Underwent Plate Fixation Research Articles

Superior Versus Anteroinferior Plating of Clavicle Fractures

Plate fixation of displaced clavicle fractures has proven to be reliable and reproducible, leading to high union rates and a low rate of associated complications. However, the decision of whether to place the plate superiorly or anteroinferiorly on the clavicle has remained controversial. The authors performed a retrospective review on a consecutive series of patients who underwent plate fixation for a displaced midshaft clavicle fracture at a Level I urban trauma center. A review of surgical records identified 138 patients with a displaced midshaft clavicle fracture requiring operative stabilization. A total of 105 patients who met the inclusion criteria were included in the analysis. Both superior and anteroinferior techniques resulted in a similar time to radiographic union (12.6±4.8 vs 11.3±5.2 weeks, respectively) and identical union rates (95%). At final follow-up, patient-reported implant prominence was nearly double in patients with a retained superior plate (54% vs 29%, respectively; P=.04). No significant difference existed in mean visual analog scale score at a mean of 2.77 years postoperatively, although a significant difference existed in the Oxford Shoulder Score questionnaire, with a mean score of 41.4 in the superior group and 44.4 in the anteroinferior group (P=.008). Implant removal occurred more frequently after superior plating but was not significant. Both superior and anteroinferior clavicle plating are safe treatment methods for displaced clavicle fractures. Superior plating leads to an increased rate of patient-reported implant prominence and may prompt more requests for implant removal.

Complications of plate fixation of femoral shaft fractures in children and adolescents

This study aims to critically analyze the major and minor complications that may be associated with plate fixation of pediatric diaphyseal femur fractures. The medical records of skeletally immature patients (6-15years of age) who underwent plate fixation of a diaphyseal femur fracture at a tertiary-care level-1 pediatric trauma center between 1/2003 and 12/2010 were reviewed. Demographic and clinical information regarding the mechanism of injury, fracture type, and surgical technique were recorded. Radiographic evaluation of bony healing, hardware position, and deformity was performed throughout the study period. All intraoperative and postoperative complications were recorded. Complication incidence and time from surgery to complication were described. Multivariate logistic regression and multivariate Cox regression models were used to assess the association between different variables and the occurrence of a complication. Kaplan-Meier survivorship curves were used to evaluate the freedom from a complication with longer follow-up. Over an 8-year period, 85 skeletally immature patients (83% males, mean age 10.2 years) underwent plate fixation for diaphyseal femur fractures. Overall, complications were identified in 11 patients (13%). Major complications, defined as those resulting in unplanned reoperation (excluding elective removal of asymptomatic plate/screws), occurred in five patients (6%) and included two patients (2%) with wound infections requiring irrigation and debridement, two patients (2%) with distal femoral valgus deformity (DFVD) leading to osteotomy and hardware removal, respectively, and one patient (1%) with a 3-cm leg length discrepancy (LLD) requiring epiphysiodesis. Minor complications, defined as those not requiring unplanned operative intervention, occurred in six patients (7%) and included two patients (2%) with delayed union, two patients (2%) with symptomatic screw prominence, one patient (1%) with a superficial wound infection effectively treated with oral antibiotics, and one patient (1%) with valgus malunion, which was asymptomatic at early follow-up. There were no intraoperative complications and no reports of postoperative knee stiffness, shortening, or reoperations to address fracture stability. Fifty-two patients (61%) underwent routineelective removal of hardware without related complications following fracture union. Overall, complications occurred postoperatively at a mean time of 20months (range 0-65months), though major complications occurred at a later time point (mean 29.1months, range 0-65months) than minor complications (mean 12.5months, range 0-40.1months). Longer follow-up was associated with higher occurrence of a complication [p=0.0012, odds ratio=1.05, 95% confidence interval (CI): 1.02-1.08]. The plating of pediatric femur fractures is associated with 6 and 7% rates of major and minor complications, respectively. There were minimal long-term sequelae associated with the complications noted. This complication rate compares favorably with the published rate of complications (10-62%) associated with titanium elastic nail fixation of similar fracture types. Most complications occurred >4months postoperatively, with major complications occurring at a later time point than minor complications. Long-term follow-up of these patients is recommended to ensure that complications do not go undetected. Retrospective case series, Level IV.

