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Domínguez-Barrios C, Altamirano-Cruz MA, Velarde-Bouche JE, Giordano V. Novel implant design for comminuted posterior wall acetabular fractures. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03951-5. [PMID: 38642123 DOI: 10.1007/s00590-024-03951-5] [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] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND In recent years, the medical community has witnessed a notable increase in high-energy traumatic injuries, leading to a surge in complex fracture patterns that challenge existing treatment methodologies. Among these, the posterior approach to acetabular fractures stands out for offering direct visualization of the retro-acetabular surface, with current fixation methods relying on 3.5 mm low-profile reconstruction plates and various other implants. Despite the effectiveness of these methods, there is a burgeoning demand for a singular, adaptable implant that not only streamlines the surgical process but also optimizes patient outcomes. METHODS In an innovative approach to address this need, three-dimensional (3D) models of the posterior acetabular wall were meticulously crafted using AutoCAD® software. The chosen material for the implant was 316L surgical steel for its durability and strength. The design of the implant featured a low-profile mesh structure, which was instrumental in facilitating osteosynthesis. This design allowed for the placement of screws of varying lengths in multiple directions, ensuring the initial reconstruction of the joint in an anatomical position without hindering the placement of the definitive implant. The primary objective was to secure the fixation and stabilization of the fracture by specifically targeting the smaller bone fragments. A comparative analysis was then conducted between this novel plate and a conventional 316L surgical steel, seven-hole, 3.5 mm reconstruction plate through finite element analysis. RESULTS The comparative analysis unveiled that both plates demonstrated comparable deformation capacities, with no significant differences in load-bearing capabilities observed. This finding suggests that the innovative plate can match the performance of traditional plates used in such surgeries. CONCLUSIONS The finite element analysis revealed that the newly developed anatomical plate for posterior wall acetabular fractures meets the necessary physical and mechanical criteria for permanent implementation in patients with these fractures. This breakthrough represents a promising advancement that could simplify surgical procedures and potentially elevate patient outcomes. LEVEL OF EVIDENCE II This study is classified as a Level II, diagnostic study.
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Affiliation(s)
- Carlos Domínguez-Barrios
- Senior Head Surgeon of Pelvis and Polytrauma Department, UMAE IMSS Hospital de Traumatología y Ortopedia Lomas Verdes, Naucalpan Estado de México, México
| | - Marco Antonio Altamirano-Cruz
- Department of Pelvis and Polytrauma Surgery, UMAE Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Av Belisario Dominguez 1000/10th Floor, CP44329, Guadalajara Jal, México.
| | | | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
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Tu TY, Huang ST, Chou YJ. Comparison of plate versus screw internal fixation in the treatment of posterior malleolar fracture: A systematic review and meta-analysis. Foot Ankle Surg 2024; 30:191-218. [PMID: 38278653 DOI: 10.1016/j.fas.2023.12.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Treatment of posterior malleolar fracture with plate or screw fixation is still controversial. Plate fixation is considered to have better stability but more soft tissue damage; screw fixation is less invasive and may yields lesser blood loss and surgery time. We conducted this meta-analysis to explore intraoperative and postoperative efficacy between plate and screw fixation in posterior malleolar fractured patients. METHODS PubMed, Cochrane, Embase, Scopus and Chinese National Knowledge Infrastructure databases were searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Random-effects model and 95% confidence intervals was used. The outcomes of interest were surgery time, blood loss, length of hospital stay, American Orthopedic Foot and Ankle Score (AOFAS), bone healing time, full weight bearing time, off bed ambulation time, Visual Analogue Scale (VAS), complication rate, and rate of use of syndesmosis screw etc. RESULTS: One randomized clinical trial and fifty-two retrospective cohort studies with a total of 3757 patients (1956 in screw group and 1801 in plate group) were included in the systematic review. Compared to screw group, plate group yielded significantly longer surgery time, more intraoperative blood loss, but shorter length of hospital stay, better AOFAS, better Baird Jackson score, better AOFAS and Baird Jackson excellent-good rate, shorter bone healing time, shorter time enabling full weight bearing, shorter time enabling off bed ambulation, lesser postoperative pain, lesser complication rate, lesser loosening rate, lesser malunion rate, and lesser postoperative osteoarthritis. CONCLUSIONS Plate fixation is a favorable alternative to screw fixation in posterior malleolar fractured patients. Although plate fixation was at risk of longer surgery time and more blood loss, it provided better postoperative functional outcome, shorter healing, weight bearing and off bed ambulation time and lesser pain compared to screw fixation.
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Affiliation(s)
- Ting-Yu Tu
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shan-Tso Huang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yi-Jiun Chou
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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Elias E, Daoud A, Smith J, Elias C, Nasser Z. Assessing Surgical Outcomes for Cage Plate System versus Stand-Alone Cage in Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 185:150-164. [PMID: 38382756 DOI: 10.1016/j.wneu.2024.02.079] [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: 01/07/2024] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure for addressing cervical spine conditions. It involves the utilization of either cage plate system (CPS) or stand-alone cage (SC). The objective of our study is to compare perioperative complications, patient-reported clinical outcomes measures, and radiographic outcomes of SC versus CPS in ACDF. METHODS We carried out a literature search in PubMed, Embase, Cochrane library, Web of science, Medline, and Google Scholar. All studies comparing the outcomes between CPS versus SC in ACDF were included. RESULTS Forty-one studies, 33 observational and 8 randomized clinical trials met the inclusion criteria. We found that both devices demonstrated comparable effectiveness in monosegmental ACDF with respect to Japanese Orthopedic Association Score, Neck Disability Index score, visual analog score, and fusion rates. CPS demonstrated superior performance in maintaining disc height, cervical lordosis, and exhibited lower incidence rates of cage subsidence. SC showed significant advantages over CPS in terms of shorter surgical duration, less intraoperative bleeding, shorter duration of hospitalization, as well as lower incidence rates of early postoperative dysphagia and adjacent segment disease. CONCLUSIONS Most of the included studies had monosegmented fusion, and there wasn't enough data to set recommendations for the multisegmented fusions. Larger studies with longer follow-up are necessary to draw more definitive conclusions to provide evidence for clinicians to make clinical decisions.
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Affiliation(s)
- Elias Elias
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA.
| | - Ali Daoud
- Department of Chemistry, Illinois College, Jacksonville, Illinois, USA
| | - Justin Smith
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Charbel Elias
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zeina Nasser
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
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Trost M, Yarkin S, Knieps M, Frey S, Neiss WF, Eysel P, Gick S, Dargel J. Biomechanical comparison of different fixation methods in tibiotalocalcaneal arthrodesis: a cadaver study. J Orthop Surg Res 2023; 18:971. [PMID: 38105223 PMCID: PMC10726638 DOI: 10.1186/s13018-023-04444-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Various fixation methods are available for tibiotalocalcaneal arthrodesis: nail, plate, or screws. An intramedullary bone stabilization system within a balloon catheter has not previously been used in tibiotalocalcaneal arthrodesis. The aim of this study was to compare the stability of these techniques. METHODS Twenty-four lower legs from fresh-frozen human cadavers were used. Tibiotalocalcaneal arthrodesis was performed with a retrograde nail, a lateral locking plate, three cancellous screws, or an intramedullary bone stabilization system. The ankles were loaded cyclically in plantarflexion and dorsiflexion. RESULTS For cyclic loading at 125 N, the mean range of motion was 1.7 mm for nail, 2.2 mm for plate, 6.0 mm for screws, and 9.0 mm for the bone stabilization system (P < .01). For cyclic loading at 250 N, the mean range of motion was 4.4 mm for nail, 7.5 mm for plate, 12.1 mm for screws, and 14.6 mm for the bone stabilization system (P < .01). The mean cycle of failure was 4191 for nail, 3553 for plate, 3725 for screws, and 2132 for the bone stabilization system (P = .10). CONCLUSIONS The stability of the tibiotalocalcaneal arthrodesis differs depending on the fixation method, with nail or plate showing the greatest stability and the bone stabilization system the least. When three screws are used for tibiotalocalcaneal arthrodesis, the stability is intermediate. As the biomechanical stability of the bone stabilization system is low, it cannot be recommended for tibiotalocalcaneal arthrodesis.
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Affiliation(s)
- Matthias Trost
- Department of Orthopaedics and Traumatology, Saint Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
| | - Suzan Yarkin
- Department of Orthopaedics and Traumatology, Protestant Hospital Cologne Weyertal, Cologne, Germany
| | - Matthias Knieps
- Department of Orthopaedics and Traumatology, Cologne University Hospital, Cologne, Germany
| | - Sönke Frey
- Department of Orthopaedics and Traumatology, Florence Nightingale Hospital, Düsseldorf, Germany
| | | | - Peer Eysel
- Department of Orthopaedics and Traumatology, Cologne University Hospital, Cologne, Germany
- Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - Sascha Gick
- Department of Traumatology, Orthopaedics and Hand Surgery, Saint Vinzenz Hospital, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedics, Saint Josefs Hospital, Wiesbaden, Germany
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Fu G, Zhang Y, Ke S, Zhu D, Wu J, Su D, Ge H, Chen J, MB YZ, Lin F, Chen J, Li R. Treatment of Distal Third Humeral Shaft Fracture with Intramedullary Nail Combined with Anterior Minimally Invasive Plate Osteosynthesis. Orthop Surg 2023; 15:3101-3107. [PMID: 37817420 PMCID: PMC10693993 DOI: 10.1111/os.13893] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE The treatment of distal third humeral shaft fracture is difficult. Studies have shown that anterior minimally invasive plate has lower probability of complication and higher healing rate. However there is no applicable anatomical plate at present. This study is to investigate the clinical effect of intramedullary nail combined with anterior minimally invasive plate in the treatment of distal humeral shaft fractures. METHODS The data of 83 patients with lower humerus shaft fracture treated from September 2015 to January 2020 were analyzed. According to different treatment methods, they were divided into two groups: 40 patients were treated with intramedullary nailing combined with minimally invasive anterior plate fixation (group A), and 43 patients were treated with double plate fixation through posterior approach (group B). General preoperative data, operative time, intraoperative blood loss, total incision length, fracture healing time, shoulder and elbow visual analogue scale (VAS) score, Constant-Murley shoulder function score, Mayo elbow function score, and complications were recorded and compared between the two groups. Two independent sample t-tests was used for follow-up, age, BMI, operation time, intraoperative bleeding, total incision length, fracture healing time, Constant-Murley score and Mayo score, and rank sum test was used for VAS score of shoulder and elbow. RESULTS There was no significant difference in preoperative general data between the two groups (p > 0.05), indicating comparability. There were no significant differences in operation time, total incision length, fracture healing time, Constant-Murley shoulder function score at the last follow-up, Mayo elbow function score, and shoulder and elbow VAS pain score between 2 groups (p > 0.05). The amount of intraoperative blood loss in observation group was 76.98 ± 16.46, which was significantly less than that in control group, and the difference was statistically significant (p < 0.01). There were no radial nerve injury, musculocutaneous nerve injury, incision infection and fracture nonunion in the observation group. In the control group, four cases of iatrogenic radial nerve injury, three cases of incision infection and three cases of fracture nonunion were found. The complication rate was 23.3% (10/43). There was statistical difference in the incidence of complications between the two groups (p < 0.01). CONCLUSION A humeral intramedullary nail combined with an anterior minimally invasive plate in the treatment of distal humeral shaft fracture has the advantages of less soft tissue damage, less blood transfusion, high fracture healing rate and low risk of iatrogenic radial nerve injury, which is an effective method for clinical treatment of this type of fracture.
