixation methods in fracture. Using finite element analysis, the postreduction behavior of AO 44A1, 44B1, and 44C1 fractures with Kirschner wire, intramedullary screw, and plate-screw fixation methods was analyzed and compared in terms of displacement and stress. The lowest amount of displacement was provided with the intramedullary screw method in AO 44A1 and 44B1 fractures and with the 4-mm Kirschner wire method in AO 44C1 fractures. The total displacement of the intramedullary screw system used for fixation in AO 44A1, 44B1, and 44C1 fractures was lower. According to finite element analysis results, the lowest amount of displacement was obtained with intramedullary screw fixation in AO 44A1 and 44B1 fractures, and 4-mm Kirschner wire fixation was achieved in AO 44C1 fractures.

Surgical Treatment for Isolated Closed Multi-metatarsal Fractures: At Least 2-Year Outcomes in 79 Feet

Multimetatarsal fractures are a particular type possibly associated with worse functional outcomes. Existing studies are scarce, fragmented, and lack control for confounders. This study aimed to explore the functional prognosis of isolated closed extra-articular multimetatarsal fractures and the different outcomes between the plate-screw and K-wire fixation. This retrospective study included 79 patients who underwent surgery for isolated closed extra-articular multimetatarsal fractures from May 2017 to December 2020. We recorded baseline characteristics. The primary outcome measure was Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Outcome Score (FAOS). Exploratory correlation analysis of the variables with VAS, AOFAS score, and FAOS was performed. The differences between the plate-screw group (n = 58) and K-wire group (n = 21) were compared. Seventy-nine patients (79 feet) were included with a follow-up of (47.3 ± 12.7) months (range, 26-70). Full weight bearing time was (11.7±5.3) weeks. VAS was (1.4±1.8) points, AOFAS score was (86.4±13.3) points, and FAOS was (79.0±11.1) points. Complications were observed in 17 cases (21.5%). According to exploratory correlation analysis, VAS was weakly associated with fixation method and gender, AOFAS was weakly associated with fixation method, FAOS was weakly associated with trauma mechanism. When the plate-screw group (n = 58) was compared with the K-wire group (n = 21), we found the former was superior to the latter in terms of full weight bearing time, VAS, AOFAS score, and malunion rate (all p < .05). FAOS was nonsignificant (p = .056). Operative treatment of isolated closed extra-articular multimetatarsal fractures showed good mid-term results. Plate-screw fixation was associated with faster rehabilitation as well as a lower malunion rate. The mid-term follow-up results showed patients with plate-screw fixation had better VAS and AOFAS scores.

Use of external fixator combined with titanium elastic nails in the treatment of tibia shaft fractures in children

Tibia shaft fractures are common in all age groups. For these fractures; Conservative and surgical treatment methods are available. In surgical treatment, numerous surgical methods such as plate screw fixation, external fixator, and titanium elastic nail and K-wire fixation have been defined. The aim of the present study was to present the results of patients for whom external fixator combined with titanium elastic nails or titanium elastic nails alone were applied due to tibia shaft fractures. The study included 40 patients treated for tibia shaft fracture in our clinic between January 2016 and January 2019. Combined external fixator (EF) fixation was applied to patients who were found to be instable after Titanium elastic nail (TEN) application during the surgery. In clinical evaluation, Flynn classification, time to fracture union, fluoroscopy count, reoperation and time to full weight bearing were used. The results of patients for whom EF combined with TEN were applied were compared with the patients who had only TEN. Thirty patients were treated using TEN and 10 patients using EF combined with TEN. After 12 months of follow-ups, fracture union was achieved in all patients. There were 5% sagittal and 2.5% coronal plane angulation. Patients developed angular deformity of an average of 2.43 ± 1.9 degrees in the coronal plane and 2.65 ± 1.9 degrees in sagittal plane. Lower percentages of angular and rotational deformity were observed compared to the literature. Despite the disadvantages of using a greater number of fluoroscopy and longer operation periods in patients who underwent TEN+EF, these patients were mobilized earlier. It was concluded that combined EF application is a more feasible method in patients with pediatric tibia shaft fracture for whom stable fixation cannot be achieved with TEN.

