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Barros EA, Ballesteros C, Noboa CE, Arteaga G, Peñaherrera C, Endara F, Bravo A, Barros Castro AX. Use of metatarsal hook plates in the treatment of multifragmentary patellar fractures - A case series. Trauma Case Rep 2024; 51:101018. [PMID: 38628458 PMCID: PMC11019277 DOI: 10.1016/j.tcr.2024.101018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 04/19/2024] Open
Abstract
The surgical management of patellar fractures typically yielded satisfactory results; however, in situations involving multifragmented patellar fractures or those affecting the inferior pole, it became imperative to employ alternative osteosynthesis techniques that enhanced stability, enabled early rehabilitation initiation, prevented implant failure, and avoided reduction loss before fracture consolidation. In this context, an unconventional osteosynthesis alternative was presented, utilizing an anatomically designed hook plate originally intended for the fifth metatarsal. This technique was successfully applied in three patients with multifragmentary patellar fractures, allowing stable fixation of small or marginal fragments through the plate's hooks without compromising vascularity. Fracture consolidation was achieved without reduction loss, and owing to its low profile, patient discomfort and irritation were minimized compared to traditional tension band or wiring techniques. This approach suggested the potential to forego early plate removal, thereby contributing to a more effective management of patellar fractures. Level of evidence IV.
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Affiliation(s)
- Edgar Alejandro Barros
- Orthopedics and Traumatology Service, Hospital Vozandes Quito and Hospital Metropolitano, Quito - Ecuador
| | - Carlos Ballesteros
- Orthopedics and Traumatology Service, Hospital Vozandes Quito and Hospital Metropolitano, Quito - Ecuador
| | - Carlos Eduardo Noboa
- Orthopedics and Traumatology Service, Hospital Vozandes Quito and Hospital Metropolitano, Quito - Ecuador
| | - Gonzalo Arteaga
- Orthopedics and Traumatology Service, Hospital Vozandes Quito and Hospital Metropolitano, Quito - Ecuador
| | - Carlos Peñaherrera
- Postgraduate Course in Orthopedics and Traumatology at the International University of Ecuador, Quito - Ecuador
| | - Francisco Endara
- Postgraduate Course in Orthopedics and Traumatology at the International University of Ecuador, Quito - Ecuador
| | - Andrés Bravo
- Posgraduate Course in Orthopedics and Traumatology at Universidad de las Americas- Quito- Ecuador
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Roytman GR, Salameh M, Rizzo SE, Dhodapkar MM, Tommasini SM, Wiznia DH, Yoo BJ. Sustentaculum fracture fixation with lateral plate or medial screw fixation are equivalent. Injury 2024; 55:111532. [PMID: 38614015 DOI: 10.1016/j.injury.2024.111532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Fixation of sustentaculum tali fractures is important to maintain the biomechanical function of the subtalar joint. A common method of fixation is securing the sustentacular fragment by way of a laterally based locking plate (LP). A medial approach with a single screw (MS) has been proposed as an alternative method of fixation. METHODS Five pairs of formalin-preserved cadaveric ankles with the subtalar joint and interosseous ligaments intact ("osseous cadavers") and four pairs of fresh-frozen cadaveric ankles with soft-tissue preserved dissected from mid-tibia down ("soft tissue cadavers") were used in the study. The left ankle was randomly assigned to one of the two fixation methods (LP or MS), while the right ankle was the opposite. These same steps for fixation were repeated for six synthetic ankle models. All models were loaded with a body mass of 80 kg. Statistical differences between LP and MS stiffness were determined using a paired t-test in cadavers and un-paired t-tests in synthetic ankles. RESULTS For osseous cadaveric ankles, LP demonstrated a mean stiffness of 232.95(SD: 59.96) N/mm, while MS was 239.72(SD:131.09) N/mm (p = 0.9293). For soft tissue cadaveric ankles, LP mean stiffness was 133.58(SD:37.84) N/mm, while MS was 134.88(SD:20.75) N/mm (p = 0.9578). For synthetic ankles, LP mean stiffness was 220.40(SD:81.93) N/mm, while MS was 261.50(SD:100.21) N/mm (p = 0.6116). CONCLUSIONS Across all three models, there was no significant difference between LP and MS methods. Retrospective observational studies are recommended to assess patient outcomes from each of the methods.
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Affiliation(s)
- Gregory R Roytman
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Biomedical Engineering, Yale University School of Engineering & Applied Science, New Haven, CT, USA.
| | - Motasem Salameh
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah E Rizzo
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Meera M Dhodapkar
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Steven M Tommasini
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Biomedical Engineering, Yale University School of Engineering & Applied Science, New Haven, CT, USA
| | - Daniel H Wiznia
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Mechanical Engineering & Materials Science, Yale University School of Engineering & Applied Science, New Haven, CT, USA
| | - Brad J Yoo
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
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Cho RY, Byun SH, Park SY, On SW, Kim JC, Yang BE. Patient-specific plates for facial fracture surgery: A retrospective case series. J Dent 2023; 137:104650. [PMID: 37544353 DOI: 10.1016/j.jdent.2023.104650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVES Surgeons often encounter challenges when treating maxillofacial fractures using conventional methods that involve trimming or bending ready-made titanium plates for open reduction and internal fixation (ORIF) since it can be time-consuming, imprecise, and inconvenient. This retrospective case series aimed to introduce a novel bone reduction method that utilizes virtual planning, patient-specific surgical guides, and titanium plates. METHODS Seven patients with mandibular symphysis or subcondylar fractures resulting from facial trauma underwent cone-beam computed tomography (CBCT) or facial CT scans, and their medical histories were documented. Virtual surgery was conducted based on three-dimensional (3D) stereolithography images derived from CT scans using the FaceGide software (MegaGen, Daegu, Korea). ORIF was performed using patient-specific surgical guides and plates that were designed, printed, and milled. Radiographic, clinical, and occlusal evaluations were conducted at two weeks and six weeks postoperatively. Subsequently, 3D images from virtual surgery and postoperative CT scans were compared. RESULTS The comparison of 3D virtual surgery and postoperative images revealed minimal surface differences of less than 1 mm. T-scan evaluations indicated that there were no statistically significant differences between the two- and six-week postoperative assessments. Favorable clinical outcomes were observed. CONCLUSION This novel method demonstrated stable outcomes in terms of occlusion and healing, with no notable complications. Consequently, this approach may serve as a viable alternative to conventional methods. CLINICAL SIGNIFICANCE Facial fracture surgery that utilizes patient-specific surgical guides and plates within a digital workflow can facilitate meticulous surgical planning, reducing the risk of complications and minimizing operation time.
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Affiliation(s)
- Ran-Yeong Cho
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Yoon Park
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sung-Woon On
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Mir Dental Hospital, Daegu 41940, Republic of Korea
| | - Byoung-Eun Yang
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea.
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Kim KB, Lee YS, Wang SI. Clinical Outcome after Clavicular Hook Plate Fixation for Displaced Medial-End Clavicle Fractures. Clin Orthop Surg 2023; 15:843-852. [PMID: 37811514 PMCID: PMC10551687 DOI: 10.4055/cios23034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/26/2023] [Accepted: 06/21/2023] [Indexed: 10/10/2023] Open
Abstract
Background Surgery of the medial end of the clavicle remains a challenge for orthopedic surgeons. Moreover, there is no standard surgical procedure for treating displaced fractures or dislocation of the medial clavicle. Thus, the present study aimed to evaluate the safety and efficacy of using a hook plate for treating medial-end clavicular fractures and present functional outcomes. Methods We retrospectively investigated 18 patients who underwent surgery with a hook plate from July 2016 to December 2021. There were 14 men and 4 women with a mean age of 57.4 years. Fracture union was assessed at follow-up by computed tomography (CT). Other outcome parameters were complications, including implant failure, infection, nonunion, osteolysis of sternal manubrium, and migration of the hook portion. Range of motion (ROM), visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), and American Shoulder and Elbow Society (ASES) scores were evaluated 6 months postoperatively and at the last follow-up. Results The mean operation time was 43.8 minutes (range, 35-50 minutes) and the mean follow-up was 22.8 months (range, 12-42 months). Bone union was confirmed in all cases. The mean union time was 6.2 months (range, 6-7 months). Implant removal was performed routinely according to the clinical course in 17 cases. The mean implant removal time was 10.0 months (range, 6-14 months). Clinical and functional outcomes measured at the last follow-up were significantly improved compared to those at 6 months postoperatively (p < 0.05). Regarding complications, there were 6 cases (33.3%) of osteolysis of the sternal manubrium. Although the anteroposterior length of the manubrium and hook depth showed significant differences between the non-osteolysis group and the osteolysis group (p = 0.024), ROM, VAS, Quick DASH, and ASES scores were not significantly different between the two groups (all p > 0.05). Conclusions Clavicle hook plating can be a safe and effective method that can be easily applied with good outcomes if it is used with appropriate surgical planning and technique for medial-end clavicle fracture. CT scans are useful for preoperative planning and postoperative evaluation of bone union or complications.
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Affiliation(s)
- Ki Bum Kim
- Department of Orthopaedics Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Young Sang Lee
- Department of Orthopaedics Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Sung Il Wang
- Department of Orthopaedics Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Sharma S, Mudgal D, Gupta V. Advancement in biological and mechanical behavior of 3D printed poly lactic acid bone plates using polydopamine coating: Innovation for healthcare. J Mech Behav Biomed Mater 2023; 143:105929. [PMID: 37263171 DOI: 10.1016/j.jmbbm.2023.105929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
The metallic biomaterials have been proclaimed to exhibit stress shielding with discharge of toxic ions, leading to polymeric implants attracting interest in 3D Printing domain. In this study, Poly Lactic Acid based 336 bone plates are fabricated using Fused Filament Fabrication with printing parameters being varied. Polydopamine, being biocompatible, is deposited on fabricated bone plates at varying submersion time, shaker speed and coating solutions concentration. The study involves witnessing the effect of printing and coating parameters on biological behavior of bone plates upon preservation in Simulated Body Fluid and Hank's Balanced Salt Solution. The findings propose the close relation of degradation with apatite growth. The highest degradation rate with significant reduction in mechanical characteristics are shown by uncoated bone plates. These bone plates have porous structure at 20% infill density, 0.5 mm layer height, 0.4 mm wall thickness and 100 mm/s print speed which could result in complete degradation with partial healing of bone fracture. The study suggests the preservation of bone plates coated at 120 h' submersion time and 120 RPM shaker speed in 3 mg/ml concentrated solution which showed lower apatite formation. Thus, the coating would slow down degradation of PLA bone plates, resulting in complete healing of bone fracture.
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Affiliation(s)
- Shrutika Sharma
- Mechanical Engineering Department, Thapar Institute of Engineering and Technology, Patiala, 147004, Punjab, India
| | - Deepa Mudgal
- Mechanical Engineering Department, Thapar Institute of Engineering and Technology, Patiala, 147004, Punjab, India
| | - Vishal Gupta
- Mechanical Engineering Department, Thapar Institute of Engineering and Technology, Patiala, 147004, Punjab, India.
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Regina Momesso N, Cristina Biguetti C, Estevão Costa B, Lucio Calazans Duarte G, Akemi Matsumoto M, Domingos Ribeiro Junior P. Immediate and late inflammatory and bone healing response post implantation of self-tapping and self-drilling osteosynthesis screws. Br J Oral Maxillofac Surg 2023; 61:362-367. [PMID: 37263889 DOI: 10.1016/j.bjoms.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/14/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023]
Abstract
The aim of this study was to comparatively analyse osseointegration after the implantation of self-tapping screws (STS) and self-drilling screws (SDS). Thus, 24 four-month-old male Wistar rats, received SDS and STS screws in their left and right tibias, respectively. Sample collection was performed immediately at 0 hours (0h), two, seven, and 21 days after implantation (2d, 7d, 21d). Samples from immediately and 21 days after were analysed by micro computed tomography (MicroCT). All time points were evaluated by histology (Haematoxylin and Eoisin and Goldner's Trichrome) and immunohistochemistry for tartrate-acid resistant phosphatase positive (TRAP+) osteoclasts. MicroCT images revealed an intimate contact between bone and each type of screw at 0h. However, SDS group presented decreased bone volume (BV, mm3) at 21 days in comparison with STS. Both SDS and STS post implantation presented areas of suitable new bone formation surrounding screw threads from seven days, and inflammation decreased from two to 21 days. Also, TRAP+ osteoclasts were mainly identified at seven days in both STS and SDS groups, particularly surrounding areas of pressure, with significant differences between groups. In conclusion, differences in shape and insertion technique for SDS and STS screws did not affect immediate and late inflammatory and bone healing response post implantation in this animal model. Both osteosynthesis screws allowed satisfactory post-surgical outcomes.
