Anatomical Posterior Acetabular Plate Versus Conventional Reconstruction Plates for Acetabular Posterior Wall Fractures: A Comparative Study.

Background: Functional recovery following the surgical fixation of acetabular posterior wall fractures remains a challenge. This study compares outcomes of posterior wall fracture reconstruction using an anatomical posterior acetabular plate (APAP) versus conventional reconstruction plates. Methods: Forty patients with acetabular fractures involving the posterior wall or column underwent surgery, with 20 treated using APAPs (APAP group) and 20 with conventional pelvic reconstruction plates (control group). Baseline patient characteristics, intraoperative blood loss and time, reduction quality, postoperative function, and postoperative complications were compared using appropriate non-parametric statistical tests. A general linear model for repeated measures analysis of variance was employed to analyze trends in functional recovery. Results: No significant differences were observed in baseline characteristics. APAP significantly reduced surgical time by 40 min (186.5 ± 51.0 versus 225.0 ± 47.7, p =0.004) and blood loss (695 ± 393 versus 930 ± 609, p = 0.049) compared to conventional plates. At 3 and 6 months following surgery, the APAP group exhibited higher functional scores (modified Merle d'Aubigné scores 10 ± 1.8 versus 7.8 ± 1.4, p < 0.001; 13.4 ± 2.8 versus 10.1 ± 2.1, p = 0.001), converging with the control group by 12 months (modified Merle d'Aubigné scores 14.2 ± 2.6 versus 12.7 ± 2.6, p = 0.072; OHS 31.6 ± 12.3 versus 30.3 ± 10.1, p = 0.398). Radiologically, the APAP group demonstrated superior outcomes (p = 0.047). Complication and conversion rates to hip arthroplasty did not significantly differ between groups (10% versus 15%, p = 0.633). Conclusions: The use of an APAP in reconstructing the posterior acetabulum significantly reduces surgical time, decreases intraoperative blood loss, and leads to earlier functional recovery compared to conventional reconstruction plates. The APAP provides stable fixation of the posterior wall and ensures the durable maintenance of reduction, ultimately yielding favorable surgical outcomes.

Volar locking and angular stability plate for treatment of comminuted scaphoid fractures: a case series of 44 cases.

BACKGROUND: The primary method employed worldwide for the treatment of scaphoid fractures is screw fixation. However, in unstable and comminuted fractures, percutaneous fixation could produce complications due to technical challenges, such as improper axis positioning, inaccurate screw length measurement, intra-articular screw penetration, and impingement. Alternative open approaches for the surgical management of scaphoid fractures have been proposed, and in recent years, a new specific volar locking plate for the treatment of scaphoid fractures has been developed. This study aims to present the outcomes of this technique applied to 44 patients with unstable and comminuted fractures of the scaphoid. AIMS: The purpose of the study is to verify the effectiveness of the volar plate in the treatment of comminuted scaphoid fractures and the necessity for plate removal when consolidation has occurred. METHODS: Between January 2021 and March 2023, a specific volar locking plate for the treatment of scaphoid fractures was used in 44 patients. A retrospective study was conducted involving all patients, consisting of continuous clinical and radiographic assessments, functional evaluations (using QuickDASH and MHQ), and patient satisfaction surveys. RESULTS: All patients achieved clinical and radiographic recovery. However, the plate can impinge with nearby structures and should be removed once the fracture is consolidated. After plate removal, further improvement in range of motion was observed. CONCLUSION: The plate and screws system is a viable and appropriate method of osteosynthesis in the treatment of unstable and comminuted recent fractures occurring in the middle third of the carpal scaphoid.

Prospective study on functional outcome of distal femur fracture treated by open reduction and internal fixation using distal femur locking plate in Tibebe Ghion Specialized Hospital, Bahirdar, North West Ethiopia.

