Functional Outcome of Forearm Fractures Managed With Screw Nails vs. Dynamic Compression Plates: A Prospective Study.

Background Fractures of the forearm are very frequently encountered in day-to-day practice. These fractures have a bimodal age distribution. The forearm fractures are considered intra-articular and need absolute stability for adequate healing. The current treatment modalities include using intramedullary devices such as a square nail, locking intramedullary nail, or using a plate for fixation. In this study, we aim to determine the functional outcome of forearm fractures managed with a screw nail used as an intramedullary device as compared to a locking plate using the Grace-Eversmann criteria. Methodology Patients with forearm fractures were divided into two groups and treated with a screw nail and a dynamic compression plate. Patients were followed up at one month, three months, six months, and one year postoperatively and assessment was done using the Grace-Eversmann criteria. Results The study included a total of 30 subjects, ranging in age from 18 to 65. The majority of the patients had encountered a road traffic accident, following which they incurred a forearm fracture. Grace-Eversmann criteria was used for these patients at follow-up, and a total of 13 patients (86.6%) had good to excellent scores, which was similar when compared to the plate osteosynthesis group (86.6%). A significant difference in the amount of blood loss was noted in the screw nail osteosynthesis group as compared to the plate osteosynthesis group (p<0.05). Conclusions Though a dynamic compression plate is considered a standard method for fixation of the forearm fractures, the use of an intramedullary screw nail as a fixation device gives a similar result with excellent functional outcomes (Grace-Eversmann criteria). It also gives an added benefit of reduced blood loss and preservation of fracture biology.

Assessing functional and radiological outcomes: open reduction and internal fixation vs. minimally invasive plate osteosynthesis for humerus shaft fractures - a prospective comparative study.

PURPOSE: To analyse and compare the functional and radiological outcome of different methods of surgical management of humerus shaft fractures in 30 patients treated by conventional open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). METHODS: This prospective interventional study was conducted among 30 patients by dividing into two equal groups over one year and six months. All patients were followed up for a minimum of at least six months. Radiological outcome was assessed using fracture union in serial radiographs and functional outcome was measured using DASH scoring. RESULTS: The majority of patients (26.7%) were between 18 to 30 years, overall mean age was 44.4 years, most of the patients (50%) had 12A3 AO type fractures, and 73.3% of patients had injuries following two-wheeler road traffic accidents. On comparing multiple factors, we found a statistically significant reduction of intra-operative blood loss in MIPO compared to ORIF. Though time taken for fracture union, functional outcome and complication rate were better in MIPO when compared to ORIF, these differences were not statistically significant. two patients in the MIPO group and one patient in the ORIF group had a peri-implant fracture following slip and fall again within the study period and underwent Revision plating. Excluding cases of peri-implant fractures, out of 13 patients in the MIPO group, only one patient developed fracture non-union. Of 14 patients in the ORIF group, three developed fracture non-union. CONCLUSION: MIPO is a safe, reproducible, efficient and good if not a better alternative to ORIF as it offers good radiological and functional outcomes with advantages of minimal soft tissue damage, minimal blood loss, better cosmesis, no incidence of radial nerve palsy and with few concerns such as the need for fluoroscopy, and a learning curve.

A Dilemma in the Management of Distal Tibia Fractures Solved by Minimally Invasive Percutaneous Plate Osteosynthesis Technique: A Prospective Study.

Introduction Managing distal tibia fractures is challenging for trauma surgeons because of their peculiar anatomy with less soft tissue coverage and poor blood supply. There are various treatment options for distal tibia fractures such as open reduction and plating, minimally invasive percutaneous plate osteosynthesis, and intramedullary interlocking nailing. Open reduction and internal fixation can lead to excessive soft tissue dissection and devascularization of fracture fragments. We conducted a study on the functional outcome of distal tibia fractures treated by biological fixation with minimally invasive percutaneous plate osteosynthesis. Methods A total of 23 patients with distal one-third tibia fractures, fulfilling the inclusion criteria, who were treated at St. John's Medical College Hospital with minimally invasive percutaneous plate osteosynthesis between November 2020 and November 2022 were studied using the American Orthopaedic Foot & Ankle Society (AOFAS) score at six weeks, three months, and six months postoperative follow-up. Results This study included 17 males and six females. The mean age of the study participants was 43.78 years, with most of the participants being in the age group between 51 and 60 years (29.2%, n = 7). All the study participants were employed. The mean operative time was two hours and 10 minutes. The mean duration for the radiological union was 22 weeks. The mean AOFAS score at six months was 92.43 + 5.696. There was only one case of superficial infection, which was treated with intravenous antibiotics. There were no cases of malunion/nonunion. Conclusion Minimally invasive percutaneous plate osteosynthesis is an effective treatment for distal tibia fractures avoiding most of the complications such as wound dehiscence and malunion/nonunion involved in conventional open reduction and internal fixation with plating. Therefore, we recommend this technique for all distal tibia fractures.