Distal Femoral Valgus Deformity Following Plate Fixation of Pediatric Femoral Shaft Fractures

This study investigated the frequency and potential risk factors associated with the development of distal femoral valgus deformity following plate fixation of diaphyseal femoral fractures in children. Records of eighty-five skeletally immature patients who underwent plate fixation of a diaphyseal femoral fracture at a tertiary-care pediatric center from January 2003 to December 2010 were reviewed. Demographic data and clinical information were analyzed. Radiographic measurement of the distance from the distal plate edge to the distal femoral physis and of the anatomic lateral distal femoral angle was performed. Development of distal femoral valgus deformity was defined as a change in the anatomic lateral distal femoral angle of ≥5° in the valgus direction. Logistic regression analysis and contingency tables were used to relate the development of distal femoral valgus deformity with retention of hardware, patient age, fracture site, plate-to-physis distance, and the location of a bend in the plate at fixation. Midshaft fractures (45%) were more common than proximal or distal diaphyseal fractures. Intraoperatively, the plate was bent proximally or distally, or both, in 80% of the patients. Distal femoral valgus deformity of ≥5° was seen in ten patients, eight of whom had distal diaphyseal fractures. Three of the ten patients developed symptoms as a result of the distal femoral valgus deformity that required at least one unplanned additional surgical procedure. On the basis of the statistical analysis, patients with a plate-to-physis distance of ≤20 mm (relative risk= 12.77, p = 0.005) and a distal fracture (relative risk = 11.0, p < 0.001) were at a significantly higher risk of developing distal femoral valgus deformity. Although not clearly an independent factor, a distal bend was also found to be associated with distal femoral valgus deformity (p = 0.004) but was not predictive of the pathology. Distal femoral valgus deformity occurred in 30% of patients with distal diaphyseal fractures and in 12% overall. We advocate long-term monitoring of patients with femoral plate fixation, particularly those in whom the plate is placed ≤20 mm from the distal femoral physis.

Comparison of Clinical Results according to the Complications after or during Open Door Laminoplasty Surgery for Cervical Myelopathy

Purpose: The purpose of this study is to compare and analyze the clinical results according to the complications occurring after laminoplasty for cervical myelopathy patients. Materials and Methods: Among patients diagnosed as cervical myelopathy, 152 cases in which patients underwent cervical laminoplasty from March 2006 to March 2011 from Chungnam National University Hospital and had follow-up for at least two years were selected for the study, and the mean follow-up period was 39.7 months. The cases were divided into two groups; cases that underwent plate fixation for hinge fracture during cervical laminoplasty or showed postoperative spontaneous interlamina fusion were included in group A and cases that did not show such complications were included in group B. Clinical results were measured using visual analogue scale (VAS) score and Neck Disability Index (NDI) preoperatively, postoperatively, and on the final follow-up. Results: Among 152 cases, 31 cases were included in group A and 121 cases in group B. Group A consisted of 11 cases of fixation due to intraoperative hinge fracture and 20 cases of postoperative spontaneous interlamina fusion. Mean preoperative VAS score was 7.52 in group A and 7.26 in group B, and mean postoperative VAS score was 2.87 in group A and 3.03 in group B. Mean NDI improved from 74.32% preoperatively to 43.84% postoperatively in group A and 75.74% preoperatively to 45.36% postoperatively in group B. In both groups, on postoperative follow-up, no significant difference of VAS score and NDI was found and both showed improvement compared to before surgery. Conclusion: The clinical results of cases that underwent plate fixation for hinge fracture that occurred during cervical laminoplasty and postoperative spontaneous interlamina fusion showed no significant difference compared to cases that did not show any complications.

