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Background: Dynamic compression plate (DCP) osteosynthesis is the gold standard for treating forearm diaphyseal fractures, providing stability and promoting healing. Locking plates (LPs) are increasingly used in modern fracture management but may increase the risk of nonunion if applied with excessive rigidity and without proper fracture site compression. The purpose of this study is to compare the nonunion rate between LPs and DCPs. Materials and methods: We conducted a retrospective study by reviewing the medical records and radiographs of 515 patients diagnosed with radial and/or ulnar shaft fractures at three trauma centers between 2014 and 2019. Inclusion criteria were patients treated with locking plates (LPs), locking compression plates (LCPs), or dynamic compression plates (DCPs) who had at least 9 months of outpatient follow-up and imaging assessments. Exclusion criteria included treatment with other methods, hospitalization for pathological fractures or implant removal, or incomplete surgical records. Data on patient demographics, injury details, and surgical outcomes were collected to compare nonunion rates, as well as early and late complications, between the LP and DCP groups. Results: A total of 368 patients were included in the analysis. Among them, 132 (35.9%) had isolated radial shaft fractures, 116 (31.5%) had isolated ulnar shaft fractures, and 120 (32.6%) had both-bone fractures. Of these, 124 patients received LP implants, 98 were treated with LCPs, and 146 were treated with DCPs. Early complications were comparable among the groups; however, the nonunion rate was significantly higher in the LP group (18.5% versus 11.2% versus 6.2%, p < 0.007). Logistic regression identified LP use [odds ratio (OR): 3.05, 95% confidence interval (CI) 1.24–7.53] as a significant predictor of nonunion. Notably, LPs lacking dynamic compression functionality were associated with markedly higher odds of nonunion in radial shaft fractures (OR: 26.94, 95% CI 3.52–206.15). These findings collectively indicate that LPs increase the nonunion rate in forearm fractures. Conclusions: Using LPs without compression functionality to treat forearm diaphyseal fractures increases the nonunion rate, particularly in radial shaft fractures. Therefore, we recommend using LCPs or DCPs for forearm diaphyseal fractures to ensure adequate compression at the fracture site during fixation, thereby promoting optimal bone healing rates. Level of evidence: Level III: retrospective comparative therapeutic study. [ABSTRACT FROM AUTHOR]

Background: To explore the advantages of a lateral tibial locking plate combined with Jail screw fixation in the treatment of anterolateral tibial plateau collapse fracture (ATPCF). Methods: A retrospective analysis was conducted on patients with ATPCFs admitted to our hospital from February 2019 to February 2023. Twenty-six patients were successfully included, including 15 males and 11 females, with an average age of 58.6 ± 7.8 years (range 45–68 years). All fractures were Schatzker type II fractures. After fracture reduction and fixation, a lateral locking titanium plate was placed through the anterolateral approach of the tibial plateau, and two screws of appropriate length were placed in the sagittal direction according to the Jail screw technique. Postoperative evaluation indices included surgery time, fracture healing time, the degree of tibial plateau collapse shown by computed tomography (CT) images at 3 days and 1 year after surgery, and the patient's knee range of motion at 1 year after surgery. The effects of fracture reduction and fixation before surgery, 3 days after surgery and 1 year after surgery were evaluated by the Rasmussen radiological score. The Hospital for Special Surgery (HSS) knee score was used to evaluate the knee joint function of patients at 1 year after surgery. Results: The average operation time was 64 ± 6.8 min (range 56–82 min). The fractures healed clinically at 13.8 ± 2.8 weeks (range 12–18 weeks) postoperation. After 15 ± 3.1 months (range 12–19 months) of average follow-up, all the patients were pain-free with a full range of motion and stable knees. At the 1-year postoperative assessment, the CT images showed no secondary collapse of the articular surface, the average knee range of motion was 136.3 ± 2.5° (range, -5° to 135°), the average Rasmussen radiological score was 16.2 ± 0.8 points, and the average HSS knee score was 93.6 ± 3.2 points. Conclusions: The fixation of a anterolateral tibial plateau collapse fracture(ATPCF) using a lateral locking plate and the Jail screw technique has achieved good knee joint function, providing a new option for the treatment of ATPCFs. The clinical efficacy is satisfactory in the short term, avoiding secondary articular surface collapse. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: The optimal management strategy for unstable distal clavicular fractures remains controversial. Recent studies on plate techniques have reported good-to-excellent outcomes with no serious complications. The questions are that: (1) Does the use of wire augmentation with locking plate in distal part (distal wire augmentation) reduce radiographic loss of reduction (RLOR) and get earlier bony union in distal clavicular fractures? (2) Which fixation methods are associated with a higher incidence of acromioclavicular (AC) joints arthritis or subluxation? We collected and analyzed clinical studies on different plate fixation methods for unstable fractures to identify the best surgical modality. Methods: This retrospective case-control study included 101 patients with Neer types IIB and V unstable distal clavicle fractures treated using plate techniques. The patients were divided into four groups according to the surgical procedure: hook plate (HP group) (n = 13), lateral locking plate alone (LP group) (n = 41), locking plate with coracoclavicular (CC) ligament suture repair (LPC group) (n = 26), and locking plate with distal wire augmentation (LPA group) without CC repair (n = 21). The clinical outcomes of shoulder function were the mean Constant score and the University of California-Los Angeles (UCLA) shoulder scale. The bony union time, loss of CC distance reduction, and AC joint condition were used to evaluate the radiographic results. One-way ANOVA, Kruskal–Wallis test, and chi-square test were performed to compare differences between groups. Multiple p-value comparison corrections were calculated using the Bonferroni method. Results: There were no significant differences in the mean Constant and UCLA scores among the groups after 1 year of follow-up. All fractures healed. The LPA and HP groups achieved earlier bone union (LPA 8.4 weeks, HP 8.9 weeks, LP 12.6 weeks, and LPC 13.4 weeks, P = 0.000); however, the HP group had the highest complication rate and required bone removal (LPA 4.0%, HP 23.1%, LP 0.0%, LPC 0.0%, P = 0.003). A low rate of RLOR was observed in the LPA group (LPA 9.5%, HP 23.1%, LP 22.0%, LPC 30.8%, P = 0.362). The incidence of AC joint subluxation was higher in the Neer type V group and was unrelated to surgical methods. Conclusions: Hook plate and locking plate with distal wire augmentation in distal clavicle fractures result in an earlier time to bone union when compared with CC suture repair or non-CC suture repair techniques. However, HP may have the higher complication rate and require subsequent implant removal. The incorporation of distal wire augmentation appears to be beneficial in maintaining fracture reduction. In the future, larger prospective studies are needed to confirm these findings. Level of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Summary: This case report describes a novel fixation technique of scapular neck fracture in a 2‐week‐old Arabian foal using two 3.5 mm tibial‐plateau‐levelling‐osteotomy (TPLO) locking plates originally designed for small animal orthopaedic surgery. The foal presented with a traumatic short oblique scapular neck fracture. Fracture fixation was performed under general anaesthesia using two anatomically pre‐shaped 3.5 mm TPLO locking plates; one on each side of the spine of the scapula. Fracture fixation was successful using two TPLO locking plates. Minimal soft tissue manipulation and identification of the suprascapular nerve allowed for relatively atraumatic application of the implants. The implants were left in place. Follow‐up evaluation 2 years after surgical intervention confirmed the horse to be sound with no clinical or gait abnormalities. Stabilisation of a short oblique scapular neck fracture in a 2‐week‐old foal with an anatomically pre‐shaped implant led to a good outcome in this case report. No complications were encountered during the recovery period. The use of an anatomically pre‐shaped locking plate intended for use on dogs, which is widely available in the veterinary industry, has proven to be a viable alternative for a scapular neck fracture fixation in this foal. [ABSTRACT FROM AUTHOR]