Anterior medial minimally invasive plate osteosynthesis for humeral shaft fractures shows superior early shoulder and elbow function compared to locking compression plate: A retrospective study.

INTRODUCTION: Humeral shaft fractures are a common injury of the upper limb, with the primary surgical treatment modality being the locking compression plate (LCP) technique. The advent of Anterior medial minimally invasive plate osteosynthesis (MIPO) technology has led to its gradual implementation in clinical practice. However, the efficacy and long-term outcomes of MIPO require further investigation. The objective of this study is to compare the therapeutic effects of LCP and MIPO in the management of humeral shaft fractures. METHODS: The present study conducted a retrospective review of patients diagnosed with humeral shaft fractures between June 2016 and December 2019. The patients were divided into MIPO and LCP groups based on the different surgical methods. The study analyzed the length of hospital stay, radiation exposure, operative time, and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores using statistical methods. RESULTS: A total of 53 patients who met the inclusion criteria were included in the study. The MIPO group demonstrated a statistically significant reduction in length of hospital stay compared to the LCP group (length of hospital stay: 5.39 ± 2.23 days vs 12.00 ± 7.19 days, P < 0.001). All patients achieved callus formation after surgery. However, the MIPO group had significantly more radiation exposures than the LCP group (45.96 ± 19.49 vs 5.33 ± 2.20, P < 0.001). Additionally, there was no statistically significant difference observed in the time from admission to surgery, operative time,and healing time between the two groups (the time from admission to surgery: P = 0.593; operative time: P = 0.407; Healing time: P = 0.664). During the postoperative follow-up, the MIPO group exhibited significantly lower 6-week and 3-month DASH scores compared to the LCP group (6-week: 34.17 ± 12.16 vs 45.65 ± 22.94, P = 0.028; 3-month: 17.43 ± 11.70 vs 30.12 ± 9.80, P < 0.001). However, there was no statistically significant difference in the 6-month and 12-month DASH scores between the two groups (6-month: P = 0.787; 12-month: P = 0.058). CONCLUSION: The MIPO technique provides better short-term functional recovery of the shoulder and elbow compared to the LCP technique in the treatment of humeral shaft fractures, while ensuring equivalent surgical healing.

Functional outcomes and complications of plate fixation for midshaft clavicle fractures by type and location: a systematic review and meta-analysis.

Background: Various plate types are used in the surgical treatment of displaced midshaft clavicle fractures. These plates can be positioned in different locations on the clavicle, although no studies to date have elucidated optimal plate type and location of fixation. This systematic review compares the functional outcomes and complications in the management of displaced midshaft clavicle fractures using plate fixation by stratifying by both plate type and location. Methods: A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to identify all papers reporting functional outcomes, union rates, and/or complications using plates for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until March 2022. A meta-analysis was conducted for functional outcomes and type of complication, stratified by plate type (locking, compression, or reconstruction) and location (superior or anteroinferior). Pooled estimates of functional outcome scores and incidence of complications were calculated using a random effects model. Risk of bias and quality were assessed using the risk of bias version 2 and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tools. The confidence in estimates were rated and described according to the recommendations of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) working group. Results: Forty-five studies were included in the systematic review and 43 were included in the meta-analysis. Depending on plate type and location, pooled Constant-Murley Scores ranged from 89.23 to 93.48 at 12 months. Nonunion rates were 3% (95% confidence interval [CI] 1-6) for superior locking plates (GRADE Low). Rates of any complication (nonunion, hardware failure, hardware irritation, wound dehiscence, keloid, superficial infection, deep infection, delayed union, malunion, and/or persistent pain) by plate type and location ranged from 3% to 17% (GRADE Very Low to Moderate). Superior compression plates had the highest incidence of any complications (17% [95% CI 5-44], GRADE Very Low), while anterior inferior compression plates had the lowest incidence of any complication (3% [95% CI 0-15], GRADE Very Low). Hardware irritation was the most reported individual complication for superior locking plates and superior compression plates, 11% (95% CI 7-17, GRADE Low) and 11% (95% CI 3-33, GRADE Very Low), respectively. Conclusion: Although most studies were of low quality, studies reporting functional outcomes generally showed good functional results and similar incidence of any complication regardless of plate type and location. There is no evidence of a plate and location combination to optimize patient functional outcomes or complications. We were unable to reliably evaluate union rates or individual complications for most plate types stratified by location.

