Newly designed plate for the treatment of posterolateral tibial plateau fractures: a finite element analysis.

BACKGROUND: This study investigated the biomechanical properties of a new plate used for the treatment of posterolateral tibial plateau fractures using finite element analysis. METHODS: The study groups were as follows: group PM, model of the new plate with posteromedial tibial plateau fracture; group PL, model of the new plate with posterolateral tibial plateau fracture; and group PC, model of the new plate with posterior tibial plateau fracture. We used two loading modes: uniform loading on the entire plateau, and loading on the posterior plateau. Data such as the displacement of the fracture and distribution of stress on the new plate and screws were recorded and analyzed. RESULTS: When the whole plateau was loaded, the displacement of fractures in groups PM, PL, and PC were 0.273, 0.114, and 0.265 mm, respectively. The maximum stresses on the plates in groups PM, PL, and PC were 118.131 MPa, 44.191 MPa, and 115.433 MPa. The maximum stresses on the screws in Groups PM, PL, and PC were 166.731, 80.330, and 164.439 MPa, respectively. When the posterior tibial plateau was loaded, the displacement of the fractures in groups PM, PL, and PC was 0.410, 0.213, and 0.390 mm, respectively. The maximum stresses on the plates in groups PM, PL, and PC were 194.012 MPa, 72.806 MPa, and 185.535 MPa. The maximum stresses on the screws in Groups PM, PL, and PC were 278.265, 114.839, and 266.396 MPa, respectively. CONCLUSION: The results of this study revealed that titanium plates have good fixation effects in all groups; therefore, the use of the new plate for posterolateral tibial plateau fractures appears to be safe and valid.

Management of traumatic hemipelvectomy through ERAS pathway: A case report.

RATIONALE: Traumatic hemipelvectomy is a rare but life-threatening injury that involves separation of the pelvic ring from pubic symphysis usually results from high energy trauma and associated with other injuries. PATIENT CONCERN: In this report, we describe a case of traumatic hemipelvectomy, who presented in hemorrhagic shock associated with other injuries such as: right groin injury with limitation of passive movement of right hip and knee joint, left pelvic visceral protruded out, and wrapped by peritoneum, all of the vulva and anal tear, lumbar vertebrae transverse process fracture. DIAGNOSES: Traumatic hemipelvectomy. INTERVENTIONS: The patient was managed through enhanced recovery after surgery (ERAS) pathway with multidisciplinary coordination. OUTCOMES: Patient was able to walk with prosthesis or crutch, with associated injuries managed appropriately. The course was complicated with hemorrhagic shock and infection which were dealt promptly, with good recovery. LESSONS: In our case, the multimodal management through ERAS path has helped decrease stress level, decrease complication, decrease morbidity, decrease the length of stay in the hospital, and aid in faster recovery.