Background: The clinical benefit of locking plates in distal fibula fractures has not yet been proven. In addition, the risk of wound complications appears to be higher than with conventional tubular plates. We hypothesize that the benefits of locking plates in terms of biomechanical properties are outweighed by a higher risk of wound complications. Methods: We conducted a retrospective review of fibula fractures treated by osteosynthesis with either a conventional one-third tubular plate or an anatomically shaped locking plate from January 1, 2015 to December 31, 2021. We recorded baseline data and relevant comorbidities and defined the need for revision surgery due to wound-related or mechanical complications as primary endpoints. Results: A total of 595 out of 727 patients were eligible for our study. Of these 595 fractures, 526 were fixed with a one-third tubular plate, 69 with a locking plate. Revision surgery was required in 54 patients, in 51 cases due to wound complications. Three patients required revision surgery for mechanical reasons and all of them were younger than 40 years of age, have not been diagnosed with osteoporosis, but experienced complex fracture types. As the third tubular plate and locking plate groups differed in terms of age and comorbidities, we performed a 2:1 matching based on age and gender, leaving data from 138 patients receiving a third tubular plate. While the two groups were comparable in many aspects, the rate of wound complications was significantly higher in the locking plate group. Although the locking plate group had a higher percentage of diabetes mellitus, there was no correlation between this comorbidity and the higher revision rate in this group. Conclusions: Our data do not support the general use of locking plates in the treatment of distal fibular fractures. The risk of mechanical complications in osteoporotic ankle fractures seems to be overrated, as there were no mechanical revisions in the osteoporotic subgroup. The rate of wound-related revision surgery was significantly higher after the use of locking plates. This might be attributed to the greater thickness of locking plates. [ABSTRACT FROM AUTHOR]

Abstract Locking plates have a rapidly growing process especially in the past decades and results are satisfactory especially in the osteoporotic bones compared to non-locking compression plates. There are many forms of failure in the fracture fixation of locking plates, and screw pull-out is one of the main failure reasons. In this study, we aim to investigate pull-out failure in locking plates using locking spongious screws. The pull-out force of an FDA approved locking plate system (LPS) and anonymous locking plate using the single lead head locking spongious screw (LPuLSS) was evaluated in vitro on the PCF-15 and PCF-10 osteoporotic sawbone models. A total of 28 individual plate-bone models were tested and pull-out force was evaluated on a distraction machine. The moment of separation of the screws from the bone blocks was noted. In the first study using PCF15 bone model, in Group 1, the pull-out force has an average of 606.82 N. In Group 2, the pull-out force has an average of 294.15 N. According to these results, Group 1 adhere to the bone model 206.29% more strongly than those in Group 2 (P = 0.025). In the second study using PCF 10, in Group 3, the average pull-out force was 166.50 N and in Group 4 the average was 42.83 N. According to these results, Group 3 adhere to the bone model 388.74% more strongly than those in Group 4 (P = 0.002). Locking plates are mostly used in osteoporotic bones and this study demonstrated that the single lead head locking spongious screws which is currently used worldwide have a serious technical problem which arouses with difference of the thread pitch distances on the body and on the head causes pull-out failure.

Abstract Background To explore the advantages of a lateral tibial locking plate combined with Jail screw fixation in the treatment of anterolateral tibial plateau collapse fracture (ATPCF). Methods A retrospective analysis was conducted on patients with ATPCFs admitted to our hospital from February 2019 to February 2023. Twenty-six patients were successfully included, including 15 males and 11 females, with an average age of 58.6 ± 7.8 years (range 45–68 years). All fractures were Schatzker type II fractures. After fracture reduction and fixation, a lateral locking titanium plate was placed through the anterolateral approach of the tibial plateau, and two screws of appropriate length were placed in the sagittal direction according to the Jail screw technique. Postoperative evaluation indices included surgery time, fracture healing time, the degree of tibial plateau collapse shown by computed tomography (CT) images at 3 days and 1 year after surgery, and the patient's knee range of motion at 1 year after surgery. The effects of fracture reduction and fixation before surgery, 3 days after surgery and 1 year after surgery were evaluated by the Rasmussen radiological score. The Hospital for Special Surgery (HSS) knee score was used to evaluate the knee joint function of patients at 1 year after surgery. Results The average operation time was 64 ± 6.8 min (range 56–82 min). The fractures healed clinically at 13.8 ± 2.8 weeks (range 12–18 weeks) postoperation. After 15 ± 3.1 months (range 12–19 months) of average follow-up, all the patients were pain-free with a full range of motion and stable knees. At the 1-year postoperative assessment, the CT images showed no secondary collapse of the articular surface, the average knee range of motion was 136.3 ± 2.5° (range, -5° to 135°), the average Rasmussen radiological score was 16.2 ± 0.8 points, and the average HSS knee score was 93.6 ± 3.2 points. Conclusions The fixation of a anterolateral tibial plateau collapse fracture(ATPCF) using a lateral locking plate and the Jail screw technique has achieved good knee joint function, providing a new option for the treatment of ATPCFs. The clinical efficacy is satisfactory in the short term, avoiding secondary articular surface collapse.

Background: Proximal humerus fractures are typically minimally displaced and often result from low-energy trauma, particularly in elderly individuals with osteoporosis. In such cases, conservative or non-surgical treatments are generally effective. However, the optimal treatment approach remains an active research and debate area for fractures with moderate to severe displacement. Aims and Objectives: This study aims to conduct a comprehensive comparative analysis, focusing on evaluating and distinguishing the functional outcomes in elderly patients with complex proximal humerus fractures. Materials and Methods: A prospective, comparative study was conducted involving 60 elderly patients. The primary goal was to assess and compare the functional outcomes of complex proximal humerus fractures treated surgically using plating versus conservative treatment methods. Results: At the 8-week follow-up, patients in the non-surgical group demonstrated significantly lower average values for flexion, abduction, external rotation, and internal rotation than the surgical group. However, by the 6-month mark, no significant differences were observed between the two groups. Conclusion: The locking plate is a preferred implant for comminuted proximal humerus fractures. In this study, outcomes from locked plate fixation were comparable to those of non-operative treatments. Early initiation of physiotherapy and a robust rehabilitation program are crucial for achieving optimal functional recovery.