BACKGROUND: Distal femur fractures account for 6% of femur fractures. The treatment of distal femur fractures is challenging. Historically, nonoperative management has been the mainstay of management, which has evolved to operative management. There is no single implant used for all types of distal femur fractures. The implant evolves with time. The introduction of a distal femur locking plate (DF LCP) has had a great impact on the treatment. In developing countries like Ethiopia, there is scarcity of studies on functional outcome of operative treatment. So, this study aimed to assess the functional outcome of distal femur fractures treatment using distal femur locking plate. METHODS: This prospective cohort study was carried out among adult patients with distal femur fractures treated using distal femur locking plate at Tibebe Ghion Specialized Hospital from august 2022 to July 2023. A total of 60 patients with AO Type A and Type C fracture were included. All patients were followed for 6 months. Functional outcomes were assessed using Neer's scoring system. Data was entered and analyzed using SPSS 27. Frequency, mean and cross tabulation were used to summarize descriptive statistics. Multinomial logistic regression was used to test the associations. RESULTS: In our study out of 60 patients ,48.3% (29) had excellent functional outcomes, 30% (18) had good functional outcomes, 10% (6) had fair functional outcomes and 11.7% (7) had unsatisfactory functional outcomes according to Neer's scoring system. Patients with closed distal femur fractures had 5 times higher probability of excellent functional outcome than those patients with open distal femur fractures (AOR (2.49(5.8 ,1.07)). Patients who had regular follow up had 7 times higher probability of excellent functional outcome than those who had no regular follow up (AOR 7.16(1.11,46.22)). The average union period was 4.63 months, with only 2 patients experiencing delayed union. CONCLUSION: Closed fracture and regular follow up were determining factors for better functional outcomes. Closed fractures preserve the biological environment, which facilitates early fracture healing. The regular follow up helped patients to assess their rehabilitation status and pick any complication early.

Fracture-Related Infection of a Distal Femur Open Fracture Treated With a Supracutaneous Locking Plate.

Fracture-related infection (FRI) is a challenging complication in open fractures. It can cause major disability to patients and a burden to the public health sector. A multidisciplinary approach is required to eradicate infection and improve the quality of life for patients. We present a case of an FRI in an open fracture of the distal femur treated using a supracutaneous locking plate, which is an uncommon technique. This technique yields excellent outcomes in controlling local infection and providing satisfactory stability, especially for a peri-articular distal femur fracture with FRI. Therefore, supracutaneous plating using a locking plate can be considered an alternative option to conventional external fixations in managing FRIs.

Headless screw fixation of unstable ulnar styloid base fractures after distal radial fractures fixation.

Ulnar styloid fractures occur frequently concomitant with distal radial fractures. Although unstable distal radial fractures are mostly surgically treated, ulnar styloid fractures are often ignored. Unstable fractures at the base of the ulnar styloid may lead to persistent ulnar pain, due to distal radioulnar joint instability or ulnar styloid non-union. We retrospectively analyzed a single-surgeon cohort series of surgically treated distal radial fractures on how these concomitant ulnar styloid fractures were regarded: indications for surgery and surgical technique with headless screw fixation. 119 surgically treated distal radial fractures were assessed. 51 (42.8%) of the surgically treated distal radial fractures had a distal ulnar fracture, and more specifically 23 (19.3%) had a base fracture of the ulnar styloid. 9 (7.6%) of the wrists had a base fracture of the ulnar styloid which was considered after distal radial fracture fixation as persistently unstable, during distal radioulnar joint ballottement translation test. This fracture subtype was immediately treated with headless screw fixation, resulting in all cases in bony union, with a mean active pronation of 85°, a mean active supination of 80° and a clinical stable distal radioulnar joint, with minimal ulnar pain after 6 weeks (mean Visual Analogue Scale 1). After at least 12 months, persistent pain did not occur and mean QuickDASH was 2.5. According to this single-surgeon cohort series, headless screw fixation provides a reliable treatment for unstable base fractures of the ulnar styloid after distal radial fixation.

Locking plate augmentation of polymethylmethacrylate-filled distal femoral defects: A biomechanical study.

