Comparative biomechanical analysis of three implants used in bicondylar tibial fractures.

BACKGROUND: Currently, the most difficult-to-treat tibial plateau fractures are complex, comminuted fractures, which result from high-energy trauma. The anatomical reconstruction of the articular surface and the preservation of the soft tissue envelope are required for a good functional result. The aim of this study is to perform a biomechanical evaluation of three constructs used in the treatment of bicondylar fractures: the L­shaped plate, the LCP locking plate, and the hybrid external fixator. METHODS: We used 30 experimental models divided into three study groups. There were ten models for each type of implant. RESULTS: The best biomechanical behavior was found with the LCP locking plate, which showed minimal deformation upon cyclic loading, followed by the hybrid external fixator. CONCLUSIONS: The LCP plate is the optimal implant for the stabilization of Schatzker type V tibial plateau fractures, with low rates of degradation for the implant and the bone-implant assembly.

Treatment of Canine Disc-Associated Cervical Spondylomyelopathy with a Cervical Distraction-Stabilization Technique (C-LOX Combined with LCP Plate) and Clinical Outcomes.

Canine disc-associated cervical spondylomyelopathy (DA-CSM) is a form of caudal CSM, characterized by the compression of the spinal cord and nerve roots due to an intervertebral disc protrusion. It is more frequent in large canine breeds. A variety of surgical techniques has been proposed for DA-CSM. The aim of the study was to evaluate the outcomes of a cervical distraction-stabilization technique using an intervertebral anchored fusion device (C-LOX) combined with a locking compression plate (LCP plate) for the treatment of DA-CSM in dogs, based on clinical and radiographical follow-up data. Thirteen dogs affected by DA-CSM were included in the study. After the surgical procedure, an improvement in neurological status was documented in 9/13 cases. This cervical distraction-stabilization technique seems to be a valuable surgical alternative to treat this canine pathology.

Extra-Articular Distal Humerus Plate 3D Model Creation by Using the Method of Anatomical Features.

Proper fixation techniques are crucial in orthopedic surgery for the treatment of various medical conditions. Fractures of the distal humerus can occur due to either high-energy trauma with skin rupture or low-energy trauma in osteoporotic bone. The recommended surgical approach for treating these extra-articular distal humerus fractures involves performing an open reduction and internal fixation procedure using plate implants. This surgical intervention plays a crucial role in enhancing patient recovery and minimizing soft tissue complications. Dynamic Compression Plates (DCPs) and Locking Compression Plates (LCPs) are commonly used for bone fixation, with LCP extra-articular distal humerus plates being the preferred choice for extra-articular fractures. These fixation systems have anatomically shaped designs that provide angular stability to the bone. However, depending on the shape and position of the bone fracture, additional plate bending may be required during surgery. This can pose challenges such as increased surgery time and the risk of incorrect plate shaping. To enhance the accuracy of plate placement, the study introduces the Method of Anatomical Features (MAF) in conjunction with the Characteristic Product Features methodology (CPF). The utilization of the MAF enables the development of a parametric model for the contact surface between the plate and the humerus. This model is created using specialized Referential Geometrical Entities (RGEs), Constitutive Geometrical Entities (CGEs), and Regions of Interest (ROI) that are specific to the human humerus bone. By utilizing this anatomically tailored contact surface model, the standard plate model can be customized (bent) to precisely conform to the distinct shape of the patient's humerus bone during the pre-operative planning phase. Alternatively, the newly designed model can be fabricated using a specific manufacturing technology. This approach aims to improve geometrical accuracy of plate fixation, thus optimizing surgical outcomes and patient recovery.

Comparative Assessment of Functional Outcomes of Surgical Treatment in Patients with Distal Radial Fractures.

BACKGROUND: Unstable and comminuted distal radial fractures require surgical treatment by percutaneous insertion of Kir-schner wires, open reduction and fixation with a non-locking or locking plate or with an external device. The aim of this paper was to try to answer the following question: are there differences in functional treatment outcomes in patients after surgery with the use of Kirschner wires vs LCP plate fixation? MATERIAL AND METHODS: The study group included 100 patients after surgical treatment by closed reduction and simple fixation with Kirschner wires (50 patients) and by open reduction and LCP locking plate fixation (50 patients). The study assessed the following parameters: global grip strength, pain severity in a VAS scale, range of motion, functional status of the wrist based on the Fernandez classification, quality of life according to the QuickDASH score, and the frequency of complications. These parameters were assessed at 6 and 12 months after surgery. RESULTS: An assessment of the treatment outcomes at 6 and 12 months after surgery showed statistically significant differences between the treatment methods in the following parameters: pain severity, global grip strength and range of motion in the sagittal plane. A comparison of the functional status of the wrist at 6 and 12 months between the groups showed considerably worse results in the Kirschner wire fixation group. The frequency of postoperative complications at 12 months was 6% in the Kirschner wire fixation group and 2% in the LCP plate fixation group. CONCLUSIONS: 1. Treatment outcomes were better in patients with distal radial fractures managed with LCP plate fixation. 2. The use of LCP plate fixation predisposes pa-tients to better ranges of mobility in the sagittal plane in the radiocarpal joint. 3.The values of global grip strength were higher in the group treated with LCP plate fixation. 4. Patients treated with LCP plates have better limb function and quality of life and lower pain intensity after treatment completion. 5. The number of complications was higher in pa-tients treated with Kirschner wire fixation.

Functional recovery following early mobilization after middle third clavicle osteosynthesis for acute fractures or nonunion: A case-control study.

BACKGROUND: Good outcomes have been reported after surgical treatment for acute or nonunion of displaced midshaft clavicle fractures. However, the postoperative rehabilitation and timeline for a complete functional recovery are poorly documented. The purpose of the current study was to evaluate the efficacy of an immediate motion protocol following plate fixation of a midshaft clavicle fracture and to compare functional recovery between acute and nonunion cases. METHODS: Between October 2011 and July 2015, all patients above the age of 18, having either an acute or a nonunion of the midshaft clavicle fracture, were considered as potentially eligible for inclusion in this prospective case-control study. Postoperatively, no immobilization was recommended and patients were to undergo rehabilitation protocol consisting of hourly stretching. RESULTS: Forty-two patients were included (31 with acute and 11 with delayed fixation) at a mean follow-up of 33months (range, 12 to 78months). Surgical complications consisted of one transient frozen shoulder, one delayed union, and two superficial infections. All patients returned to work, retrieved full shoulder range of motion (ROM), and returned to heavy sports and activities. Function returned faster in the acute group compared to the nonunion group based on the SANE score at 2weeks (73±21 vs. 45±26 respectively, P=0.01), SANE score at 6weeks (89±15 vs. 66±23 respectively, P=0.01), SANE score at 3months (96±10 vs. 85±14 respectively, P=0.03), and based on return of full ROM (17±25 vs. 44±31 days respectively, P=0.01). A trend was observed for nonunion cases needing more time to return to work and sports activities. CONCLUSION: Functional outcome is excellent following the treatment of both acute and non-united clavicle fractures, but recovery occurs earlier following acute treatment. An early mobilization rehab protocol can be safely recommended for both types of conditions and may result in substantial healthcare cost-savings, without increasing complication rate and decreasing patient satisfaction. LEVEL OF EVIDENCE: Level III; case-control study; treatment study.