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Affiliation(s)
- N Regina Momesso
- Department of Maxillofacial Surgery, University of the Holy Heart (USC), Rua Irmã Arminda, 10-50, 17011-160 Bauru, SP, Brazil.
| | - C Cristina Biguetti
- Laboratory of Regenerative Medicine, Department of Surgery and Biomechanics, UTRGV School of Podiatric Medicine, 2102 treasure Hills Blvd. Harlingen, TX 78550, USA.
| | - B Estevão Costa
- Department of Maxillofacial Surgery, University of the Holy Heart (USC), Rua Irmã Arminda, 10-50, 17011-160 Bauru, SP, Brazil.
| | - G Lucio Calazans Duarte
- Department of Maxillofacial Surgery, University of the Holy Heart (USC), Rua Irmã Arminda, 10-50, 17011-160 Bauru, SP, Brazil.
| | - M Akemi Matsumoto
- Department of Diagnosis and Surgery, Aracatuba Dental School, UNESP, Rua José Bonifácio, 1193, 16015050 Araçatuba, SP, Brazil.
| | - P Domingos Ribeiro Junior
- Department of Maxillofacial Surgery, University of the Holy Heart (USC), Rua Irmã Arminda, 10-50, 17011-160 Bauru, SP, Brazil.
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Nakamoto JC, Xavier RM, Burgos FH, Wataya EY, do Carmo Iwase F, Nakamoto HA, Júnior RM. Comparative analysis of scaphoid nonunion treatment with screw fixation and angular stable plate. Arch Orthop Trauma Surg 2023; 143:2247-2253. [PMID: 36182974 DOI: 10.1007/s00402-022-04625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/11/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Scaphoid fractures represent 5-10% of nonunion rate and the treatment options consist of an open reduction with correction of deformity, restoration of the scaphoid length with autologous wedge grafting and fixation. However, there is still no consensus in the literature on the best fixation method. Therefore, the purpose of the study is to compare plate fixation and screw fixation in treating scaphoid nonunion with humpback deformity and carpal instability. METHODS Prospective, non-randomised study comparing the treatment of two groups of patients with scaphoid nonunion. A total of 19 patients were included in the study, the first ten patients were included in group 1 (plate fixation), subsequently nine patients were included in group 2 (screw fixation). The nonunion duration was longer than 6 months and patients did not present type III Scaphoid Nonunion Advanced Collapse (SNAC). Clinical evaluations included pain intensity, range of motion, grip strength, pinch test and functional scales Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist Score. Radiographic evaluations consisted of radiographs of both wrists in AP, AP with ulnar deviation, lateral and oblique views. Patients further underwent a tomography of the affected wrist for bone deformity, carpal collapse and later consolidation evaluation. RESULTS According to post-operative measurements, group 1 showed a significant improvement in the scapholunate angle (p = 0.011) and in the intrascaphoid angle (p = 0.002). Group 2 only showed an improvement in the scapholunate angle (p = 0.011). All patients in group 1 achieved consolidation in 8 weeks, while group 2 patients had a slower consolidation, with a mean of 14 weeks and standard deviation (SD) of 4.2, with statistical significance (p = 0.006). CONCLUSION Our prospective study, despite the limitations, contributes to the literature for demonstrating a better fixation using plate, with a better correction of humpback deformity and Dorsal Intercalated Segment Instability (DISI) and a faster consolidation. LEVEL OF EVIDENCE II, therapeutics studies; prospective comparative study.
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Affiliation(s)
| | - Renato Martins Xavier
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 333 Ovídio Pires de Campos St., Cerqueira César, SP, Brazil.
| | - Felipe Hellmeister Burgos
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 333 Ovídio Pires de Campos St., Cerqueira César, SP, Brazil
| | - Erick Yoshio Wataya
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 333 Ovídio Pires de Campos St., Cerqueira César, SP, Brazil
| | - Fernanda do Carmo Iwase
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 333 Ovídio Pires de Campos St., Cerqueira César, SP, Brazil
| | - Hugo Alberto Nakamoto
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 333 Ovídio Pires de Campos St., Cerqueira César, SP, Brazil
| | - Rames Mattar Júnior
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 333 Ovídio Pires de Campos St., Cerqueira César, SP, Brazil
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Zhang JF, Li Y, Huo YX, Yan M, Liang SL, Wang L, Wang BC. Biomechanical analysis of locking plates for fixation of metacarpal shaft fractures: A finite element analysis. Orthop Traumatol Surg Res 2022; 108:103340. [PMID: 35643362 DOI: 10.1016/j.otsr.2022.103340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/04/2021] [Accepted: 03/03/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND There appears to be a paucity of knowledge about the biomechanics of locking plates for the fixation of metacarpal shaft fractures. A thorough understanding of the biomechanics of locking plates is needed to apply them correctly, optimize outcomes, and avoid complications. The purpose of this study is to investigate the biomechanics of the fixation of metacarpal fractures using locking plate-screw constructs with different numbers of screws. HYPOTHESIS The difference in the number of screws in the locking plate influenced the biomechanical outcome of the metacarpal fracture. METHODS Finite element models of third metacarpal fractures with locking plate-screw constructs were established, and the magnitude and distribution of their stresses and displacements were investigated when a vertical load of 100N was applied. RESULTS For the metacarpal fracture with a locking plate and screws, the stress in the metacarpal was largely shared by the plate-screw construct. For the plate-screw construct, the stress is concentrated in the area close to the fracture line, and the 6-screw Group has the lowest failure risk since it has the lowest plate stress and the second-lowest screw stress. The implant-bone construct with 8 screws has better biomechanical stability because of minimal displacement, but increased stress on both the metacarpal bone and the screws, leading to increased failure rates. DISCUSSION The stresses in the metacarpal were mostly shared by the plate-screw constructs and the screws closest to the fracture line were the most likely to break or loosen. For the implant-bone constructs, the locking plate with 2 screws was the most vulnerable to break or loosen, whereas the locking plate with 6 screws was the least likely to break or loosen. The implant-bone construct with 8 screws had better biomechanical stability, but the stresses in both the metacarpal and the screws were increased, which increased the risk of failure. LEVEL OF EVIDENCE IV, basic science study.
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Affiliation(s)
- Jian-Feng Zhang
- Department of orthopedics, The Second Hospital of Tangshan, Hebei, China.
| | - Yong Li
- Department of orthopedics, The Second Hospital of Tangshan, Hebei, China
| | - Yong-Xin Huo
- Department of Hand Surgery, The Second Hospital of Tangshan, Hebei, China
| | - Ming Yan
- Department of orthopedics, The Second Hospital of Tangshan, Hebei, China
| | - Shou-Lei Liang
- Department of orthopedics, The Second Hospital of Tangshan, Hebei, China
| | - Lei Wang
- Department of Trauma Surgery, The Second Hospital of Tangshan, Hebei, China
| | - Bao-Cang Wang
- Department of orthopedics, The Second Hospital of Tangshan, Hebei, China
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Sun FG, Liu R, Xiong XW, Xu RM, Zhang QL. [Treatment of acute unstable proximal clavicular fracture with hook plate of sternoclavicular joint]. Zhongguo Gu Shang 2022; 35:1004-1007. [PMID: 36280422 DOI: 10.12200/j.issn.1003-0034.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate clinical effect of sternoclavicular hook plate in treating acute proximal clavicle fracture. METHODS The clinical of 12 patients with acute unstable proximal clavicle fracture from June 2016 to June 2019 were retrospectively analyzed. There were 8 males and 4 females, aged from 46 to 63 years old. Ten patients caused by car accident and 2 patients caused by high falling. All patients had multiple injuries;the time from injury to surgery ranged from 2 to 14 d. All patients were treated with domestic sternoclavicular joint hook plate. The operative time ranged from 40 to 115 min. The intraoperative bleeding volume ranged from 30 to 110 ml, follow-up time ranged from 10 to 36 months, the fracture healing time ranged from 8 to 18 weeks. At the latest follow-up, the efficacy was evaluated by using shoulder joint function score (Rockwood score). RESULTS All 12 patients were followed up, with no obvious pain at the latest follow-up. The rockwood scores of the affected shoulder ranged from 13 to 14, and the healthy shoulder ranged from 14 to 15. CONCLUSION The sternocleidoclavicular joint plate is fixed with preformed plate. The cantilever is designed to retain the motion of the sternoclavicular joint. It's safe and simple, avoid, the injury of important organs during operation, and has a good prognosis. It is an ideal fixation method for the treatment of proximal clavicle fracture.
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Affiliation(s)
- Fang-Gui Sun
- The Orthopaedic Centre, Mingzhou Hospital of Zhejiang University, Ningbo 315000, Zhejiang, China
| | - Rui Liu
- The Orthopaedic Centre, Mingzhou Hospital of Zhejiang University, Ningbo 315000, Zhejiang, China
| | - Xin-Wei Xiong
- The Orthopaedic Centre, Mingzhou Hospital of Zhejiang University, Ningbo 315000, Zhejiang, China
| | - Rong-Ming Xu
- The Orthopaedic Centre, Mingzhou Hospital of Zhejiang University, Ningbo 315000, Zhejiang, China
| | - Qiang-Li Zhang
- The Orthopaedic Centre, Mingzhou Hospital of Zhejiang University, Ningbo 315000, Zhejiang, China
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Costa DL, Torres AM, Bergamaschi IP, Kluppel LE, de Oliveira RB, Weber JBB. Assessment of Resorbable and Non-resorbable Fixation Systems in Sagittal Split Ramus Osteotomy: An In vitro Study. J Maxillofac Oral Surg 2022; 21:779-784. [PMID: 36274902 PMCID: PMC9474976 DOI: 10.1007/s12663-021-01581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
Objective The internal fixation has been purpose of study for many years, but there is still no consensus on the best method of fixation in relation to resistance for bilateral sagittal split ramus osteotomy (BSSO) using plates. Therefore, the aim of this study was to assess five different methods of osteosynthesis using resorbable and non-resorbable plates and screws in simulated sagittal split osteotomy (SSO) of the mandibular ramus. Materials and Methods SSO was performed in 25 polyurethane synthetic mandibular replicas. The distal segments were moved forward 5 mm, and the specimens were grouped according to the fixation method: Inion resorbable plate, KLS resorbable plate, standard four-hole titanium miniplate (Medartis), two standard four-hole titanium miniplates (Medartis) and an adjustable titanium miniplate (Slider/Medartis). Mechanical evaluation was performed by applying compression loads to first molar using an Instron universal testing machine up to a 5 mm displacement of the segments. Resistance forces were obtained in Newtons (N), and statistical analysis was performed using the software R v. 3.5 with significance level of 0.05. Linear mixed models were used to compare the force required to move each type of plate. Results The results showed that the resistance of SSO was better accomplished using two titanium miniplates and KLS resorbable plate showed the least resistance. However, both titanium and resorbable plates behaved similarly in small displacements, which are most commonly observed in BSSO postoperative time. Conclusion It can be concluded that both resorbable and non-resorbable systems might offer suitable mechanical resistance in the procedures where there are no mechanical postoperative complications.
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Affiliation(s)
- Davani Latarullo Costa
- Oral and Maxillofacial Surgery Department at Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Alexandre Machado Torres
- Oral and Maxillofacial Surgery Department at Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Isabela Polesi Bergamaschi
- Oral and Maxillofacial Surgeon, Private Practice, Rua XV de Novembro 2177 – Alto XV, Curitiba, PR CEP 80.045-125 Brazil
| | - Leandro Eduardo Kluppel
- Oral and Maxillofacial Surgery Department at Federal University of Paraná, Curitiba, PR Brazil
| | - Rogério Belle de Oliveira
- Oral and Maxillofacial Surgery Department At Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS Brazil
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11
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Teimouri M, Ravanbod H, Farrokhzad A, Sabaghi J, Mirghaderi SP. Comparison of hook plate versus T-plate in the treatment of Neer type II distal clavicle fractures: a prospective matched comparative cohort study. J Orthop Surg Res 2022; 17:369. [PMID: 35907856 PMCID: PMC9338617 DOI: 10.1186/s13018-022-03261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to compare the clinical and radiological outcomes of distal clavicle fracture fixation with a hook plate versus the standard non-locking T-plate for unstable Neer type II fractures.