Benign, locally aggressive tumors of the distal femur are typically treated with intralesional curettage and polymethylmethacrylate (PMMA) cementation. However, it is not known whether plate fixation should be added to biomechanically augment these PMMA-filled defects. The purpose of this study was to evaluate the performance of two competing techniques for reconstruction of a distal femoral defect. For this biomechanical study, we used 12 composite femurs with properties comparable to bone. In nine femurs, identical contained medial distal femoral defects were created using a robotic arm. Group A contained three intact femurs, Group B three femurs with an unfilled defect, Group C three femurs reconstructed with PMMA alone, and Group D three femurs reconstructed with PMMA plus a medial locking plate. Locations of greatest stress concentration were determined by PhotoStress analysis, then three strain gauges were applied to each specimen at these high-stress locations. Specimens were loaded within a physiologic range followed by loading to failure. Outcome measures included construct stiffness, strain along the distal femur, and load at failure. Results showed that stiffness and strain were not significantly different between reconstructive techniques; however, both techniques reduced tensile strain along the popliteal surface by approximately 40% compared to non-reconstructed specimens. All specimens failed at the femoral neck before failing at the distal femur. These findings suggest that plate augmentation of PMMA-filled distal femoral defects like the one in this study offers insignificant biomechanical benefit within physiologic loads and therefore may be unnecessary.

Lag screw versus locking plate fixation for traumatic displaced medial malleolar fractures: a systematic review and meta-analysis.

BACKGROUND: Lag screw fixation (LSF) or locking plate fixation (LPF) are both recommended for the treatment of medial malleolar fractures (MMFs). However, no standard has been established for attaining optimal surgical treatment or functional recovery. We hypothesized that LPF for MMFs would result in superior outcomes compared to LSF. To test this hypothesis, we conducted a systematic review and meta-analysis of the clinical outcomes of LSF and LPF in the treatment of MMF. PATIENTS AND METHODS: We searched for studies published prior to November 2023 across the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. Standardization of individual effect sizes was conducted; subsequently, pooled effect sizes were derived by employing random-effects models. RESULTS: Five retrospective studies involving 394 patients were reviewed. American Orthopedic Foot and Ankle Society (AOFAS) scores were significantly higher among patients who received LPF (mean difference [MD]: 2.21; 95% confidence interval [CI]: 0.37-4.04; p = 0.02) than among those who received LSF. Pain scores were significantly lower among patients who received LPF (MD: -0.35; 95% CI: -0.64 to -0.05; p = 0.02) than among those who received LSF. No significant differences in delayed union was observed between the groups (Relative risk [RR]: 1.43; 95% CI, 0.37-4.04; p = 0.42). Fixation failure was slightly higher in patients who received LSF than in those who received LPF (RR: 3.11; 95% CI, 0.88-11.01; p = 0.08). DISCUSSION: Compared with LSF, LPF yields superior functional outcomes, superior patient comfort, and comparative complication rates. LPF is also better able to prevent rotation and apply compressive forces across fracture sites, which can facilitate the management of different types of MMF. Additional randomized controlled trials with larger sample sizes are warranted. LEVEL OF EVIDENCE: III.

Articular Fragment Escape and Carpal Subluxation Following Distal Radius Fracture Fixation.

Surgical fixation of distal radius fractures is among the more common procedures performed by hand surgeons. The approach to surgical management is based on a variety of factors including injury mechanism, fracture pattern, patient characteristics, bone quality, soft tissue injury, and surgeon preference. For the majority of fracture types, volar locking plate fixation has become the most commonly used method of fracture fixation. Although uncommon, complications can arise following this form of treatment, one of which is escape of an articular fragment with resultant carpal instability. More often seen in conjunction with poorly reduced or captured displaced volar lunate facet fragments, fixation failure and carpal instability can occur with other fracture patterns that have garnered less attention, particularly those involving the radial column or dorsal lunate facet. Thorough preoperative planning to recognize fracture patterns that lead to this complication is paramount. Proper selection of implants used to secure the fracture and the choice as well as duration of postoperative immobilization is critical to minimizing this complication. We aim to (1) describe the relevant anatomy involved with this complication, (2) organize and classify the various distal radius articular fragment escape patterns that can occur following fracture fixation, and (3) discuss strategies that can help prevent this complication.