Aims: To assess the feasibility and safety of a locking cortical pearl plate system for the repair of lumbar vertebral fractures and luxation in cats using an ex vivo feline model. Methods: This cadaveric study of the lumbar vertebral column (L1–L7) involved 28 Domestic Short-hair cats without vertebral column pathology. Surrounding soft tissue was removed, except for the paravertebral musculature, joint capsules, and ligaments associated with the L1–L7 vertebrae. To determine whether the application of a 2.0-mm, 69-mm-long, 12-hole locking cortical pearl plate (LCPP) and screws was feasible, the dimensions of the feline lumbar vertebral bodies (length, width, and height) were measured using CT imaging. Width and height were evaluated at five locations along the length of the vertebrae with implant corridors (cor 1–cor4) located in between. Following CT, plates were applied to the vertebral columns. After implantation, another CT scan was performed to evaluate plate positions, screw trajectories, screw implantation angles, and vertebral canal breaching. Implantation was classified according to the modified Zdichavsky scoring system for vertebral canal penetration and grade I and IIa defined as acceptable. Results: A total of 371 screws were inserted into the lumbar vertebral bodies, and breaching occurred in 32 cases (8.6%), of which 29 (90.6%) were at L6 and L7. The median angle of inserted screws was 61.6° (min 53.4°, max 76.3°). Aside from one location, no significant angle deviations were observed between breaching (median 62.8°; min 53.4°, max 76.3°) and non-breaching (median 61.2°; min 53.8°, max 74.7°) screws. All 267 screws implanted in L1–L5 were graded I or IIa (acceptable). In contrast, low rates of acceptable implantation were achieved for L6 (52/60; 86.7%) and L7 (24/44; 54.4%), caused by clustering of breachings in corridor 3 of the two vertebrae. Conclusions: Application of the LCPP immediately proximal to the transverse processes and ventral to the pedicles with a screw implantation angle of 60° is feasible and appears safe for L1–L5, resulting in a low number of vertebral canal breaches and a high rate of acceptable implantations. Clinical relevance: The 2.0-mm, 69-mm-long, 12-hole LCPP can be considered an acceptable option for treating feline vertebral fractures and luxations of L1–L5. It cannot be recommended for use in corridor 3 of L6 or L7 due to the high risk of breaching the vertebral canal. [ABSTRACT FROM AUTHOR]

Abstract Background Titanium plantar plates have proven successful in the fixation of the first tarsometatarsal arthrodesis (TMT). However, a second surgery is typically needed for implant removal, and potential adverse effects, carried by the conventional implantations, are not uncommon. The purpose of this study was to determine whether a novel magnesium-based plantar plate system provides similar fusion stability to a titanium-based plantar plate system under various loading conditions. Methods Six matched-pair human cadaveric specimens underwent TMT fusions using either a magnesium plantar plate system prototype or a titanium plantar plate system. Specimens were cyclically loaded with a force ranging from 5 N to 50 N for 5,000 cycles, and displacement was recorded. Axial stiffness (N/mm) was calculated from load-displacement curves. Each specimen was loaded to failure at a rate of 5 mm/min, and the ultimate load was recorded. Results No significant difference was found in the vertical displacement between Ti group and Mg group after 100 cycles (2.4 ± 1.0 mm vs. 1.3 ± 1.4 mm, p = 0.196), 500 cycles (3.3 ± 1.3 mm vs. 1.7 ± 1.7 mm, p = 0.142), 1,000 cycles (3.7 ± 1.5 mm vs. 1.9 ± 1.9 mm, p = 0.128), 2,500 cycles (4.2 ± 1.7 mm vs. 2.3 ± 2.2 mm, p = 0.172) and 5,000 cycles (4.5 ± 1.8 mm vs. 2.3 ± 3.3 mm, p = 0.125), Additionally, no significant differences were observed in initial stiffness (53.1 ± 19.2 N/mm vs. 82.2 ± 53.9 N/mm, p = 0.257), final stiffness (90.6 ± 48.9 N/mm vs. 120.0 ± 48.3 N/mm, p = 0.319), or maximum load-to-failure (259.8 ± 98.2 N vs. 323.9 ± 134.9 N, p = 0.369). Conclusions Based on the performed biomechanical testing, the magnesium plantar plate system provides mechanical stability equivalent to the titanium plantar plate system in fixation for the first TMT joint fusion.

Abstract Calcaneal body fractures are often associated with varying degrees of shortening deformities. Restoring calcaneal length is crucial for the functional prognosis of the foot. Through finite element analysis, this study compared the biomechanical effects of multiple fixation schemes for calcaneal fractures. We delineated and assembled the finite element model of the Sanders type II calcaneal fracture and four internal fixation simulations (namely distraction screw, lag screw, frame locking plate, and T-shaped locking plate). Different axial forces (350, 700, and 1400 N) were then applied to simulate various postures. We then compared the inner and outer shortening distances (D1 and D2, respectively), equivalent von Mises stress, and maximum von Mises stress of the calcaneus. In the individual model, with an increase in the pressure, D1, D2, and the maximum von Mises stress gradually increased. At 1400 N, D1 and D2 for the internal fixation schemes were as follows: distraction screw (0.03 mm, 0.1 mm)

Background: Titanium plantar plates have proven successful in the fixation of the first tarsometatarsal arthrodesis (TMT). However, a second surgery is typically needed for implant removal, and potential adverse effects, carried by the conventional implantations, are not uncommon. The purpose of this study was to determine whether a novel magnesium-based plantar plate system provides similar fusion stability to a titanium-based plantar plate system under various loading conditions. Methods: Six matched-pair human cadaveric specimens underwent TMT fusions using either a magnesium plantar plate system prototype or a titanium plantar plate system. Specimens were cyclically loaded with a force ranging from 5 N to 50 N for 5,000 cycles, and displacement was recorded. Axial stiffness (N/mm) was calculated from load-displacement curves. Each specimen was loaded to failure at a rate of 5 mm/min, and the ultimate load was recorded. Results: No significant difference was found in the vertical displacement between Ti group and Mg group after 100 cycles (2.4 ± 1.0 mm vs. 1.3 ± 1.4 mm, p = 0.196), 500 cycles (3.3 ± 1.3 mm vs. 1.7 ± 1.7 mm, p = 0.142), 1,000 cycles (3.7 ± 1.5 mm vs. 1.9 ± 1.9 mm, p = 0.128), 2,500 cycles (4.2 ± 1.7 mm vs. 2.3 ± 2.2 mm, p = 0.172) and 5,000 cycles (4.5 ± 1.8 mm vs. 2.3 ± 3.3 mm, p = 0.125), Additionally, no significant differences were observed in initial stiffness (53.1 ± 19.2 N/mm vs. 82.2 ± 53.9 N/mm, p = 0.257), final stiffness (90.6 ± 48.9 N/mm vs. 120.0 ± 48.3 N/mm, p = 0.319), or maximum load-to-failure (259.8 ± 98.2 N vs. 323.9 ± 134.9 N, p = 0.369). Conclusions: Based on the performed biomechanical testing, the magnesium plantar plate system provides mechanical stability equivalent to the titanium plantar plate system in fixation for the first TMT joint fusion. [ABSTRACT FROM AUTHOR]