Methods A prospective matched cohort study including two groups of hook plates and T-plates fixation was conducted in our two tertiary trauma centers. Patients with distal clavicle fractures Neer type II were assessed for union and the Constant-Murley score (CMS) at 1-, 3-, and 6-month follow-ups. Inadequate radiographic consolidation > 6 months after surgery was defined as non-union. Subscales of CMSpain, CMSactivities of daily living, CMSrange of motion (ROM), and CMSstrength were also compared between groups. According to recommendations, the implant was removed after union confirmation in the hook plate at a planned second surgery. Results Sixty consecutive patients were enrolled: 30 in the T-plate group and 30 in the hook plate group. CMS showed similar functional outcomes for T-plates and hook plates at all follow-ups (Month 6: 92.0 vs. 91.7, P = 0.45). However, on the month 1 follow-up, the T-plate group scored higher than the hook plate group for ROM and pain (CMSpain = 13.0 vs. 12.3, P = 0.03; CMSROM = 35.2 vs. 33.2, P = 0.002). Despite this, Pain, ROM, and other CMS domains were comparable between groups (P > 0.05). The mean time to union was 2.5 + 1.4 months for the T-plate group and 2.3 + 1.6 months for the hook plate group (P = 0.44). There was one fixation failure in each group and one periprosthetic fracture in the hook plate group (two revisions for the hook plates and one for T-plates, P = 1.00). Non-union and other complications were not observed. Conclusion Both surgical approaches resulted in full recovery and good function. However, in the hook plate group ROM and pain scores were lower at 1 month. Standard non-locking T-plates are a viable alternative to hook plates with low cost and promising outcomes for treating displaced distal clavicle fractures.
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Affiliation(s)
- Mehdi Teimouri
- Department of Orthopedic Surgery, Ayatollah Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hadi Ravanbod
- Department of Orthopedic Surgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhosein Farrokhzad
- Department of Orthopedic Surgery, Ayatollah Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamal Sabaghi
- Department of Orthopedic Surgery, Ayatollah Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Peyman Mirghaderi
- Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. .,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
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12
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Zarifian A, Akbarinezhad Fough A, Eygendaal D, Rivlin M, Mousavi Shaegh SA, Kachooei AR. Length of Plates and Number of Screws for the Fixation of Distal Humerus Fractures: A Finite Element Biomechanical Study. J Hand Surg Am 2022; 47:690.e1-690.e11. [PMID: 34474947 DOI: 10.1016/j.jhsa.2021.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 04/29/2021] [Accepted: 07/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We performed a biomechanical analysis using the finite element method to assess the effects of plate length and the number of screws on construct stiffness, stress distribution, and fracture displacement in the fixation of type A2 distal humerus fractures. METHODS A 3-dimensional humerus model was constructed using computed tomography of a healthy man. After creating a 2-mm extra-articular fracture gap, orthogonal double-plate fixation was performed with an incremental increase in plate length and the number of screws, creating 17 fixation models. Four screws were placed in each plate's distal segment, and the number of screws was increased incrementally in the segment proximal to the fracture, starting from 2 in the medial (M) and 2 in the lateral (L) plate (M2∗L2). RESULTS The fifth screw proximal to the fracture in the lateral plate (L5) played an essential role in increasing stiffness under bending, axial, and torsional forces surpassing the intact bone, which may have been due to the bypassing of the stress riser area. Minimum construct stiffness was created when 5 (M3∗L2) screws were inserted into the proximal segment. For bending forces, the M4∗L2 construct was stronger than M3∗L3 (total 6 proximal screws), and M5∗L3 was stronger than M4∗L4 (total 8 proximal screws), showing higher stiffness when the plates ended at different levels. The M4∗L2 construct (6 screws) had stiffness comparable with M4∗L3, M4∗L4, and M5∗L4 during bending, showing comparable stiffness with the least instrumentation density. CONCLUSION Our findings suggested M3∗L5 as the optimum and M3∗L2 as the minimum construct to resist all bending, axial and torsional forces. CLINICAL RELEVANCE Applying the results may improve surgical techniques, decrease the rate of complications, including fixation failure and nerve injury, and optimize the time of surgery. Moreover, hardware removal is less cumbersome with fewer screws.
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13
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Abstract
CLINICAL ISSUE Fractures of the distal femur represent rare but serious injuries with a high 1‑year mortality. An increasingly older patient population requires adapted treatment concepts. STANDARD TREATMENT PROCEDURE Surgical treatment using angular stable plating and retrograde nailing is the standard procedure. Conservative treatment is only indicated in cases of low demands and high perioperative risks of the patient. TREATMENT INNOVATIONS Primary double plate osteosynthesis and primary implantation of a distal femoral replacement represent new treatment procedures and show promising initial results in the collective of geriatric patients. DIAGNOSTIC WORK-UP Conventional radiographs in 2 planes and computed tomography with multiplanar and 3D reconstructions should be performed to enable an adequate assessment of the indications and treatment planning. PERFORMANCE Nonunion rates of plate and nail osteosyntheses range from 4% to 10%. No significant differences in long-term results can be observed. The results regarding double plate osteosynthesis and distal femoral replacement so far do not show any disadvantages compared to the existing procedures but there is still insufficient data for general recommendations. ASSESSMENT Complex fractures with extensive reconstructive procedures and treatment by distal femoral replacement should be performed in specialized centers. PRACTICAL RECOMMENDATIONS The gold standard is still surgical treatment by means of minimally invasive angular stable plate or retrograde nail osteosynthesis. Complex fracture forms require individual treatment planning considering all currently available treatment options.
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Affiliation(s)
- S Barzen
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und orthopädische Chirurgie, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland.
| | - S Buschbeck
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und orthopädische Chirurgie, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
| | - R Hoffmann
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und orthopädische Chirurgie, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
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14
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van Veelen NM, Beeres FJ, Link BC, Babst R. [Augmentation in the treatment of proximal humeral and femoral fractures]. Unfallchirurg 2022; 125:436-442. [PMID: 35416480 DOI: 10.1007/s00113-022-01172-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Proximal humeral and trochanteric femoral fractures in older patients are typically caused by low-energy trauma and are therefore often associated with osteoporosis. The treatment of such fragility fractures can be difficult as implant purchase is reduced in osteoporotic bone. By augmenting the fixation with cement the contact surface between implant and bone can be increased, which improves the stability of the osteosynthesis. OBJECTIVE This article describes the operative technique for the augmentation of trochanteric femoral fractures treated with the Trochanteric Fixation Nail-Advanced (TFNA, DePuy Synthes, Oberdorf BL, Switzerland) and proximal humeral fractures stabilized with a PHILOS plate (DePuy Synthes). Furthermore, the evidence for the augmentation of these two fracture types is elucidated. RESULTS Biomechanical studies could show an improved stability of the osteosynthesis after successful augmentation for both fracture types. The current evidence also indicates a clinical reduction of fixation failure. Whether the augmentation has an influence on the functional result could so far not yet clearly be proven. CONCLUSION Augmentation seems to be a safe and valuable addition to available treatment options especially for patients with fragility fractures.
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Affiliation(s)
- Nicole M van Veelen
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstraße, 6000, Luzern 16, Schweiz
| | - Frank Jp Beeres
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstraße, 6000, Luzern 16, Schweiz
| | - Björn-Christian Link
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstraße, 6000, Luzern 16, Schweiz
| | - Reto Babst
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstraße, 6000, Luzern 16, Schweiz. .,Departement Gesundheitswissenschaften und Medizin, Universität Luzern, Frohburgstraße 3, 6002, Luzern, Schweiz.
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15
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Tang D, Zhong HZ, Liang KL. [Locking plate fixation with fibular strut allograft versus locking plate fixation alone for the treatment of proximal humeral fractures in adults:a Meta-analysis]. Zhongguo Gu Shang 2022; 35:186-193. [PMID: 35191274 DOI: 10.12200/j.issn.1003-0034.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the clinical efficacy of locking plate fixation with a fibular strut allograft (FA group) and locking plate fixation alone (LP group) in the treatment of proximal humeral fractures in adults by Meta-analysis. METHODS Databases including PubMed, The Cochrane Library, Embase, Chinese BioMedical Literature Database(CBM), China National Knowledge Infrastructure(CNKI), WanFang Data, and China Science and Technology Journal Database (cpvip Database) were searched by computer from establishing to March 2020 to collect studies about locking plate fixation with fibular strut allograft versus locking plate fixation alone for proximal humeral fractures in adults. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. The postoperative humeral head height changes, neck-shaft angle changes, Constant-Murley score, American Shoulder and Elbow Surgeons(ASES)score, visual analogue scale(VAS), varus malunion rate, and screw penetration rate were compared by RevMan 5.3 software for Meta-analysis. RESULTS Ten cohort studies were enrolled in a total of 749 patients, 300 patients in the FA group and 449 patients in the LP group. The results of Meta-analysis showed that locking plate with fibular strut allograft was superior to locking plate fixation alone in the changes in humeral head height [MD=-2.69, 95%CI(-3.24, -2.13), P<0.000 01], the changes in neck-shaft angle [MD=-5.65, 95%CI(-7.18, -4.12), P<0.000 01], Constant-Murley score [MD=9.00, 95%CI(4.26, 13.73), P=0.000 2], the ASES score [MD=5.56, 95%CI(4.29, 6.84), P=0.000 01], VAS score [MD=-0.23, 95%CI(-0.37, -0.09), P=0.001], the varus malunion rate [RR=0.22, 95%CI(0.09, 0.53), P=0.000 7] and the screw penetration rate [RR=0.26, 95%CI(0.13, 0.55), P=0.000 3], respectively.While there was no significant difference in the rate of osteonecrosis of the humeral head [RR=1.18, 95%CI(0.57, 2.45), P=0.65]. CONCLUSION For proximal humeral fractures in adults, current evidence shows that locking plate fixation with fibular strut allograft is superior to single locking plate fixation in improving postoperative radiological outcomes and shoulder function, relieving postoperative pain, reducing varus malunion rate and screw penetration rate. However, the efficacy in decreasing the osteonecrosis rate is not clear. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
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Affiliation(s)
- Di Tang
- Department of Orthopaedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Hong-Zhi Zhong
- Department of Orthopaedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Kai-Lu Liang
- Department of Orthopaedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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16
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Chun DI, Min TH, Kang EM, Yu W, Won SH, Cho J, Yi Y. Comparison of Radiological and Clinical Outcomes in Patients Treated with Standard Plating versus Intramedullary Nailing in Distal Tibial Fracture. Orthop Surg 2022; 14:536-542. [PMID: 35106932 PMCID: PMC8927007 DOI: 10.1111/os.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate clinical and radiological outcomes including hindfoot alignment after plate vs intramedullary nailing (IMN) for distal tibia fracture and to define radiologic parameters that influence changes in hindfoot alignment. Methods Among 92 patients with distal tibia metaphyseal fractures treated from 2002 to 2015, 39 cases of intramedullary nailing and 53 cases of standard plate osteosynthesis were performed. Union rate and complication rate were compared in both groups. Radiographic measurements including hindfoot angulation, moment arm, calcaneal pitch angle, and Meary angle were evaluated at a minimum of 1‐year follow‐up. Hindfoot alignment changes after surgery were compared between both groups using student t‐test. Correlation and regression were analyzed between fracture alignment parameters and hindfoot alignment. Results All patients ultimately healed, with an average union period of 26 weeks in both groups. The AOFAS and VAS scores were not significantly different between the two groups. Complications were similar between the two groups. Hindfoot alignment angle, calcaneal pitch, and Meary angle showed no significant differences between the groups. The hindfoot moment arm increased with valgus in the IMN group. A low correlation was detected between angulation at the fracture site in the coronal view and hindfoot alignment (angulation and moment arm) changes (R = 0.38). A significantly high correlation was noted only between transverse rotation and hindfoot alignment changes (R = 0.79). Conclusions Rotation in the transverse plane notably influenced changes in hindfoot alignment. And this suggests that patients with distal tibia fracture should be closely monitored for hindfoot alignment changes caused by intraoperative transverse rotation regardless of the fixation method.
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Affiliation(s)
- Dong-Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Tae-Hong Min
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Eun Myeong Kang
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Woojin Yu
- Department of Orthopaedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Jaeho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon-si, South Korea
| | - Young Yi
- Department of Orthopaedic Surgery, Seoul Foot and Ankle Center, Inje University, Seoul, South Korea
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17
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Thamyongkit S, Abbasi P, Parks BG, Shafiq B, Hasenboehler EA. Weightbearing after combined medial and lateral plate fixation of AO/OTA 41-C2 bicondylar tibial plateau fractures: a biomechanical study. BMC Musculoskelet Disord 2022; 23:86. [PMID: 35078451 PMCID: PMC8790864 DOI: 10.1186/s12891-022-05024-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Combined medial and lateral plate fixation is recommended for complex tibial plateau fractures with medial fragments or no cortical bone contact. Although such fixation is adequate to resist forces during range of motion, it may be insufficient to support immediate postoperative weightbearing. Here, we analyzed displacement, stiffness, and fixation failure during simulated full weightbearing of bicondylar tibial plateau fractures treated with combined medial and lateral locking plate fixation. Methods We used 10 fresh-frozen adult human cadaveric tibias and mated femurs. Osteotomies were performed with an oscillating saw and cutting template to simulate an AO Foundation and Orthopaedic Trauma Association (AO/OTA) 41-C2 fracture (simple articular, multifragmentary metaphyseal fracture). Specimens were anatomically reduced and stabilized with combined medial and lateral locking plates (AxSOS, Stryker, Mahwah, NJ). Specimens were loaded axially to simulate 4 weeks of walking in a person weighing 70 kg. The specimens were cyclically loaded from 200 N to a maximum of 2800 N. Then, if no failure, loading continued for 200,000 cycles. We measured displacement of each bone fragment and defined fixation failure as ≥5 mm of displacement. Construct stiffness and load at failure were calculated. Categorical and continuous data were analyzed using Chi-squared and unpaired t-tests, respectively. Results Mean total displacement values after 10,000 loading cycles were as follows: lateral, 0.4 ± 0.8 mm; proximal medial, 0.3 ± 0.7 mm; distal medial, 0.3 ± 0.6 mm; and central 0.4 ± 0.5 mm. Mean stiffness of the construct was 562 ± 164 N/mm. Fixation failure occurred in 6 of 10 specimens that reached 5 mm of plastic deformation before test completion. In the failure group, the mean load at failure was 2467 ± 532 N, and the mean number of cycles before failure was 53,155. After test completion, the greatest displacement was found at the distal medial fracture site (2.3 ± 1.4 mm) and lateral fracture site (2.2 ± 1.7 mm). Conclusions Although combined medial and lateral plate fixation of complex tibial plateau fractures provides adequate stability to allow early range of motion, immediate full weightbearing is not recommended.