Proximal to Middle One-Third Humerus Shaft Fractures may Lead to Poorer Shoulder Function Compared to Middle to Distal One-Third Humerus Shaft Fractures following Internal Fixation

Background The radiographic and functional outcomes following an anterior approach for plate fixation of humeral shaft fractures were evaluated and compared with those of a group having undergone plate fixation from a posterior approach. The hypothesis was that there would be no significant difference between these two groups in shoulder, elbow and overall upper extremity function. Methods We retrospectively reviewed radiographs and data for 78 humerus shaft fractures. Twenty-six patients returned to complete the Constant–Murley Score (CMS), Simple Shoulder Test (SST), Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results The overall median CMS [76.5 (A) versus 83.5 (P)] approached a significant difference between anterior and posterior fixation groups ( p = 0.07). Active shoulder elevation was significantly better ( p = 0.03) in the posterior group. There was no significant difference in median DASH score ( p = 0.51), MEPS score ( p = 0.69), nor in 10 of 12 individual responses on the SST. Fracture union rate was 97%. Discussion Anterior fixation of humeral shaft fractures yields satisfactory upper extremity functional outcomes that are comparable to those of extremities that have undergone posterior fixation. However, shoulder function tends to be better following posterior fixation, possibly as a result of anterior approaches being more commonly performed for more proximal shaft fractures.

Post-operative numbness and patient satisfaction following plate fixation of clavicular fractures

Introduction and aim Numbness across the shoulder and upper chest wall is a frequent complication following plate fixation of clavicular shaft fractures. This is usually attributed to damage to branches of the supraclavicular nerve caused by the surgical approach. We investigate whether the use of an incision perpendicular to the long axis of the clavicle (vertical incision) rather than one parallel to it (horizontal incision) is associated with reduced post-operative numbness and improved patient satisfaction. Methods We retrospectively assessed a group of patients who underwent plate fixation of a fractured clavicle at our institution. Using a patient-completed questionnaire, we compared differences in numbness, scar satisfaction, pain, and overall satisfaction with the operation, between those who received a horizontal incision ( n = 21) versus those treated using a vertical incision ( n = 14). Results The likelihood of experiencing post-operative numbness was less in the vertical incision group. Those who had undergone vertical incisions also reported a significantly reduced degree of numbness and significantly less awareness of the numbness with clothing and shoulder straps. There was no statistically significant difference between the groups in terms of pain and scar satisfaction. Patients who reported being most bothered by their numbness also tended to report the highest dissatisfaction with the operation. Conclusion Vertical incisions for plate fixation of clavicular shaft fractures may be associated with reduced post-operative numbness and avoid some cases of patient dissatisfaction. Surgeons should consider using this approach in plate fixation of clavicle fractures.

Lessons Learned From a Case of Proximal Humeral Locked Plating Gone Awry

A 59-year-old woman underwent plate fixation of her 2-part anatomic neck proximal humerus fracture through an open anterolateral approach. The fixation subsequently failed, and the operation resulted in a dense axillary nerve palsy. Six weeks after her initial procedure, she was returned to the operating room. Exploration of the nerve revealed that it was compressed beneath the plate and irreparably damaged. Sural nerve cable grafting was required in an attempt to salvage deltoid function. The recent introduction of proximal humeral locking plates provides an opportunity for surgeons to reevaluate their methods of managing proximal humerus fractures. Indications for operative fixation have broadened, and a renewed interest in the anterolateral surgical approach has been reported. This case is the first description of an axillary nerve injury occurring in association with the open anterolateral approach when used for the treatment of a proximal humerus fracture and serves as a reminder that surgeons considering the use of a lateral approach must have a thorough understanding of axillary nerve anatomy. An additional review of the case provides a forum for discussion of the anterolateral approach to the proximal humerus and an opportunity to highlight the methods that can be used to optimize fixation when locked plates are employed. It must be emphasized that our enthusiasm for advances in technique and technology should not distract from basic surgical principles when treating these fractures.