Calcaneal body fractures are often associated with varying degrees of shortening deformities. Restoring calcaneal length is crucial for the functional prognosis of the foot. Through finite element analysis, this study compared the biomechanical effects of multiple fixation schemes for calcaneal fractures. We delineated and assembled the finite element model of the Sanders type II calcaneal fracture and four internal fixation simulations (namely distraction screw, lag screw, frame locking plate, and T-shaped locking plate). Different axial forces (350, 700, and 1400 N) were then applied to simulate various postures. We then compared the inner and outer shortening distances (D1 and D2, respectively), equivalent von Mises stress, and maximum von Mises stress of the calcaneus. In the individual model, with an increase in the pressure, D1, D2, and the maximum von Mises stress gradually increased. At 1400 N, D1 and D2 for the internal fixation schemes were as follows: distraction screw (0.03 mm, 0.1 mm) < T-shaped locking plate (0.45 mm, 0.26 mm) < frame locking plate (0.50 mm, 0.26 mm) < lag screw (0.66 mm, 0.64 mm). The maximum von Mises stress values for the internal fixation methods were as follows: lag screw (491.0 MPa) < distraction screw (663.1 MPa) < frame locking plate (772.7 MPa) < T-shaped locking plate (931.8 MPa). In patients with calcaneal body fractures, the distraction screw is a potential therapeutic option for resisting calcaneal shortening. [ABSTRACT FROM AUTHOR]

Abstract 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.

Abstract 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.

Abstract Background The calcar of the proximal humerus is a fundamental structure for medial humeral column support. This study aimed to assess the outcome of osteosynthesis across cases of unstable proximal humerus fractures (PHFs) with medial calcar comminution, following treatment with a PHILOS locking plate and medial support screw (MSS). Methods Between January 2010 and December 2018, we retrospectively analyzed the outcomes of 121 cases of osteosynthesis for PHFs with medial column disruption. For the medial support, at least one oblique screw was inserted within 5 mm of the subchondral bone in the inferomedial quadrant of the humeral head. All patients were categorized into two groups: 26 patients in the single MSS group, and 95 in the multiple MSS group. Follow-up after at least an year involved clinical and radiographic outcome evaluations, and correspondingly measuring the Constant-Murley score, University of California, Los Angeles (UCLA) shoulder scale, pain visual analogue scale (VAS), major complications, neck-shaft angle (NSA), humeral head height (HHH), and the eventual time to bone union. Risk factors for the major complications were assessed by multivariate logistic regression analyses. Results The cohort’s mean age was 64.4 ± 15.4 years, and the mean follow-up duration was 19.5 ± 7.6 months. At the final follow-up, between the single MSS and multiple MSS groups, no significant differences in the Constant-Murley score (p = 0.367), UCLA score (p = 0.558), VAS (p = 0.571), time to bone union (p = 0.621), NSA loss (p = 0.424), and HHH loss (p = 0.364) were observed. The incidence of complications (p = 0.446) based on the number of MSS were not significantly different. The initial insufficient reduction after surgery (of NSA

Abstract Background The aim of this study was to explore the efficacy of a novel intramedullary fixation technique using the ortho-bridge system (OBS) for midshaft clavicle fractures. Methods A total of 63 patients were included in this study: 35 underwent plate internal fixation (LP group) and 28 underwent OBS intramedullary fixation (OBS group). Surgical time, intraoperative blood loss, incision length, fracture healing time, removal of the internal fixation agent, visual analog scale (VAS) score for shoulder pain, Constant–Murley shoulder score and complication occurrence were compared between the two groups. Results Preoperative general data, such as sex, age and fracture type, were not significantly different between the two groups (P > 0.05). However, the OBS group exhibited better outcomes than the LP group exhibited in terms of surgical time, intraoperative blood loss and total incision length (P 0.05). None of the patients in the OBS group experienced scarring of the surgical incision, and 6 patients in the LP group experienced scarring of the surgical incision. Finally, the complication incidence in the OBS group was lower than that in the LP group. Conclusion For midshaft clavicle fractures, OBS intramedullary fixation is better than locking-plate internal fixation because it led to less trauma, a faster recovery, better efficacy, and better esthetic outcomes and comfort. Therefore, this technique may have potential as a novel treatment for midshaft clavicle fractures. Level of evidence: III, retrospective observational study.

BACKGROUND: Proximal humerus internal locking system locking plate is the most commonly used fixation method for proximal humeral fractures, but its failure rate is still high in clinical practice. Reasonable screw placement is an important factor affecting the stability of internal fixation. OBJECTIVE: To investigate the distribution of humeral head screws in the treatment of proximal humeral fractures with proximal humerus internal locking system plate and its influence on internal fixation failure. METHODS: From January 2017 to December 2021, data from patients with proximal humeral fractures undergoing proximal humerus internal locking system plate in Third Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively analyzed. A total of 124 patients were enrolled, including 16 males and 108 females, at the age of ≥60 years. According to whether there was internal fixation failure after operation, they were divided into normal group (n=101) and internal fixation failure group (n=23). The patient's age, gender, fracture type, the integrity of the medial column, plate height, neck-shaft angle, whether the talus screw was inserted, and the number of humeral head screws, were collected. The humeral head was divided into eight zones according to the postoperative digital radiography anteroposterior film, and the distribution characteristics of the screws in each zone were collected, and the heat map of the screw distribution was drawn. RESULTS AND CONCLUSION: (1) There were no significant differences between the two groups in age, gender, fracture type, the integrity of the medial column, plate height, neck-shaft angle, whether to insert talus screws, and the number of humeral head screws (P > 0.05). (2) The heat map showed that the humeral head screws were evenly distributed in the normal group, mainly scattered in zones 4, 6, and 7. However, the screw distribution in the internal fixation failure group was not uniform, mainly concentrated in zones 4 and 6. In addition, in the ideal area of talus screws (7/8 zone), there were significantly more screws in the normal group than in the internal fixation failure group. (3) It is indicated that in the treatment of proximal humeral fractures with proximal humerus internal locking system plate, the uniform distribution of humeral head screws is the key to ensuring the internal fixation effect. A reasonable distribution of humeral head screws helps to improve the treatment effect and the success rate of internal fixation. [ABSTRACT FROM AUTHOR]

