Optimization of gearbox housing shape for agricultural UTV using structural-acoustic coupled analysis.

In this study, gearbox radiated noise was successfully reduced through housing shape optimization. First, dynamic and structural-acoustic coupled analysis models of an agricultural UTV gearbox were developed. Then, the test equipment was configured to match that of the simulation model, and a test was conducted. The analysis and test results showed errors within 0.1 dB for vibration and 0.2 dB(A) for noise, indicating that the models were reliable. The housing design was then optimized using topology optimization based on the developed structural-acoustic coupling analysis model. The sound pressure level around the housing was used as an objective function for topology optimization. The optimal distribution of materials for the housing was also derived to reduce the radiated noise. Lastly, the housing rib was designed based on the optimization result, and an improvement in the radiated noise by approximately 2.43 dB(A) was confirmed in the operation area.

Social Support, eHealth Literacy, and mHealth Use in Older Adults With Diabetes: Moderated Mediating Effect of the Perceived Importance of App Design.

Mobile healthcare has emerged as a prominent technological solution for self-management of health. However, the development and utilization of tailored mobile healthcare applications for older adults with diabetes mellitus remain limited. This study examined the relationship between social support and mobile healthcare use and further explored how this relationship varies with eHealth literacy and application design among older adults with diabetes mellitus. A descriptive cross-sectional trial was conducted with a structured self-report questionnaire, surveying 252 South Korean older adults with diabetes mellitus via offline and online modes. The mediating effect and moderated mediating effect were analyzed with the PROCESS macro of SPSS. eHealth literacy mediated the relationship between social support and mobile healthcare use. High levels of eHealth literacy and social support may increase mobile healthcare use among older adults with diabetes. Application design aesthetics facilitated mobile healthcare use. Future researchers, healthcare providers, and developers can contribute to the development of tailored mobile healthcare applications for older adults with diabetes mellitus by considering application design aspects such as font size, color, and menu configuration.

Outcomes and complications after treatment for anteromedial facet fracture of the coronoid process: A systematic review.

BACKGROUND: Fracture of the anteromedial facet (AMF) of the coronoid process is associated with varus posteromedial rotatory instability (VPMRI). However, there is still controversy regarding the optimal treatment for AMF fracture. The purpose of this study is to report on a systematic review of the outcomes and complications after treatment for AMF fracture. METHODS: This study was conducted using electronic databases, PubMed, EMBASE and Scopus. Studies reporting outcome scores and complications were included. Studies that did not utilize O'Driscoll classification for AMF fractures were excluded. Through conduct of a thorough review of included studies, definite VPMRI were identified and cases involving other injury mechanisms were excluded. RESULTS: Fifteen articles reporting on 246 patients were included. According to O'Driscoll classification, 6.2% of cases were anteromedial subtype I, 73.7% were subtype II, and 20.1% were subtype III. Two-hundred sixteen patients (87.8%) were treated surgically and 30 patients (12.2%) were treated conservatively. Lateral collateral ligament (LCL) injuries were 76.2% (157/206) and medial collateral ligament injuries were 16.9% (33/195). Among 216 cases who underwent surgical treatment, depending on the fragment size, displacement, and instability, coronoid fixation was performed in 189 cases and LCL repair alone was performed in 27 cases. The mean final Mayo Elbow Performance Score was 92.1 and the Broberg & Morrey score was 89.5. The overall complication and reoperation rates were 17.7% (41/232) and 12.9% (26/202). CONCLUSIONS: Both surgical and conservative treatment for AMF fractures resulted in satisfactory final clinical outcomes. However, high complication and reoperation rates were observed.

Understanding the Trap Characteristics of Perovskite Solar Cells via Drive-Level Capacitance Profiling.

Perovskite solar cells (PSCs) are gaining significant interest as the future of photovoltaics owing to their superior performance and cost-effectiveness. Nevertheless, traps in PSCs have emerged as issues that adversely affect the efficiency and stability of the devices. In this study, the methylammonium chloride (MACl) additive and phenyltrimethylammonium iodide (PTMAI) posttreatment were applied to passivate bulk and surface defects. Furthermore, variations of the traps' quantitative spatial arrangement have been monitored by using the drive-level capacitance profiling (DLCP) analysis. A similar magnitude of trap reduction was observed for the bulk perovskite layer and two interfaces (electron transport layer (ETL)/perovskite and hole transport layer (HTL)/perovskite) with an optimal concentration of the MACl additive. However, the effect of perovskite posttreatment in reducing the trap density was much more noticeable at the HTL/perovskite interface compared to the bulk and ETL/perovskite regions. This observation was reinforced by the outcomes of the 500 h thermal stability tests at 60 °C from seven independent batches, which demonstrated a substantial suppression of trap accumulation, particularly at the HTL/perovskite interface, by an order of magnitude.