Usefulness of double plate fixation after failed ORIF for clavicle shaft fracture.

PURPOSE: We aimed to evaluate the clinical and radiological outcomes of double plate fixation for failed clavicle shaft fracture surgery. MATERIALS AND METHODS: We analyzed 14 patients who underwent double plate fixation due to plate failure after clavicle shaft fracture surgery from March 2016 to March 2021. The study used 3.5 mm locking compression plates for superior clavicle and anterior reconstruction in all patients. In addition, moldable allograft bone was used to fill the bone defect. Clinical and radiological evaluation was performed immediately, at 2 and 4 weeks, and 3, 6, 9, and 12 months postoperatively. The visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder scale, and American Shoulder and Elbow Surgeons (ASES) scores and range of motion of the shoulder were evaluated as clinical results. For radiological evaluation, anteroposterior, caudal, and cephalad views of both clavicles were used. Successful bone union was defined as complete adjoining of the fracture site through callus formation. RESULTS: Successful bone union was achieved in all patients, and the mean time to bone union was 16.7 ± 1.2 weeks (range, 12-24 weeks). Statistically significant improvement in forward flexion and external and internal rotation was observed from 135.5° ± 6.3, 45.2° ± 5.3, and 13° ± 2.3 preoperatively to 157.0° ± 9.3, 68.7° ± 6.3, and 9.8° ± 3.1 at the final follow-up, respectively. The VAS score improved from an average of 6.2 ± 2.8 preoperatively to 1.3 ± 0.7 at the final follow-up, which was statistically significant (P = 0.018). In addition, the ASES score significantly increased from a mean of 52.1 ± 6.3 points preoperatively to 83.6 ± 7.8 points at the final follow-up (P = 0.001). The average UCLA shoulder score was 16.7 ± 1.4 and 31.4 ± 2.2 points preoperatively and at the final follow-up, respectively, which was statistically significant (P = 0.001). CONCLUSION: Double plate fixation has shown good results after failed open reduction and internal fixation (ORIF) for clavicle shaft fractures. Therefore, in complicated situations after ORIF, double plate fixation is considered a surgical treatment option.

Comparative Outcomes of Elastic Stable Intramedullary Nailing vs. Plate Fixation in Pediatric Femoral Shaft Fractures. A Prospective Study.

BACKGROUND: Pediatric femoral fractures are common in emergency rooms, with treatment options varying by age. This study compares elastic stable intramedullary nailing (ESIN) and plate fixation for diaphyseal femoral fractures in children aged 5-10. MATERIAL AND METHODS: Conducted at Al-Kindi Teaching Hospital, Baghdad, from December 2017 to December 2019, this prospective study included 32 children with closed transverse diaphyseal femoral fractures. Patients were divided into two groups: 16 treated with ESIN (Group 1) and 16 with plate fixation (Group 2). Criteria excluded comminuted, open, or pathological fractures. RESULTS: Group 1 had a mean age of 7.1 years and weight of 23.7 kg; Group 2 had a mean age of 7.8 years and weight of 30.9 kg. ESIN resulted in shorter operative times (58.4 minutes), earlier weight-bearing, and quicker fracture union (8.8 weeks) compared to plate fixation (76.3 minutes, 11.9 weeks). Blood loss was significantly less in Group 1 (32.8 ml) versus Group 2 (205.0 ml). No significant differences in wound healing or leg length discrepancies were observed. CONCLUSIONS: 1. Our study indicates a preference for Elastic Stable Intramedullary Nailing (ESIN) over plate fixation for pediatric femoral shaft fractures in children aged 5-10 years. 2. ESIN is associated with shorter operative times and faster commencement of weight-bearing, critical in pediatric recovery. 3. While ESIN is generally preferable, plate fixation may be better suited in certain clinical scenarios, emphasizing the importance of personalized treatment. 4. Based on our findings, ESIN is recommended for treating transverse diaphyseal femur fractures in the specified pediatric age group. 5. Recommends further studies, including randomized controlled trials, for a more comprehensive understanding of these treatments' long-term outcomes.