Objective: To analyze the short-term and long-term efficacy and complications of different internal fixation in the treatment of elderly patients with unstable intertrochanteric fracture of femur (IFF). Methods: 60 elderly patients with unstable IFF admitted to our hospital from January 2020 to January 2023 were selected as research samples. According to different surgical methods, they were divided into two groups, including 30 cases in PF-LCP group (receiving PF-LCP surgery) and 30 cases in PFNA group (receiving PFNA internal fixation surgery). The surgical conditions, hip function (HHS), bone metabolism indexes and inflammatory factors levels[type I procollagen amino terminal peptide (PINP), type I collagen carboxy terminal peptide (CTX), serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)], quality of life and complications were compared between the two groups. Results: The surgical time, hospital stay and fracture healing time in the PFNA group were shorter than those in PF-LCP group, and the intraoperative blood loss was less (P＜0.05). The HHS score of the two groups at 3 months, 6 months and 12 months after surgery was gradually higher than that before surgery, and the HHS scores in the PFNA group at 3 months and 6 months after surgery were higher than those in the PF-LCP group (P＜0.05). There was no significant difference in HHS score between the two groups at 12 months after surgery (P＞0.05). The PINP level in the two groups at 6 months after surgery was higher than that before surgery, and the PFNA group had higher PINP level than the PF-LCP group (P＜0.05). The levels of CTX, IL-6 and TNF-α were reduced than those before surgery, and the levels in the PFNA group were lower (P＜0.05). At 12 months after surgery, the quality of life scores of the two groups were higher than before surgery, and the PFNA group had higher scores than the PF-LCP group (P＜0.05). After 12 months of follow-up, there were 4 cases of internal fixation failure in PFNA group (including 3 cases of main nail fracture and 1 case of screw blade withdrawal), and the failure rate was 13.33%. There was no case of internal fixation failure in PF-LCP group, and the failure rate of internal fixation in PFNA group was higher than that in control group (P＜0.05). There was no significant difference in the total incidence of other postoperative complications between the two groups (P＞0.05). Conclusion: Both PFNA and PF-LCP can effectively treat unstable IFF in the elderly. Compared with PF-LCP, PFNA has faster postoperative recovery and better short-term efficacy, but the risk of internal fixation failure is relatively greater. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: Common surgical procedures in the treatment of periprosthetic distal femur fractures (PPFF) include osteosynthesis with fixed angle locking plates (LP) and retrograde intramedullary nails (RIN). This study aimed to compare LPs to RINs with oblique fixed angle screws in terms of complications, radiographic results and functional outcome. Methods: 63 PPFF in 59 patients who underwent treatment in between 2009 and 2020 were included and retrospectively reviewed. The anatomic lateral and posterior distal femoral angle (aLDFA and aPDFA) were measured on post-surgery radiographs. The Fracture Mobility Score (FMS) pre- and post-surgery, information about perceived instability in the operated leg and the level of pain were obtained via a questionnaire and previous follow-up (FU) examinations in 30 patients (32 fractures). Results: The collective (median age: 78 years) included 22 fractures treated with a RIN and 41 fractures fixed with a LP. There was no difference in the occurrence of complications (median FU: 21.5 months) however the rate of implant failures requiring an implant replacement was higher in fractures treated with a LP (p = 0.043). The aPDFA was greater in fractures treated with a RIN (p = 0.04). The functional outcome was comparable between both groups (median FU: 24.5 months) with a lower outcome in the post-surgery FMS (p = < 0.001). Conclusion: Fractures treated with RIN resulted in an increased recurvation of the femur however the rate of complications and the functional outcome were comparable between the groups. The need for implant replacements following complications was higher in the LP group. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intramedullary nails and locking plates are widely used in the treatment of proximal humeral fractures, but there is no consensus on the choice of internal fixation. OBJECTIVE: To compare the biomechanical stability of intramedullary nails and locking plates in the treatment of two-part and three-part proximal humeral fractures by finite element analysis. METHODS: CT data of the humerus of a volunteer were collected and imported into Minics 21.0, Geomagic Wrap, Soildwork 2017, and Abaqus 2021 to establish finite element models of two-part and three-part fractures treated with two internal fixation methods, respectively. Group A: two-part fracture fixed with intramedullary nail model; group B: two-part fracture fixed with locking plate model; group C: three-part fracture fixed with intramedullary nail model; group D: three-part fracture fixed with locking plate model. The stress distribution, displacement degree, and maximum value of the humerus and internal fixation were compared and analyzed. RESULTS AND CONCLUSION: (1) The maximum stress and maximum displacement of the humerus were the smallest in the model of group A, and the maximum stress and maximum displacement of the humerus were the largest in the model of group D. The stress of the locking plate group was mainly concentrated in the medial inferior part of the humeral head and the screw hole area, while the stress of the intramedullary nail group was mainly concentrated around the fracture line and the lateral inferior part of the surgical neck of the humerus. There is no significant difference in displacement distribution between the two. It is mainly concentrated in the distal humerus. (2) The maximum stress value of the intramedullary nail was the lowest in the model of group A, and the maximum stress value of the locking plate was the highest in the model of group D. The maximum stress of the two internal fixations was mainly concentrated in the talar screw and the connection with the internal fixation. The stress cloud distribution of the locking steel plate was concentrated, while the stress cloud distribution of the intramedullary nail was more uniform. (3) The results showed that compared with the locking plate, the intramedullary nail had more biomechanical advantages, and this advantage was more obvious in three-part fractures. [ABSTRACT FROM AUTHOR]