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Affiliation(s)
- Sorawut Thamyongkit
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA.,Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Pooyan Abbasi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Brent G Parks
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Babar Shafiq
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA
| | - Erik A Hasenboehler
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore, MD, 21224-2780, USA.
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Al-Tamimi AA. 3D Topology Optimization and Mesh Dependency for Redesigning Locking Compression Plates Aiming to Reduce Stress Shielding. Int J Bioprint 2021; 7:339. [PMID: 34286146 PMCID: PMC8287512 DOI: 10.18063/ijb.v7i3.339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Current fixation plates for bone fracture treatments are built with biocompatible metallic materials such as stainless steel, titanium, and its alloys (e.g., Ti6Al4V). The stiffness mismatch between the metallic material of the plate and the host bone leads to stress shielding phenomena, bone loss, and healing deficiency. This paper explores the use of three dimensional topology-optimization, based on compliance (i.e., strain energy) minimization, reshaping the design domain of three locking compression plates (four-screw holes, six-screw holes, and eight-screw holes), considering different volume reductions (25, 45, and 75%) and loading conditions (bending, compression, torsion, and combined loads). A finite-element study was also conducted to measure the stiffness of each optimized plate. Thirty-six designs were obtained. Results showed that for a critical value of volume reductions, which depend on the load condition and number of screws, it is possible to obtain designs with lower stiffness, thereby reducing the risk of stress shielding.
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Affiliation(s)
- A A Al-Tamimi
- Industrial Engineering Department, College of Engineering, King Saud University, Riyadh 11421 Saudi Arabia
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19
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Abstract
The development of prosthetic bioimplants for fracture fixation using curved bone plates has been used as an established procedure for treatment in orthopedic. Here-in, we propose a novel curved bone plate fixation strategy to fix the designed biocompatible plates in different fracture models. Various biocompatible metallic biomaterials such as Ti-alloy (Ti-6Al-4V), stainless steel (SS 316L), and Co-alloy (Co-Cr) were created in SOLID works and used for the design of the bone plates. The typical fracture models (transverse and oblique) were created over a standard femur bone (models created using Materialize MIMIC/MAGIC) and two bone plates of similar materials were fixed side-by-side over the fractured femur using the screws made from Ti-6Al-4V. The finite element analysis (FEA) was carried out to evaluate the interface deformation, stress, and strain generated at the bone-bioimplant interface. The results from FEA demonstrated that the interface deformation and stress for a bone-bioimplant assembly are significantly reduced when natural anisotropic condition (functionally graded materials properties) of the human femur was well considered. Based on the analysis, Ti-6AL-4V and SS 316L were found as the best fit metallic biomaterials for the design and development of bone plate prosthetic bioimplants for fixation of an oblique fracture and transverse fracture respectively.
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Affiliation(s)
- Harbhajan Ahirwar
- Biomedical Engineering and Technology Laboratory, Discipline of Mechanical Engineering, Indian Institute of Information Technology Design and Manufacturing, Jabalpur, MP, India
| | - Vijay Kumar Gupta
- Design and Vibrations Laboratory, Discipline of Mechanical Engineering, Indian Institute of Information Technology Design and Manufacturing, Jabalpur, MP, India
| | - Himansu Sekhar Nanda
- Biomedical Engineering and Technology Laboratory, Discipline of Mechanical Engineering, Indian Institute of Information Technology Design and Manufacturing, Jabalpur, MP, India
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Lim JR, Yoon TH, Lee HM, Chun YM. Anatomic fit of precontoured extra-articular distal humeral locking plates: a cadaveric study. Clin Shoulder Elb 2021; 24:66-71. [PMID: 34078013 PMCID: PMC8181839 DOI: 10.5397/cise.2021.00227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background Extra-articular distal humerus locking plates (EADHPs) are precontoured anatomical plates widely used to repair distal humeral extra-articular diaphyseal fractures. However, EADHPs frequently cause distal protrusion and resulting skin discomfort. The purpose of this study was to predict the occurrence of anatomic fit mismatch. We hypothesized that the smaller the humerus size, the greater the anatomic fit mismatch with EADHP. Methods Twenty humeri were analyzed in this study. Humeral length and distal humeral width were used as parameters of humeral size. Plate protrusion was measured between the EADHP distal tip and the distal humerus. We set the level of unacceptable EADHP anatomic fit mismatch as ≥10 mm plate protrusion. Results A significant negative linear correlation was also confirmed between humeral size and plate protrusion, with a coefficient of determination of 0.477 for humeral length and 0.814 for distal humeral width. The cutoff value of humeral length to avoid ≥10 mm plate protrusion was 293.6 mm (sensitivity, 88.9%; specificity, 81.8%) and for distal humeral width was 60.5 mm (sensitivity, 100%; specificity, 81.8%). Conclusions Anatomic fit mismatch in distal humeral fractures after EADHP fixation has a negative linear correlation with humeral length and distal humeral width. For patients with a distal humeral width <60.5 mm, ≥10 mm plate protrusion will occur when an EADHP is used, and an alternative implant or approach should be considered.
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Affiliation(s)
- Joon-Ryul Lim
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hwan Yoon
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Han Y, Xia J, Jin L, Qiao A, Su T, Li Z, Xiong J, Wang H, Zhang Z. Computational fluid dynamics study of the effect of transverse sinus stenosis on the blood flow pattern in the ipsilateral superior curve of the sigmoid sinus. Eur Radiol 2021; 31:6286-6294. [PMID: 33492472 DOI: 10.1007/s00330-020-07630-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/18/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effect of different types of transverse sinus stenosis on blood flow patterns in the ipsilateral superior curve of the sigmoid sinus. METHODS According to the morphology of transverse and sigmoid sinus sections in pulsatile tinnitus patients, ten idealized models with different degrees and positions of transverse sinus stenosis were constructed. Computational fluid dynamics simulations were performed to compare the hemodynamic characteristics among these models. Follow-up images of previous cases were included, which preliminarily confirmed the hypothesis that bone plate erosion of the sigmoid sinus sulcus is related to blood flow impingement. RESULTS Blood flow impingement on the superior curve of the sigmoid sinus wall intensified with increasing degree of stenosis and decreased with increasing distance between the stenosis and the sigmoid sinus. The impact zone was generally confined to the anterior and lateral walls of the superior curve of the sigmoid sinus. When the stenosis was located far from the middle of the transverse sinus, the blood flow impingement on the sigmoid sinus wall was very weak. CONCLUSIONS When stenosis is located far from the sigmoid sinus, the causes of tinnitus should be comprehensively considered instead of assuming that stenosis is the main cause. Bone plate erosion of the sigmoid sinus sulcus was promoted by blood flow impingement. KEY POINTS • Ten idealized models with different degrees and positions of stenosis were constructed. • The causes of pulsatile tinnitus should be comprehensively considered. • Sigmoid sinus plate dehiscence was promoted by blood flow impingement.
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Affiliation(s)
- Yanjing Han
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Jun Xia
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100124, China
| | - Long Jin
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Aike Qiao
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100124, China.
| | - Tianhao Su
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - ZhenFeng Li
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Jianping Xiong
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Haochen Wang
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhiyuan Zhang
- Department of Interventional Radiography, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
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Adhikari M, Bhatt K, Yadav R, Mandal J, Bhutia O, Roychoudhury A. Fixation of subcondylar fractures of the mandible: a randomized clinical trial comparing one trapezoidal plate with two miniplates. Int J Oral Maxillofac Surg 2021; 50:756-62. [PMID: 33280989 DOI: 10.1016/j.ijom.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/04/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022]
Abstract
Subcondylar fracture of the mandible accounts for 25-35% of all mandibular fractures. In the past, most subcondylar fractures were managed non-surgically. The traditional method of fixation for subcondylar fractures uses two miniplates; however some bench studies have reported that trapezoidal plates are superior. The aim of this study was to compare the outcomes of subcondylar fractures fixed either with two non-parallel straight miniplates or with one trapezoidal plate. A randomized clinical trial was designed and implemented. Fifty-two consecutive patients with subcondylar fractures were recruited. All patients underwent surgery via a retromandibular approach. The time taken for fixation of the plate after fracture reduction and postoperative outcomes and complications were compared between the groups. The trapezoidal plates were superior in terms of ease of adaptation and time taken for fixation (P= 0.0001). Plate fracture was observed only in the two miniplates group, in four (16%) patients. Outcomes were similar in the two groups in terms of occlusion, mouth opening, protrusion, and lateral excursion. In conclusion, both systems - two miniplates and the trapezoidal plate - provide functionally stable fixation. The outcome was significantly better for the trapezoidal plate than for two miniplates regarding the time taken for insertion and ease of adaptation, but not for other parameters.
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Donovan RL, Harries L, Whitehouse MR. Flexible nails have a significantly increased risk of complications compared with plating techniques when treating diaphyseal femoral fractures in children aged 5-12: A systematic review. Injury 2020; 51:2763-2770. [PMID: 33039182 DOI: 10.1016/j.injury.2020.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND One third of paediatric femoral fractures occur between the ages of 5 and 12. The American Academy of Orthopaedic Surgeons (AAOS) provide evidence-based guidance for treating such fractures that occur in children under 5 and over 12 but not for this age cohort. We aimed to synthesise the available evidence comparing flexible nailing versus plating techniques for diaphyseal femoral fractures in children between the ages of 5 and 12. METHODOLOGY A systematic review of interventional and observational studies was performed using MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, WHO Global Index Medicus and LILACS. The search strategy combined keywords for: children, diaphyseal femoral fractures, plates and nails. Two independent reviewers screened, selected, assessed quality and extracted data from identified studies. The primary outcome was overall complication rates. Secondary outcomes assessed rates of individual complications, and operative variables (e.g. operative time, blood loss). RESULTS Five studies fulfilled the eligibility criteria. No RCTs were identified. The studies included 308 femoral fractures in 306 patients: 174 fractures were treated with flexible nailing and 134 with plating. The post-operative complication rate was 27.0% (n = 47) after flexible nails and 12.7% (n = 17) after plating, relative risk 2.13 (95% CI 1.28, 3.53; p = 0.0035). The relative risk of malunion was 3.59 (95% CI 1.05, 12.25; p = 0.0409) with flexible nails and of prominent metalwork was 5.39 (95% CI 1.25, 23.31; p = 0.0241) with flexible nails. CONCLUSIONS Data on this topic for this age group is limited despite accounting for one third of paediatric femoral fractures. This review identified a significantly increased relative risk of all complications, and in particular with respect to malunion and prominent metalwork when fractures in this cohort are treated with flexible nails compared to plates. A multi-centre randomised trial to determine if either treatment is superior would be justified.
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Affiliation(s)
- Richard L Donovan
- North Bristol NHS Trust, Southmead Rd, Bristol, BS10 5NB, UK; Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Bristol, BS10 5NB, UK; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD, UK.
| | - Luke Harries
- North Bristol NHS Trust, Southmead Rd, Bristol, BS10 5NB, UK.
| | - Michael R Whitehouse
- North Bristol NHS Trust, Southmead Rd, Bristol, BS10 5NB, UK; Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Bristol, BS10 5NB, UK.