Is the Direct Fixation of Displaced Quadrilateral Plates in Acetabular Fractures Necessary?

Quadrilateral plate fractures represent a heterogeneous group of acetabular fractures. Accurate reduction is required to prevent post-traumatic arthritis. The purpose of this study is to determine the reduction effect of the direct fixation of quadrilateral plates in acetabular fractures, and to evaluate the strength of direct fixation compared to indirect fixation. Between 2005 and 2021, 49 patients underwent surgery for open reduction and internal fixation in acetabular fractures with severely displaced quadrilateral plates. Twenty-nine patients comprised the indirect fixation group, and twenty patients comprised the direct fixation group. In a comparison of primary outcome between two groups, 10 out of 29 indirect-group patients and 1 out of 20 direct-group patients developed post-traumatic osteoarthritis, wherein the difference between the two groups is statistically significant. In the assessment of postoperative Matta's radiological reduction status, 19 out of 20 patients in the direct group had achieved anatomical and congruent reduction. The treatment using a direct reduction and internal fixation improved the reduction quality of articular displacement and offered a better survivorship of the affected hip joint.

Mobile Efficient Diagnostics of Infectious Diseases via On-Chip RT-qPCR: MEDIC-PCR.

The COVID-19 outbreak has caused public and global health crises. However, the lack of on-site fast, reliable, sensitive, and low-cost reverse transcription polymerase chain reaction (RT-PCR) testing limits early detection, timely isolation, and epidemic prevention and control. Here, the authors report a rapid mobile efficient diagnostics of infectious diseases via on-chip -RT-quantitative PCR (RT-qPCR): MEDIC-PCR. First, the authors use a roll-to-roll printing process to accomplish low-cost carbon-black-based disposable PCR chips that enable rapid LED-induced photothermal PCR cycles. The MEDIC-PCR can perform RT (3 min), and PCR (9 min) steps. Further, the cohort of 89 COVID-19 and 103 non-COVID-19 patients testing is completed by the MEDIC-PCR to show excellent diagnostic accuracy of 97%, sensitivity of 94%, and specificity of 98%. This MEDIC-PCR can contribute to the preventive global health in the face of a future pandemic.

Clinical outcome of rim-plate-augmented separate vertical wiring with supplementary fixation for the treatment of patellar fracture associated comminuted inferior pole.

Despite the variety of treatment methods, comminuted inferior pole fractures of the patella remain difficult and technically demanding to achieve stable internal fixation. The purpose of this study is to evaluate the clinical outcomes of rim plate-augmented separate vertical wiring with supplementary fixation in the management of comminuted inferior pole fractures, AO/OTA 34-A1, C2, and C3, which has the secondary horizontal fracture line on lower articular boundary. From our study, bony union was achieved in all patients at an average of 3.1 ± 1.4 months after surgery. There was no patient with loss of reduction, fixation failure, or infection during follow-up. The average final range of motion was 131.6° ± 7.2°. Lysholm knee scores gradually increased over 3, 6, 9, and 12 months postoperatively by 58.7, 74.0, 82.9, and 89.4, respectively. Isokinetic peak torque deficit of the knee extensor muscles in 3, 6, 9, and 12 months postoperatively was 59.9%, 49.7%, 35.7%, and 28.1%, respectively. The rim plate-augmented separate vertical wiring with supplementary fixation for the treatment of patellar fracture associated comminuted inferior pole is effective and can be safely applied AO/OTA 34-C2 or C3 with favorable outcomes.

The Clinical Efficacy of Contouring Periarticular Plates on a 3D Printed Bone Model.