Background: The calcar of the proximal humerus is a fundamental structure for medial humeral column support. This study aimed to assess the outcome of osteosynthesis across cases of unstable proximal humerus fractures (PHFs) with medial calcar comminution, following treatment with a PHILOS locking plate and medial support screw (MSS). Methods: Between January 2010 and December 2018, we retrospectively analyzed the outcomes of 121 cases of osteosynthesis for PHFs with medial column disruption. For the medial support, at least one oblique screw was inserted within 5 mm of the subchondral bone in the inferomedial quadrant of the humeral head. All patients were categorized into two groups: 26 patients in the single MSS group, and 95 in the multiple MSS group. Follow-up after at least an year involved clinical and radiographic outcome evaluations, and correspondingly measuring the Constant-Murley score, University of California, Los Angeles (UCLA) shoulder scale, pain visual analogue scale (VAS), major complications, neck-shaft angle (NSA), humeral head height (HHH), and the eventual time to bone union. Risk factors for the major complications were assessed by multivariate logistic regression analyses. Results: The cohort's mean age was 64.4 ± 15.4 years, and the mean follow-up duration was 19.5 ± 7.6 months. At the final follow-up, between the single MSS and multiple MSS groups, no significant differences in the Constant-Murley score (p = 0.367), UCLA score (p = 0.558), VAS (p = 0.571), time to bone union (p = 0.621), NSA loss (p = 0.424), and HHH loss (p = 0.364) were observed. The incidence of complications (p = 0.446) based on the number of MSS were not significantly different. The initial insufficient reduction after surgery (of NSA < 125°) was found to be a significant risk factor for post-surgical complications. Conclusions: To treat unstable PHFs, the use of at least one MSS along with a locking plate system is sufficient to achieve satisfactory outcomes. Successful operative treatment using a locking plate for PHF treatment is inherent in anatomical fracture reduction, coupled with medial column support. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical efficacy of the minimally invasive locking plate technique (Philos plate) and interlocking intramedullary nailing technique (TRIGEN intramedullary nail) in the treatment of Neer two-part and three-part proximal humeral fractures. Methods and materials: The clinical data of 60 patients with Neer two-part and three-part proximal humerus fractures admitted to the hospital from April 2017 to April 2021 were retrospectively analyzed. Thirty-two patients were treated with the minimally invasive locking plate technique (minimally invasive plate group), and 28 patients were treated with the interlocking intramedullary nailing technique (intramedullary nail group). The operation time, intraoperative blood loss, incision length, fracture healing time, and postoperative complications were compared between the two groups. The ASES score and Constant–Murley score were used to evaluate the shoulder joint function of the two groups one year after surgery. Results: All 60 patients were followed up for 12 to 24 months, with an average of 16 months. There was no significant difference in operation time, intraoperative blood loss, incision length, or fracture healing time between the two groups (P > 0.05). The incidence of postoperative complications in the intramedullary nail group was significantly lower than that in the minimally invasive steel plate group, and the difference between the groups was statistically significant (P < 0.05). There was no significant difference in the ASES score or Constant–Murley score between the two groups one year after surgery (P > 0.05). Conclusion: The use of the minimally invasive locking plate technique and interlocking intramedullary nailing technique in the treatment of Neer two-part and three-part proximal humerus fractures has the advantages of a small incision, less blood loss, and a high fracture healing rate, and both can achieve satisfactory clinical effects. The internal nail technique is more convenient than the minimally invasive locking plate technique in controlling postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Operative treatment of the distal tibia fractures have higher rate of non-union and infection rates. Minimally Invasive Plate Osteosynthesis (MIPO) is one treatment option with added advantages of minimal soft tissue dissection. In this paper we explained the radiological and functional outcome of closed distal tibial fractures treated by MIPO. The objectives of this study were to determine the radiological and functional outcome of closed tibial fractures treated by Minimally Invasive Plate Osteosynthesis (MIPO). Material and Methods: This descriptive study was conducted in Orthopaedic Division Lady Reading Hospital Peshawar from 30th July 2021 to 30th June 2023. In this study all patients of distal tibia fracture fulfilling the inclusion criteria were treated with MIPO. Post-operative radiological outcomes was determined using Radiologic Union Scale in Tibia(RUST) and functional outcome using Knee Society Clinical Rating and Olerud-Molander Ankle Score(OMAS) respectively. The data was analyzed with SPSS version 29. Results: We treated 38 distal tibia fractures with MIPPO. Thirty-three patients were male and 5 females. The mean age was 31±3.2 years (ranged 20 to 60 years). At 9±5.3 months 35(92.1%) patients were radiologically healed with RUST score of 3. At one year 32 (91.42%) patients had excellent outcome and 3 (8.57%) had acceptable outcome using Knee Society Clinical Rating. The Olerude-Molander Ankle score was excellent in 30(85.71%) and good in 5(14.28%) patients. Conclusion: Minimally Invasive Plate Osteosynthesis (MIPO) produced excellent radiological and functional results in majority of our patients. We therefore recommend MIPO as treatment of first choice for closed distal tibial fractures. [ABSTRACT FROM AUTHOR]

Introduction: Non-union is a complex, multifactorial orthopaedic problem that requires multiple treatment modalities for its management. It can result from infection, segmental bone loss, soft-tissue loss, and associated host factors. External fixators as management of gap non-union are bulky and give rise to a number of complications In our study, we have described a technique where we have used extramedullary fixation in the form of a tibial locking plate and transportation of part of the tibial bone after corticotomy by a monorail fixator. Materials and Methods: The procedure was done in two stages where internal and external fixation was done after creating a gap at the non-union site. The bone was transported after corticotomy and fixed to the internal fixation device in the second stage. The external fixator was removed in the second stage and the patient was then followed up till the bony union. The evaluation was done by functional and radiological assessment along with the complications noted with the described procedure. Results: Ten patients were enrolled in the study with a mean age of 33 years. The mean age of the patients was 33.7 ± 11.32 years with a mean size of the defect was 4.8 ± 1.7 cm. At 30 weeks out of nine patients, three patients had excellent and six had good functional results on the Association of Surgeons for Application and Methodology of Ilizarov (ASAMI) scale. The composite Musculoskeletal Tumor Society (MSTS) score was 76.66 % at the end of 30 weeks of follow-up. The mean time of consolidation was 134.4 days, whereas the mean union time was 145 days from index surgery. Ankle stiffness was the most common complication affecting 50% of the patients. Following closely was pin tract infection, which was present in 40% of the patients. According to Paley's classification, there were 11 obstacles, two problems and none were true complications. Conclusion: The integrated fixation is both safe and effective and has the advantage of early removal of the external fixator and a low complication rate as compared to use of a bulky conventional fixator alone. Moreover, it gives protection to the regenerated bone for a long period. So, this technique can be recommended for the management of segmental tibial defects. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to explore the efficacy of a novel intramedullary fixation technique using the ortho-bridge system (OBS) for midshaft clavicle fractures. Methods: A total of 63 patients were included in this study: 35 underwent plate internal fixation (LP group) and 28 underwent OBS intramedullary fixation (OBS group). Surgical time, intraoperative blood loss, incision length, fracture healing time, removal of the internal fixation agent, visual analog scale (VAS) score for shoulder pain, Constant–Murley shoulder score and complication occurrence were compared between the two groups. Results: Preoperative general data, such as sex, age and fracture type, were not significantly different between the two groups (P > 0.05). However, the OBS group exhibited better outcomes than the LP group exhibited in terms of surgical time, intraoperative blood loss and total incision length (P < 0.05). Additionally, the OBS group exhibited a significantly shorter fracture healing time and internal-fixation removal time than the LP group exhibited (P < 0.05). The VAS scores on postoperative day 1, week 1, month 1 and month 3 were lower in the OBS group than in the LP group (P < 0.05). Furthermore, the Constant–Murley shoulder scores at 1, 3, and 6 months postoperatively were higher in the OBS group than in the LP group (P < 0.05), with no significant difference at 1 year after surgery (P > 0.05). None of the patients in the OBS group experienced scarring of the surgical incision, and 6 patients in the LP group experienced scarring of the surgical incision. Finally, the complication incidence in the OBS group was lower than that in the LP group. Conclusion: For midshaft clavicle fractures, OBS intramedullary fixation is better than locking-plate internal fixation because it led to less trauma, a faster recovery, better efficacy, and better esthetic outcomes and comfort. Therefore, this technique may have potential as a novel treatment for midshaft clavicle fractures. Level of evidence: III, retrospective observational study. [ABSTRACT FROM AUTHOR]