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Aghdashi F, Forouzmehr A, Nahvi G, Tabrizi R, Jafarian M, Majdi S. Assessment of compression and strength of divergent screws mounted on miniplates and dynamic compression plate in fixation of mandibular body fractures: an in vitro study. Br J Oral Maxillofac Surg 2020; 58:e260-e264. [PMID: 32811725 DOI: 10.1016/j.bjoms.2020.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/17/2020] [Indexed: 11/18/2022]
Abstract
Achieving compression in the fracture line gap by open reduction and internal fixation leads to more primary bone healing and therefore hastens the healing process and patient's rehabilitation. We aimed to evaluate the application of compression by a modification in screw insertion in miniplates to improve the efficiency of the previous relevant methods. In this in vitro experimental study 20 sheep hemimandibles were prepared. Following intentional fracturing of the hemimandibular bodies, the specimens were divided into two: the control and study groups (n=10 each). The control group was fixed with straight four-hole dynamic compression plate (DCP) without a bar and with parallel screws. The study group was fixed with a straight four-hole miniplate without a bar. Screws were divergently inserted into the bone with an angle of 45°. The differences in the fracture line gap were measured before and after fixation considering the indicators of compression. The strength of the fixation was also assessed with a universal testing machine. The control group provided more compression than the study group (p=0.4). There was no difference in the strength of fixation between the two groups. It is concluded that the application of the miniplates with divergent screws instead of DCP could encompass the advantages of both perspectives such as intraoral incisions and compressive force and prevent the disadvantages of compression plates such as hard adaptation.
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Affiliation(s)
- F Aghdashi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Forouzmehr
- Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - G Nahvi
- Department of Orthodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - R Tabrizi
- Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Jafarian
- Department of Oral andMaxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Majdi
- Department of Oral and Maxillofacial Surgery, Dental school, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sarkarat F, Ahmady A, Farahmand F, Fateh A, Kahali R, Nourani A, Rakhshan V. Comparison of strengths of five internal fixation methods used after bilateral sagittal split ramus osteotomy: An in vitro study. Dent Res J (Isfahan) 2020; 17:258-265. [PMID: 33282151 PMCID: PMC7688040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Results on the strength and displacement of internal fixation methods for bilateral sagittal split ramus osteotomy are controversial, and some designs have not been adequately studied. Therefore, this study was conducted to compare techniques using bicortical or monocortical screws. MATERIALS AND METHODS In this in vitro study, 35 sheep hemi-mandibles were randomly assigned to five groups of seven each: fixation using (1) a 13 × 2 screw, (2) two 13 × 2 screws (arranged vertically), (3) three 13 × 2 screws, (4) 1 plate with 4 holes and four monocortical screws, and (5) a Y-shaped plate and five monocortical screws. Specimens underwent vertical forces until failure. Breakage forces and displacements of groups were recorded and compared statistically. Using one-way analysis of variance (ANOVA) with a Tukey's post hoc test and Kruskal-Wallis test. Level of significance was predetermined as 0.05. RESULTS Strengths of Groups 1-5 were, respectively, 14.43 ± 4.35, 28.00 ± 8.89, 28.29 ± 8.01, 29.43 ± 8.24, and 61.29 ± 12.38 N, respectively (P = 0.000, analysis of variance). The corresponding displacement extents were 7.98 ± 0.04, 7.85 ± 0.26, 8.00 ± 0.00, 7.35 ± 1.73, and 6.79 ± 2.03 mm (P = 0.298, Kruskal-Wallis test). CONCLUSION Use of a single bicortical screw is the weakest method, while Y-shaped plates might provide the highest strength. Using two or three bicortical screws or 4-hole plates might deliver similar strengths.
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Affiliation(s)
- Farzin Sarkarat
- Department of Oral and Maxillofacial Surgery, Tehran, Iran,Craniomaxillofacial Research Center, Islamic Azad University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Farzin Sarkarat, #4, Neyestan 10th, Pasdaran Ave., Tehran, Iran. E-mail:
| | - Atiye Ahmady
- Private Practice, School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Private Practice, School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Ali Fateh
- Craniomaxillofacial Research Center, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Roozbeh Kahali
- Department of Oral and Maxillofacial Surgery, Tehran, Iran,Craniomaxillofacial Research Center, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Amir Nourani
- Department of Mechanical Engineering, School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Vahid Rakhshan
- Private Practice, School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Wu HY, Shao QP, Song CJ, Shang RR, Liu XM, Cai XH. Personalized Three-Dimensional Printed Anterior Titanium Plate to Treat Double-Column Acetabular Fractures: A Retrospective Case-Control Study. Orthop Surg 2020; 12:1212-1222. [PMID: 32725701 PMCID: PMC7454211 DOI: 10.1111/os.12741] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 01/15/2023] Open
Abstract
Objective To compare the clinical efficacy and safety of a personalized three‐dimensional (3D) printed dynamic anterior plate–screw system for the quadrilateral area (DAPSQ) titanium plate and a traditional DAPSQ reconstruction plate in the treatment of double‐column acetabular fractures. Methods This was a retrospective case‐control study. From May 2014 to January 2018, 43 patients with double‐column acetabular fractures underwent open reduction and internal fixation. Among these, 20 cases were fixed with a 3D printed DAPSQ plate (3D printed group) and 23 cases were fixed with a DAPSQ reconstruction plate (control group). The 3D printed group comprised 15 men and 5 women, with an average age of 50.1 ± 8.2 years. The control group comprised 16 men and 7 women, with an average age of 51.0 ± 8.6 years. The evaluation index included the surgical data (i.e. blood loss, operating time, duration of hospital stay, and intraoperative and postoperative complications), position and length of implants, reduction quality, hip function, and related complications. The reduction quality was evaluated using the Matta scoring standard and hip function was evaluated using the modified Merle d’Aubigné score. Results A total of 43 patients met the inclusion criteria. The mean postoperative follow up was 35.2 months in the 3D printed group and 36.9 months in the control group. There were no significant group differences in demographic data between the two groups. The position and length of the 3D printed implants were generally in accord with preoperative planning using a 3D pelvic model. Patients in the 3D printed group had significantly shorter operation time (223.2 vs 260.5 min, P < 0.05) and less intraoperative blood loss (930.4 vs 1426.1 mL, P < 0.05) compared to the control group. Anatomic, imperfect, and poor reduction was obtained in 13, 5, and 2 cases in the 3D printed group, respectively, and was obtained in 12, 8, and 3 cases in the control group. The modified Merle d’Aubigné scores were excellent in 11 cases, good in seven cases, and fair in two cases in the 3D printed group. They were excellent in 11 cases, good in eight cases, fair in three cases, and poor in one case in the control group. The reduction quality and hip function did not differ within the groups (P > 0.05). The general complication rate in the 3D printed group and the control group was 15% and 26.1%, respectively, but the difference between the two groups was not statistically significant. Conclusion Use of a personalized 3D printed DAPSQ plate has potential advantages in reducing the operation time and blood loss during the treatment of double‐column acetabular fractures.
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Affiliation(s)
- Hai-Yang Wu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Qi-Peng Shao
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Cheng-Jing Song
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Ran-Ran Shang
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Xi-Ming Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Xian-Hua Cai
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
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de Carvalho PHM, Oliveira SDS, Favaro M, Sverzut CE, Trivellato AE. Which type of method shows the best mechanical behavior for internal fixation of bilateral sagittal split osteotomy in major advancements with clockwise rotation? Comparison of four methods. Oral Maxillofac Surg 2020; 25:27-34. [PMID: 32661574 DOI: 10.1007/s10006-020-00883-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the four methods for bilateral sagittal osteotomy fixation. METHODS In this study, 56 replicas of whole mandibles made of rigid polyurethane were used. After simulation of major advancement (11 mm) with clockwise rotation of the mandible (6o) in relation to the occlusal plane, the bone segments were fixed with plates and screws of the 2.0-mm system on both the right and left sides: group I, double "H" plate; group II, two mini-plates; group III, "hybrid technique"; and group IV, three bicortical screws in the "inverted L" pattern. The mandibles were submitted to load on the central incisors and right first molar. RESULTS The mean value of group I was higher than those of groups IV and II in the displacement of 1 mm (F = 4.705; p = 0.010) with load on the incisor. The mean value of group III was higher than those of groups I and II in the displacement of 1 mm (F = 5.166; p = 0.007) and 3 mm (F = 5.166; p = 0.007). The mean value of group IV was higher than that of group II (F = 3.142; p = 0.044) with load on the molar. CONCLUSION Therefore, after the analyses, the hybrid technique was the one that showed the best results.
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Affiliation(s)
- Pedro Henrique Mattos de Carvalho
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Soraya da Silva Oliveira
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Matheus Favaro
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Cássio Edvard Sverzut
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Alexandre Elias Trivellato
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil.
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Ganesh G, Tripathi T, Rai P. Orthopaedic and orthodontic treatment with hyrax, Class III elastics on mandibular miniplates, maxillary mini-implants in a Class III adolescent: A case report. Int Orthod 2020; 18:827-38. [PMID: 32654977 DOI: 10.1016/j.ortho.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The treatment of Skeletal Class III malocclusion continues to be considered as one of the biggest challenges in orthodontics as the success of its correction is largely unpredictable. Early diagnosis and treatment are highly recommended to eliminate primary etiological factors and prevent an increase in severity of the existing malocclusion. However, if the diagnosis is delayed until adulthood, treatment becomes restricted to orthognathic surgery due to limited or no remaining growth potential left. The inherent risks involved with the surgical procedures often preclude the patients from opting for it, thus leaving the orthodontist with no option but to perform possible compensatory treatments to improve facial aesthetics and restore functional occlusion. OBJECTIVE To report the case of a 15-year old boy (adolescent) with Skeletal Class III malocclusion, a concave facial profile with an anterior crossbite and no incisor visibility during smile. METHODS Intra-oral skeletally anchored maxillary protraction (I-SAMP) and mini-implants associated with fixed appliance to aid in the correction of the skeletal bases and subsequently relieve the dental crowding. RESULTS After 36 months of treatment, functional normal occlusion with a Class I molar and canine relation was achieved. The consequential increase in upper lip thickness and decrease in lower lip fullness alongwith an increased exposure of maxillary incisors during smile resulted in a significant improvement of the patient's facial profile and an aesthetically pleasing smile.
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Figueiredo CE, Paranhos LR, da Silva RP, Herval ÁM, Blumenberg C, Zanetta-Barbosa D. Accuracy of orthognathic surgery with customized titanium plates-Systematic review. J Stomatol Oral Maxillofac Surg 2020; 122:88-97. [PMID: 32622000 DOI: 10.1016/j.jormas.2020.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
This systematic review aimed to evaluate the accuracy of customized titanium plates in orthognathic surgery compared to standard outcome in virtual surgical planning. PRISMA and JBI guidelines were followed. Research protocol was registered in PROSPERO. Six databases and two gray literature repositories were used as sources of research articles. Descriptive clinical studies, that performed orthognathic surgery using custom titanium plates, were included. Risk of bias was assessed by "The Joanna-Briggs Institute Critical Appraisal tools for use in Systematic Reviews Checklist for Case Series". Of the 11,916 studies initially identified, seven met the eligibility criteria and were included. The studies were published between 2015 and 2019. Most of the studies (57%) had a low risk of bias, while one had a high risk of bias. Total sample included 74 patients with 63 bimaxillary surgeries and 11 unimaxillary surgeries. All studies showed acceptable accuracy within previously established clinical parameters. Although the eligible articles assessed the accuracy of the orthognathic surgery with respect to virtual planning, the wide variability of evaluation methodologies made it impossible to calculate a combined accuracy measure. It was not possible to perform a meta-analysis, so a pragmatic recommendation on the use of these plates is not possible.
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Affiliation(s)
- C E Figueiredo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - L R Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil.
| | - R P da Silva
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Á M Herval
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - C Blumenberg
- Centre for Epidemiological Research, International Centre for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - D Zanetta-Barbosa
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
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Shen QJ, Xing GS, Liu ZY, Li EQ, Zhao BC, Zheng YC, Cao Q, Zhang T, Zhang JL. [Surgical treatment of the complex bicondylar tibial plateau fracture using a midline longitudinal incision]. Zhonghua Yi Xue Za Zhi 2020; 100:1260-1263. [PMID: 32344500 DOI: 10.3760/cma.j.cn112137-20190904-01962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the outcomes after treatment of the complex bicondylar tibial plateau fracture through a midline longitudinal approach. Methods: A review of fifteen patients with an average age of (51.3±12.3) years old (range17-65yers;7 males, 8 females) surgically treated from October 2013 to Febuary 2018 were included. Sahatker Ⅴ in 10, Sahatker Ⅵ in 5; fractures of medial and lateral columns in 9, fractures of three columns in 6. All the patients were adopt a midline longitudinal approach combined with the posterior approach and bone grafting were conducted. Results: All cases were followed-up for (14.4±3.8) month, with an average of 12-24 month. All patients gained bone union during 12-16 weeks after operation, with an average of (15.2±1.3) weeks. There were significant differeces in both tibial plateau angle and posterior slope angle on radiography between preoperation and postoperation (P<0.05), there were no significant differeces in either tibial plateau angle or posterior slope angle on radiography between immediate postoperation and 12 months postoperation (P>0.05). At final follow-up,both the Lachman test and the Pivot-shift test were negative. All patients had complete knee extension, knee flexion angle 100°-135°, with an average of 117.7°±11.3°. The HSS (the Hospital for Special Surgery) score were 66-98, with an average of 85.1±9.3, six cases were excellent and seven cases were good, two cases was fair, the excellent and good rate was 86.7%. The Rasmussen radiological evaluationre were 9-18, with an average of 15.1±2.5, three cases were excellent and eleven cases were good, one cases was fair, the excellent and good rate was 93.3%. 1 patient had fat liquefactionof in antero incision, and got good outcomes after debridement dressing. Conclusion: The treatment of the complex bicondylar tibial plateau fracture through a midline longitudinal approach combined with the posterior approach can result in good exposure and satisfying knee function in short-term.