We report our experience of preoperative plate contouring for periarticular fractures using three-dimensional printing (3DP) technology and describe its benefits. We enrolled 34 patients, including 11 with humerus midshaft fractures, 12 with tibia plateau fractures, 2 with pilon fractures, and 9 with acetabulum fractures. The entire process of plate contouring over the 3DP model was videotaped and retrospectively analyzed. The total time and number of trials for the intraoperative positioning of precontoured plates and any further intraoperative contouring events were prospectively recorded. The mismatch between the planned and postoperative plate positions was evaluated. The average plate contouring time was 9.2 min for humerus shaft, 13.8 min for tibia plateau fractures, 8.8 min for pilon fractures, and 11.6 min for acetabular fractures. Most precontoured plates (88%, 30/34) could sit on the planned position without mismatch. In addition, only one patient with humerus shaft fracture required additional intraoperative contouring. Preoperative patient specific periarticular plate contouring using a 3DP model is a simple and efficient method that may alleviate the surgical challenges involved in plate contouring and positioning.

Green Synthesis of Controlled Shape Silver Nanostructures and Their Peroxidase, Catalytic Degradation, and Antibacterial Activity.

Nanoparticles with unique shapes have garnered significant interest due to their enhanced surface area-to-volume ratio, leading to improved potential compared to their spherical counterparts. The present study focuses on a biological approach to producing different silver nanostructures employing Moringa oleifera leaf extract. Phytoextract provides metabolites, serving as reducing and stabilizing agents in the reaction. Two different silver nanostructures, dendritic (AgNDs) and spherical (AgNPs), were successfully formed by adjusting the phytoextract concentration with and without copper ions in the reaction system, resulting in particle sizes of ~300 ± 30 nm (AgNDs) and ~100 ± 30 nm (AgNPs). These nanostructures were characterized by several techniques to ascertain their physicochemical properties; the surface was distinguished by functional groups related to polyphenols due to plant extract that led to critical controlling of the shape of nanoparticles. Nanostructures performance was assessed in terms of peroxidase-like activity, catalytic behavior for dye degradation, and antibacterial activity. Spectroscopic analysis revealed that AgNDs demonstrated significantly higher peroxidase activity compared to AgNPs when evaluated using chromogenic reagent 3,3',5,5'-tetramethylbenzidine. Furthermore, AgNDs exhibited enhanced catalytic degradation activities, achieving degradation percentages of 92.2% and 91.0% for methyl orange and methylene blue dyes, respectively, compared to 66.6% and 58.0% for AgNPs. Additionally, AgNDs exhibited superior antibacterial properties against Gram-negative E. coli compared to Gram-positive S. aureus, as evidenced by the calculated zone of inhibition. These findings highlight the potential of the green synthesis method in generating novel nanoparticle morphologies, such as dendritic shape, compared with the traditionally synthesized spherical shape of silver nanostructures. The synthesis of such unique nanostructures holds promise for various applications and further investigations in diverse sectors, including chemical and biomedical fields.

Ex Vivo Transdermal Delivery of Nicotinamide Mononucleotide Using Polyvinyl Alcohol Microneedles.

Nicotinamide mononucleotide (NMN), which has recently been spotlighted as an anti-aging agent, is a precursor of the coenzyme nicotinamide adenine dinucleotide that plays an important role in intracellular redox reactions. NMN capsules for oral administration currently on the market have a problem in that they are almost fully metabolized in the stomach and liver and excreted as nicotinamide. Therefore, there is a need to develop a patient-friendly delivery method that can improve the bioavailability of NMN. For this purpose, various polyvinyl alcohol (PVA)-based microneedle patches were fabricated to develop a transdermal delivery system for NMN. First, the molecular weight effect of PVA on the shape and microstructure of microneedles was studied. After selecting the optimal molecular weight PVA, the swelling of the microneedles and the ex vivo release of NMN were studied. The effect of carboxymethyl cellulose (CMC) and dimethyl sulfoxide on NMN release was also investigated. The highest NMN release of 91.94% in 18 h was obtained using a 9.5 kDa molecular weight PVA microneedle containing NMN and CMC.

Priority evaluation factors for blockchain application services in public sectors.