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Affiliation(s)
- Gang Fu
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Yichong Zhang
- Department of Trauma & OrthopedicsPeking University People's HospitalBeijingChina
| | - Shuyujiong Ke
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Dengke Zhu
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Jingxiang Wu
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Dengbang Su
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Hui Ge
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Jianlong Chen
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Yan Zhang MB
- Department of Trauma & OrthopedicsPeking University People's HospitalBeijingChina
| | - Fengfei Lin
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Jianhai Chen
- Department of Trauma & OrthopedicsPeking University People's HospitalBeijingChina
| | - Renbin Li
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
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Abstract
Scaphoid fixation, whether for acute injuries or nonunion, is made challenging by the small and intra-articular nature of the most commonly fractured carpal bone. The purpose of this article is to review the techniques to simplify scaphoid fixation and to optimize healing and early return to activity.
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Affiliation(s)
- Jill Putnam
- The Hand and Upper Extremity Center, The Ohio State University, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
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Mishra A, Rawat SK, Yaseen M, Pant M. Development of machine learning algorithm for assessment of heat transfer of ternary hybrid nanofluid flow towards three different geometries: Case of artificial neural network. Heliyon 2023; 9:e21453. [PMID: 38027640 PMCID: PMC10660166 DOI: 10.1016/j.heliyon.2023.e21453] [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: 06/23/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
The focus of this paper revolves around the examination of flow of ternary hybrid nanofluid, specifically the Al2O3-Cu-CNT/water mixture, with buoyancy effect, across three distinct geometries: a wedge, a flat plate, and a cone. The study takes into account the presence of quadratic thermal radiation and heat source/sink of non-uniform nature. To develop the model, the Cattaneo-Christov theory is utilized. The equations governing the flow are solved by applying similarity transformations and employing the "bvp4c function in MATLAB" for numerical analysis and solution. Conventional methods for conducting parametric studies often face challenges in producing significant conclusions owing to the inherent complex form of the model and the method involved. To address the aforementioned issue, this paper explores the potential of machine learning methods to foresee the conduct of the flow characterized by multiple interconnected parameters. By utilizing simulated data, an artificial neural network is trained using the Levenberg-Marquardt algorithm to learn and comprehend the underlying patterns. Subsequently, the trained neural network is employed to estimate the Nusselt number on the surfaces of all three geometries. This approach offers a promising alternative to traditional parametric studies, enabling more precise predictions and insights into the behavior of complex systems. The Nusselt number is highest for THNF flow over the cone. The mean squared error (MSE) values for the ANN algorithm, across all analyzed cases, range from 0 to 0.03972. The findings contribute to an improved understanding of the characteristics and dynamics of ternary hybrid nanofluid flow in various geometries, assisting in the design and optimization of heat transfer systems involving such fluids.
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Affiliation(s)
- Ashish Mishra
- Department of Applied Sciences and Engineering, Tula's Institute, Dehradun, 248197, Uttarakhand, India
| | - Sawan Kumar Rawat
- Department of Mathematics, Graphic Era Deemed to be University, Dehradun, 248002, Uttarakhand, India
| | - Moh Yaseen
- Department of Mathematics, Chandigarh University, Mohali, 140 413, Punjab, India
| | - Manish Pant
- Department of Applied Sciences and Humanities, Invertis University, Bareilly, 243123, Uttar Pradesh, India
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Sivakumar BS, Lawson RD, An VVG, Ledgard JP. Dual Construct Fixation of the Scaphoid. J Hand Surg Asian Pac Vol 2023; 28:587-589. [PMID: 37905366 DOI: 10.1142/s2424835523710091] [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] [Indexed: 11/02/2023]
Abstract
Dual construct fixation has been increasingly used in complex peri-articular or peri-prosthetic long bone fractures, those with poor bone quality and in revision situations. We describe the utilisation of a screw-plate construct in the setting of a juxta-articular distal pole scaphoid fracture, review the literature and provide recommendations for future use. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Brahman Shankar Sivakumar
- Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Richard Dorrien Lawson
- Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Vincent V G An
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - James P Ledgard
- Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
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Knie C, van Schoonhoven J. Long-term results after total wrist fusion. Arch Orthop Trauma Surg 2023; 143:6469-6475. [PMID: 37344687 DOI: 10.1007/s00402-023-04938-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/25/2023] [Indexed: 06/23/2023]
Abstract
Sixty-eight patients with seventy-one total wrist fusions were retrospectively reviewed with a mean follow-up of 11.7 years. The main purpose of this study was to determine long-term functional results and define possible reasons for remaining pain. Except one asymptomatic non-union, all wrist fusions united. The long-term functional result averaged 30 points using the DASH score and appears to be more favorable compared to midterm results in another publication from this department. Only 15 patients were completely free of pain. Most patients complained about remaining pain during strong activities with a mean VAS of 4/10 that could not further been defined on clinical or radiological examinations. Patients with more than two previous operations had a significant worse outcome concerning the modified Mayo wrist score [≤ 1 operation mean 61 points vs. ≥ 2 operations mean 56 points (Mann-Whitney U test: p = 0.009)] and PRWE-G [≤ 1 operation mean 27 points vs. ≥ 2 operations mean 37 points (t test: p = 0.047)] and furthermore a downward trend for worse DASH [≤ 1 operation mean 265 points vs. ≥ 2 operations mean 35 points (t test: p = 0.086)] results. Despite the loss of wrist motion and remaining pain, patients were highly satisfied with the long-term result and 93% would undergo the operation again.
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Affiliation(s)
- C Knie
- Clinic for Hand Surgery, Rhön-Klinikum, Von-Guttenberg-Straße11, 97616, Bad Neustadt a.d. Saale, Germany.
| | - J van Schoonhoven
- Clinic for Hand Surgery, Rhön-Klinikum, Von-Guttenberg-Straße11, 97616, Bad Neustadt a.d. Saale, Germany
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Hoelscher-Doht S, Zufall N, Heilig M, Heilig P, Paul MM, Meffert RH. "Mother and baby plate": a strategy to improve stability in proximal fractures of the ulna. Arch Orthop Trauma Surg 2023; 143:6251-6259. [PMID: 37460845 PMCID: PMC10491518 DOI: 10.1007/s00402-023-04979-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/29/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Proximal ulna fractures with a large zone of comminution, such as in the context of Monteggia injuries, require mechanically strong osteosyntheses as they occur in regions with high physiological joint load. Consequently, implant failure and pseudarthrosis are critical and devastating complications, especially with the background of mainly young patients being affected. An effective solution could be provided by adding a small second plate 90° angulated to the standard dorsal plate in the area of non-union. Thus, this study investigates whether, from a biomechanical point of view, the use of such a mini or baby plate is worthwhile. MATERIALS AND METHODS Comminuted fractures distal to the coronoid process, equivalent to Jupiter type IIb fractures, are generated on artificial Sawbones® of the ulna and stabilized using two different plate osteosyntheses: in the first group, a dorsal locking compression olecranon plate is used (LCP group). In the second group, a small, ulnar 5-hole olecranon plate is added as a baby plate in addition to the mother plate at the level of the fracture zone (MBP group). Dynamic biomechanical loading in degrees of flexion from 0° to 90° is carried out to determine yield load, stiffness, displacement, and changes in fracture gap width as well as bending of the dorsal plate. RESULTS The "mother-baby-plate" osteosynthesis had a significantly higher yield load (p < 0.01) and stiffness (p = 0.01) than the LCP group. This correlates with the increased movement of the proximal fracture element during cyclic testing for the LCP group compared to the MBP group as measured by an optical metrology system. CONCLUSIONS Here, we show evidence that the addition of a small plate to the standard plate is highly effective in increasing the biomechanical stability in severe fractures equivalent to Jupiter type IIb. As it hopefully minimizes complications like pseudarthrosis and implant failure and as the additional preparatory effort leading to compromised blood supply is regarded to be negligible, this justifies and highly advises the use of a mother-baby-plate system.
