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The main tools used by an orthopaedic surgeon for managing distal radial fracture treatment are recent literature and treatment guidelines. The aim of the present study was to find which factors within the study design influence study outcomes the most. Trials in three major databases (PubMed, Scopus, Embase) comparing surgical and non-surgical treatment options for adolescent and adult distal radial fractures with their original data, between 2013 and 2021, were included. The selected 47 studies were classified according to their outcomes. The relationship between study characteristics and outcomes was statistically analysed. It was more likely to find no difference in outcomes between volar locking plate and less invasive treatments when the sample size was above 100, follow-up was more than 1 year and functional assessments were used. A small sample size and short follow-up time affect study outcomes in favour of a volar locking plate. Readers should focus on the design criteria and read the full text of the studies before making any conclusions. Level of evidence: III [ABSTRACT FROM AUTHOR]

Background: Conservative treatment of lateral clavicle fractures (Neer type II) often ends with unsatisfactory results for patients. Operative treatment is thus gaining acceptance. A retrospective study found success using a double plate technique for these injuries. For the current study, a standardized testing setup was developed to compare the mechanical properties of single versus double plate technique for lateral clavicle fractures. Methods: Six synthetic bones were tested for each technique. Neer type IIB fractures were created using computer-aided design (CAD). Fatigue testing was carried out with a cantilever bending test. Parameters measured were cycles undergone, failure load and stiffness at the point of failure. Results: The standardized testing setup was able to provide reproducible failures. The double plate technique lasted about 16,000 more cycles and withstood an additional 22.4 N on average. Conclusions: The new modified standardized testing setup produced reproducible fixation failures for both clavicle fracture fixation techniques. The double plate technique seems to be mechanically superior to the single plate technique. [ABSTRACT FROM AUTHOR]

Purpose To introduce a new model of telescopic intramedullary rod (TIR), evaluate its effects on treating patients presenting with moderate and severe osteogenesis imperfecta (OI) and to compare the findings with those of other telescopic rods. Methods A total of 21 patients (nine girls and 12 boys; mean age at first operation, 6.6 years, 1.52 to 13.18) who underwent 52 femoral operations were monitored during a mean of 9.96 years (3.39 to 14.54). Patient characteristics, telescoping rod capability and its complications were examined. Results According to the Sillence classification, we investigated one patient with type I, nine with type III and 11 with type IV OI. Revision rates at up to five years (36%) were inferior to those found for the Fassier-Duval rod (46%). The main cause of revision was fracture (15 patients), followed by rod migration (nine), and infection (two). The rod exhibited higher telescopic capacity in boys than girls. Type III most commonly required an operation; the age group with the highest number of procedures was five to ten years. Male migration was the main cause of rod migration. Conclusion The TIR has a satisfactory cost-benefit ratio with less complication rates and low production costs. The TIR is a feasible alternative to the commonly used Fassier-Duval rod. [ABSTRACT FROM AUTHOR]

Background Guided growth by tension band plating is commonly used to correct coronal plane deformity. The purpose of this study was to measure the effect and further define parameters that influence results in coronal plane deformity around the knee. Methods The retrospective multicentre study included data on 967 physes in 537 patients, with an average follow-up of 16 months after plate insertion. Alignment analysis was compared preoperatively and in at least two measurements postoperatively, as well as with parameters that influence the rate and amount of correction. Results Average age at plate implantation was 11.35 years (SD 3.29). Of those with femoral deformities, 85% of the patients finished the treatment and of those, 70% were corrected to standard alignment, while 14% have not yet achieved correction, and are still growing. Of those with tibial deformities, 75% of the patients finished the treatment and of those 80% were corrected to standard alignment, while 25% have not yet achieved correction and are still growing. The calculated rate of correction was 0.77°/month for the femur and 0.79°/month for the tibia. In terms of complications, the overall rate of infection was 1.48%. In three patients (0.55%) screw breakage was recorded. Factors found to significantly influence the amount of correction were age at plate implantation and direction of deformity. Conclusion Temporary hemiepiphysiodesis takes the advantage of physiological physeal growth to effectively treat angular deformities. Success of treatment is influenced by the age of the patient at plate implantation and direction of deformity. [ABSTRACT FROM AUTHOR]