Evaluation of the Stability of Internal Fixation Constructs in a Low Distal Tibia Extra-articular Cadaveric Fracture Model: A Comparative Biomechanical Study.

Introduction Despite the recent advances in implant design, the choice of an internal fixation modality for extra-articular distal tibia fractures remains controversial, and there is sparse literature comparing the stability of intramedullary nails and locked plates for such fractures. Hence, we conducted a biomechanical study on an AO type 43A3 tibia fracture cadaveric model stabilized by four different constructs, viz., intramedullary (IM) interlocking nail, anteromedial plate, anterolateral plate, and posterior plate. An AO type 43A3 fracture is defined as an extra-articular fracture of the distal tibia with metaphyseal comminution. Methods A biomechanical comparative study on formalin-preserved human cadaveric tibiae was undertaken; a total of four groups were tested, with eight bones in each group. Out of the 32 cadaveric tibiae, 19 bones belonged to male cadavers, and 13 bones belonged to female cadavers. All bones were dissected from age-appropriate cadavers and fixed with an implant, followed by the creation of a 1 cm osteotomy to simulate an AO type 43A3 fracture. All fixation constructs were subjected to three-point bending tests in the anteroposterior (AP) and mediolateral (ML) planes. Three parameters, viz., bending stiffness, peak fracture gap angle, and neutral zone, were evaluated on the load-displacement curves. A fixation construct was deemed biomechanically stable if it had a high bending stiffness, a low neutral zone (inherent toggle in the construct by its weight), and a low peak fracture gap angle. Results Out of the four implants tested, locked IM nails exhibited the maximum biomechanical stability in terms of higher bending stiffness, smaller peak fracture gap angle, and smaller neutral zones. The IM nail exhibited the highest bending stiffness in the AP plane, and the anterolateral plate had the lowest bending stiffness, and the difference was statistically significant (p= 0.032). In the AP plane, the anterolateral plate exhibited a bending stiffness of 1.51 ± 0.69 Nm/degree, whereas the intramedullary nail exhibited a bending stiffness of 2.34 ± 0.81 Nm/degree, and the posterior locked plate had a bending stiffness of 1.57 ± 0.44 Nm/degree. In the ML plane, the anterolateral plate exhibited the highest neutral zone as compared to the intramedullary nail, which had the lowest neutral zone, and the difference was statistically significant (p = 0.019). The intramedullary nail exhibited the lowest neutral zone of 0.46 ± 0.31 degrees, whereas the posterior locked plate exhibited a neutral zone of 0.78 ± 0.43 degrees in the ML plane. The anterolateral plate exhibited a neutral zone of 1.43 ± 1.00 (expressed as mean ± SD) degrees in the mediolateral plane. Conclusion Our biomechanical study supports the recommendations of using a locked intramedullary nail for AO type 43A3 fractures. We concluded that the anterolateral plate construct exhibited the least biomechanical stability, in terms of lower AP bending stiffness and higher neutral zone. If the surgeon must choose a locked plating technique for any reason, the anterolateral locking plate should be avoided. If plating is at all required, we can recommend both anteromedial and posterior locked plating as biomechanically sound options.

Biomechanical analysis of combi-hole locking compression plate during fracture healing: A numerical study of screw configuration.

Locking compression plates (LCPs) have become a widely used option for treating femur bone fractures. However, the optimal screw configuration with combi-holes remains a subject of debate. The study aims to create a time-dependent finite element (FE) model to assess the impacts of different screw configurations on LCP fixation stiffness and healing efficiency across four healing stages during a complete fracture healing process. To simulate the healing process, we integrated a time-dependent callus formation mechanism into a FE model of the LCP with combi-holes. Three screw configuration parameters, namely working length, screw number, and screw position, were investigated. Increasing the working length negatively affected axial stiffness and healing efficiency (p < 0.001), while screw number or position had no significant impact (p > 0.01). The time-dependent model displayed a moderate correlation with the conventional time-independent model for axial stiffness and healing efficiency (ρ ≥ 0.733, p ≤ 0.025). The highest healing efficiency (95.2%) was observed in screw configuration C125 during the 4-8-week period. The results provide insights into managing fractures using LCPs with combi-holes over an extended duration. Under axial compressive loading conditions, the use of the C125 screw configuration can enhance callus formation during the 4-12-week period for transverse fractures. When employing the C12345 configuration, it becomes crucial to avoid overconstraint during the 4-8-week period.