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Affiliation(s)
- Stefanie Hoelscher-Doht
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany.
| | - Nicola Zufall
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany
| | - Maximilian Heilig
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany
| | - Philipp Heilig
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany
| | - Mila Marie Paul
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany
| | - Rainer Heribert Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Staße 6, 97080, Würzburg, Germany
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Qian J, Jiang KM, Su KZ, Lin JH, Fang MY. [Dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius]. Zhongguo Gu Shang 2023; 36:782-5. [PMID: 37605920 DOI: 10.12200/j.issn.1003-0034.2023.08.016] [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: 08/23/2023]
Abstract
OBJECTIVE To explore clinical efficacy of dorsal plate assisted fixation of dorsal lunate fossa fracture block of distal radius. METHODS From January 2019 to January 2022, 30 patients were treated with dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius, including 13 males and 17 females, aged from 42 to 68 years old with an average of (48.7±5.6) years old;According to Doi fracture classification, 24 patients were type 3 blocks and 6 patients were type 4 blocks. The degree of palmar angle of anterior and posterior distal radius was fixed by dorsal steel plate during operation. Fracture healing and functional recovery of wrist were observed after operation. Functional evaluation was performed by Gartland and Werley scoring system at 12 months after operation. RESULTS All patients were followed up from 12 to 13 months with an average of (11.3±0.9) months. All fractures healed for 4 to 5 months with an average of(4.7±0.8) months. Median palpal inclination of anterior and posterior distal radius fixed by dorsal plate was 5.30°(4.85°, 6.03°), 12.45°(11.98°, 13.43°) respectively, and had statistical difference( P<0.01). Gartland and Werley scores was (1.1±0.4) at 12 months afteropertaion, and 27 patients got excellent result and 3 good. CONCLUSION Dorsal plate assisted fixation of dorsal lunate fossa fractures is beneficial to reduction and stabilization of displaced dorsal fractures and restoration of palmar inclination.
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Affiliation(s)
- Jun Qian
- The Fifth Hospital of Jinhua, Jinhua 321000, Zhejiang, China
| | - Kai-Ming Jiang
- The Fifth Hospital of Jinhua, Jinhua 321000, Zhejiang, China
| | - Kun-Zhi Su
- The Fifth Hospital of Jinhua, Jinhua 321000, Zhejiang, China
| | - Jun-Hong Lin
- The Fifth Hospital of Jinhua, Jinhua 321000, Zhejiang, China
| | - Mei-Yuan Fang
- The Fifth Hospital of Jinhua, Jinhua 321000, Zhejiang, China
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El-Sharkasy MH, El-Singergy AA, Mansour AMR, Badawy MA, Khedr A. Union in Lateral Column Lengthening by Plate Fixation Without Bone Graft in Flexible Flatfoot: A Case Series. Indian J Orthop 2023; 57:1283-1289. [PMID: 37525734 PMCID: PMC10387035 DOI: 10.1007/s43465-023-00945-z] [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: 01/03/2023] [Accepted: 06/22/2023] [Indexed: 08/02/2023]
Abstract
Purpose This study's goal was to evaluate the outcomes of lateral column lengthening by plate fixation without bone graft in the management of symptomatic flexible flatfoot. Methods A prospective randomized trial study included 30 feet (27 patients) and was performed from March 2017 to December 2019. Functional and radiological evaluations were done pre-operative and at the final post-operative follow-up. The functional assessment was done using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results The mean follow-up was 16.5 ± 3.027 months. The mean age of patients was 22.6 ± 6.29 years. All cases showed union ranging from 8 to 12 weeks, with a mean of 10 ± 1.88 weeks. The mean AOFAS score improved from 51.6 ± 6.75 to 92.2 ± 6.21. The mean anteroposterior (AP) talo-first metatarsal angle improved from 25.3° ± 8.31° to 3.4° ± 5.10°. The mean anteroposterior (AP) talo-navicular coverage improved from 22.10° ± 4.28° to 2.3° ± 3.46°. The mean Lateral talo-first metatarsal angle improved from 18.6° ± 4.79° to 3.3° ± 3.16°. The calcaneal pitch angle improved from 9.6° ± 4.14° to 15.1° ± 4.43°. The mean lateral talo-calcaneal angle improved from 45.7° ± 3.77° to 37.5° ± 3.47°. Conclusion Using an interposition wedge plate for LCL without bone graft leads to a high union rate, maintains the correction, and avoids possible complications of autografts and allografts.
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Affiliation(s)
- Mohamed Hegazy El-Sharkasy
- Orthopedic Surgery Department, Shoubra General Hospital, Cairo, Egypt
- Orthopedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | | | - Ali M. Reda Mansour
- Orthopedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | | | - Ahmed Khedr
- Orthopedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
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Shi H, Zhang K, Hu Y, Wu W, Liu N, Lu H. Novel Claw-shaped Bone Plate in Complex Unstable Scapular Neck and Body Fractures: Comparison with Reconstruction Locking Plate. Orthop Surg 2023; 15:2124-2131. [PMID: 37226558 PMCID: PMC10432470 DOI: 10.1111/os.13766] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE For complex and unstable scapular fractures requiring simultaneous fixation of the glenoid neck, the lateral margin of the body, and/or the scapular diaphysis, reconstruction locking plate is difficult to achieve satisfactory fixation. In order to optimize the fixation effect, the newly designed claw-shaped bone plate was designed for fixing such fractures. We also evaluate the clinical effects and follow-up at an average of 1 year after treatment in scapular internal fixation by using reconstruction locking plate and claw-shaped bone plate in complex unstable scapular body and glenoid neck fracture. METHODS A retrospective study was conducted from 2018 to 2021, thirty-three patients (27 males and six females) who were defined unstable scapular fractures by Ada-Miller. Fifteen patients (52.86 ± 8.26 years) received claw-shaped bone plate and 18 cases (51.61 ± 11.31 years) received reconstruction locking plate with the intermuscular approach. The clinical effect was evaluated based on the operation time, intraoperative blood loss, surgical complications, clinical healing time and Constant-Murley score (CMS). The data analysis by Student t, Mann-Whitney U test and Pearson's chi squared test. RESULTS Compared with reconstruction locking plate, the claw-shaped bone plate showed shorter operation time (102.73 ± 18.43 min vs. 156 ± 37.53, P < 0.0001), higher CMS (94.00 ± 4.07 vs. 89.88 ± 5.42, P = 0.02) and no differences between the two groups regarding intraoperative blood loss (208.00 ± 96.45 mL vs. 269.44 ± 120.21, P = 0.12) and clinical healing times (9.96 ± 1.52 vs. 10.05 ± 1.67, P = 0.87). Follow-up were conducted at first, third, 6 and 12 months after surgery. The operation was successful in all patients with no intraoperative complications. CONCLUSIONS For the treatment of complex and unstable scapular neck body fractures, the application of claw-shaped bone plate demonstrated short operation time, better stability of the fracture block, and higher CMS. In the intraoperative and postoperative follow-up showed better clinical results and rehabilitation effects.
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Affiliation(s)
- Huiming Shi
- School of Basic Medical SciencesXi'an Jiaotong UniversityXi'anChina
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Kun Zhang
- Orthopaedics Department of Xi'an Honghui HospitalXi'anChina
| | - Yuanjun Hu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Wei Wu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Ning Liu
- Traumatic Orthopaedics DepartmentHanzhong Central HospitalHanzhongChina
| | - Haixia Lu
- School of Basic Medical SciencesXi'an Jiaotong UniversityXi'anChina
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Emet A, Yilmaz ET, Danisman M, Aksoy C, Yilmaz G. Fixation techniques in lower extremity correction osteotomies and fractures in mild-to-severe osteogenesis imperfecta patients: evaluation of the results and complications. J Orthop Surg Res 2023; 18:437. [PMID: 37328762 DOI: 10.1186/s13018-023-03917-z] [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: 03/27/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Osteogenesis imperfecta is a genetic disorder leading to multiple fractures and deformities. Intramedullary rods have been used in the surgical treatment of osteogenesis imperfecta for decades. Complication rates reported by current techniques have been high. This study aimed to examine the results of intramedullary fixation combined with plate and screw technique in patients with osteogenesis imperfecta compared to isolated intramedullary fixation. METHODS Between 2006 and 2020, forty patients who had surgical treatment for deformities or fractures of the femur, tibia or both with at least two years of follow-up after surgery were included in the study. Patients were divided into groups according to fixation methods. Group 1 was intramedullary fixation only (Titanium Elastic Nail [TEN], Rush Pin, and Fassier-Duval Rod), and Group 2 was intramedullary fixation combined with plate and screws. Medical records and follow-up radiographs were reviewed to evaluate healing and callus formation, types of complications and infection rates. RESULTS The total number of operated lower extremities of these forty patients was 61 (45 femur and 16 tibia). The mean age of the patients was 9.3 ± 4.6 years. Mean follow-up duration of the patients was 4.4 ± 1.7 years. Thirty-seven (61%) were in Group 1, and 24 (39%) were in Group 2. There was no statistically significant difference in callus formation time between Group 1 and Group 2 (p = 0.67). Complications occurred in 21 of 61 surgeries. While 17 of these complications were in Group 1, 4 were in Group 2 (p = 0.01). CONCLUSION Intramedullary fixation combined with the plate and screw technique in children with osteogenesis imperfecta is successful considering the complications and revision requirements.
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Affiliation(s)
- Abdulsamet Emet
- Department of Orthopedics and Traumatology, Yuksek Ihtisas University, Private Liv Hospital, Turan Gunes Bulv. Koz Apt No: 41/22 Cankaya, Ankara, Turkey.
| | - Engin Turkay Yilmaz
- Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Danisman
- Department of Orthopedics and Traumatology, Giresun University Prof. Dr. A. Ilhan Ozdemir Hospital, Giresun, Turkey
| | - Cemalettin Aksoy
- Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Guney Yilmaz
- Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Mohamed J, Bouaicha W, Lamouchi M, Ammar AB, Jaziri S, Daas S. Comparison of the results of the synthesis of Schatzker II and III tibial plateau fractures by screwing versus plate. Int Orthop 2023:10.1007/s00264-023-05849-z. [PMID: 37289239 DOI: 10.1007/s00264-023-05849-z] [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] [Received: 02/19/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Lateral tibial plateau fractures with depression are the most common. Their treatment is currently surgical. Many therapeutic procedures have been described. Our aim is to evaluate the results of open surgery and to compare the two internal fixation methods used: lag screw versus plates. MATERIALS AND METHODS This is a retrospective comparative study of two series of tibial plateau fractures Schatzker types II and III treated surgically over a period of ten years with two different methods: Group A: Internal fixation using screws for 86 patients. Group B: Internal fixation using plates for 71 patients. Functional and anatomical results were assessed according to Rasmussen's clinical and radiological scores. RESULTS The patients' average age was 44 years (range from 18 to 76). The male gender was predominant (104 males and 53 females). Road traffic accidents were the most common aetiology with over two thirds of the cases. The fractures were type Schatzker II in 61% of the cases. The mean follow-up was five years. Although the clinical and radiological Rasmussen scores were better in group A (internal fixation with lag screws), those differences were statistically insignificant (p = 0.6 and p = 0.8). Group A clinical and radiological scores were 26.06 and 16.57, respectively and those of group B were 25.72 and 16.45. We noticed more sepsis and skin complications and a longer operating time (95 min versus 70 min) in group B patients with a statistically significant difference. None of the patients of our series had bone grafting. CONCLUSION For Schatzker II and III fractures, an internal fixation with lag screws would be preferable when possible especially in the case of a pure depression fracture. It yields satisfactory results with a shorter operating time and less complication rate.