Management of Non-Union Distal Femur Fracture with Augmentation Nail-Plate Construct: A Case Report.

Introduction: Non-union fractures of the distal femur pose significant challenges in orthopedic surgery, often requiring revision procedures to achieve successful bone healing. In cases where the initial implant has failed, innovative solutions are necessary to promote bone union and functional recovery. Case Report: We present a case of a non-union distal femur fracture in a 22-year-old male patient, with a broken implant in situ. The patient had previously undergone internal fixation with a locking plate, which subsequently failed to promote bone healing. The patient was reoperated using a supracondylar nail and augmented with a distal femur locking plate to address the non-union. The combination of the supracondylar nail and distal femur locking plate successfully provided stability to the fracture site, promoting bone union and enabling functional recovery. Radiographic evidence and clinical assessment demonstrated excellent healing progress. Conclusion: This case report highlights the importance of individualized treatment for non-union distal femur fractures, especially when prior implant failure occurs. The combined approach of a supracondylar nail and distal femur locking plate can be a valuable option in addressing complex non-union fractures, achieving stable fixation, and facilitating successful bone healing.

First Dorsal Compartment Release During Volar Approach for Distal Radius Fracture Fixation Reduces Symptoms in Patients With Pre-Existing De Quervain Disease.

Purpose: Release of the first dorsal compartment is a described technique during volar approach for distal radius fracture fixation. Our objective was to determine whether release of the first dorsal compartment during volar approach for distal radius fracture fixation impacted corresponding symptoms in pre-existing de Quervain disease. Methods: A prospective, randomized cohort study was performed with patients grouped for release (release group) or no release (control group) of the first dorsal compartment during volar approach for distal radius fracture fixation. Inclusion required a confirmed diagnosis of de Quervain disease within the 12 months preceding a distal radius fracture. Results: Patients in the release group were significantly less symptomatic than those in the control group at 3 and 6 months after surgery. Lateral pinch strength in the release group was significantly greater than that in the control group at 3 and 6 months after surgery. Conclusions: The current results demonstrated a significantly greater reduction in de Quervain disease symptoms in the release group compared with the no release group during the short-term follow-up. This indicates that routine first dorsal compartment release during distal radius fracture fixation may expedite symptom relief in patients with de Quervain disease. Type of study/level of evidence: Therapeutic I.

Proximal humerus fracture and acromioclavicular joint dislocation.

Proximal humerus fractures and injuries to the acromioclavicular joint are among the most common traumatic diseases of the upper extremity. Fractures of the proximal humerus occur most frequently in older people and are an indicator fracture of osteoporosis. While a large proportion of only slightly displaced fractures can be treated non-operatively, more complex fractures require surgical treatment. The choice of optimal treatment and the decision between joint-preserving surgery by means of osteosynthesis or endoprosthetic treatment is often a difficult decision in which both fracture morphology factors and individual factors should be taken into account. If endoprosthetic treatment is indicated, satisfactory long-term functional and clinical results have been achieved with a reverse shoulder arthroplasty. Injuries to the acromioclavicular joint occur primarily in young, athletic individuals. The common classification according to Rockwood divides the injury into 6 degrees of severity depending on the dislocation. This classification forms the basis for the decision on non-operative or surgical treatment. The indication for surgical treatment for higher-grade injuries is the subject of controversial debate in the latest literature. In chronic injuries, an autologous tendon transplant is also performed. Whereas in the past, treatment was often carried out using a hook plate, which was associated with complications, the gold standard today is minimally invasive treatment using Endobutton systems. This review provides an overview of the two injury patterns and discusses the various treatment options.