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Background: One of the body's main joints for bearing weight is the knee. Its issues are likewise difficult to resolve. Damage to this joint can cause abnormalities in the alignment, stability, and motion of the knee, which impairs function. Objective: To compare the functional and radiological outcome in AO type C1 distal femur fractures fixed with locking plate versus dynamic condylar screw. Methods: The study comprised 94 patients aged 18 to 60 years who had an isolated distal femur fracture and an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C1 closed fracture. Patients with diabetes mellitus, chronic renal disease, chronic liver disease, ischemic heart disease, pathological fractures, head injuries with a Glasgow coma scale of less than 14, and malignancy were excluded from the sample. The patients were assigned by lottery to groups A and B. In groups A and B, they were treated with dynamic condylar screws (DCS) and locking plate fixation, respectively.. Results: Of the 94 patients, 30 (63.8%) were men and 17 (36.2%) were women in Group A; similarly, 33 (70.2%) were men and 14 (29.8%) were women in Group B. Patients in group A had an average age of 38.8±6.19 years, whereas those in group B had an average age of 39.5±7.36 years. 02 patients (4.2%) in Group-A and 05 patients (10.6%) in Group-B experienced infection. The union rate was 45 (95.7%) in group A (locking plate fixation technique) and 40 (85.10%) in group B (dynamic condylar screw technique). 35 (74.46%) in group A, 08 (17.1%) in good, 03 (6.38%) in average, and 01 (2.1%) in poor; in group B, 25 (53.2%) in excellent, 09 (19.2%) in decent, and 10 (21.3%) had average and 03(6.3%) had poor functional outcome. Conclusion: In terms of clinical and radiological evaluation, the type C1 distal shaft femur fixation with locking plate performs better than the dynamic condylar screw, which has a lower infection rate and better union and functional success. [ABSTRACT FROM AUTHOR]

Background: Locked plating for distal femur fractures is widely recommended and used. We systematically reviewed clinical studies assessing the benefits and harms of fracture fixation with locked plates in AO/OTA Type 32 and 33 femur fractures. Methods: A comprehensive literature search of PubMed, Embase, Cinahl, Web of Science, and the Cochrane Database was performed. The studies included randomized and non-randomized clinical trials, observational studies, and case series involving patients with distal femur fractures. Studies of other fracture patterns, studies conducted on children, pathological fractures, cadaveric studies, animal models, and those with non-clinical study designs were excluded. Results: 53 studies with 1788 patients were found to satisfy the inclusion and exclusion criteria. The most common harms were nonunion (14.8%), malunion (13%), fixation failure (5.3%), infection (3.7%), and symptomatic implant (3.1%). Time to full weight-bearing ranged from 5 to 24 weeks, averaging 12.3 weeks. The average duration of follow-up was 18.18 months, ranging from 0.5 to 108 months. Surgical time ranged between 40 and 540 min, with an average of 141 min. The length of stay in days was 12.7, ranging from 1 to 61. The average plate length was ten holes, ranging from 5 to 20 holes. Conclusion: This review aimed to systematically synthesize the available evidence on the risk associated with locked plating osteosynthesis in distal femur fractures. Nonunion is the most common harm and is the primary cause of reoperation. The overall combined risk of a major and critical complication (i.e., requiring reoperation) is approximately 20%. [ABSTRACT FROM AUTHOR]

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Cite this article: Bone Joint Res 2024;13(3):124–126.

Background: About 20% of proximal humerus fractures (PHFs) are unstable and/or markedly displaced and therefore require surgery. Locking plate fixation after anatomical reduction has become the current treatment of choice for these fractures in the active population. However, studies have shown complication rates up to 36%, such as loss of reduction and avascular necrosis. To date, data from literature are inconclusive on outcomes following the use of an intramedullary fibula allograft in PHFs, possibly due to the case mix. It is hypothesized that the use of a fibula allograft is beneficial to prevent secondary displacement of the fracture in cases where the medial hinge is markedly displaced and unstable, resulting in better clinical and patient reported outcomes. Methods: In this multicenter matched cohort study, patients with an unstable, displaced PHF, including anatomic neck fractures and significantly displaced surgical neck fractures, were included. Patients that were treated with a locking plate augmented with a fibula allograft were matched to patients who had undergone locking plate reconstruction without the allograft. The matches were made based on fracture characteristics, age, and performance status. Functional outcomes, Patient Reported Outcome Measures, complications, and radiographic results were compared. Results: Twelve patients with fibula allograft augmented osteosyntheses were included and matched to 12 control patients. The mean age was 58 years in the fibula allograft group compared to 62 years in the control group. Minimum follow-up was 12 months. Disability of the Arm Shoulder and Hand score, Constant Shoulder score, abduction, and external rotation were significantly better in the fibula allograft group (17.4 ± 8.6 vs. 26.1 ± 19.2, P = .048; 16.5 ± 11.5 vs. 19.8 ± 16.5 P = .040; mean 127° ± 38° vs. mean 92° ± 49° P = −.045; 50° ± 21° vs. mean 26° ± 23°, P = .004). There was no statistically significant difference in the Oxford Shoulder score between groups (P = .105). The Visual Analog Scale was not significantly different between groups (3.1 ± 1.8 vs. 1.6 ± 1.9, P = .439). Radiographic union was reached in 11 patients of the fibula allograft group compared to 8 in the control group (P = .317). The complication rate was twice as high in the control group (3 vs. 7). Conclusion: Additional support of the medial hinge in unstable PHFs with a locking plate in combination with a fibula allograft appears to create a more stable construct without compromising the viability of the articular surface of the head. The use of a fibula allograft in selected complex cases could therefore result in better clinical outcomes with lower complication rates.

Abstract Background and objective Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. Methods A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. Results After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was

Introduction: Distal femoral shaft fractures are characterized by their increasing incidence and complexity, presenting a significant challenge in management. The objective of this retrospective study was to compare the clinical and radiological results of patients with extra-articular distal third femoral shaft fractures treated using either retrograde Talon Distal Fix nail or a distal femur locking plate. Material and Method: The study comprised 40 patients aged >18 years who presented at our hospital with a distal third femoral shaft fracture between January 2017 and January 2023. The patients were divided into two groups: Group TDN, treated with retrograde Talon Distal Fix nailing (n=18), and Group DLP, treated with a distal locking plate (n=22). Demographic data, follow-up period, operating time, time to union, range of motion (ROM), mechanism of injury (traffic accident, fall from height, workplace accident, gunshot injury), fracture type, complications, and surgical method were retrospectively recorded. Clinical evaluation included deformity, knee ROM, pain, and the knee total score (KSS) for walking and knee stability. Results: The mean age of the patients was 48.03±12.31 (min-max: 23-69) years, and the mean follow-up time for all patients was 15.88±2.32 (12-21) months. The mean time to union was 25.55±1.86 (22-30) weeks. Delayed union and non-union rates were similar between the research groups (P=1.000, P=0.673, respectively). Union time (weeks) and mean ROM were not significantly different between the groups (P=0.881, P=0.892, respectively). The mean operation time of the TDF group (48.78±3.94 minutes) was significantly lower than that of the DLP group (62.45±3.33 minutes) (P