Background: Microfracture and the autologous matrix-induced chondrogenesis (AMIC) technique are popular for the treatment of articular cartilage defects. However, breaching of the subchondral bone plate could compromise the subchondral bone structure. Hypothesis: Microfracture and AMIC will cause deleterious effects on the subchondral bone structure. Study Design: Controlled laboratory study. Methods: A total of 36 sheep received an 8-mm-diameter cartilage defect in the left medial femoral condyle. Control animals (n = 12) received no further treatment, and the rest received 5 microfracture holes either with a type I/III collagen scaffold implanted (n = 12; AMIC group) or without the collagen scaffold (n = 12; microfracture group). Macroscopic infill of defects, histology, and histomorphometry of the subchondral bone were performed at 13 and 26 weeks postoperatively, and micro–computed tomography (CT) was also performed at 26 weeks postoperatively. Results: Microfracture and AMIC resulted in subchondral bone cyst formation in 5 of 12 (42%) and 11 of 12 (92%) specimens at 13 and 26 weeks, respectively. Subchondral bone changes induced by microfracture and AMIC were characterized by an increased percentage of bone volume, increased trabecular thickness, and a decreased trabecular separation, and extended beyond the area below the defect. High numbers of osteoclasts were observed at the cyst periphery, and all cysts communicated with the microfracture holes. Cartilage repair tissue was of poor quality and quantity at both time points and rarely reached the tidemark at 13 weeks. Conclusion: Microfracture technique caused bone cyst formation and induced severe pathology of the subchondral bone in a sheep model. Clinical Relevance: The potential of microfracture technique to induce subchondral bone pathology should be considered. [ABSTRACT FROM AUTHOR]

A prospective randomised controlled trial of operative versus non-operative management of fractures of the humeral diaphysis: the HUmeral shaft fracture FIXation (HU-FIX) study protocol. Quotation errors related to the distal radius acute fracture fixation trial paper. A prospective randomised controlled trial of operative versus non-operative management of fractures of the humeral diaphysis: the HUmeral shaft fracture FIXation (HU-FIX) study protocol. [Extracted from the article]

The article presents a study on the use of the Synthes™ locking compression plate (LCP) for extra-articular distal humeral fractures. The study obtained and analyzed patients' demographics, visual analogue score (VAS), and satisfaction after fracture fixation. Results revealed two patients who had pre- and postoperative radial nerve neuropraxia and recovered. The study concluded that the Synthes™ plate can provide satisfactory outcome for the management of extra-articular fracture.

Polymers prepared from polylactic acid (PLA) have found a multitude of uses as medical devices. For a material that degrades, the main advantage is that an implant would not necessitate a second surgical event for removal. In this study, fibers produced from a quaternary phosphate-based glass (PBG) in the system 50P2O5-40CaO-5Na2O-5Fe2O3 were used to reinforce PLA polymer. The purpose of this study was to assess the effect of screw holes in a range of PBG-reinforced PLA composites with varying fiber layup and volume fraction. The flexural properties obtained showed that the strength and modulus values increased with increasing fiber volume fraction; from 96 MPa to 320 MPa for strength and between 4 GPa and 24 GPa for modulus. Furthermore, utilizing a larger number of thinner unidirectional (UD) fiber prepreg layers provided a significant increase in mechanical properties, which was attributed to enhanced wet out and thus better fiber dispersion during production. The effect of gamma sterilization via flexural tests showed no statistically significant difference between the sterilized and nonsterilized samples, with the exception of the modulus values for samples with screw holes. Degradation profiles revealed that samples with screw holes degraded faster than those without screw holes due to an increased surface area for the plates with screw holes in PBS up to 30 days. Scanning electron microscope (SEM) analysis revealed fiber pullout before and after degradation. Compared with various fiber impregnation samples, with 25% volume fraction, 8 thinner unidirectional prepreg stacked samples had the shortest fiber pull-out lengths in comparison to the other samples investigated. [ABSTRACT FROM PUBLISHER]

In this study, bioresorbable phosphate-based glass (PBG) fibers were used to reinforce poly(lactic acid) (PLA). PLA/PBG random mat (RM) and unidirectional (UD) composites were prepared via laminate stacking and compression molding with fiber volume fractions between 14% and 18%, respectively. The percentage of water uptake and mass change for UD composites were higher than the RM composites and unreinforced PLA. The crystallinity of the unreinforced PLA and composites increased during the first few weeks and then a plateau was seen. XRD analysis detected a crystalline peak at 16.6° in the unreinforced PLA sample after 42 days of immersion in phosphate buffer solution (PBS) at 37°C. The initial flexural strength of RM and UD composites was ∼106 and ∼115 MPa, whilst the modulus was ∼6.7 and ∼9 GPa, respectively. After 95 days immersion in PBS at 37°C, the strength decreased to 48 and 52 MPa, respectively as a result of fiber–matrix interface degradation. There was no significant change in flexural modulus for the UD composites, whilst the RM composites saw a decrease of ∼45%. The molecular weight of PLA alone, RM, and UD composites decreased linearly with time during degradation due to chain scission of the matrix. Short fiber pull-out was seen from SEM micrographs for both RM and UD composites. [ABSTRACT FROM PUBLISHER]