Blockchain is rapidly becoming established as the core technology of the Fourth Industrial Revolution. By combining blockchain to improve processes in existing industries, innovative new services will emerge, but services not effectively applied by blockchain will also develop. This study investigated the factors to be considered when applying the characteristics of blockchain technology to business. We developed a framework of blockchain service utility evaluation indexes using the analytic hierarchy process method. The Delphi method is used to identify highly effective blockchain application service cases by applying the evaluation framework to actual use cases in the public sector. By proposing a framework of utility evaluation factors for blockchain application services, this study provides a systematic foundation for blockchain business review. We address the question of "why blockchain should be applied to this service" by providing a more comprehensive approach than existing research, such as a fragmentary decision tree. Blockchains are expected to become more active along with the full-scale digital transformation of industries, and thus, we must examine the ways to broadly use blockchain as a base technology in a form applicable to the diverse industries and societies constituting the digital economy. Accordingly, this study presents an evaluation solution for promoting efficient policies and developing successful blockchain application services.

Structure-mechanical analysis of various fixation constructs for basicervical fractures of the proximal femur and clinical implications; finite element analysis.

OBJECTIVE: This present study was conducted to determine the structural-mechanical stability of various fixation constructs through finite element (FE) analysis following simulation of a basicervical fracture and to introduce the clinical implications. MATERIALS AND METHODS: We simulated fracture models by using a right synthetic femur (SAWBONES®). We imported the implant models into ANSYS® for placement in an optimal position. Five assembly models were constructed: (1) multiple cancellous screws (MCS), (2) FNS (femoral neck system®), (3) dynamic hip screw (DHS), (4) DHS with anti-rotation 7.0 screw (DHS + screw), and PFNA-II (Proximal Femoral Nail Antirotation-II®). The femur model's distal end was completely fixed and 7° abducted. We set the force vector at a 3° angle laterally and 15° posteriorly from the vertical ground. Analysis was done using Ansys® software with von Mises stress (VMS) in megapascals (MPa) and displacement (mm) RESULTS: The displacements of the proximal femur were 10.25 mm for MCS, 9.66 mm for DHS, 9.44 mm for DHS + screw, 9.86 mm for FNS, and 9.31 mm for PFNA-II. The maximum implant VMS was 148.94 MPa for MCS, 414.66 MPa for DHS, 385.59 MPa for DSH + screw, 464.07 MPa for FNS, and 505.07 MPa for PFNA-II. The maximum VMS at the fracture site was 621.13 MPa for MCS, 464.14 MPa for DHS, 64.51 MPa for DHS + screw, 344.54 MPa for FNS, and 647.49 MPa for PFNA-II. The maximum VMS at the fracture site was in the superior area with the high point around the posterior screw in the MCS, anterosuperior corner in the DHS, the posteroinferior site of the FNS, and posterosuperior site around the entry point in the PFNA-II. In the DHS + screw, the stresses were distributed evenly and disappeared at the maximum VMS fracture site. CONCLUSION: Based on the fracture site and implant's stress distribution, the model receiving the optimal load was a DHS + screw construct, and the FNS implant could be applied to anatomically reduced fractures without comminution. Considering the high-stress concentration around the entry point, a PFNA-II fixation has a high probability of head-neck fragment rotational instability.

Thermal Transport Properties of Phonons in Halide Perovskites.

Halide perovskites have emerged as promising candidates for various applications, such as photovoltaic, optoelectronic and thermoelectric applications. The knowledge of the thermal transport of halide perovskites is essential for enhancing the device performance for these applications and improving the understanding of heat transport in complicated material systems with atomic disorders. In this work, the current understanding of the experimentally and theoretically obtained thermal transport properties of halide perovskites is reviewed. This study comprehensively examines the reported thermal conductivity of methylammonium lead iodide, which is a prototype material, and provides theoretical frameworks for its lattice vibrational properties. The frameworks and discussions are extended to other halide perovskites and derivative structures. The implications for device applications, such as solar cells and thermoelectrics, are discussed.

Prediction of IGS RTS Orbit Correction Using LSTM Network at the Time of IOD Change.

The international GNSS service (IGS) real-time service (RTS) provides orbit and clock corrections for the global navigation satellite system (GNSS) via the internet. RTS is widely used for real-time, precise positioning and its data is transmitted via the internet. Intermittent data loss can occur and cause positioning accuracy degradation. RTS data has a discontinuity when the issue of data (IOD) changes every two hours. If the signal loss occurs immediately after the IOD change, then the performance of the RTS prediction degrades significantly. We propose an adjustment method to make the RTS data across the IOD change, which makes it possible to use long RTS data for building a prediction model. The proposed adjustment method is combined with a long-short-term memory (LSTM) network to improve long-period prediction accuracy. Experiments with GPS and RTS were performed to evaluate the RTS orbit prediction accuracy. The LSTM with the IOD adjustment outperforms other polynomial prediction methods, and the positioning accuracy with the predicted RTS orbit correction shows a significant improvement.