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Affiliation(s)
- Jlidi Mohamed
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia.
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Walid Bouaicha
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mouldi Lamouchi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia
| | - Ahmed Ben Ammar
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia
| | - Salma Jaziri
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Anaesthesia and Intensive Care, Mohamed Bourguiba Hospital, Kef, Tunisia
| | - Selim Daas
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Sivakumar BS, Vaotuua DL, McCarron L, Graham DJ. Cost Analysis of Intramedullary Screw versus Plate Osteosynthesis for Phalangeal and Metacarpal Fractures: An Observational Study. J Hand Surg Asian Pac Vol 2023; 28:369-376. [PMID: 37173145 DOI: 10.1142/s242483552350039x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 05/15/2023]
Abstract
Background: To compare the observed healthcare and societal costs of intramedullary screw (IMS) and plate fixation of extra-articular metacarpal and phalangeal fractures in a contemporary Australian context. Methods: A retrospective analysis, based on previously published data, was performed utilising information from Australian public and private hospitals, the Medicare Benefits Schedule (MBS) and the Australian Bureau of Statistics. Results: Plate fixation demonstrated longer surgical lengths (32 minutes, compared to 25 minutes), greater hardware costs (AUD 1,088 vs. AUD 355), more extended follow-up requirements (6.3 months, compared to 5 months) and higher rates of subsequent hardware removal (24% compared to 4.6%), resulting in an increased healthcare expenditure of AUD 1,519.41 in the public system, and AUD 1,698.59 in the private sector. Wage losses were estimated at AUD 15,515.78 when the fracture cohort is fixed by a plate, and AUD 13,542.43 when using an IMS - a differential of AUD 1,973.35. Conclusions: There is a substantial saving to both the health system and the patient when using IMS fixation over dorsal plating for the fixation of extra-articular metacarpal and phalangeal fractures. Level of Evidence: Level III (Cost Utility).
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Affiliation(s)
- Brahman S Sivakumar
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
- Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Sydney, NSW, Australia
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
- Discipline of Surgery, the Faculty of Medicine and Health, Sydney Medical School, the University of Sydney, Camperdown, NSW, Australia
| | - Darren L Vaotuua
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - Luke McCarron
- Bond University Occupational Therapy Department, Robina, QLD, Australia
| | - David J Graham
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
- Griffith University School of Medicine and Dentistry, Southport, QLD, Australia
- Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Sheng N, Shi T, Wang Q, Wang L, Chen Y. Nonanatomic healing of the greater tuberosity after plating in proximal humeral fractures: a case control study. J Orthop Surg Res 2023; 18:374. [PMID: 37208767 DOI: 10.1186/s13018-023-03811-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 04/23/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Open reduction and plate internal fixation (ORIF) is one of the most common treatment methods for proximal humeral fractures. Complications associated with the greater tuberosity (GT) are rarely reported, therefore, the purpose of this study was to analyze the complications associated with the GT and the risk factors after locked-plate internal fixation. METHODS We retrospectively analyzed the medical and radiographic data of patients with proximal humeral fractures involving the GT treated with locking plates between January 2016 and July 2019. We divided all patients into two groups, the anatomic GT healing group and the nonanatomic GT healing group, depending on the radiographic outcomes of the GT. Clinical outcome was assessed by the Constant scoring system. Potential risk factors included preoperative and intraoperative factors. Preoperative factors included sex, age, body mass index, fracture type, fracture-dislocation, proximal humeral bone mineral density, humeral head extension, hinge integrity, comminuted GT, volume and surface area of the main GT fragment, and displacement of the main GT fragment. Intraoperative factors were adequate medial support, residual head-shaft displacement, head-shaft angle and residual GT displacement. Univariate logistic regression and multivariate logistic regression were used to identify risk factors. RESULTS There were 207 patients (130 women and 77 men; mean age, 55 years). GT anatomic healing was observed in 139 (67.1%) patients and nonanatomic healing in 68 (32.9%). Patients with GT nonanatomic healing had significantly inferior Constant scores than those with GT anatomic healing (75.0 ± 13.9 vs. 83.9 ± 11.8, P < 0.001). Patients with high GT malposition had worse Constant scores than patients with low GT malposition (73.3 ± 12.7 vs. 81.1 ± 11.4, P = 0.039). The multivariate logistic model showed that GT fracture characteristics were not risk factors for nonanatomic GT healing, while residual GT displacement was. CONCLUSIONS Nonanatomic healing of the GT is a high-rate complication of proximal humeral fractures, resulting in inferior clinical outcomes, especially for high GT malposition. Fracture characteristics of the GT are not risk factors for GT nonanatomic healing and GT comminution should not be regarded as a contraindication to ORIF for proximal humeral fractures.
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Affiliation(s)
- Ning Sheng
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Tingwang Shi
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Qiuke Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Lei Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
| | - Yunfeng Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
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Dewarrat A, Terrier A, Barimani B, Vauclair F. Comparison of the ALPS and PHILOS plating systems in proximal humeral fracture fixation - a retrospective study. BMC Musculoskelet Disord 2023; 24:371. [PMID: 37165381 PMCID: PMC10170861 DOI: 10.1186/s12891-023-06477-9] [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: 06/17/2022] [Accepted: 04/29/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Open reduction and plate osteosynthesis are considered as a successful technique for the treatment of proximal humerus fracture (PHF) despite high complication rates. The objective of our study was to review the clinical outcome and complications of the Anatomic Locking Plate System (ALPS) and compare it to the Proximal Humeral Internal Locking System (PHILOS). Our hypothesis was that ranges of motion (ROM) were superior and complication rates were lower with ALPS. METHODS Twenty patients treated with ALPS for PHF were retrospectively compared to 27 patients treated with PHILOS. Union, ROM and complications were clinically and radiologically assessed at 6 weeks, 3, 6, 12 and 18-24 months post-operatively. RESULTS Mean age was 52 ± 14 in the ALPS group and 58 ± 13 in the PHILOS group. Last follow-ups were conducted at a mean of 20.6 ± 4.8 months. Mean shoulder abduction was superior with ALPS by 14° (p-value = 0.036), 15° (p-value = 0.049), and 15° (p-value = 0.049) at 3, 6, and 12 months respectively. Mean shoulder external rotation was superior with ALPS by 11° (p-value = 0.032), 15° (p-value = 0.010) and 12° (p-value = 0.016) at 6 weeks, 3 and 6 months respectively. At the end of the follow-up, ROM remained better with ALPS, but not significantly. Complication rates over 21 months reached 20% with ALPS and 48% with PHILOS (p-value = 0.045). Implant removal rates reached 10% with ALPS and 37% with PHILOS (p-value = 0.036). Avascular necrosis was the only cause for hardware removal in the ALPS group. CONCLUSION The ALPS group showed better clinical outcomes with faster recovery in abduction and external rotation, although no difference in ROM remained after 21 months. Additionally, the complications rate was lower at last follow up. In our experience, the ALPS plating system is an effective management option in some PHF.
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Affiliation(s)
| | - Alexandre Terrier
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Station 9, 1015, Lausanne, Switzerland
| | - Bardia Barimani
- Division of Orthopedic Surgery, McGill University, Montreal, QC, Canada
- University of Toronto, Toronto, Canada
| | - Frédéric Vauclair
- University of Lausanne, Lausanne, Switzerland
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
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Redondo-Trasobares B, Sarasa-Roca M, Rosell-Pradas J, Calvo-Tapies J, Gracia-Villa L, Albareda-Albareda J. [Translated article] Comparative clinical and biomechanical study of different types of osteosynthesis in the treatment of distal femur fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T216-T225. [PMID: 36863523 DOI: 10.1016/j.recot.2023.02.025] [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: 12/04/2022] [Accepted: 01/10/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures. MATERIAL AND METHOD A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ2 test were used to evaluate the significance of the different factors, with the condition of P<.05. RESULTS In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail. CONCLUSIONS Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.
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Affiliation(s)
- B Redondo-Trasobares
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - M Sarasa-Roca
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J Rosell-Pradas
- Departamento de Ingeniería Mecánica, Universidad de Zaragoza, Zaragoza, Spain
| | - J Calvo-Tapies
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - L Gracia-Villa
- Departamento de Ingeniería Mecánica, Universidad de Zaragoza, Zaragoza, Spain
| | - J Albareda-Albareda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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20
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Redondo-Trasobares B, Sarasa-Roca M, Rosell-Pradas J, Calvo-Tapies J, Gracia-Villa L, Albareda-Albareda J. Comparative clinical and biomechanical study of different types of osteosynthesis in the treatment of distal femur fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:216-225. [PMID: 36649756 DOI: 10.1016/j.recot.2023.01.003] [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: 12/04/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures. MATERIAL AND METHOD A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ2 test were used to evaluate the significance of the different factors, with the condition of P<.05. RESULTS In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail. CONCLUSIONS Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.