Mechanics of dynamic compression plate application in fracture fixation.

BACKGROUND: Dynamic compression plating is a fundamental type of bone fracture fixation used to generate interfragmentary compression. The goal of this study was to investigate the mechanics of the surgical application of these plates, specifically how plate prebend, screw location, fracture gap, and applied torque influence the resulting compressive pressures. METHODS: Synthetic bones with transverse fractures were fixed with locking compression plates. One side of the fracture was fixed with locking screws. On the other side of the fracture, a nonlocking screw was inserted eccentrically to induce interfragmentary compression. A pressure mapping sensor within the fracture gap was used to record the resulting pressure distribution. Plate prebends of 0 mm, 1.5 mm, and 3 mm were tested. Three locations of the eccentric screw, four levels of screw torque, and two initial fracture gap conditions also were tested. FINDINGS: With increasing plate prebend, fracture compression pressures shifted significantly toward the far cortex; however, compression force decreased (P < 0.05). The 1.5 mm prebend plate resulted in the greatest contact area. Increasing screw torque generally resulted in greater fracture compression force. The introduction of a 1 mm fracture gap at the far cortex prior to dynamic compression resulted in little or no fracture compression. INTERPRETATION: The model showed that increasing plate prebend results in an increasing shift of fracture compression pressures toward the far cortex; however, this is accompanied by decreases in compressive force. Initial fracture gaps at the far cortex can result in little or no compression.

The application of inverted lateral clavicle locking compression plate for medial clavicle fractures: biomechanical study and clinical implementation.

BACKGROUND: There has been no absolute consensus on the optimal implant for fixation of medial clavicle fracture. The purpose of the present study was to test the biomechanical efficacy of inverted lateral clavicle locking compression plate (LCP-LC) in fixation of this specific fracture location by finite element analysis. METHODS: Transverse and comminuted medial clavicle fracture simulated models stabilized by three different devices including inverted LCP-LC, superior clavicle LCP (LCP-SC), and dual reconstruction (LCP-RP) with LCP-SC were investigated biomechanical performance under three loading conditions, i.e., axial compression, inferior bending, and axial torsion. RESULTS: EQV stress exhibited on implant and elastic strain at fracture site under inferior bending was greater than other loading cases. LCP-SC construct represented the greatest EQV stress and elastic strain. The inverted LCP-LC construct demonstrated lower EQV stress than the LCP-SC construct and was comparable to dual plating. Under axial compression and axial torsion, elastic strain produced from the inverted LCP-LC construct was comparable to dual plating, but greater than dual plating when subjected to inferior bending. CONCLUSION: By the results of FE analysis, inverted LCP-LC could be a potential application for fixation of clavicle fracture with short medial fragment.

Precontoured dynamic compression plate using patient-specific 3D-printed models in minimally invasive surgical technique for midshaft clavicle fractures.

INTRODUCTION: This study introduced a novel approach for the treatment of midshaft clavicle fractures, utilizing patient-specific 3D-printed models for accurate preoperative contouring of dynamic compression plates (DCPs) and an alternative minimally invasive plate osteosynthesis (MIPO) technique with precontoured DCPs through small vertical separated incisions. PATIENT AND METHODS: Mirror image 3D clavicular models were reproduced from 40 patients with acute displaced midshaft clavicle fractures who underwent MIPO using precontoured DCPs inserted through small, vertical separated incisions. Exclusion criteria included patients with open fractures, pathological fractures, ipsilateral limb injury, skeletal immature patients, and those who had previous clavicle fractures or surgery. Postoperative evaluation was conducted using clinical and radiographic review. The Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were used for clinical evaluations, and the Patient and Observer Scar Assessment Scale was used to assess surgical scars. RESULTS: The average time to union of all fractures was 12.88 weeks (range, 8-15) without loss of reduction. The patient-specific precontoured DCPs fitted well in all cases, with fracture consolidation and minimal three cortical sides connecting the fracture fragment. No hardware prominence and skin complications occurred, and clinical evaluation showed no existing difference compared with the contralateral sides. The average Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were 96.33 ± 3.66 and 93.26 ± 5.15, respectively. Two patients requested their implant removal, and scar qualities were satisfactory. CONCLUSIONS: Our study demonstrated that the use of a patient-specific precontoured DCP, in combination with 3D printing technology, provides accurate preoperative planning, effective fracture reduction, and improved postoperative outcomes in displaced midshaft clavicle fractures. The MIPO with a patient-specific precontoured DCP through separated vertical incisions along the Langer's lines appears to be a promising option, regarding appearance, avoiding associated complications, and obviating the need for reoperation. These results suggest that this technique has merit and can be a viable option for the treatment of midshaft clavicle fractures.