Environmental Regulation and Chronic Conditions: Evidence from China's Air Pollution Prevention and Control Action Plan.

In January 2013, a dense haze covered 1.4 million kilometers of China and affected more than 800 million people. Air pollution in China had become a serious threat to the daily lives of people. The State Council of China enacted the "Air Pollution Prevention and Control Action Plan" (APPCAP) in 2013 to lower the particulate matter (PM) level. Between 2013 and 2017, each administrative division established its own environmental preservation strategy in accordance with the APPCAP. We examined the effects of the nationwide air pollution control policy, APPCAP, on chronic health conditions among adults using a nationally representative survey, CFPS, conducted in 2012, 2014, and 2016. We applied a difference-in-differences model, using the time gap when each administrative division implemented the APPCAP. We found that the APPCAP significantly reduced doctor-diagnosed chronic conditions of the respiratory and circulatory systems in the last six months. In respiratory diseases and circulatory system diseases, the treatment effect of the APPCAP was a 34.6% and 11.5% reduction in the sample mean, respectively. The poorest socioeconomic groups and the elderly benefited the most. The stronger the goal, the more positive the effects were on health; the longer the policy intervention, the better the health outcomes were.

Three-dimensional morphologic features of Asian atypical femur and clinical implications of cephalomedullary nail fixation: Computational measurement at actual size.

PURPOSE: (1) To analyze three-dimensional (3D) morphologic features of atypical femur fracture at actual size without projection error; and (2) to provide clinical implications of cephalomedullary nail (CMN) fixation by separating the medullary canal and the cortex. MATERIALS AND METHODS: Fifty-nine atypical femurs (opposite non-fractured femurs) were reconstructed as 3D models with medullary canal by importing CT data into Mimics® software. A reference line was drawn from the tip of the greater trochanter to the center of the intercondylar notch and used for classifying bowing grade according to the centerline of medulla. Proximal and distal straight lines (length of 60 mm, diameter of 1 mm) were placed in the centerline of medulla. Acute angles between the two straight lines were measured as lateral and anterior bowing. The acute angle by straight line and reference line was measured as proximal and distal bowing in both AP and lateral view. The diameter of curve (DOC) of medulla along the posterior border was measured. RESULTS: The anterior bowing of all femur on lateral view was an average of 13.82° (range, 6.2°-31.1°, SD 3.91), and the values of proximal and distal anterior bowing were an average of 7.82° (range, 2.7°-14.3°, SD 2.23) and 6.0° (range, 2.2°-16.8°, SD 2.31), respectively. The lateral bowing of all femur on AP view was an average of 5.49° (range, 0.1°-17.3°, SD 4.48), and the values of proximal and distal anterior bowing were an average of 3.64° (range, 0.1°-11.3°, SD 2.70) and 2.48° (range, 0-7.4°, SD 1.98), respectively. The medullary canal was changed to be straightened and more bowed anteriorly. Concerning the lateral bowing grade of entire diaphysis, it was grade -I for 15 femurs, grade 0 for 21 femurs, grade I for nine femurs, grade II for five femurs, and grade III for nine femurs. Regarding anterior bowing grade, it was grade II for 14 femurs and grade III for 45 femurs. The average diameter of medullary canal was 1276.3 ± 232.25 mm. CONCLUSION: Asian atypical femur had three morphologic features: (1) straightened medullary canal, (2) positive values of lateral bowing, and (3) significantly increased ante-curvature of medullary canal. Considering that conventional CMN had about 4° of mediolateral angle, the disparity between implant and medullary canal might be clear. Thus, new nail design for Asian atypical femur that could increase the radius of curve (ROC) but decrease the mediolateral angle needs to be introduced.

Pathomechanism of Triangular Fibrocartilage Complex Injuries in Patients with Distal-Radius Fractures: A Magnetic-Resonance Imaging Study.

