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Articular fractures of the elbow require direct reduction and interfragmentary fixation to restore anatomic stability. The fragments are often small, with limited bone stock, hence implants are often placed through the articular surface to gain maximal purchase. Traditional techniques involve the use of countersunk cortical screws or cannulated headless compression screws. We describe a technique in which small locking screws are used independently from a plate as a substitute for headless or other traditional screws. This method of fixation negates the need for countersinking the screw head, or over drilling a guide wire, and enables the use of smaller diameter screws which provide excellent purchase in very small fragments. Independent locking screws can be considered for any fracture that previously would have been amenable to cortical or headless compression screw fixation. Locking screws from several manufacturers have been used with equal success. Screws can be used in a unicortical manner if necessary, as the grip comes from engaging the subchondral bone with the locking thread. This technique has been used on 35 consecutive articular elbow fractures with a minimum 6-month follow-up. All fractures have achieved bony union within this period, and there have been no loss of fixations or requirement for further surgeries to remove prominent metalwork.

Achieving stable fixation of displaced acute and chronic nonunited scaphoid fractures continues to be a challenge for the treating surgeon. The threaded compression screw has been the mainstay of treatment of these fractures for the last 3 decades; however, persistent nonunion after screw fixation has prompted development of new techniques. Recent results of volar buttress plating have been promising. We describe a novel technique of dorsal scaphoid plating. In contrast to volar plating, the dorsal plate is biomechanically more favorable as it utilizes the tension side of the scaphoid bone for dynamic compression. Dorsal scaphoid plating provides a more stable construct than the traditional Herbert screw and mitigates the need for vascular or corticocancellous bone grafting in most cases.

Unstable mallet fractures of the digit pose a challenge when treated surgically. We present the results of a technique, not earlier described, for the fixation of these uncommon injuries. The technique involves anatomical reduction and stable fixation of the distal articular fragment combined with stabilization of the distal interphalangeal joint with buried Kirschner wires allowing early mobilization of the digit. Twenty patients with an average follow-up of 12.7 months (10 mo to 21 mo) are presented. Results were good/excellent (Crawford's criteria) in 16 patients, fair in 3, and poor in 1 with those operated upon within 2 weeks postinjury achieving the best results. There were no incidences of fixation failure, loss of reduction, or posttraumatic osteoarthritis. One patient had a minor infection, but there were no cases of nail deformity or wound breakdown. There was high patient satisfaction and all patients returned to work after treatment. We conclude that this is a reliable technique with minimal complications and is comparable with other published operative and nonoperative treatment modalities.