근위 상완골 골절에서 잠김 압박 금속판과 비잠김 금속판 고정의 방사선학적 임상적 추시 결과 비교

Purpose: The purpose of this study is to compare the results of using a locking compression plate and an unlocked plate for treating proximal humeral fractures. Materials and Methods: This study was based on 20 patients who underwent plate fixation for proximal humeral fractures out of the 87 patients with proximal humeral fractures and who were admitted from 2003 to 2007 in our hospital. Of the 20 patients, 10 were treated with a locking compression plate and the other 10 were treated with an unlocked plate. Each group was evaluated according to the humeral neck shaft angle, the period until bony union, the complications and the Constant score. The humeral neck shaft angle was based on plain x-rays taken immediately after the operation and at 6 months postoperatively. The Constant score was evaluated on the last visit to our clinic. Results: There was no significant statistical difference between the two groups in terms of the neck shaft angle, the period until bony union and the Constant score. Yet, there were three cases of screw migration in the unlocked plate group. Conclusion: There was no significant difference between the two groups in terms of the neck shaft angle, the period until bony union and the Constant score. The locking compression plate is considered to achieve more effective fixation for proximal humerus fractures because there were less complications such as screw migration.

Treatment of Metacarpal Fractures using Transverse Kirschner-wire Fixation

Purpose: To analyze the clinical results of transverse Kirschner (K)-wire fixation for metacarpal fractures. Materials and Methods: Between May 2002 and May 2005, thirty-four cases (thirty-nine fingers) of unstable metacarpal fractures underwent a closed reduction and transverse K-wire fixation. The neck, shaft and base fractures of the metacarpals except the thumb were included. The follow-up period ranged from 12 months to 3 years and 4 months (mean; 2 years and 1 month). Interfragmentary fixation was performed on 24 cases. A short arm splint was maintained until postoperative 4 weeks, after which the full range of motion was permitted. The K-wires were removed after achieving the full-range of motion or pin-site infection. Results: At the last follow-up, there was no limitation of motion and discomfort during the daily living activities. Five cases had skin problems around the tip of the K-wire. All cases, except for three cases with angulation over 20 degrees, had achieved the union under five degrees (average 3.24 degrees dorsal angulation). Three cases had minimal rotational deformities but they did not complain of discomfort. The one case of nonunion, in whom the K-wires had been removed four weeks after surgery, underwent plate fixation and a bone graft. Conclusion: Transverse K-wire fixation and additional interfragmentary fixation of the metacarpal fractures can allow the full range of motion without the need to remove the K-wires. The clinical results were excellent.

Outcome of plate fixation of olecranon fractures.

To evaluate the functional outcome of plate fixation for displaced olecranon fractures, both simple and comminuted. Retrospective patient, chart, and radiographic review. Academic teaching hospital. Twenty-five patients who underwent plate fixation of displaced olecranon fractures by two surgeons were independently reviewed at an average follow-up of thirty-four months (range, 15-69 months). Physical capability was assessed by measuring range of motion and isometric elbow strength. Patient-rated outcomes were evaluated using the SF-36, DASH, Mayo Elbow Performance Index (MEPI), and visual analogue scales for patient satisfaction and pain. Radiographs were evaluated preoperatively, postoperatively, and at the time of final review. The average patient age was fifty-four years (range, 14-81 years). The Mayo classification of fractures was fourteen Type II and eleven Type III. An adequate reduction was maintained in all elbows until union. Physical capability measures indicated nonsignificant side-to-side differences in motion or strength, except for supination motion, which was reduced in the injured arm (p = 0.003). The MEPI-rated outcome was twenty-two excellent or good. Patient satisfaction was high (9.7/10), with a low pain rating (1/10). The mean DASH score was consistent with almost normal upper extremity function. The SF-36 showed no difference in physical health as compared with the average American population. Twenty percent of patients required plate removal because of prominence of the internal fixation. The outcome was not influenced by fracture pattern. Plate fixation is an effective treatment option for displaced olecranon fractures with a good functional outcome and a low incidence of complications.