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Affiliation(s)
- B Redondo-Trasobares
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - M Sarasa-Roca
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Rosell-Pradas
- Departamento de Ingeniería Mecánica, Universidad de Zaragoza, Zaragoza, España
| | - J Calvo-Tapies
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - L Gracia-Villa
- Departamento de Ingeniería Mecánica, Universidad de Zaragoza, Zaragoza, España
| | - J Albareda-Albareda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Wagner RK, Guarch-Pérez C, van Dam AP, Zaat SAJ, Kloen P. Antimicrobial Mechanisms and Preparation of Antibiotic-impregnated Cement-coated Locking Plates in the Treatment of Infected Non-unions. Strategies Trauma Limb Reconstr 2023; 18:73-81. [PMID: 37942437 PMCID: PMC10628616 DOI: 10.5005/jp-journals-10080-1586] [Citation(s) in RCA: 1] [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: 10/19/2022] [Accepted: 04/30/2023] [Indexed: 11/10/2023] Open
Abstract
Background Antibiotic-impregnated cement-coated plates (ACPs) have been used successfully for temporary internal fixation between stages in the two-stage treatment of infected non-unions. We describe our approach of using an ACP in the staged treatment of a methicillin-resistant Staphylococcus aureus (MRSA)-infected distal femoral non-union below a total hip prosthesis. In addition, we present the results of an in vitro experiment to provide an in-depth insight into the capacity of ACPs in (i) treating residual biofilm and (ii) preventing bacterial recolonisation. Materials and methods In the first stage, we used a titanium LISS plate coated with hand-mixed PALACOS with vancomycin (PAL-V) for temporary internal fixation combined with commercially prepared COPAL with gentamicin and vancomycin (COP-GV) to fill the segmental defect. In the second stage, the non-union was treated with double-plate fixation and bone grafting.A Kirby-Bauer agar disc diffusion assay was performed to determine the antimicrobial activity of both ACPs and a drug-release assay to measure antibiotic release over time. A biofilm killing assay was also carried out to determine if the antibiotic released was able to reduce or eradicate biofilm of the patient's MRSA strain. Results At one-year follow-up, there was complete bone-bridging across the previous non-union. The patient was pain-free and ambulatory without need for further surgery. Both ACPs with COP-GV and PAL-V exerted an antimicrobial effect against the MRSA strain with peak concentrations of antibiotic released within the first 24 hours. Concentrations released from COP-GV in the first 24 hours in vitro caused a 7.7-fold log reduction of colony-forming units (CFU) in the biofilm. At day 50, both COP-GV and PAL-V still released concentrations of antibiotic above the respective minimal inhibitory concentrations (MIC), likely contributing to the positive clinical outcome. Conclusion The use of an ACP provides stability and infection control in the clinical scenario of an infected non-union. This is confirmed in vitro where the release of antibiotics from ACPs is characterised by an early burst followed by a prolonged sustained release above the MIC until 50 days. The burst release from COP-GV reduces CFU in the biofilm and prevents early recolonisation through synergistic activity of the released vancomycin and gentamicin. Clinical significance An antibiotic-impregnated cement-coated plate is a useful addition to the surgeon's armamentarium to provide temporary internal fixation without the disadvantages of external fixation and contribute to infection control in an infected non-union. How to cite this article Wagner RK, Guarch-Pérez C, van Dam AP, et al. Antimicrobial Mechanisms and Preparation of Antibiotic-impregnated Cement-coated Locking Plates in the Treatment of Infected Non-unions. Strategies Trauma Limb Reconstr 2023;18(2):73-81.
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Affiliation(s)
- Robert Kaspar Wagner
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9; Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Clara Guarch-Pérez
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, The Netherlands
| | - Alje P van Dam
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, The Netherlands
| | - Sebastian AJ Zaat
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, The Netherlands
| | - Peter Kloen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9; Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
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22
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Quadlbauer S, Pezzei C, Jurkowitsch J, Beer T, Moser V, Rosenauer R, Salminger S, Hausner T, Leixnering M. Double screw versus angular stable plate fixation of scaphoid waist nonunions in combination with intraoperative extracorporeal shockwave therapy (ESWT). Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04806-0. [PMID: 36808564 DOI: 10.1007/s00402-023-04806-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/29/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Over the past years, different fixation techniques focused on rotational stability in order to increase stability and stimulate union rates. Additionally, extracorporeal shockwave therapy (ESWT) has gained importance in the treatment of delayed and nonunions. Purpose of this study was to compare the radiological and clinical outcome of two headless compression screws (HCS) and plate fixation in scaphoid nonunions, in combination with intraoperative high energy ESWT. MATERIALS AND METHODS Thirty-eight patients with scaphoid nonunions were treated by using a nonvascularized bone graft from the iliac crest and stabilization with either two HCS or a volar angular stable scaphoid plate. All patients received one ESWT session with 3000 impulses and energy flux per pulse of 0.41 mJ/mm2 intraoperatively. Clinical assessment included range of motion (ROM), pain according to the Visual Analog Scale (VAS), grip strength, disability of the Arm Shoulder and Hand Score, Patient-Rated Wrist Evaluation Score, Michigan Hand Outcomes Questionnaire and modified Green O'Brien (Mayo) Wrist Score. To confirm union, a CT scan of the wrist was performed. RESULTS Thirty-two patients returned for clinical and radiological examination. Out of these, 29 (91%) showed bony union. All patients treated with two HCS compared to 16 out of 19 (84%) patients treated by plate showed bony union on the CT scans. The difference was not statistically significant. However, at a mean follow-up interval of 34 months, no significant differences could be found in ROM, pain, grip strength and patient-reported outcome measurements between the two HCS and plate group. Height-to-length ratio and capitolunate angle improved significantly in both groups compared to preoperative. CONCLUSIONS Scaphoid nonunion stabilization by using two HCS or angular stable volar plate fixation and intraoperative ESWT results in comparable high union rates and good functional outcome. Due to the higher rate for a secondary intervention (plate removal), HCS might be preferable as first choice, whereas the scaphoid plate fixation should be reserved for recalcitrant (substantial bone loss, humpback deformity or failed prior surgical intervention) scaphoid nonunions.
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Affiliation(s)
- S Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria. .,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Beer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - V Moser
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - R Rosenauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - S Salminger
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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23
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Song KS, Lee J, Ham DW, Jung CW, Kang H, Park SW, Chang DG, Kim YB. Postoperative Segmental Motion up to 1 Year Following Single-Level Anterior Cervical Discectomy and Fusion: Plate versus Non-plate. Asian Spine J 2023:asj.2022.0192. [PMID: 36775832 DOI: 10.31616/asj.2022.0192] [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: 05/09/2022] [Accepted: 08/30/2022] [Indexed: 02/14/2023] Open
Abstract
Study Design Retrospective observational study. Purpose This study aimed to investigate the impact of plating on postoperative serial segmental motion and its correlation with clinical outcomes in single-level anterior cervical discectomy and fusion (ACDF) for up to 1 year. Overview of Literature The advantages and disadvantages of using cervical plating in ACDF have been well discussed; however, few studies compared the early serial segmental motions at the postoperative level between plating and non-plating. Methods In retrospectively collected data, 149 patients who underwent single-level ACDF for degenerative disease were enrolled and divided into non-plating (n=66) and plating (n=83). Interspinous motion (ISM) at the arthrodesis segment, Numeric Rating Scale (NRS) for neck pain, and Neck Disability Index (NDI) were serially evaluated at 3, 6, and 12 months postoperatively. Predictable factors for fusion, including age, sex, plating, diabetes, smoking, and type of grafts, were investigated, and fusion was defined as ISM <1 mm. Results In both groups, ISM was the highest at 3 months and gradually decreased thereafter, and the plating group showed significantly lower serial ISM than the non-plating group at 12 months. The plating group had lower NRS and NDI scores than the nonplating group at 12 months, and the difference in the NRS scores was statistically significant, particularly at 3 and 6 months, although that of the NDI scores was not. In a multivariate analysis, plating was the most powerful predictor for fusion. Conclusions Plating significantly decreases the serial ISM compared with non-plating in single-level ACDF, and such decreased motion is correlated with decreased neck pain until 12 months postoperatively, particularly at 3 and 6 months. Given that plating was the most predictive factor for fusion, we recommend plating even in single-level ACDF for better early clinical outcomes.
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Affiliation(s)
- Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeongik Lee
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dae Woong Ham
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Chan-Woo Jung
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Youngbae B Kim
- Department of Orthopaedic Surgery, VHS Medical Center, Seoul, Korea
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24
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Feng D, Jiang W, Kang X, Jiang Y, Zhu Y, Zhang J. Simultaneous bilateral traumatic clavicle fractures: incidence, characteristics, and surgical outcomes. BMC Musculoskelet Disord 2023; 24:112. [PMID: 36765310 PMCID: PMC9912484 DOI: 10.1186/s12891-023-06228-w] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Although clavicle fractures are common injuries in adults, simultaneous bilateral clavicle fractures are rarely reported. The present report describes 13 patients with simultaneous bilateral traumatic clavicle fractures who were treated with surgical management and followed for more than 12 months postoperatively. METHODS This retrospective chart review involved skeletally mature patients with traumatic clavicle injuries. Patients with bilateral clavicle fractures who were followed up for at least 12 months after surgery were included. Data regarding the patients' demographics, injury characteristics, fracture classification, comorbidities, concomitant injuries, and treatment strategies were collected. Each displaced fracture was managed with open reduction and internal fixation. Postoperative follow-up included radiographs for assessment of bone union; calculation of the Constant-Murley score for shoulder function; administration of the Disability of the Arm, Shoulder, and Hand questionnaire for upper limb function; determination of the visual analogue scale score for pain; and assessment of complications. RESULTS From October 2013 to November 2021, 15 patients (10 men, 5 women) were diagnosed with bilateral clavicle fractures among 1542 patients with clavicle injuries (overall incidence of 1.0%). Of these 15 patients, this study included 13 patients (8 men, 5 women; mean age, 38.3 ± 15.3 years) who were followed up for more than 12 months postoperatively. Among the 13 patients, 10 (77.0%) had associated concomitant injuries, and 25 sides were fixed with internal plate fixation. After a follow-up period of 29.9 ± 28.5 months, all fractures achieved bone healing. Eleven patients attained excellent shoulder function on both sides and returned to their pre-injury daily activities, and the remaining two patients had unilateral shoulder dysfunction. No complications occurred. CONCLUSIONS Bilateral clavicle fractures are extremely rare and associated with polytrauma. Open reduction and internal fixation is recommended for such patients, especially those with severe chest injuries, because osteosynthesis of the clavicle can improve respiratory function and reduce the duration of functional disability.
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Affiliation(s)
- Dongxu Feng
- grid.452452.00000 0004 1757 9282Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi China
| | - Wuqiang Jiang
- grid.452452.00000 0004 1757 9282Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi China
| | - Xiaomin Kang
- grid.452438.c0000 0004 1760 8119Center for Translational Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi China
| | - Yuxuan Jiang
- grid.452452.00000 0004 1757 9282Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi China
| | - Yangjun Zhu
- grid.452452.00000 0004 1757 9282Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi China
| | - Jun Zhang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China.