Treatment of supracondylar fractures of the humerus in adults using a novel anatomical locking plate on the anterior distal humerus: a case report.

BACKGROUND: Due to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus. CASE PRESENTATION: A 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient's elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications. CONCLUSION: In this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

Three-Dimensional Morphometric Analysis of the Volar Cortical Shape of the Lunate Facet of the Distal Radius.

In cases of distal radius fractures, the fixation of the volar lunate facet fragment is crucial for preventing volar subluxation of the carpal bones. This study aims to clarify the sex differences in the volar morphology of the lunate facet of the distal radius and its relationship with the transverse diameter of the distal radius. Sixty-four CT scans of healthy wrists (30 males and 34 females) were evaluated. Three-dimensional (3D) images of the distal radius were reconstructed from the CT data. We defined reference point 1 as the starting point of the inclination toward the distal volar edge, reference point 2 as the volar edge of the joint on the bone axis, and reference point 3 as the volar edge of the distal radius lunate facet. From the 3D coordinates of reference points 1 to 3, the bone axis distance, volar-dorsal distance, radial-ulnar distance, 3D straight-line distance, and inclination angle were measured. The transverse diameter of the radius was measured, and its correlations with the parameters were evaluated. It was found that in males, compared to females, the transverse diameter of the radius is larger and the protrusion of the volar lunate facet is greater. This suggests that the inclination of the volar surface is steeper in males and that the volar locking plate may not fit properly with the volar cortical bone of the lunate facet, necessitating additional fixation.

[Proximal femoral nail antirotation combined with locking plate in the treatment of femoral intertrochanteric fractures with lateral wall fractures].

OBJECTIVE: To investigate the effect of locking plate internal fixation for the treatment of proximal lateral femoral wall fracture. METHODS: From January 2021 to June 2022, 31 patients with intertrochanteric fractures and lateral wall fractures were treated. Among them, 15 patients were treated with proximal femoral nail antirotation (PFNA) fixation including 3 males and 12 females with an average age of (75.87±7.46) years old;the other 16 patients were treated with 3.5 mm pre-curved screw locking plate fixtion for lateral wall fracture including 4 males and 12 females with an average age of (76.15±9.47) years old. After surgery, the surgical index, tip-apical distance(TAD), postoperative standing weight-bearing time, and fracture reduction were compared between two groups. Postoperative hip function was evaluated according to Harris hip score. RESULTS: All patients were followed up for an average of (12±5) months ranging from 7 to 17 months. The immediate postoperative neck angle ranged from 111° to 132°(119.3±8.3)°. Fracture reduction results were excellent in 11 cases, fair in 2, worse in 1 in PFNA group;excellent in 12, fair in 3, worse in 1 in PFNA+locking plate group. One case of the PFNA group had a spiral blade cut out through the femoral head. There were significant differences in the time of operation, the amount of blood loss during the operation, the length of incision between two groups(P<0.05). There was no significant difference in TAD and postoperative standing weight-bearing time between two groups(P>0.05). There were significant differences in Harris scores at 6 months after surgery between two groups(P<0.05). CONCLUSION: The application of PFNA-assisted locking plate in the treatment of femoral intertrochanteric fractures with lateral wall fractures is effective, and can restore the integrity of lateral wall, improve the stability of PFNA internal fixation, and reduce postoperative complications.

Retrograde tibial intramedullary nail versus minimally invasive locking plate for extra-articular distal tibial fractures: a comparative and retrospective study.