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Affiliation(s)
- Q J Shen
- Department of Orthopaedics, Tianjin Hospital, Tianjin 300211 China
| | - G S Xing
- Tianjin Institute of Orthopedics, Tianjin, 300050 China
| | - Z Y Liu
- Department of Orthopaedics, Tianjin Hospital, Tianjin 300211 China
| | - E Q Li
- Department of Orthopaedics, Tianjin Hospital, Tianjin 300211 China
| | - B C Zhao
- Department of Orthopaedics, Tianjin Hospital, Tianjin 300211 China
| | - Y C Zheng
- Department of Orthopaedics, Tianjin Hospital, Tianjin 300211 China
| | - Q Cao
- Department of Orthopaedics, Tianjin Hospital, Tianjin 300211 China
| | - T Zhang
- Department of Orthopaedics, Tianjin Hospital, Tianjin 300211 China
| | - J L Zhang
- Department of Orthopaedics, Tianjin Hospital, Tianjin 300211 China
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Park YH, Song JH, Choi GW, Kim HJ. Comparative analysis of clinical outcomes of fixed-angle versus variable-angle locking compression plate for the treatment of Lisfranc injuries. Foot Ankle Surg 2020; 26:338-342. [PMID: 31054803 DOI: 10.1016/j.fas.2019.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fixed-angle locking compression plate (LCP) and variable-angle LCP are utilized for internal fixation of Lisfranc injuries. However, studies regarding the difference of clinical outcomes of these two plates are limited. The purpose of present study was to compare postoperative outcomes between these two plate types in Lisfranc injuries. METHODS A total of 45 consecutive patients (22 patients with fixed-angle LCP and 23 patients with variable-angle LCP) who underwent surgical treatment for Lisfranc injury were reviewed for this retrospective study. The Foot Function Index (FFI), numerical rating scale (NRS) for pain, development of complications, operative time, and patient satisfaction for current activity were compared. RESULTS There were no significant differences in FFI and NRS for pain at three months and 12 months following surgery. Postoperative complication rate was similar between two groups. Patients with variable-angle LCP had an 18 min shorter mean length of operation (p = 0.040). Patient satisfaction for current activity was not differ between two groups. CONCLUSIONS The use of variable-angle LCP for treatment of Lisfranc injuries did not show superiority in functional outcomes, pain, complication rates, or patient satisfaction to fixed-angle LCP, but operative time was shorter with variable-angle LCP. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Jong Hyub Song
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea.
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Zamboni C, Carmo BL, Moraes LVM, Hungria JOS, Mercadante MT, Fucs PMMB. A practical guide for the use of contour locking plates for the repair of humeral diaphyseal fractures with proximal extension. Injury 2019; 50:2247-2251. [PMID: 31606134 DOI: 10.1016/j.injury.2019.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 09/04/2019] [Accepted: 09/19/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The emergence of minimally invasive techniques has expanded the use of plates and improved their safety for the repair of humeral diaphyseal fractures with proximal extension. In this study, we aimed to determine the best contouring method for long locking plates in the repair of humeral fractures using this approach. PATIENTS AND METHODS Comparative observations were performed between helical and spiral modelling in plastic models to identify which shape best fits the contours of the humerus. To determine the best shape, we attempted to assess the torsion required for the plate to settle laterally in the greater tuberosity and anteriorly in the diaphyseal region of the humerus. After establishing the best approach, we transferred the method to two anatomical specimens and confirmed the viability of the method and pathways. Additionally, to confirm the clinical applicability of the method, we applied the method in ten patients. RESULTS After placing the plates in the bone models, it was found that the helical plate was more distant from the bone. On the other hand, the spiral plate achieved better accommodation along the contours of the humerus. The amount of twist was tested at 50°, 70° and 90°. When the plate was twisted at 70°, it maintained contact with the greater tuberosity proximally and the anterior cortical diaphyseal region. Eight patients completed the follow-up. Radiographic consolidation and good functional outcomes were achieved in all patients. CONCLUSIONS Spiral modelling at 70° allows anatomical accommodation at the greater tuberosity proximally and in the diaphyseal region.
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Affiliation(s)
- Caio Zamboni
- Trauma Surgery Group of Santa Casa de São Paulo, Brazil; Orthopaedics and Traumatology Department of Irmandade da Santa Casa de Misericóridia de São Paulo, Brazil.
| | - Bruno L Carmo
- Department of Orthopedics and Traumatology, Santa Casa de São Paulo, Brazil; Orthopaedics and Traumatology Department of Irmandade da Santa Casa de Misericóridia de São Paulo, Brazil
| | - Leonardo V M Moraes
- Department of Orthopedics and Traumatology, Santa Casa de São Paulo, Brazil; Orthopaedics and Traumatology Department of Irmandade da Santa Casa de Misericóridia de São Paulo, Brazil
| | - José O S Hungria
- Trauma Surgery Group of Santa Casa de São Paulo, Brazil; Orthopaedics and Traumatology Department of Irmandade da Santa Casa de Misericóridia de São Paulo, Brazil
| | - Marcelo T Mercadante
- Trauma Surgery Group of Santa Casa de São Paulo, Brazil; Orthopaedics and Traumatology Department of Irmandade da Santa Casa de Misericóridia de São Paulo, Brazil
| | - Patricia M M B Fucs
- Neuromuscular Diseases Group of Santa Casa de São Paulo, Brazil; Orthopaedics and Traumatology Department of Irmandade da Santa Casa de Misericóridia de São Paulo, Brazil
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Wang B, He D, Wang M, Qian Y, Lu Y, Shi X, Liu Y, Zhan X, Di D, Zhu K, Zhang X. Analysis of sternal healing after median sternotomy in low risk patients at midterm follow-up: retrospective cohort study from two centres. J Cardiothorac Surg 2019; 14:193. [PMID: 31711516 PMCID: PMC6849321 DOI: 10.1186/s13019-019-1000-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/20/2019] [Indexed: 11/26/2022] Open
Abstract
Background For low risk patients undergoing median sternotomies, no midterm follow-up studies involving sternal healing have been conducted. In this study we evaluated sternal healing in low risk patients by chest CT scan and the risk factors associated with poor healing were analyzed. Methods Patients who underwent sternal median incision heart surgery from September 2014 to March 2015 were recruited. The clinical information of these patients during hospitalization was collected, and the CT scan data were submitted to the two chief physicians of the Radiology Department for radiographical sternal healing score determination. Based on the method of wound closure, the patients were divided into sternum plate (Plates) and wire groups (Wires). Results Forty-four patients were recruited. The mean CT examination time was 17.27 ± 2.30 months postoperatively. Twenty-nine (65.9%) patients met the criteria for radiographic sternal healing. Three segments, including the aortopulmonary window, the main pulmonary artery, and the aortic root, had healed less in comparison to the manubrium segment. Compared to patients in whom 6–7 metal wires were used for sternal closure, healing of the lower sternum was worse in patients in whom five wires were used, but the difference in healing was not statistically significant. Univariate analysis of sternal healing showed that patient age was a risk factor for sternal non-healing. When the patient age was > 45 years, the predicted risk of radiographic sternal non-union was 1.833 (95% CI: 1.343–2.503). Conclusions At the mid-term follow-up, 65.9% of patients undergoing median sternotomies demonstrated radiographic sternal healing. Age, but not closure device, was a risk factor for sternal non-healing in low risk patients. Use of more wires had a positive impact on sternal healing. Trial registration researchregistry4918, registered 28 May 2019, retrospectively registered.
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Affiliation(s)
- Bin Wang
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Soochow University, Juqian Street, Changzhou, 185, China
| | - Dapu He
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanhua University, Hengyang, China
| | - Min Wang
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Soochow University, Juqian Street, Changzhou, 185, China
| | - Yongxiang Qian
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Soochow University, Juqian Street, Changzhou, 185, China
| | - Youran Lu
- Department of Radiology, the Third Affiliated Hospital of Soochow University, Juqian Street, Changzhou, 185, China
| | - Xinping Shi
- Department of Radiology, the Third Affiliated Hospital of Soochow University, Juqian Street, Changzhou, 185, China
| | - Yang Liu
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Soochow University, Juqian Street, Changzhou, 185, China
| | - Xianghong Zhan
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Soochow University, Juqian Street, Changzhou, 185, China
| | - Dongmei Di
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Soochow University, Juqian Street, Changzhou, 185, China
| | - Kai Zhu
- Department of Cardiac Surgery, Zhongshan Hospital of Fudan University, Fenglin Street, Shanghai, 180, China.
| | - Xiaoying Zhang
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Soochow University, Juqian Street, Changzhou, 185, China.
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Kim YM, Lee JH. Clinical courses and degradation patterns of absorbable plates in facial bone fracture patients. Arch Craniofac Surg 2019; 20:297-303. [PMID: 31658793 PMCID: PMC6822079 DOI: 10.7181/acfs.2019.00409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background Absorbable plates are widely used in open reduction and internal fixation surgeries for facial bone fractures. Absorbable plates are made of polyglycolic acid (PGA), polylactic acid (PLA), polydioxane (PDS), or various combinations of these polymers. The degradation patterns of absorbable plates made from different polymers and clinical courses of patients treated with such plates have not been fully identified. This study aimed to confirm the clinical courses of facial bone fracture patients using absorbable plates and compare the degradation patterns of the plates. Methods A retrospective chart review was conducted for 47 cases in 46 patients who underwent open reduction and internal fixation surgery using absorbable plates to repair facial bone fractures. All surgeries used either PLA/PGA composite-based or poly-L-lactic acid (PLLA)/hydroxyapatite (HA) composite-based absorbable plates and screws. Clinical courses were confirmed and comparisons were conducted based on direct observation. Results There were no naturally occurring foreign body reactions. Post-traumatic inflammatory responses occurred in eight patients (nine cases), in which six recovered naturally with conservative treatment. The absorbable plates were removed from two patients. PLA/PGA composite-based absorbable plates degraded into fragments with non-uniform, sharp surfaces whereas PLLA/HA composite-based absorbable plates degraded into a soft powder. Conclusion PLA/PGA composite-based and PLLA/HA composite-based absorbable plates showed no naturally occurring foreign body reactions and showed different degradation patterns. The absorbable plate used for facial bone fracture surgery needs to be selected in consideration of its degradation patterns.
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Affiliation(s)
- Young Min Kim
- Department of Plastic and Reconstructive Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jong Hun Lee
- Department of Plastic and Reconstructive Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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Tran BNN, Chen AD, Granoff MD, Johnson AR, Kamali P, Singhal D, Lee BT, Fukudome EY. Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database. Arch Plast Surg 2019; 46:336-43. [PMID: 31336422 DOI: 10.5999/aps.2018.01102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database. Methods Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications. Results There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P<0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P<0.001). Conclusions Sternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation >48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF’s purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.
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Abstract
Objective: To assess and compare radiographic, tomographic and functional pre and postoperative parameters of patients submitted to treatment of nonunion of the scaphoid waist with locked plate for scaphoid. Methods: This is a case series of scaphoid waist nonunion, operated from March 2017 to March 2018 at the Institute of Orthopedics and Traumatology of HCFMUSP, using the technique of Fisk-Fernandez and osteosynthesis with locked plate for scaphoid APTUS®Hand from Medartis. The patients were submitted to radiographs, computed tomography and functional evaluation by the occupational therapy team in the pre and postoperative periods. Results: There was consolidation of the scaphoid waist nonunion in all cases, improvement in the parameters of carpal alignment in the imaging examinations, but functionally we observed reduction of the range of motion and grip strength in relation to the contralateral limb. Conclusions: The treatment of the scaphoid waist nonunion with locked plate was effective, with a high index of consolidation and improvement of the carpal alignment in the imaging tests, although with a reduction in the range of motion and grip strength in relation to the contralateral limb when evaluated with 12 weeks postoperatively. Level of Evidence IV, Case series.