Injury to the triangular fibrocartilage complex (TFCC) is one of the most common complications following a fracture of the distal radius. In this study, an examination of TFCC injuries in patients with distal-radius fractures was conducted using magnetic-resonance imaging (MRI); the aim of the study was to analyze the prevalence of TFCC injury as well as to suggest acceptable radiologic parameters for use in prediction of the injury pattern. Fifty-eight patients with distal-radius fractures who underwent MRI prior to undergoing open-reduction surgery between April 2020 and July 2021 were included in this study. An analysis of various radiologic parameters, the fracture type, and the MRI classification of TFCC injuries was performed. Radiologic parameters were used in the evaluation of distal radioulnar joint (DRUJ), radial shortening, and the dorsal angularity of the fracture. All of the patients in this study had definite traumatic TFCC injuries. A statistical relationship was observed between the radial length gap between the intact wrist and the injured wrist, which represents relative radial shortening, and the pattern of TFCC injury. In conclusion, the shortening of the distal radius, causing peripheral soft tissue of the ulnar side to become tauter, is highly relevant with regard to the pattern of TFCC injury. However, because no data on the clinical outcome were utilized in this study, it is lacking in clinical perspective. The conduct of further studies on patients' clinical outcome will be necessary.

Prolonged ileus in traumatic pelvic ring injury patients who underwent arterial angio-embolization: A retrospective study.

Paralytic ileus occurs in up to 18% of the patients with pelvic bone fractures. The aim of this study is to determine if massive bleeding requiring arterial angio-embolization is related with the duration of ileus in patients with traumatic pelvic ring injuries. This retrospective study included 25 patients who underwent arterial angio-embolization for traumatic pelvic ring injuries. Data were collected from prospectively maintained databases of two independent hospitals. Demographic characteristics (such as age, sex, body mass index, and Charlson Comorbidity Index), cause of trauma, and severity of pelvic injuries were similar in the non-prolonged and prolonged ileus groups. As expected, the prolonged ileus group had a significantly longer duration of ileus than the non-prolonged ileus group (8.0 ±â€…4.2 days vs 1.2 ±â€…0.4 days, respectively; P < .001). The mortality rate was higher in the prolonged ileus group (20% vs 0%), but it was not significantly different (P = .13). Interestingly, the prolonged ileus group received significantly higher amounts of packed red blood cell transfusions (6.1 ±â€…2.1 units vs 3.8 ±â€…2.5 units; P = .02). The amount of packed red blood cell transfusions was associated with a greater risk of prolonged ileus development (P = .03, odds ratio = 2.04, 95% confidence interval = 1.08-3.88). This study supports the idea that the duration of the ileus is related with the amount of bleeding caused by the traumatic pelvic ring injury. In order to prevent further complications, conservative treatments of the ileus should be considered.

Comparison of Locking Plate Osteosynthesis versus Coracoclavicular Stabilization for Neer Type IIB Lateral Clavicle Fractures.

Background: The best option for the treatment of Neer type IIB lateral clavicle fractures remains controversial. The aim of this study was to compare outcomes and complications between pre-contoured locking plate osteosynthesis (PLPO) and coracoclavicular stabilization (CCS) using a TightRope for the treatment of type IIB fractures. Methods: Forty-six consecutive type IIB fractures were treated with PLPO (17 cases) or CCS (29 cases). The mean follow-up period was 33.7 months (range, 12-144 months). Radiographic outcomes were evaluated using serial plain radiographs. Clinical outcomes were evaluated using the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV). Results: Of the 46 cases, complete bony union within 6 months after surgery was achieved in 42 cases (91.3%). The union rate was 100% (17/17) in the PLPO group and 86.2% (25/29) in the CCS group, showing a statistically significant difference (p = 0.043). No significant differences in terms of UCLA score (32.8 vs. 32.1), ASES score (93.2 vs. 90.8), or SSV (89.1% vs. 90.3%) were observed between the PLPO and CCS groups. The complication rates were 17.6% (3/17; 2 cases of screw breakage and 1 case of stiffness) in the PLPO group and 37.9% (11/29; 4 cases of nonunion, 3 cases of stiffness, 2 cases of skin irritation, 1 case of superficial infection, and 1 case of coracoid button migration) in the CCS group, showing no statistically significant difference (p > 0.05). Four cases with nonunion after CCS did not require reoperation because they had good to excellent clinical outcomes without radiographic progression. Conclusions: Although a higher nonunion rate was observed in the CCS group compared with the PLPO group, satisfactory clinical outcomes were obtained for both groups. Both techniques can be regarded as useful options for the treatment of Neer type IIB lateral clavicle fractures.