BACKGROUND: Distal tibial fractures represent common lower limb injuries, frequently accompanied by significant soft tissue damage. The optimal surgical approach for managing these fractures remains a topic of considerable debate. The aim of this study was to perform a comparative analysis of the outcomes associated with retrograde intramedullary tibial nails (RTN) and minimally invasive plate osteosynthesis (MIPO) in the context of treating extra-articular distal tibial fractures. METHODS: A retrospective review was conducted on a cohort of 48 patients who sustained extra-articular distal tibial fractures between December 2019 and December 2021. Patients underwent either RTN or MIPO procedures. Various parameters, including operative duration, intraoperative fluoroscopy exposure, time to union, duration until full weight-bearing, American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications, were recorded and compared between the two treatment groups. RESULTS: No statistically significant differences were observed in operative duration, time to union, angulation of the distal tibial coronal plane, or AOFAS scores between the RTN and MIPO groups. However, the RTN group had a higher average number of intraoperative fluoroscopy images (8.2 ± 2.3) compared to the MIPO group (4.1 ± 2.0). The RTN group demonstrated shorter average hospital stays (7.1 ± 1.4 days) and a quicker return to full weight-bearing (9.9 ± 1.3 weeks), which were significantly superior to the MIPO group (9.0 ± 2.0 days and 11.5 ± 1.5 weeks, respectively). In terms of complications, the RTN group had one case of superficial infection, whereas the MIPO group exhibited two cases of delayed union and nonunion, two occurrences of deep infection, and an additional three cases of superficial infection. CONCLUSIONS: Both RTN and MIPO are effective treatment options for extra-articular distal tibial fractures. However, RTN may offer superior outcomes in terms of decreased inpatient needs, faster return to full weight-bearing capacity, and a lower rate of complications.

Extensor pollicis longus tendon penetration by a screw post-distal radius fracture plating in a young woman: A case report.

INTRODUCTION: Due to its ability to provide stable fixation and permit early mobilization, volar plating has become the recommended technique for the surgical stabilization of distal radius fractures. The extensor pollicis longus (EPL) tendon may be injured or ruptured as a result of undetected screw penetration or drill plunging. During surgery, it is critical to detect any potential screw penetration so that it can be corrected. CASE PRESENTATION: A 32-year-old woman presented six weeks post-distal radius plating with an inability to extend her left thumb. Clinical examination revealed loss of extension at the interphalangeal joint, stiff wrist, tender point over the dorsal aspect of the wrist, and an intact sensory nerve function. DISCUSSION: Dynamic ultrasound and magnetic resonance imaging (MRI) both revealed no evidence of tendon rupture or EPL tendon movement. X-rays revealed the distal epiphyseal screws penetrating the far cortex. Intraoperatively, the EPL tendon was found to be impinged by a screw. The tendon was released, tenolysis was performed, and the distal screws were shortened. CONCLUSION: In order to assess screw penetration into the far cortex, volar plating for distal radius fractures should be performed using intraoperative imaging views such as lateral, 45-degree supination, 45-degree pronation, dorsal tangential, and skyline views. Timely interventions after distal radius fracture fixation preserve tendon function, and early detection of tendon compromise is essential to preventing additional damage.

[Effectiveness of minimally invasive internal fixation with locking plates for mid-shaft clavicle fractures].

Objective: To explore effectiveness of minimally invasive internal fixation with locking plates for mid-shaft clavicle fractures. Methods: Between October 2022 and August 2023, 28 patients with mid-shaft clavicle fractures were treated by minimally invasive internal fixation with locking plates. There were 10 males and 18 females with a mean age of 46.2 years (range, 18-74 years). The fractures were caused by traffic accident in 16 patients, sports-related injury in 7 patients, and other injuries in 5 patients. According to Robinson classification, the fractures were classified as type 2A1 in 1 case, type 2A2 in 6 cases, type 2B1 in 15 cases, and type 2B2 in 6 cases. The interval between fracture and operation ranged from 5 hours to 21 days (median, 1.0 days). The pain visual analogue scale (VAS) score was 8.1±1.6. The VAS score at 3 days after operation and the occurrence of complications after operation were recorded. During follow-up, X-ray films were re-examined to observe the healing of the fracture; the shoulder joint function was evaluated according to the Constant-Murley score at 6 months, and the length of the incision scar (total length of the distal and proximal incisions) was measured. Results: All operations were successfully completed without any subclavian vascular or nerve damage. All incisions healed by first intention. The VAS score was 1.2±0.7 at 3 days after operation, and there was a significant difference in VAS score between pre- and post-operation ( t=8.704， P<0.001). At 1 week after operation, the patient's shoulder was basically painless, and they resumed normal life. All patients were followed up 12-20 months (mean, 13.3 months). X-ray films showed that the bone callus began to form at 2-4 months after operation (mean, 2.7 months). There was no delayed healing or non healing of the fracture, and no loosening or fracture of the internal fixators during follow-up. At 6 months after operation, the mean total incision length was 1.5 cm (range, 1.1-1.8 cm); no patient complained of numbness or paresthesia on subclavicular region or anterior chest wall. The Constant-Murley score of shoulder joint function was 93-100 (mean, 97.6). Conclusion: Minimally invasive internal fixation with locking plates is a good surgical method for treating mid-shaft clavicle fractures, with simple operation, minimal trauma, good postoperative results, and high satisfaction.