How can we reduce the ischemic time for forearm replantation? Tips to simplify the bone fixation

PurposeIschemic time is a key factor in satisfactory functional results after forearm replantation. In this study, we provide a detailed description of our surgical technique, the temporary screw plate fixation technique, which aims to reduce ischemic time.MethodsFrom June 2007 to June 2017, we performed a retrospective study of 20 patients who underwent forearm replantation. Eighteen cases involved male patients, and their mean age was 46 years. The mechanism of injury was roller injuries in 5 cases, power saw injuries in 3 cases, traffic accident in 7 cases, rope injuries in 2 cases, machinery injuries in 2 cases, and crushing injuries by rebar beam in 1 case.ResultsA total of 20 replantation patients survived. According to injury level, there were 3 cases of the proximal type, 11 cases of the middle type, and 6 cases of the distal type. The average time to revascularization was 331 min. The total operation time was, on average, 5.73 h. In the rest of the 18 cases, the temporary screw plate fixation technique was performed, and the average time required for bone shortening and plate fixation was 38.3 min.ConclusionsTo reduce ischemic time, we need a plan that progressively reduces time at each stage. Among our tips, temporary screw plate fixation can reduce the initial bone surgical operation to < 40 min, does not have many complications, and can be used as definitive surgery. This method for bone fixation should be considered as a strategy to actively reduce operation time during forearm replantation.Level of evidenceRetrospective study, Level III.

Distal Tibiofibular Malreduction in Ankle Fractures Received Fibula Plate and Syndesmotic Screw Fixation.

The aim of the study was to examine the effect of the position of the plate and syndesmotic screw on postoperative tibiofibular joint malreductions in cases where the syndesmotic screw is inserted through the hole of the anatomically locked lateral distal fibula plate. Thirty patients (13 female and 17 male patients) with postoperative computed tomographic scans were examined retrospectively. Patient information (eg, tibiofibular congruence measured from postoperative computed tomographic scans, the anterior and posterior tibiofibular distance at axial sections, the presence and orientation of fibular rotation, the presence of tibiofibular intraarticular piece, the angle between the syndesmotic screw and incisural line, the placement of the plate, and the localization of the screw on the fibula in axial images) was recorded. Those with fibular internal rotation had a lower syndesmotic screw-incisural line angle (SIA) (P = .001).There was a very strong negative significant correlation between the tibiofibular angle and SIA (rho, -0.780; P = .001). The median tibiofibular angle was found to be higher in cases with the fibula plate placed anteriorly (P = .009).The median SIA was found to be lower in cases with the fibula plate placed anteriorly (P = .004).The rate of placement of syndesmotic screw in the anterior third of the fibula was found to be high in cases with the fibula plate placed anteriorly (P = .049). In ankle fractures treated with insertion of a syndesmotic screw through the plate, the orientation of the syndesmotic screw in the axial plane and the position of the plate may be associated with the incidence of postoperative syndesmosis malreduction.

Stability Analysis of Plate-Screw Fixation for Femoral Midshaft Fractures.

An understanding of the biomechanical characteristics and configuration of flexible and locked plating in order to provide balance stability and flexibility of implant fixation will help to construct and promote fast bone healing. The relationship between applied loading and implantation configuration for best bone healing is still under debate. This study aims to investigate the relationship between implant strength, working length, and interfragmentary strain (εIFM) on implant stability for femoral midshaft transverse fractures. The transverse fracture was fixed with a fragment locking compression plate (LCP) system. Finite element analysis was performed and subsequently characterised based on compression loading (600 N up to 900 N) and screw designs (conventional and locking) with different penetration depths (unicortical and bicortical). Strain theory was used to evaluate the stability of the model. The correlation of screw configuration with screw type shows a unicortical depth for both types (p < 0.01) for 700 N and 800 N loads and (p < 0.05) for configurations 134 and 124. Interfragmentary strain affected only the 600 N load (p < 0.01) for the bicortical conventional type (group BC), and the screw configurations that were influenced were 1234 and 123 (p < 0.05). The low steepness of the slope indicates the least εIFM for the corresponding biomechanical characteristic in good-quality stability. A strain value of ≤2% promotes callus formation and is classified as absolute stability, which is the minimum required value for the induction of callus and the maximum value that allows bony bridging. The outcomes have provided the correlation of screw configuration in femoral midshaft transverse fracture implantation which is important to promote essential primary stability.