Purpose: To compare union rate, union time, alignment, and complication rate in ipsilateral tibia plateau and shaft fractures treated via suprapatellar intramedullary nailing with screw fixation and minimally invasive locking plate fixation. Materials and methods: A retrospective study was conducted on 48 patients who underwent minimally invasive plate fixation (n = 35) or suprapatellar intramedullary nailing with screw fixation (n = 13), for the treatment of ipsilateral tibial plateau and shaft fractures with at least 1-year follow-up. Union rate, union time, radiologic alignment, and complication rate such as malalignment, nonunion, and fracture-related infection (FRI) were investigated. Results: Demographic data were not different between the two groups. Coronal plane alignment was 0.17 ± 4.23 in the plate group and −0.48 ± 4.17 in the intramedullary nail group (p = 0.637). Sagittal plane alignment was −0.13 ± 5.20 in the plate group and −1.50 ± 4.01 in the suprapatellar intramedullary nail group (p = 0.313). Coronal and sagittal malalignment recorded equal results: (p > 0.99), FRI (p = 0.602), nonunion and union times recorded (p = 0.656) and (p = 0.683, 0.829), respectively, and showed no significant difference between the two groups. Conclusion: Suprapatellar intramedullary nailing with screw fixation had similar surgical outcomes with minimally invasive locking plate fixation in ipsilateral tibial plateau and shaft fractures in terms of union rate, union time, alignment, and complication rate. Thus, frequent use of intramedullary nailing combined with screw fixation is anticipated in patients with ipsilateral tibial plateau and shaft fractures when the soft tissue condition is not desirable. Level of evidence: Level III [ABSTRACT FROM AUTHOR]

Purpose: A locking plate (LP) or non-locking plate (NLP) can be used for distal fibula fracture fixation. However, the advantages of LP over NLP in patients with distal fibula fractures are not clear. In terms of indications, the role of the two plates probably differs; however, to draw comparative conclusions, we conceptualized this systematic review and meta-analysis of studies that directly compared the two plates, wherein both groups' indications and baseline parameters were similar. Methods: An electronic literature search was performed using PubMed/Medline, Embase, Scopus, and Cochrane Library databases for studies comparing the LP versus NLP fixation for the lateral malleolus fracture. A total of 18 studies were included in qualitative and quantitative analysis. A subgroup analysis was performed for patients aged < 55 years and patients aged > 55 years. The statistical analysis was performed by Review Manager Software version 5.4.1. Results: A meta-analysis of 4243 fractures was performed across 18 studies. The rate of fracture union and overall complication rates did not differ between the two fixation groups with an OR of 0.71 (95% CI 0.26, 1.96, p = 0.51 and 1.11 (95% CI 0.84, 1.47, p = 0.47, respectively. There is no difference in the reoperation rate due to minor or major complications between the two groups. There was no difference in functional outcome (MD −0.85, with 95% CI −5.63, 3.93, p = 0.73), but NLP has a shorter surgical duration (MD 3.0, with 95% CI 0.26, 5.75, p = 0.03). A leave-one-out sensitivity analysis performed for overall complications affected the final outcome of the meta-analysis. Conclusion: This meta-analysis demonstrates no clear benefit in selecting LP over NLP for the fixation of lateral malleolus fractures. [ABSTRACT FROM AUTHOR]

Introduction: Orthopaedic doctors see many cases of distal tibial fractures every year. Our goal is to investigate and contrast the healing, functional, and complication rates of extra articular distal tibia fractures treated with multidirectional interlocking intramedullary nails and anterolateral locking compression plates. Materials and Methods: Our study utilized a sample size of 20 individuals who presented with distal tibial fractures. The age range of participants in the nail group was 33 to 55 years, whereas in the plating group, the age range was 27 to 60 years. The current investigation was carried out from August 2022 to July 2023 at the Department of Orthopaedics, King George Hospital, Visakhapatnam, Andhra Pradesh, India, utilizing both retrospective and prospective methodologies. Results: The average time for union in the multidirectional interlocking intramedullary group was found to be 4.5 months, but in the plating group, it was 6.4 months. This difference was statistically significant. Additionally, the mean duration for partial and full weight bearing in the nailing group was 4.2 weeks and 9.6 weeks, respectively, which exhibited a statistically significant reduction compared to 7.12 weeks and 13.42 weeks in the plating group. The interlocking group had reduced instances of implant discomfort, ankle stiffness, and infection in comparison to the plating group. Conclusion: Our research led us to conclude that closed intramedullary interlocking nailing is the treatment of choice for distal tibia fractures because it allows for early weight bearing, promotes early fracture union, and reduces implant-related complications. For distal tibiofibular fractures, intramedullary nailing or locking plate fixation is advised. [ABSTRACT FROM AUTHOR]

Purpose: To compare the radiological alignment, union time, union rate, and complication rate between suprapatellar intramedullary nails and minimally invasive locking plate fixation in the treatment of proximal tibial fractures. Materials and methods: We retrospectively analyzed 103 patients who underwent plate fixation (n = 50) or suprapatellar intramedullary nailing (n = 53) for proximal tibial fractures involving the meta-diaphyseal junction between November 2015 and October 2020 at our institution. The union rate, union time, radiologic alignments, and complications, such as malalignment, nonunion, and deep infection, were investigated. Results: The demographic data did not differ between the plate and suprapatellar intramedullary nail groups. The alignment of the coronal plane was 0.24 ± 3.19 in the plate group and − 0.49 ± 2.22 in the intramedullary nail group (p = 0.196). Sagittal plane alignment was − 0.29 ± 4.97 in the plate group and 0.24 ± 4.12 in the intramedullary nail group (p = 0.571), and coronal malalignment (p = 0.196), sagittal malalignment (p = 0.57), deep infection (p = 0.264), nonunion (p = 0.695), union time (p = 0.329), and final union rate (p = 0.699) were not significantly different between groups. Conclusion: Compared with the minimally invasive locking compression plate group, the suprapatellar intramedullary nail group yielded comparable results in terms of radiological alignment and complications. Considering that proximal tibial fractures are associated with high-energy trauma and severe soft tissue damage, we believe that a suprapatellar intramedullary nail may be a good alternative. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Depending on the fracture pattern and soft tissue mantle involvement, clavicle fractures can be treated surgically or non-operatively. Historically, displaced fractures of the clavicle shaft in adults have been treated non-operatively. However, the nonunion rate after non-operative therapy seems to be higher than reported in the past. Additionally, publications reporting better functional outcomes after surgical therapy are accumulating. The current literature suggests that primary surgical stabilization, especially of displaced fractures, provides more rapid functional exercise treatment and thus earlier physical recovery than nonoperative therapy. Individualized treatment is suggested, with careful consideration of the advantages and disadvantages of each therapeutic approach and patient preferences. [ABSTRACT FROM AUTHOR]