Retrospective evaluation of perioperative clinical outcomes of diaphyseal femoral fractures repaired with the string-of-pearls locking plate system with adjunctive fixation.

OBJECTIVE: To evaluate outcomes and complication rate of utilizing a string-of-pearls (SOP) plate augmented with adjunctive fixation in the repair of canine femur fractures. METHODS: Records of canine patients with mid-diaphyseal femoral fractures repaired with the SOP plate and adjunctive fixation were reviewed. Information retrieved from medical records included signalment, patient weight, fracture configuration, repair technique, healing time, and complications based on perioperative radiographic follow-up to clinical union. Forty client-owned dogs met inclusion criteria for this study. Variables analyzed for association with major complications included body weight, fracture configuration, repair technique, and adjunctive fixation. RESULTS: Major complications requiring surgical revision occurred in 8 of 40 fractures. Five cases experienced intramedullary pin migration and were successfully treated with sedated pin removal. The remaining 3 cases involved implant failure via screw shear breakage and required surgical revision of the fixation to achieve a successful outcome. On the basis of a calculated Bonferroni correction, no statistical significance of the tested variables was found in association with major complications; however, significance was limited due to the low statistical power of this study. CONCLUSIONS: The use of adjunctive fixation with the SOP locking plate system led to radiographic union without complication in most cases, and no instances of plate breakage were reported. However, implant complications secondary to the adjunctive fixation can occur. CLINICAL RELEVANCE: Adjunctive fixation used with the SOP plate for repair of canine femur fractures has a high success rate, though pin migration as a complication persists.

Finite element analysis of the treatment of a minimally invasive approach combined with a novel anatomical locking plate for scapular body fractures.

BACKGROUND: The minimally invasive approach for the treatment of displaced scapular neck or body fractures has the advantages of less trauma and minimal muscle dissection. In clinical practice, the minimally invasive approach combined with an anatomical locking plate has been used to treat scapular body fractures. In addition, we have made minor modifications to the minimally invasive approach. However, the biomechanical study about the approach combined with an anatomical locking plate in treating scapular body fractures was limited. METHODS: Finite element analysis (FEA) was used to conduct the biomechanical comparison between the anatomical locking plate (AP model) and reconstructive plate (RP model) in the treatment of scapular body fractures through the modified minimally invasive approach. A healthy male volunteer with no history of scapula or systemic diseases was recruited. High-resolution computed tomography images of his right scapula were obtained. Two scapula models were constructed and analyzed by the software of Mimics 21.0, Geomagic Wrap 2021, SolidWorks 2021, and ANSYS Workbench 2022, respectively. RESULTS: Through static structural analysis, in terms of equivalent von Mises stress, equivalent elastic strain, and total deformation, the AP model exhibited superior safety characteristics, enhanced flexibility, and anticipated stability compared with the RP model. This was evidenced by lower maximum stress, lower maximum strain and displacement. CONCLUSION: The minimally invasive approach combined with an anatomical locking plate for scapular body fractures had better biomechanical stability. The study provided a biomechanical basis to guide the clinical treatment of scapular body fractures.