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25
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Oppizzi G, Xu D, Patel T, Diaz JJ, Zhang LQ. Open reduction internal fixation of rib fractures: a biomechanical comparison between the RibLoc U Plus ® system and anterior plate in rib implants. Eur J Trauma Emerg Surg 2023; 49:383-391. [PMID: 36018371 PMCID: PMC10148598 DOI: 10.1007/s00068-022-02075-x] [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: 04/07/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In this study, we assessed the bending strength of two surgical repairs of rib fracture using RibLoc® U Plus system made by Acute Innovations and the anterior plate by Synthes. METHODS After a rib fracture was created in seven pairs of cadaveric rib specimens, one side was repaired with the anterior plate and the other side repaired with the RibLoc U Plus® plate. Each of the rib is loaded using a custom device over 360,000 bending cycles to simulate in vivo fatiguing related to respiration. Upon completion of the cyclic loading, the specimens were compressively loaded to failure and the failure bending moment was determined. RESULTS The ribs repaired with the RibLoc U Plus® system showed 79% higher failure bending moment than that of the anterior plate, with a p value of 0.033. The ribs repaired with RibLoc U Plus® showed a trend of less stiffness reduction over the 360,000 loading cycles. CONCLUSION The biomechanical study showed that the RibLoc U Plus® system is stronger in the bending moment loading of repaired ribs, possibly due to the U-shape structure supporting both the inner and outer cortices of a repaired rib.
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Affiliation(s)
- Giovanni Oppizzi
- Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, College Park, MD, 20742, USA.,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA
| | - Dali Xu
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA
| | - Tirth Patel
- Chicago College of Osteopathic Medicine, Midwestern University, 555 31st Street, Downers Grove, IL, 60515, USA
| | - Jose J Diaz
- Department of Surgery, School of Medicine, University of Maryland, 22 S Greene Street, Baltimore, MD, 21201, USA.,Department of Orthopedics, School of Medicine, University of Maryland, 110 S. Paca Street, Baltimore, MD, 21201, USA
| | - Li-Qun Zhang
- Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, College Park, MD, 20742, USA. .,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA. .,Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 660 W. Redwood Street, Baltimore, MD, 21201, USA. .,Department of Orthopedics, School of Medicine, University of Maryland, 110 S. Paca Street, Baltimore, MD, 21201, USA.
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26
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Feng D, Liu Y, Li Z, Huang J, Fan M, Kang X, Zhang J. Treatment of bipolar clavicle injury with internal plating: a case series and literature review. BMC Musculoskelet Disord 2023; 24:8. [PMID: 36604726 PMCID: PMC9814211 DOI: 10.1186/s12891-023-06126-1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Bipolar clavicle injury is a rare injury involving any combination of dislocation and/or fracture at both ends of the clavicle. Most reports of bipolar clavicle injury have been based on a single case, and treatment of this injury remains controversial. The present study was performed to evaluate the efficacy of surgical management with internal plating for bipolar clavicle injuries. METHODS We performed internal plating to treat seven consecutive bipolar clavicle injuries with different injury patterns from May 2013 to June 2021. A clavicle hook plate was used for five sternoclavicular joint injuries (including a revision surgery) and three acromioclavicular joint dislocations, a T plate was used for one sternoclavicular joint injury, and an anatomic plate was used for one distal clavicle fracture. At follow-up, radiographs were assessed for bone alignment, joint congruity, fracture union or malunion, and implant failure or migration. Clinical evaluation included determination of the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant-Murley score; visual analog scale (VAS) score; and complications. RESULTS The patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1 ± 22.0 months, each fracture had solid bone union, and each dislocation showed no sign of recurrent instability. The mean shoulder forward flexion was 159.3° ± 7.9°, and the mean DASH score was 8.8 ± 5.1. The mean Constant-Murley score was 88.9 ± 7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0 ± 1.5, and the mean patient satisfaction score was 9.3 ± 0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfied with their treatment. CONCLUSIONS In the present study, internal plating for bipolar clavicle injury allowed early mobilization and resulted in good joint function. We recommend fixation of the more severely affected side first because the other side may be passively reduced and acquire stability once the more severely affected side has been fixed. Internal fixation of the other end may therefore be unnecessary unless residual instability exists.
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Affiliation(s)
- Dongxu Feng
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Yong Liu
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Zijun Li
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Jie Huang
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Mei Fan
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Xiaomin Kang
- grid.452438.c0000 0004 1760 8119Center for Translational Medicine, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jun Zhang
- grid.43169.390000 0001 0599 1243Department of Orthopaedic Trauma, Hong Hui Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
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27
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Silins K, Turkmen T, Vögelin E, Haug LCP. Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating. Arch Orthop Trauma Surg 2023; 143:1699-1706. [PMID: 35994095 PMCID: PMC9957854 DOI: 10.1007/s00402-022-04516-z] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Phalangeal fractures are the most common injuries in humans and account for approximately 10% of all fractures. With plate fixation, anatomic reduction is achievable in most cases, but extension lag is seen in up to 67%. Intramedullary headless screw offers treatment of unstable proximal phalangeal fractures using a minimally invasive procedure with very few complications. One of the major disadvantages of this technique is the transarticular screw position, damaging the articular surface and thus preventing very proximal fractures from being treated with a distally inserted screw. In this study, we present a modified approach to the fixation of the proximal phalangeal fractures and compare outcomes with plate osteosynthesis. MATERIALS AND METHODS Twenty-nine patients with 31 comparable fractures of the proximal phalanx were treated either with a plate (14) or with minimal invasive cannulated compression screw (17). Pain, strength, range of motion (ROM), work disability and QuickDASH score were assessed. RESULTS TAM was significantly better in the screw group. The extension lag was worse in the plate group. Plate removal had to be performed in 13 of 14 the cases, while the screw had to be removed in only 3 cases. The average duration of work disability was 9.9 weeks in the plate group, compared to 5.6 weeks in the screw group. CONCLUSION Minimally invasive screw osteosynthesis not only has the advantage of significantly shorter work disabilities, but also shows remarkably improved postoperative range of motion. In contrast to plate osteosynthesis, removal of the screw is only necessary in exceptional cases. With the antegrade screws position, even difficult fractures close to the base can be treated without destroying any articular surface. In proximal phalanx fractures with both options of plate or single-screw osteosynthesis, we recommend minimal invasive cannulated screw osteosynthesis.
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Affiliation(s)
- Kaspars Silins
- Department of Hand Surgery, Inselspital University Hospital of Bern, Schänzlistrasse 33, 3010 Bern, Switzerland
| | - Tutku Turkmen
- Faculty of Computer Science and Information Technology, Riga Technical University, Ķīpsalas iela 6A, Kurzemes rajons, Riga, LV-1048 Latvia
| | - Esther Vögelin
- Department of Hand Surgery, Inselspital University Hospital of Bern, Schänzlistrasse 33, 3010 Bern, Switzerland
| | - Luzian C. P. Haug
- Department of Hand Surgery, Inselspital University Hospital of Bern, Schänzlistrasse 33, 3010 Bern, Switzerland
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28
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Yano K, Fukuda M, Uemura T, Kaneshiro Y, Yamanaka K, Teraura H, Yamamoto K, Sasaki R, Matsuura T. Clinical Results of Surgical Treatment for Comminuted Radial Head and Neck Fracture: Headless Compression Screws Versus Plate Fixation. Indian J Orthop 2023; 57:253-61. [PMID: 36777116 DOI: 10.1007/s43465-022-00792-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/23/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
Background We surgically treated comminuted radial head and neck fractures using headless compression screws, including multiple screws for the radial head and a single oblique screw for the radial neck. This study aimed to compare the clinical and radiological results for comminuted radial head and neck fractures between surgery using headless compression screws with a single oblique screw for the radial neck, our new procedure, and a plate system precontoured to the proximal radius. Methods This retrospective study included 23 patients (11 and 12 in the screw and plate groups, respectively). The fractures were type 3 according to the Mason-Johnston classification modified by Broberg and Morrey. Clinical outcomes analyzed included the motion range of the elbow and forearm, Mayo Elbow Performance Score, and radiological assessments. In addition, postoperative complications were also investigated. The average follow-up was 18 months. Results The bone union was achieved in all the patients, and there were no significant differences in clinical outcomes and radiological assessments except forearm supination (p = 0.02). Furthermore, additional surgical procedures were performed in one and five patients in the screw and plate groups, respectively (p = 0.16). Posterior nerve palsy was observed in two patients in the plate group. Complications were observed in one and six patients in the screw and plate groups, respectively (p = 0.07). Conclusion Both surgical procedures achieved good clinical and radiological outcomes with bone and ligament injury repair. The screw group had a greater range of forearm supination than the plate group.
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29
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Jang JH, Rhee SJ, Jun SB, Choi YY. Scattering and clustering the proximal screw construct in unilateral locking plate osteosynthesis of distal femoral fractures. Arch Orthop Trauma Surg 2022; 142:2193-2203. [PMID: 34018021 DOI: 10.1007/s00402-021-03912-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The importance of fixation construct in locking compression plate (LCP) is not well enlightened until recently. The aim of this study was to investigate radiological and clinical outcomes of scattering and clustering of the proximal screw fixation construct in unilateral LCP treatment of the distal femoral fractures. MATERIALS AND METHODS Patients who were treated for distal femoral fractures using unilateral LCP between January 2014 and December 2019 in our institute were included in this retrospective study. They were divided into groups 1 (35 cases, scattered proximal screw fixation) and 2 (35 cases, clustered proximal screw fixation). Mean follow-up period was 23.6 months for group 1 and 21.3 months for group 2. Medical history, patient demographics, injury characteristics, and surgical characteristics were reviewed and analyzed. Radiological findings including time to callus formation, bridging callus formation, union, and symmetry of the union were assessed and compared between the groups. Clinical outcomes included total blood loss during the operation, postoperative range of motion, and number of revision surgery. RESULTS The time for callus formation (5.8 weeks in group 1 vs. 4.1 weeks in group 2, p = 0.009) and bridging callus formation (12.5 weeks in group 1 vs. 10.7 weeks in group 2, p = 0.009) was significantly earlier in group 2. Despite similar union rates between groups, the mean time for radiological union was longer in group 2 (10.7 vs 7.4 months, p = 0.001). Though statistically insignificant, more asymmetric union was observed in group 2 (17 vs 11 cases). CONCLUSIONS Despite a delay in initial callus and bridging callus formation, scattering the proximal screws was better in achieving earlier and more balanced radiographic union than the clustered fixation. We recommend to avoid bridging more than five holes in the whole plate fixation construct to lessen the asymmetric callus formation and to prevent eventual plate breakage.