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‘Skiving’ is commonly used to refer to the condition when the subchondral plate is disrupted and the overlying cartilage physically displaced without the screw tip entering the joint. In this study we sought to define radiographic parameters of skiving and compare radiographs with computed tomography (CT) for accuracy in determining joint skiving. Cadaveric specimens of the distal radius were implanted with a volar plate and screws. Arthrotomies were performed to definitively assess the positions of the screws. Standard and anatomic tilt radiographs as well as CT were performed. Orthopaedic surgeons and radiologists evaluated the images and reported whether screw penetration or skiving had occurred. For screws which penetrated or skived, measurements were made to record the distances from the screw tips to the subchondral plate. Sensitivity, specificity and percent correct interpretations were 53%, 83%, 60% respectively for radiographs; and 100%, 72%, 69% for CT. Screws penetrating the articular surface protruded an average 2.3 mm (range 2–2.6 mm) from the subchondral plate and those skiving protruded 1.4 mm (range 1–1.8 mm). This study shows that articular skiving can occur with penetration of the subchondral plate of up to 1.8 mm. CT has a greater sensitivity and lower specificity in determining skiving compared to radiographs. [ABSTRACT FROM PUBLISHER]

This study aimed to develop a plate to treat fractures of the mandibular body in dogs and to validate the project using finite elements and biomechanical essays. Mandible proto-types were produced with 10 oblique ventrorostral fractures (favorable) and 10 oblique ventrocaudal fractures (unfavor-able). Three groups were established for each fracture type. Osteosynthesis with a pure titanium plate of double-arch geometiy and blocked monocortical screws of free angula-tion were used. The mechanical resistance of the prototype with unfavorable fracture was lower than that of the favorable fracture. In both fractures, the deflection increased and the relative stiffness decreased proportionally to the diminishing screw number. The finite element analysis validated this plate study, since the maximum tension concentration observed on the plate was lower than the resistance limit tension admitted by the titanium. In conclusion, the double-arch geometry plate fixed with blocked monocortical screws has sufficient resis-tance to stabilize oblique fractures, without compromising mandibular dental or neurovascular structures. [ABSTRACT FROM AUTHOR]

A patient previously treated by cannulated screws fixation of a femoral neck fracture and plate and screw fixation of an ipsilateral shaft fracture presented for a total hip arthroplasty due to femoral head avascular necrosis. The cortical bone at the previous fracture site was weak and damage on the proximal femur was considered likely during removal of the plate. We were also concerned that a periprosthetic fracture might occur during or after the insertion of a conventional femoral stem. We used a short-stemmed femoral component for total hip arthroplasty in this patient, to avoid the risk of potential complications. [ABSTRACT FROM AUTHOR]

The article discusses some of the challenges that are associated with the use of stabilizing plates to surgically treat rib fractures, flail chest injuries, and chest wall-related bony reconstruction injuries. Surgical hardware failures and mechanical strain are examined, along with the use of titanium plates in surgical procedures. Bone grafting and repetitive motion wear are assessed, as well as corrosive wear, brittle fractures, and the reconstruction of bony defects.

The efficacy of the reverse Less Invasive Plating System in the management of unstable proximal femoral extracapsular fractures was retrospectively evaluated. Twenty-seven patients with complex proximal femoral fractures were identified. There were three open fractures. The mean age was 71 years (range; 65-79). The mean follow up was 24 months (range; 15-32). The main outcome measures were union, union time, requirement for secondary procedures, development of deep infection, pain, and functional impairment. Nonunion was observed in one patient. The average Harris hip score at the last assessment was 73 points (range 58-85). The outcome was adversely affected by concomitant medical problems, anatomical reduction and fixation of the plate. The use of this plate in the management of proximal femoral fractures of all types may be a safe and alternative method to other treatment options. [ABSTRACT FROM AUTHOR]

We report an unusual case of early erosion of acromion with a Hook-plate used for fixation of lateral clavicle fracture. The management options and treatment is discussed further. [ABSTRACT FROM AUTHOR]

The author comments on a study by A. P. Riddick et al on the accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation. He suggests that volar plating was introduced in response to problems related to extensor tendon adherence and damage following the placement of dorsal plates among surgeons not familiar with the approach. He describes the design of modern dorsal plates. He suggests the implications for companies that invest in volar implants.