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Louie PK, Sexton AC, Bohl DD, Tabaraee E, Presciutti SM, Mayo BC, Paul JC, Saifi C, An HS. Rigid-Plating and Cortico-Cancellous Allograft Are Effective for 3-Level Anterior Cervical Discectomy and Fusion: Radiographic and Clinical Outcomes. Neurospine 2019; 17:146-155. [PMID: 31154693 PMCID: PMC7136101 DOI: 10.14245/ns.1836052.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 01/06/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the risk factors associated with radiographic changes and clinical outcomes following 3-level anterior cervical discectomy and fusion (ACDF) using rigidplate constructs and cortico-cancellous allograft. ACDF has demonstrated efficacy for treatment of multilevel degenerative cervical conditions, but current data exists in small heterogeneous forms. METHODS A retrospective review included 98 patients with primary 3-level ACDF surgery at one institution from 2008 to 2013 with minimum 1-year follow-up. Cervical sagittal vertical axis (SVA), segmental height, fusion, and lordosis radiographs were measured preoperatively and at 2 postoperative periods. RESULTS Rates of asymptomatic pseudarthroses and total reoperations were 18% and 4%, respectively. Results demonstrated immediate improvements in cervical lordosis (5.5°, p < 0.01) and segmental height (5.0-mm increase, p < 0.01) with little changes in the cervical SVA (3.2-mm increase, p < 0.01). The segmental height decreased from immediate postoperative period to final follow-up (1.7-mm decrease, p < 0.01). Older age was protective against radiolucent lines (p < 0.05). Patient-reported outcomes significantly improved following surgery (p < 0.01). Current smoking status and diagnosis of diabetes mellitus had no impact on radiographic or clinical outcomes. Risk factors were not identified for the 5 reoperations (4%). CONCLUSION Three-level ACDF with rigid-plating and cortico-cancellous allograft is an effective procedure for degenerative diseases of the cervical spine without the application of additional adjuncts or combined anteriorposterior cervical surgeries. Significant improvements in cervical lordosis, segmental height, and segmental alignment can be achieved with little change in cervical SVA and a low rate of reoperations over short-term follow-up. Similarly, patient-reported outcomes show significant improvements.
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Affiliation(s)
- Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew C Sexton
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Danel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Benjamin C Mayo
- Department of Orthopaedics, University of Illinios at Chicago, Chicago, IL, USA
| | - Justin C Paul
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Comron Saifi
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Geßmann J, Königshausen M, Schildhauer TA, Seybold D. [Periprosthetic humeral fractures: from osteosynthesis to prosthetic replacement]. Oper Orthop Traumatol 2019; 31:84-97. [PMID: 30820585 DOI: 10.1007/s00064-019-0591-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/02/2018] [Accepted: 11/30/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Stabilization of the humeral shaft and the restoration of shoulder function dependent on the osseous integrity of the prosthetic stem component. INDICATIONS In cases of a stable prosthesis stem, an isolated plate osteosynthesis is possible. Prosthesis stem replacement is indicated in cases of a loose stem. With sufficient bone stock of the proximal humeral segment, a change to a shorter humeral shaft component with subsequent plate fixation of the fracture is possible. If the bone stock is poor, conversion to a long revision stem is necessary. CONTRAINDICATIONS Inoperability of the patient due to serious comorbidities. Advanced age and low demands on shoulder function are relative contraindications for complex prosthesis replacements. SURGICAL TECHNIQUE Plate osteosynthesis can be done through an anterior or posterior approach, stem replacement only from anterior deltopectoral approach. When changing humeral shaft components, the loose shaft and all cement residues are removed, the fracture is reduced and, if possible, a shorter shaft is implanted with subsequent plate osteosynthesis of the fracture. When changing to a long revision stem, additional osteosynthesis with cerclages wires is usually sufficient. In case of poor bone stock, an additive autologous or allogenic bone grafting can be performed. An instable anatomical prosthesis with poor shoulder function may require conversion to an inverse prosthesis. POSTOPERATIVE MANAGEMENT In cases of an isolated plate osteosynthesis with an otherwise stable prosthesis, immediate active rehabilitation of the upper limb is advocated. When a prosthesis replacement and conversion to an inverse prosthesis is performed the shoulder is immobilized in 30° abduction for 6 weeks. Passive and after 3 weeks active-assistive shoulder movement up to 90° abduction and flexion is allowed. RESULTS In 40 patients with a periprosthetic humeral fracture, an isolated plate osteosynthesis was performed in 30 cases and a prosthesis replacement in 10 cases. Complications included 3 infections and 3 temporary radial nerve palsies. Revisions due to pseudarthrosis were necessary in 2 cases.
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Affiliation(s)
- J Geßmann
- Chirurgische Klinik und Poliklinik, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, 44789, Bochum, Deutschland.
| | - M Königshausen
- Chirurgische Klinik und Poliklinik, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, 44789, Bochum, Deutschland
| | - T A Schildhauer
- Chirurgische Klinik und Poliklinik, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, 44789, Bochum, Deutschland
| | - D Seybold
- Chirurgische Klinik und Poliklinik, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, 44789, Bochum, Deutschland
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Nayak C, Acharyya B, Jain M, Kamboj K. Valgus osteotomy in delayed presentation of femoral neck fractures using fixed angle simple dynamic hip screw and plate. Chin J Traumatol 2019; 22:29-33. [PMID: 30824174 PMCID: PMC6529366 DOI: 10.1016/j.cjtee.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/15/2018] [Accepted: 01/05/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Reduction and fixation in femoral neck fracture in young patients have a problem of nonunion requiring additional procedure like valgus osteotomy but fixation devices are technically difficult for inexperienced surgeons. We aims to assess the results of valgus osteotomy in femoral neck fracture in our setup. METHODS We report a series of 20 patients of higher Pauwel's angled fracture of femoral neck fracture presenting late wherein for valgus osteotomy was added to reduction fixation secured with a commonly available 135° dynamic hip screw and plate. RESULTS Femoral neck fractures united in 16 patients (80%). Excellent to good results (Harris hip score >80) were seen in 70% patients. Angle of correction of preoperative Pauwels has been changed from 68.3 to 34.3. CONCLUSION 135° dynamic hip screw and plate provides rigid internal fixation after valgus osteotomy and being a more familiar fixation device simplifies the procedure with good results.
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Affiliation(s)
- Chandrakant Nayak
- Department of Orthopedics, Nil Ratan Sircar Medical College & Hospital, Kolkata 700014, India
| | - Biplab Acharyya
- Department of Orthopedics, Nil Ratan Sircar Medical College & Hospital, Kolkata 700014, India
| | - Mantu Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar 751019, India,Corresponding author.
| | - Kulbhushan Kamboj
- Department of Orthopedics, Lady Hardinge Medical College, New Delhi 110001, India
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Yoon B, Kim JY, Lee JS, Jung HS. The Radiologic Comparison of Operative Treatment Using a Hook Plate versus a Distal Clavicle Locking Plate of Distal Clavicle Fracture. Clin Shoulder Elb 2018; 21:227-233. [PMID: 33330181 PMCID: PMC7726406 DOI: 10.5397/cise.2018.21.4.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to compare the radiologic results of patients who underwent surgery with a hook plate and a locking plate in distal clavicle fractures. Methods Sixty patients underwent surgical treatment for Neer type IIa, IIb, III, and V distal clavicle fracture. Twenty-eight patients underwent fracture fixation with a hook plate and 32 with a locking plate. Coracoclavicular distance was measured on standard anteroposterior radiographs before and after the surgery, and union was confirmed by radiograph or computed tomography taken at 6 months postoperatively. Other radiologic complications like osteolysis was also checked. Results Bony union was confirmed in 59 patients out of 60 patients, and 1 patient in the hook plate group showed delayed union. Coracoclavicular distance was decreased more in the hook plate group after surgery (p<0.01). After 6 weeks of the hook plate removal, the coracoclavicular distance was increased a little compared to before metal removal, but there was no difference compared to the contralateral shoulder. Eleven out of 28 patients (39.3%) showed osteolysis on the acromial undersurface in the hook plate group. Conclusions Both the hook plate group and the locking plate group showed satisfactory radiologic results in distal clavicle fractures. Both hook plate and locking plate could be a good treatment option if it is used in proper indication in distal clavicle fracture with acromioclavicular subluxation or dislocation.
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Affiliation(s)
- Byungil Yoon
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Yoon Kim
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae-Sung Lee
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyoung Seok Jung
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Al F, Tosun B, Sinmazcelik T, Ozmen M. BIOMECHANICAL COMPARISON OF MEDIAL VERSUS LATERAL SIDED PLATING IN FEMORAL FRACTURES. Acta Ortop Bras 2018; 26:265-270. [PMID: 30210258 PMCID: PMC6131281 DOI: 10.1590/1413-785220182604191645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: The aim of the present study was to determine whether the side of application of the plate itself affects the mechanical stability of the fixation. The specific question addressed is whether or not a lateral or medial plate application is biomechanically better, for the treatment of distal diaphysis fractures of the femur. Methods: Stability and stiffness of medial sided plating relative to the conventional lateral sided plating in distal diaphysis of the femur were measured by analyzing axial loading forces leading to implant failure. Sixty synthetic femurs were tested in physiological bending, to calculate the yield and ultimate load to displacement following fixation of distal diaphysis fractures of the femur by either medial or lateral sided plating. Axial loading was applied to samples using a uniaxial testing machine. Results: There was more implant deformation in the lateral sided plating group – a difference with statistical significance. Conclusion: Medial sided plating was found to be as stiff as lateral plating. Medial plating may be a reasonable treatment option that can be used safely in selected cases. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment
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Affiliation(s)
- Firat Al
- Golcuk Necati Celik State Hospital, Kocaeli, Turkey
| | | | | | - Mustafa Ozmen
- Mechanical Engineering, Kocaeli University, Kocaeli, Turkey
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Kim TH, Kang SJ, Sun H. Delayed degradation according to the location of fixation with using an absorbable plate. Arch Craniofac Surg 2018; 19:114-119. [PMID: 29921116 PMCID: PMC6057132 DOI: 10.7181/acfs.2018.01795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 12/05/2022] Open
Abstract
Background The ideal absorbable plating system should provide sufficient rigidity and then be absorbed within a timely manner. The Resorb-X has been recently developed as a plating system with a mixture ratio of 50:50 poly(D, L-lactide). Methods We present seven of 121 patients who experienced delayed degradation with this absorbable plate. One hundred twenty-one patients with facial bone fracture underwent surgical treatment from March 2011 to March 2015, and rigid fixation was achieved with the Resorb-X. Results Of 121 patients, seven (5.8%) developed complications at the surgical sites. Six of 102 cases underwent fixation of the infraorbital rim and one of 73 underwent fixation of the frontozygomatic buttress; the other sites of fixation did not develop delayed degradation. Foreign body granuloma developed at the earliest by postoperative 20 months and at the latest by postoperative 28 months (average, 23.5 months).Conclusion: We observed that the use of absorbable plates in incision sites or areas with thin skin can increase the possibility of delayed degradation. When performing surgery in these areas, the normal skin above the fixed location should be covered sufficiently.
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Affiliation(s)
- Tae Ho Kim
- Department of Plastic and Reconstructive Surgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
| | - Seok Joo Kang
- Department of Plastic and Reconstructive Surgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
| | - Hook Sun
- Department of Plastic and Reconstructive Surgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
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Ibrahim S, Meleppuram JJ. Retrospective study of superior anterior plate as a treatment for unstable (Neer type 2) distal clavicle fractures. Rev Bras Ortop 2018; 53:306-13. [PMID: 29892581 DOI: 10.1016/j.rboe.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/06/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To analyze the sequelae of Neer type 2 distal end clavicle fractures treated with superior anterior locking plate. Methods From June 2012 to February 2015 a study was conducted with 14 male patients; 12 with unilateral and two with bilateral distal clavicle fractures treated with superior anterior plate. They were evaluated at intervals, with mean follow up of 16 months (14–18 months). All patients were evaluated clinically by both the Oxford Shoulder Score and the QuickDASH score. Results Union was seen in all fractures within 7–9 weeks (mean time: 8.2 weeks). All patients had good shoulder range-of-motion. The average Oxford Shoulder Score and QuickDASH score were 45.6 and 7.1, respectively. All patients returned to work within 3–4 months of the postoperative period. Conclusion Displaced distal clavicle fractures treated with superior anterior plates accomplished superlative results in terms of bony union, with rarely any complications.