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Affiliation(s)
- Jae Hoon Jang
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea
| | - Seung Joon Rhee
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
| | - Se Bin Jun
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea
| | - Yoon Young Choi
- Department of Diagnostic Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Jia Y, Liu A, Guo T, Chen J, Yu W, Zhai J. Efficacy and safety of tension band wire versus plate for Mayo II olecranon fractures: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:373. [PMID: 35922818 PMCID: PMC9351198 DOI: 10.1186/s13018-022-03262-7] [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: 05/29/2022] [Accepted: 07/24/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose For olecranon fractures, the choice of tension band wire (TBW) or plate fixation has long been controversial. Therefore, this study aimed to evaluate the efficacy and safety of TBW and plate in the treatment of patients with Mayo II olecranon fractures by Meta-analysis.
Methods PubMed, Embase, Cochrane, the Web of Science, China National Knowledge Infrastructure, Wanfang, and China Biomedical Database were searched for randomized controlled trials (RCTs) and cohort studies (CSs) where TBW was compared with plate for Mayo II olecranon fractures (OF). Subsequently, the data were extracted by two reviewers independently and were analysed via RevMan5.4.1. Besides, mean difference (MD), risk ratio (RR), and 95% confidence intervals (CIs) were calculated. Furthermore, Cochrane Risk of Bias Tool 2.0 and Newcastle–Ottawa Scale were adopted for assessing the risk of bias. Results A total of 1RCT and 10 CSs were included, when 449 cases were treated with TBW and 378 with plate. The plate has favourable postoperative long-term (≥ 1 year) functional score in MEPS (MD: − 3.06; 95% CI − 5.50 to 0.62; P = 0.01; I2 = 41%) and Dash score (MD: 2.32; 95% CI 1.91, 2.73; P < 0.00001; I2 = 0%), also carrying fewer complications (RR: 2.13; 95% CI 1.48, 3.08; P < 0.0001; I2 = 58%). Besides, there exists no significant difference in postoperative long-term (≥ 1 year) elbow flexion (MD: − 1.82°; 95% CI − 8.54, 4.90; P = 0.60; I2 = 71%) and extension deficits (MD: 1.52°; 95% CI − 0.38, 3.42; P = 0.12; I2 = 92%). Moreover, TBW is featured with a shorter operation time (MD = − 5.87 min; 95% CI − 7.93, − 3.82; P < 0.00001; I2 = 0) and less intraoperative bleeding (MD: − 5.33 ml; 95% CI − 8.15, − 2.52; P = 0.0002; I2 = 0). In terms of fracture healing time, it is still controversial. Furthermore, the subgroup analysis has revealed that for Mayo IIA OF, the plate has a better outcome in the long-term (≥ 1 year) postoperative MEPS, the Dash score, and the incidence of postoperative complications than TBW, while there is no significant difference in the long-term (≥ 1 year) postoperative elbow motion between two groups. Conclusions Plate has better efficacy and safety for Mayo II OF. Considering that few studies are included in the meta-analysis, more high-quality RCTs are still required to confirm these findings. PROSPERO registration number: CRD42022313855. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03262-7.
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Affiliation(s)
- Yizhen Jia
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Aifeng Liu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China. .,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
| | - Tianci Guo
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jixin Chen
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Weijie Yu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jingbo Zhai
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
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Shi F, Hu H, Tian M, Fang X, Li X. Comparison of 3 treatment methods for midshaft clavicle fractures: A systematic review and network meta-analysis of randomized clinical trials. Injury 2022; 53:1765-1776. [PMID: 35459544 DOI: 10.1016/j.injury.2022.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 02/09/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our study aims to evaluate the fracture nonunion rate and the functional score of plate and screw fixation, intramedullary nailing and non-surgical treatment in midshaft clavicle fractures patients using a network meta-analysis of data from clinical randomized controlled trials. MATERIAL/METHODS The studies were abstracted from Medline, Embase, Web of Science, Google Scholar and the Cochrane Central Register of Controlled Trials. RCTs meeting the inclusion and exclusion criteria were selected. Statistical analyses were conducted using Stata software, version 14.0 (Stata Corporation, College Station, Texas, USA). RESULTS 24 randomized controlled trials involving 2161 participants were included. The studies were published between 2007 and 2019. A total of 3 treatment methods-plate and screw fixation, intramedullary nailing and non-surgical treatment- were included in the literature. The treatments were ranked based on the Surface Under the Cumulative Ranking Curve (SUCRA) probability. In terms of the constant score, the treatment methods were ranked as follows: intramedullary nailing, plate and screw fixation and non-surgical treatment. In terms of the DASH index, the treatment methods were ranked as follows: intramedullary nailing, plate and screw fixation and non-surgical treatment. In terms of the nonunion rate, the treatment methods were ranked as follows: intramedullary nailing, plate and screw fixation and non-surgical treatment. CONCLUSION Non-surgical treatment has a high rate of nonunion for clavicular fractures with obvious displacement and notable comminution. Surgical treatment reduces the nonunion rate leads to better functional scores at long-term follow-up, although there may be no significant clinical differences. The fracture nonunion rate of plate screw fixation group and intramedullary nail group was low and the functional prognosis was similar. More RCTs focused on clavicular fractures are needed to further substantiate this conclusion.
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Affiliation(s)
- Fangling Shi
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo 315040, China
| | - Haoliang Hu
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo 315040, China
| | - Mintao Tian
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo 315040, China
| | - Xuanliang Fang
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo 315040, China
| | - Xueyuan Li
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo 315040, China.
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Ott N, Hackl M, Prescher A, Scaal M, Lanzerath F, Müller LP, Wegmann K. The effect of long calcar screws on the primary stability of 3-part, varus impacted proximal humeral fractures compared to short calcar screws: a real fracture simulation study. Arch Orthop Trauma Surg 2022; 143:2485-2491. [PMID: 35635575 PMCID: PMC10110638 DOI: 10.1007/s00402-022-04473-7] [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: 09/17/2021] [Accepted: 04/27/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Complex proximal humeral fracture ranks among the most common fracture types, especially in elderly patients. In locked plate fixation of proximal humerus fractures, the calcar is deciding for screws providing further medial column support. To date, the biomechanical effect of the length of these calcar screws is not well known. The purpose of this study was to analyze the effect of long calcar screws on fresh frozen prefractured cadaveric specimens. METHODS In the present biomechanical study, 8 pairs of cadaveric proximal humeri were fractured identically using a custom-made fracture simulator. ORIF was performed using a locking plate (PHILOS; Fa. Synthes). The specimens were tested in a biomechanical setup under increased axial load without any calcar screws installed, with short calcar screws and long calcar screws installed. Strain gages (4-wire-120 Ohm, Fa. Vishay) mounted on the locking plate were used to evaluate the fixation strain and to give an estimate for primary stability.. RESULTS The measured strain of the locking plate without calcar screws (804,64 µm/m) at maximum load (200 N) was significantly higher than with short (619,07 µm/m; p = 0.02) or long calcar screws (527,31 µm/m; p = 0.007). Additionally, strain with short calcar screws was noticeably higher in comparison to long calcar screws (619,07 µm/m vs. 527,31 µm/m; p = 0.03). CONCLUSION Use of calcar screws improves the stability of realistically impacted 3-part varus humeral fractures. Long calcar screws that are positioned as close as possible to the joint provide further primary stability compared to short calcar screws. LEVEL OF EVIDENCE Basic science study.
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Affiliation(s)
- Nadine Ott
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - Michael Hackl
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy -Prosektur, RWTH Aachen, Aachen, Germany
| | - Martin Scaal
- Department of Anatomy, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Fabian Lanzerath
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Lars Peter Müller
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Kilian Wegmann
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany.,Orthopädische Chirurgie München, OCM Clinic, Steinerstrasse 6, 81369, Munich, Germany
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Toro G, Braile A, De Cicco A, Pezzella R, Ascione F, Cecere AB, Schiavone Panni A. Fragility Fractures of the Acetabulum: Current Concepts for Improving Patients' Outcomes. Indian J Orthop 2022; 56:1139-1149. [PMID: 35813545 PMCID: PMC9232661 DOI: 10.1007/s43465-022-00653-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
The incidence of fragility fractures of the acetabulum (FFA) is constantly increasing. Generally, these fractures are related to a fall on the greater trochanter involving the anterior column. The management of FFA is extremely difficult considering both patients' comorbidities and poor bone quality. Both non-operative and several operative treatment protocols are available, and the choice among them is still ambiguous. The proposed surgical techniques for FFA [namely open reduction and internal fixation (ORIF), percutaneous fixation and total hip arthroplasty (THA)] are associated with a high complication rate. The treatment with the higher early mortality is the ORIF + THA, while the one with the lowest is the non-operative. However, at longer follow-up, this difference dreadfully change is becoming the opposite. Frequently ORIF, percutaneous fixation, and non-operative treatment need a subsequent re-operation through a THA. This latter could be extremely difficult, because of poor bone quality, acetabular mal union/non-union, bone gaps and hardware retention. However, the outcomes of each of the proposed treatment are mostly poor and controverted; therefore, a comprehensive patient evaluation and an accurate fracture description are required to appropriately manage acetabular fracture in the elderly.