Outcomes of spring-locking plate fixation method using locking mesh plate/box plate for posterior wall fractures of the acetabulum: a retrospective single-centre study.

INTRODUCTION: This retrospective study evaluated the outcomes of variable-angle locking compression plate, mesh plate, or footplate box fixation for posterior acetabular wall fractures. PATIENTS AND METHODS: The study included nine patients with unstable posterior acetabular wall fractures who underwent internal fixation with the "spring-locking plate fixation method" between January 2015 and December 2019. Patient demographics, fracture classifications, surgical details, radiological and clinical evaluations, and complications were collected from electronic medical records. Statistical analyses were performed to assess the relationship between preoperative and postoperative dislocations. RESULTS: The mean age of the patients was 46 years, and the majority were men (88.9%). Fracture types included posterior wall fractures and posterior column plus posterior wall fractures. The mean operative time was 246 min and the mean blood loss was 663 mL. The surgical approaches included the Kocher-Langenbeck, Ganz trochanteric flip, and transtrochanteric approaches. Variable-angle locking compression plate mesh plates and footplate box type implants were used for fixation. The mean preoperative dislocation was 23 mm, which was significantly reduced to 1 mm immediately post-operation and at the final observation. The bone fusion rate was 100% and radiological and clinical evaluations revealed favourable outcomes. Complications were minimal, with mild heterotopic ossification observed in four patients. CONCLUSION: The spring-locking plate fixation method demonstrated satisfactory outcomes for the treatment of posterior acetabular wall fractures. This technique provides rigid fixation. Furthermore, the use of variable-angle locking screws minimizes the risk of intra-articular perforations. Despite limitations such as a small sample size and the absence of a control group, the results suggest that the spring-locking plate fixation method may be valuable in managing these fractures.

Comparative analysis of external locking plate and combined frame external fixator for open distal tibial fractures: a comprehensive assessment of clinical outcomes and financial implications.

BACKGROUND: Open distal tibial fractures pose significant challenges regarding treatment options and patient outcomes. This retrospective single-centre study aimed to compare the stability, clinical outcomes, complications, and financial implications of two surgical interventions, namely the external locking plate and the combined frame external fixator, to manage open distal tibial fractures. METHODS: Forty-four patients with distal open tibial (metaphyseal extraarticular) fractures treated between 2020 and 2022 were selected and formed into two main groups, Group A and Group B. Group A (19 patients) are patients that underwent treatment using the external locking plate technique, while Group B (25 patients) received the combined frame external fixator approach. Age, gender, inpatient stay, re-operation rates, complications, functional recovery (measured by the Johner-Wrush score), pain ratings (measured by the Visual Analogue Scale [VAS]), and cost analyses were evaluated for each group. Statistical analyses using SPSS were conducted to compare the outcomes between the two groups. RESULTS: The research found significant variations in clinical outcomes, complications, and cost consequences between Group A and Group B. Group A had fewer hospitalisation periods (23.687.74) than Group B (33.5619.47). Re-operation rates were also considerably lower in Group A (26.3%) than in Group B (48%), owing to a greater prevalence of pin-tract infections and subsequent pin loosening in the combination frame external fixator group. The estimated cost of both techniques was recorded and analysed with the locking average of 26,619.69 ± 9,602.352 and the combined frame average of 39,095.64 ± 20,070.077. CONCLUSION: This study suggests that although the two approaches effectively manage open distal tibia fractures, the locking compression plate approach (Group A) has an advantage in treating open distal tibia fractures. Shorter hospitalisation times, reduced re-operation rates, and fewer complications will benefit patients, healthcare systems, and budget allocation. Group A's functional recovery results demonstrate the locking plate technique's ability to improve recovery and patient quality of life. According to the cost analysis, the locking plate technique's economic viability and cost-effectiveness may optimise healthcare resources for open distal tibia fractures. These findings might improve patient outcomes and inform evidence-based orthopaedic surgery.