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Cavalieri-Pereira L, Spagnol G, Sverzut CE, de Moraes M, Trivellato AE. Resistance of four fixation techniques used to treat subcondylar fractures. Oral Maxillofac Surg 2018; 22:91-96. [PMID: 29344821 DOI: 10.1007/s10006-018-0675-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/09/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study aimed to evaluate the resistance of four fixation techniques used to treat subcondylar fractures. The following techniques were evaluated: fixation with one 4-hole single straight plate; fixation with one 2-mm 4-hole system plate and one 1.5-mm 3-hole system plate; fixation with two 2-mm plates with a 3-hole anterior plate; and fixation with two 2-mm plates with four holes each. STUDY DESIGN Each fixation technique was subjected to a resistance test. The load values were measured when displacement of 1, 2, and 5 mm was reached. Load values were compared for statistically significant differences using analysis of variance (ANOVA; p < 0.5) and Tukey's test. RESULTS Statistically significant differences were observed, when the load was applied to the first molar on the side of the fracture. The group treated with a 4-hole, 2-mm, one plate system showed resistance to lower load values than the groups treated with two plates in any combination. CONCLUSIONS When the fracture was fixed using two plates, regardless of the kind of plates used, no statistically significant difference between the groups was observed. However, two plate systems showed better resistance than one plate systems.
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Affiliation(s)
- Lucas Cavalieri-Pereira
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Guilherme Spagnol
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café, s/n-Campus USP, 14090-904, Ribeirão Preto, São Paulo, Brazil
| | - Cássio Edvard Sverzut
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café, s/n-Campus USP, 14090-904, Ribeirão Preto, São Paulo, Brazil
| | - Márcio de Moraes
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Alexandre Elias Trivellato
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café, s/n-Campus USP, 14090-904, Ribeirão Preto, São Paulo, Brazil.
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Souza NASMD, Belangero PS, Figueiredo EAD, Pochini ADC, Andreoli CV, Ejnisman B. Displaced midshaft clavicle fracture in athletes - should we operate? Rev Bras Ortop 2018; 53:171-175. [PMID: 29911083 PMCID: PMC6001394 DOI: 10.1016/j.rboe.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/06/2017] [Indexed: 11/26/2022] Open
Abstract
Objective To assess the results of the treatment of fractures of the middle third of the clavicle with a pre-contoured plate in athletes. Methods The authors performed 26 osteosyntheseis in 25 patients with fractures of the middle third of the clavicle. The fractures were classified according to Robinson as 16 type B1 and ten type B2. The mean age was 37 years, ranging from 15 to 63 years, 20 patients were male and five were female, and all play sports in an amateur or professional manner. All patients were operated on in the acute phase of fracture within five days after trauma. Patients were treated with open reduction and internal fixation using pre-contoured plates. The technique and the implant used were the same, but the time of immobilization and rehabilitation protocol were individualized for each patient according to physical activity. Mean follow-up was 16.8 months (6–48 months), with return to sport activities in 45.6 days. Results Functional assessment was performed using the University of California at Los Angeles (UCLA) score. The results averaged 34.07 of 35 points. No cases presented nonunion. Only one complication was observed (thrombosis of the subclavian vein with good response to conservative treatment); two patients required implant removal. Conclusion The surgical treatment of clavicle fractures in athletes presented satisfactory functional outcome and early return sport.
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Affiliation(s)
| | - Paulo Santoro Belangero
- Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Antônio de Figueiredo
- Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alberto de Casto Pochini
- Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Carlos Vicente Andreoli
- Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Katthagen JC, Lutz O, Voigt C, Lill H, Ellwein A. Cement augmentation of humeral head screws reduces early implant-related complications after locked plating of proximal humeral fractures. ACTA ACUST UNITED AC 2018; 13:123-129. [PMID: 29887918 PMCID: PMC5976700 DOI: 10.1007/s11678-018-0440-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/05/2018] [Indexed: 11/09/2022]
Abstract
Background Cement augmentation (CA) of humeral head screws in locked plating of proximal humeral fractures (PHF) was found to be biomechanically beneficial. However, clinical outcomes of this treatment have not been well evaluated to date. Objectives To assess outcomes of locked plating of PHF with additional CA and to compare them with outcomes of conventional locked plating without CA. Methods 24 patients (mean age, 74.2 ± 10.1 years; 22 female) with displaced PHF were prospectively enrolled and treated with locked plating and additional CA. The Constant score (CS), the Simple Shoulder Test (SST), and the Simple Shoulder Value (SSV) were assessed 3 and 12 months postoperatively. Fracture healing and potential complications were evaluated on postoperative radiographs. The CS and complications were compared with the outcomes of a matched group of 24 patients (mean age, 73.9 ± 9.4 years; 22 female) with locked plating of displaced PHF without CA. Results At the 3‑month follow-up, the mean CS was 59.9 ± 15.6 points, the mean SST was 7.5 ± 2.7 points, and the mean SSV was 63.9 ± 21.7%. All scores significantly improved by the 12-month follow-up (p < 0.05; CS, 72.9 ± 17.7; SST, 9.2 ± 3.2; SSV, 77.2 ± 17.3%). There were two cases (8%) of biological complications (n = 1 varus malunion and n = 1 humeral head necrosis). Compared with locked plating without CA, no significant differences were observed between the CS at the 3‑ (57.8 ± 13.4 points; p = 0.62) and 12-month (73.0 ± 12.8 points; p = 0.99) follow-up. However, patients without CA had a significantly increased risk of early loss of reduction and articular screw perforation (p = 0.037). Conclusion Locked plating of proximal humeral fractures with trauma cement augmentation of humeral head screws could be translated from the ex-vivo lab setting into the clinical situation without additional complications. Locked plating of displaced PHF with additional cement augmentation showed similar clinical outcomes but reduced the rate of early implant-related complications compared to locked plating without additional CA.
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Affiliation(s)
- J Christoph Katthagen
- Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hannover, Germany.,2Department of Trauma, Hand and Reconstructive Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Str. 1, 48149 Münster, Germany
| | - O Lutz
- Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hannover, Germany
| | - C Voigt
- Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hannover, Germany
| | - H Lill
- Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hannover, Germany
| | - A Ellwein
- Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hannover, Germany
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Giordano V, Santos ALGD, Belangero WD, Pires RES, Labronici PJ, Koch HA. Mind the gap between the fracture line and the length of the working area: a 2-D finite element analysis using an extramedullary fixation model. Rev Bras Ortop 2018; 53:88-93. [PMID: 29367912 PMCID: PMC5771796 DOI: 10.1016/j.rboe.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/09/2017] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the ideal working area for a simple transverse fracture line treated with a bridge plate. Methods A 2-D finite element analysis of a hypothetical femur was performed for the quantitative evaluation of a large-fragment titanium alloy locking plate based on the precept of relative stability in a case of a simple transverse diaphyseal fracture. Two simulations (one case of strain and another case of stress distribution) were analyzed in three unique situations according to the von Mises stress theory. Load distributions were observed when the bone was subjected to a single vertical load of 1000 N. Results The longer the length of the implant flexion, which coincided with the working area of the plate, the greater the flexion of the implant. The highest concentrations of stress on the plate occurred in the region around the screws closest to the bone gap. The closer the screws to the fracture site, the greater the demands on the plate. Conclusion When using a large-fragment titanium alloy locking plate to stabilize a simple transverse fracture based on the precept of relative stability (bridge plate), there must be considerable distance between the proximal and distal screws closest to the fracture line. The farther away this fixation is, the lower the stress on the plate and the greater the dissipation of force in the form of deflection.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | | | - William Dias Belangero
- Disciplina de Ortopedia e Traumatologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - Pedro José Labronici
- Departamento de Ortopedia e Traumatologia, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Hilton Augusto Koch
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Abstract
Proximal humerus fractures constitute a significant percentage of fragility fractures. The growing use of locking plate has helped treat this problem, but at the same time has brought about complications. Past systematic reviews have documented these complications, however a large number of recent studies have been published since, reporting their own complication rates with different techniques. This study reviews the current complications associated with locking plate of proximal humerus fractures as well as methods to reduce them. A systematic review, following the PRISMA guidelines, was conducted in November 2013 and repeated in March 2015, using PubMed, Scopus, and Cochrane databases, to evaluate locking plate fixation (and complications) of traumatic proximal humerus fractures. Inclusion criteria included adults (>18 years), minimum of 12-month postoperative followup, articles within the last 5 years, and studies with >10 participants. Exclusion criteria included pathologic fractures, cadaveric studies, and nonhuman subjects. Eligible studies were graded using a quality scoring system. Articles with a minimum of 7/10 score were included and assessed regarding their level of evidence per the Journal of Bone and Joint Surgery and Centre for Evidence-Based Medicine guidelines. The initial query identified 51,206 articles from multiple databases. These records were thoroughly screened and resulted in 57 articles, consisting of seven Level 1, three Level 2, 10 Level 3, and 37 Level 4 studies, totaling 3422 proximal humerus fractures treated with locking plates. Intraarticular screw penetration was the most reported complication (9.5%), followed by varus collapse (6.8%), subacromial impingement (5.0%), avascular necrosis (4.6%), adhesive capsulitis (4.0%), nonunion (1.5%), and deep infection (1.4%). Reoperation occurred at a rate of 13.8%. Collapse at the fracture site contributed to a majority of the implant-related complications, which in turn were the main reasons for reoperation. The authors of these studies discussed different techniques that could be used to address these issues. Expanding use of locking plate in the proximal humerus fractures leads to improvements and advancements in surgical technique. Further research is necessary to outline indications to decrease complications, further.
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Affiliation(s)
- Venkat Kavuri
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA,Address for correspondence: Dr. Venkat Kavuri, Department of Orthopaedic Surgery, Drexel University College of Medicine, Hahnemann University Hospital, 245 N. 15th St. M.S. 420, Philadelphia, PA 19103, USA. E-mail:
| | - Blake Bowden
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA
| | - Neil Kumar
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA
| | - Doug Cerynik
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA
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Ibrahim S, Meleppuram JJ. A retrospective analysis of surgically-treated complex proximal femur fractures with proximal femoral locking compression plate. Rev Bras Ortop 2017; 52:644-650. [PMID: 29234646 PMCID: PMC5720848 DOI: 10.1016/j.rboe.2016.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022] Open
Abstract
Objective Analyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these complex fractures. Methods This study retrospectively analyzed 21 proximal femoral fractures treated with PF-LCP from June 2013 to February 2015. There were 15 females (71%) and six males (29%) with an average age of 61.4 years (range: 34–80 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by the Boyd and Griffin classification and Seinshemier's classification, respectively. Among them, 16 cases (76%) were of intertrochanteric and five cases (24%) were of subtrochanteric fracture pattern. The functional outcome was assessed by Harris Hip Score and the Parker Palmer mobility score one year post-surgery. Results Among 21 patients, 19 patients obtained fracture union without further intervention; two patients required additional bone grafting. No cases of the hip screw cutting the femoral head were noted. There was no post-operative mortality in this study. The average Harris Hip Score was 84.5 (range: 83–94). The assessment by Parker and Palmar mobility score was 7.5 (range: 4–9). Conclusion The PF-LCP is a good, stable alternative in the treatment of peritrochanteric femoral fractures. It provides good-to-excellent bone healing with reduced complications.
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Affiliation(s)
- Syed Ibrahim
- Vinayaka Missions Medical College and Hospital, Department of Orthopaedics, Karaikal, Pondy India
| | - Jimmy Joseph Meleppuram
- Vinayaka Missions Medical College and Hospital, Department of Orthopaedics, Karaikal, Pondy India
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Labronici PJ, Santos Filho FCD, Reis TB, Pires RES, Junior AFM, Kojima KE. Are diaphyseal clavicular fractures still treated traditionally in a non-surgical way? Rev Bras Ortop 2017; 52:410-416. [PMID: 28884098 PMCID: PMC5582807 DOI: 10.1016/j.rboe.2017.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/24/2016] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the decision of orthopedics surgeons regarding which cases they would indicate surgery or non-surgical treatment. Methods 20 images of radiographs with fracture in the middle third of the collar bone (AO/OTA 15-B) in anteroposterior view were analyzed, and divided into four groups: group 1 – fracture type AO/OTA 15-B1 without displacement; group 2 – fracture type AO/OTA 15-B1 with displacement; group 3 – fracture type AO/OTA 15-B2; group 4 – fracture type AO/OTA 15-B3. The evaluator was requested to indicate the choice of treatment, surgical or non-surgical. Results There was no strong correlation between the amount of surgical indications and the working experience or age of the medical evaluator. It was observed that the average of surgical indications in the total sample was 52%. When indications were studied in different areas of Brazil, there was no significant difference among them. No pattern for the Brazilian regions studied was observed in the case analysis. Even within a group (cases of the same complexity), no specific pattern of surgical indication was observed. Conclusion No association between surgical indication and the length of professional experience was found. The Southern and Southeastern regions were those that most recommended surgeries in groups 2, 3, and 4. In no region the same level of surgical indication for cases of the same complexity rate was kept.
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Affiliation(s)
| | | | - Tales Bregalda Reis
- Hospital Santa Teresa, Serviço de Ortopedia e Traumatologia, Petrópolis, RJ, Brazil
| | | | | | - Kodi Edson Kojima
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, Grupo de Trauma Ortopédico, São Paulo, SP, Brazil
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