Intramedullary Nailing versus Dynamic Screw and Plate for Treatment of Trochanteric Fractures of the Femur

Background Trochanteric and intertrochanteric femur fractures are extracapsular fractures of the proximal femur at the level of the greater and lesser trochanter. Trochanteric fractures in adults mostly affect elderly subjects. Frequency is increasing with population aging despite the development of treatments for osteoporosis. The two most widely used types of internal fixation are intramedullary nailing and screw-plate fixation, often performed by trainee surgeons due to their frequency and reputed simplicity. Aim of the Work The aim of the study is to conduct a systematic review of literature and metaanalysis comparing between intramedullary nailing and dynamic plate and screw in treatment of trochanteric fractures of the femur according to: Length of mean operation time, time of radiation exposure (fluoroscopy time), Intraoperative blood loss, reoperation rate, fracture non-union and postoperative wound infection wither superficial or deep infection. Patients and Methods We followed the PRISMA statement guidelines during this study preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane, and Web of Science, Embase, and Science Direct in June 2021 and updated the search in July 2021 using relevant Keywords. The eligibility inclusion criteria for studies inclusion were the following: (1) Adult patients above 18 years old (2) Double arm designs (3) Studies designs are limited to randomized control trial (RCT) (4) English studies (5) Any outcome is acceptable. The risk of bias was evaluated by the Cochrane handbook of systematic reviews of interventions 5.1.0. Regarding the data extraction, we obtained data from text, tables, figures (using graph grabber version 2.0), and supplementary data. We conducted this metaanalysis by using Review Manager software (RevMan version 5.4). Results Compared to the control group (Dynamic hip screw and plate technique), Intramedullary nailing (IMN) showed a significant improvement in length of operation time (MD = −9.27; 95% CI: [-18.07, -0.47]; P = 0.04) and perioperative blood loss(MD = -120; 95% CI: [-164.05, -77.89]; P &amp;lt; 0.00001) than dynamic hip screw with plate fixation technique. However, in the term of intraoperative radiation exposure time (Fluoroscopy time), dynamic hip screw (DHS) with plate fixation showed a significant lesser fluoroscopy time than IMN(MD = 0.61; 95% CI: [0.23, 0.99]; P = 0.002). Regarding the postoperative patient satisfaction (assessed by visual analogue scale), postoperative Fracture non-union, perioperative wound infection, femur shaft fracture, and hip prosthetic instability, they showed no significant difference between IMN and dynamic hip screw with plate fixation. Reoperation rate also showed no significant difference between IMN and DHS with plate fixation. Conclusion DHS with plate is not the preferred implant for stable intertrochanteric femur fractures. IMN showed a better result than DHS. We believe that the IMN is biologically superior to DHS for fixation of unstable inter-trochanteric fractures as it provides stable intramedullary fixation resistant to varus collapse and fixation failure, with relatively less operation time, and blood loss.

Does intramedullary elastic nail augmentation increase resistance to bending stress in plate fixation of long bones? A biomechanical study on lamb cadaveric femurs.

The aim of this study was to evaluate the bending strength of plate-screw fixation augmented with titanium elastic nails (TENs) in a simple long bone fracture model using lamb cadaver femurs. A total of 24 lamb cadaveric femurs that were osteotomized transversely from the mid-diaphysis with a bone saw were used to obtain a simple fracture model. The femurs were divided randomly into three groups. In Group 1, only plate-screw was used for fixation. In Group 2, plate-screw fixation was augmented with a 2.5-mm TEN. In Group 3, plate-screw fixation was augmented with two 2.5-mm TENs. Each bone model was positioned on a mechanical testing machine. Subsequently, three-point bending loads were applied to each bone to measure the force required for failure at the osteotomy site. The data were recorded on a computer connected to the test device and the bending strengths of all samples were calculated. There was no statistically significant difference in the bending strength (megapascals) between Groups 1 and 2 or between Groups 2 and 3 (p>0.05). However, the bending strength in Group 3 was significantly higher than in Group 1 (p<0.05). The application of intramedullary TEN during surgery in long bone fractures, combined with a bridge plate, may be helpful to strengthen the fixation stability.