Case report: Scapulohumeral arthrodesis in a reindeer.

This case report describes the anesthetic, surgical, and postoperative management of scapulohumeral arthrodesis in a juvenile reindeer with severe lameness due to a chronic proximal humeral fracture and scapulohumeral luxation. The reindeer was managed with prolonged stall confinement and physical therapy and 9 months postoperatively was walking and bearing weight equally when standing. This case demonstrates that comparative techniques from other veterinary species coupled with considerations for reindeer anesthesia can be successful in restoring functional soundness after scapulohumeral arthrodesis.

Biomechanical analysis of bridge combined fixation system as a novel treatment for the fixation of type A3 distal femoral fractures.

Background: To compare the biomechanical parameters of AO/OTA type A3 distal femoral fractures fixed bilaterally with a bridge combined fixation system (BCFS) and lateral locking compression plate + locking reconstruction plate (LCP + LRP). Methods: Twelve A3 distal femoral fracture models with medial cortical defects of the distal femur were created using synthetic femoral Sawbones. BCFS and LCP + LRP were used for bilateral fixation, with six in each group. Axial compression and torsion tests were performed on the two groups of fracture models to determine their stiffness during axial compression and the Torsional stiffness during torsion tests. Axial compression failure tests were performed to collect the vertical loads of the ultimate failure tests. Results: In the test conducted on the fixed type A3 distal femoral fracture models, the axial stiffness in the BCFS group (group A) (1,072.61 ± 113.5 N/mm) was not significantly different from that in the LCP + LRP group (group B) (1,184.13 ± 110.24 N/mm) (t = 1.726, P = 0.115), the Torsional stiffness in group A (3.73 ± 0.12 N.m/deg) was higher than that in group B (3.37 ± 0.04 N.m/deg) (t = 6.825, P < 0.001),and the ultimate failure test of type A3 fracture model showed that the vertical load to destroy group A fixation (5,290.45 ± 109.63 N) was higher than that for group B (3,978.43 ± 17.1 N) (t = 23.28, P < 0.05). Notably, intertrochanteric fractures occurred in groups A and B. Conclusions: In the fixation of type A3 distal femoral fractures, the anti-axial compression of the BCFS group was similar to that of the LCP + LRP group, but the anti-torsion was better.

An open comminuted tibia fracture including a 5 cm tibial bone defect in a child: Successful management using a locking compression plate.

Traumatic bone defects (TBDs), although rare in children, are severe injuries that often represents a challenge for both orthopaedic and trauma surgeons. We present a case of a 6-year-old girl who sustained an open (Gustilo-Anderson type II) comminuted tibia fracture including a ± 5.0 cm distal tibial TBD following a road traffic accident. Open reduction and internal fixation with a 3.5 Locking Compression Plate (LCP) without additional bone grafting was performed, followed by cast immobilization for four months. One and a half years after reconstruction, the patient regained pain-free activity including full-range of motion of her leg and radiographs showed good tibial and fibular alignment, the presence of fracture consolidation and sufficient filling of the TBD. This case report aims to show first evidence of the safety and efficacy of single LCP plating followed by cast immobilization applied in a paediatric patient with a large tibial TBD.

Comparison of percutaneous compression plate to parallel screws in the treatment of nondisplaced femoral neck fractures in elderly patients: a prospective, randomized study.

BACKGROUND: The optimal internal fixation for non-displaced femoral neck fractures remains controversial. This study aimed to compare the clinical results of the percutaneous compression plate (PCCP) with parallel screws (PS) in treating femoral neck fractures in elderly patients. MATERIALS AND METHODS: A total of 218 patients who underwent internal fixation were randomized to receive either a percutaneous compression plate (PCCP group) or parallel screws (PS group) using a computerized random sequence generator which was used to assign the order of randomization. Patients were assessed by the operating time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stay, the time to full weight-bearing, reduction quality, fracture healing time, Harris hip score, and postoperative complications. RESULTS: There was no significant difference between PCCP and PS groups regarding operative time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stays, reduction quality, and Harris hip score (p > 0.05). The time to full weight-bearing and the fracture healing time in the PCCP group were shorter than those in the PS group (p < 0.05). The overall complication rates were slightly lower in the PCCP compared to the PS patients, but there was no significant difference (p > 0.05). However, the implant failure rate was significantly higher in the PS group compared to the PCCP group (p < 0.05). CONCLUSIONS: The present study suggests that the PCCP is superior to the parallel screws fixation in the treatment of non-displaced elderly femoral neck fractures in terms of earlier full weight-bearing, shorter fracture healing time, and lower implant failure rate. Therefore, it may be a better therapeutic strategy for non-displaced femoral neck fractures in elderly patients.

Anterolateral and Medial Locking Compression Plates for the Management of Distal Tibial Fractures: A Comparative Prospective Study.

INTRODUCTION: Open/close reduction (OR/CR) and internal fixation (IF) of displaced fractures of distal tibia with either a medial or anterolateral plate is a commonly performed procedure. Anterolateral plating avoids an incision along the medial subcutaneous border of tibia and has been shown to have reduced risk of wound complications. The aim of our study was to determine the functional outcome of these fractures treated with anterolateral and medial distal tibial locking compression plates. METHODS: This was a prospective study that included 60 patients with distal tibial fractures (close or grade I open injury) divided into two groups with 30 patients in each where one group was treated with OR/CR and IF using an anterolateral distal tibial locking plate (Group A) and the other using a medial distal tibial locking plate (Group B). The duration of surgery and intraoperative blood loss and time to union were recorded for all the patients. Functional evaluation was done at one year in terms of pain, function and alignment using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and complications, if any, were noted. RESULTS: Both the groups were comparable in terms of age, gender, time of presentation, AO classification and presence of wound. The mean duration of surgery as well as the intraoperative blood loss were more in the anterolateral plate group than in the medial plate group, but the difference was statistically insignificant. Ten patients (33%) with medial plates had symptomatic hardware and 7 (23.3%) underwent removal while only 3 (10%) patients in the anterolateral plate group had similar complaints and none had to undergo removal. Two patients with anterolateral plate and one with medial plate had malunion. The mean time to fracture union as well as the rate of infection was less and the functional outcome at one year was better in the group treated with anterolateral plates as compared to the one with medial plates, but the difference again was not statistically significant for all the parameters. CONCLUSION: With reduced risk of soft tissue complications and by obviating the need for implant removal, anterolateral plates can prove to be a better alternative to the medial plates especially in elderly patients in the management of these fractures.

Comparison of a 2.7-mm and 3.5-mm locking compression plate for ulnar fractures: a biomechanical evaluation.

Objectives: Implant prominence after ulnar fracture fixation may be mitigated by the use of lower profile plates. The biomechanical strength and stability of 2.7-mm and 3.5-mm locking compression plates for fixation were compared. Methods: Two fracture conditions, transverse (N = 10) and oblique (N = 10), were evaluated in an in vitro study. Half of the specimens for each condition were fixed with 2.7-mm plates and the other half with 3.5-mm plates, all fixed with conventional dynamic compression mechanisms. Specimens were loaded under ±2 Nm of cyclic axial torsion, then under 10 Nm of cyclic cantilever bending, and bending to failure. Interfragmentary motion and strain were analyzed to determine construct stability as a function of fracture pattern and plate size. Results: Interfragmentary motion was significantly larger in all constructs fixed with 2.7-mm plates, compared with 3.5-mm plates (P < 0.01). The 2.7-mm constructs with transverse fractures had the greatest motion, ranging between 5° and 10° under axial rotation and 5.0-6.0 mm under bending. Motions were the lowest for 3.5-mm constructs with oblique fractures, ranging between 3.2 and 4.2 mm under bending and 2°-3.5° for axial rotation. For oblique fractures, the bending moment at ultimate failure was 31.4 ± 3.6 Nm for the 2.7-mm constructs and 10.0 ± 1.9 Nm for 3.5-mm constructs (P < 0.01). Similarly, for transverse fractures, the bending moment was 17.9 ± 4.0 Nm for the 2.7-mm constructs and 9.7 ± 1.3 Nm for the 3.5-mm constructs (P < 0.01). Conclusions: Although 3.5-mm plates were more effective at reducing fracture motion, they were consistently associated with refracture at the distal-most screw hole under load to failure. By contrast, 2.7-mm plates plastically deformed despite excessive loads, potentially avoiding a subsequent fracture. Level of Evidence: Level V.