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Affiliation(s)
- Giuseppe Toro
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy ,grid.6530.00000 0001 2300 0941Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Adriano Braile
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Annalisa De Cicco
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Raffaele Pezzella
- Unit of Orthopedics and Traumatology, AORN San Giuseppe Moscati, 83100 Avellino, Italy
| | - Francesco Ascione
- grid.461850.eDepartment of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Naples, Italy
| | - Antonio Benedetto Cecere
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Alfredo Schiavone Panni
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Kaya V, Kilic F, Yamak F, Ekin EE, Basar H, Misir A. Biomechanical and fracture characteristics of different filling and fixation methods applied to various proximal tibial metaphyseal defect sizes in an ovine model. Clin Biomech (Bristol, Avon) 2022; 93:105597. [PMID: 35193076 DOI: 10.1016/j.clinbiomech.2022.105597] [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: 06/05/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ideal treatment method based on the size of the defect in local aggressive bone tumors is yet to be described. We evaluated the mechanical behavior of different fixation methods for various defect sizes located in the proximal tibia. METHODS Ninety-one sheep tibiae were distributed in five groups. Each study group was further divided into three subgroups, forming 25%, 50%, and 75% metaphyseal defects. The five groups were divided as follows: 1) control group where tibiae remained intact (n = 7); 2) isolated defect created, without filling (n = 21); 3) filling with cement (n = 21); 4) application of two subchondral cortical screws in addition to cement (n = 21); and 5) application of plate-screw fixation in addition to cement (n = 21). A loading test simulating the axial load applied by the distal femur to the tibia plateau was performed. The maximum failure load was compared between groups according to the defect size and fixation method. FINDINGS In 25% defects, group 5 had significantly higher failure load than other groups. However, in 50% and 75% defects, additional fixation did not increase the failure load. Also, additional screw fixation did not increase failure load in all defect sizes. There was a significant positive correlation between fracture morphology and defect size, fixation method, and failure load. INTERPRETATION Additional plate-screw fixation would increase the stability in defects ≤25%. In defects ≥50%, additional fixation does not increase stability. Screw fixation in addition to cementing does not increase stability in all defect sizes.
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Affiliation(s)
| | - Feyzi Kilic
- Health Sciences University Gaziosmanpasa Training and Research Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Fatih Yamak
- Istanbul Technical University, Faculty of Mechanical Engineering, Strength of Materials and Biomechanics Laboratory, Istanbul, Turkey.
| | - Elif Evrim Ekin
- Health Sciences University Gaziosmanpasa Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Hakan Basar
- Health Sciences University Gaziosmanpasa Training and Research Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Abdulhamit Misir
- Medicana International Istanbul Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey.
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Shapiro G, Adato T, Paz S, Shrabaty T, Ron L, Simanovsky N, Zaidman M, Goldman V. Hemiepiphysiodesis for coronal angular knee deformities: tension-band plate versus percutaneous transphyseal screw. Arch Orthop Trauma Surg 2022; 142:105-113. [PMID: 32959086 DOI: 10.1007/s00402-020-03602-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/20/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Pediatric coronal plane knee deformities can be treated surgically using hemiepiphysiodesis. The two leading techniques used for hemiepiphysiodesis are: tension-band plates (TBP) and percutaneous transphyseal screws (PETS). We hypothesized that PETS would lead to faster guided correction of angular knee deformities than TBP. MATERIALS AND METHODS A retrospective cohort of 35 patients treated with either TBP or PETS in one medical institution was established. The cohort included both genu varum and genu valgum of both primary and secondary etiologies. We first compared the treatment groups for differences in demographic and malalignment characteristics. Then, we compared the treatment groups for differences in operation-related outcomes, radiological mechanical correction and complication rates. RESULTS We found that the use of PETS, compared to TBP, was associated with a faster implantation surgery and a shorter interval between implantation and removal, i.e., faster correction. Furthermore, PETS were associated with faster correction rates of the mechanical axis deviation, lateral distal femoral angle and medial proximal tibial angle. No significant differences in complication rates were found between the two treatments. CONCLUSION PETS provided a faster correction of angular knee deformities compared to TBP at similar complication rates. Hence, PETS could be considered a superior technique for hemiepiphysiodesis.
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Affiliation(s)
- Galina Shapiro
- Medical Corps, Israel Defense Forces, Military Post, 02149, Ramat Gan, Israel
| | - Tohar Adato
- Medical Corps, Israel Defense Forces, Military Post, 02149, Ramat Gan, Israel
| | - Shai Paz
- Pediatric Orthopedics Unit, Department of Orthopedic Surgery, Kyriat Hadassah, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Tareq Shrabaty
- Pediatric Orthopedics Unit, Department of Orthopedic Surgery, Kyriat Hadassah, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Lamdan Ron
- Pediatric Orthopedics Unit, Department of Orthopedic Surgery, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Naum Simanovsky
- Pediatric Orthopedics Unit, Department of Orthopedic Surgery, Kyriat Hadassah, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Michael Zaidman
- Pediatric Orthopedics Unit, Department of Orthopedic Surgery, Kyriat Hadassah, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Vladimir Goldman
- Pediatric Orthopedics Unit, Department of Orthopedic Surgery, Kyriat Hadassah, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
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Jung HS, Cho HC, Lee JS. Combined Approach for Intra-articular Distal Radius Fracture: A Case Series and Literature Review. Clin Orthop Surg 2021; 13:529-538. [PMID: 34868503 PMCID: PMC8609214 DOI: 10.4055/cios20291] [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: 11/28/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to classify the possible indications for a combined approach to distal radius fractures (DRFs) by investigating surgical outcomes of patients treated according to our treatment algorithm. Methods A combined approach was performed in 32 patients. Patients who were thought to need a combined approach were classified into three types according to the combined injuries associated with loss of volar cortical buttresses in DRFs. The classifications included the following: type 1, free intra-articular fragments; type 2, distally migrated dorsal fragments located beyond the wrist joint; and type 3, centrally impacted articular fragments and displaced dorsal fragments, not reduced by indirect methods. Results Seven patients had type 1 fractures treated with volar plates and excision of the intra-articular fragments. Fourteen patients had type 2 fractures: 12 were treated with volar plates and excision of dorsal fragments, and 2 with relatively large unstable dorsal fragments were treated with combined volar and dorsal plates. The remaining 11 patients had type 3 fractures treated with combined volar and dorsal plates. At the latest follow-up, the radiographs revealed an average of 16.9° of radial inclination, an average of 4.2° of volar tilt, and an average of 7.5 mm of radial height. According to the Garland and Werley scores, the functional results were excellent for 3 patients, good for 25, and fair for 4. Conclusions The classification system indicated when an additional dorsal approach was needed in unstable DRFs, and it may establish useful guidelines for appropriate surgical decision-making.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Hyung-Chul Cho
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jae Sung Lee
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
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Jamshidi K, Bahardoust M, Karimi Behnagh A, Bagherifard A, Mirzaei A. How the Choice of Osteosynthesis Affects the Complication Rate of Intercalary Allograft Reconstruction? A Systematic Review and Meta-analysis. Indian J Orthop 2021; 56:547-558. [PMID: 35342531 PMCID: PMC8921354 DOI: 10.1007/s43465-021-00563-7] [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: 07/18/2021] [Accepted: 11/01/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no clear consensus on the optimal type of fixation in intercalary allograft reconstruction. In this study, we aimed to compare the rate of most common complications following the plate and nail fixation of the intercalary allograft. MATERIALS AND METHODS We searched PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library. Studies in which the complication rate of the single bridging plate and intramedullary nail fixation was extractable were included. Studies that used extra procedures such as cementation and fibular vascular graft augmentation were excluded. The primary outcome was the fixation-specific rate of nonunion. Secondary outcomes were the fixation-specific rate of fracture, infection, and local recurrence. RESULTS In total, 13 studies with 431 reconstructions (352 reconstructions in the plate group and 79 reconstructions in the intramedullary nailing group) were included in this study. In the plate fixation, the rate of nonunion, fracture, infection and local recurrence was 12%, 11%, 11%, and 3%, respectively. In the intramedullary nail fixation, the rate of nonunion, fracture, infection, and local recurrence was 37%, 5%, 4%, and 0%, respectively. The rate of nonunion was significantly higher in the intramedullary nail group (OR = 6.34; 95% CI 2.98-13.49, P < 0.001). The rate of fracture, infection, and local recurrence was not significantly different between the two fixation methods. CONCLUSIONS Intramedullary nail is associated with a significantly higher rate of nonunion. Since the rate of other complications was not significantly different between the two osteosynthesis types, plate fixation could be considered as a better type of fixation. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00563-7.
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Affiliation(s)
- Khodamorad Jamshidi
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Bahardoust
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran ,grid.411600.2Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Karimi Behnagh
- grid.411746.10000 0004 4911 7066Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Wright DJ, Etiz B, Scolaro JA. Combined plate and nail fixation of bicondylar tibial plateau fractures. Injury 2021; 52:3104-3110. [PMID: 34275650 DOI: 10.1016/j.injury.2021.07.010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/01/2021] [Accepted: 07/04/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bicondylar tibial plateau fractures with meta-diaphyseal comminution commonly have a compromised soft tissue envelope. Combined plate-nail fixation is an emerging technique that utilizes a limited anterolateral approach for plate application and percutaneous incisions for placement of an intramedullary nail. This technique alleviates the need for a separate medial approach to the proximal tibia. We report a series of patients treated with this approach and outline the steps for implementation. METHODS We performed a retrospective review of 18 consecutive patients treated with combination lateral locked plating and intramedullary nailing at a single academic institution from 2016 to 2019. Of these, 16 patients met inclusion criteria and were included in this study. All patients had AO/OTA type 41C2/C3 fractures. Primary outcomes included coronal plane and sagittal plane alignment at latest follow up, rate of articular subsidence at latest follow up, and rate of postoperative infection. RESULTS Of the 16 patients included, average followup was 8.2 months (range 0.1-29.7 months). At latest follow-up, average coronal alignment ranged from 0.8±1.2 degrees of varus (maximum 4.0 degrees) to 1.4±1.7 degrees of valgus (maximum 4.0 degrees). Average sagittal alignment ranged from 0.8±1.1 degrees of procurvatum (maximum 3.0 degrees) to 0.6±1.2 degrees of recurvatum (maximum 4.0 degrees). There was no radiographic evidence of articular subsidence at latest follow up for any patient. One patient (5.9%) presented at 141 days postoperatively with a draining wound and infection. CONCLUSIONS Combination plate-nail fixation is a viable option for treating patients with select bicondylar tibial plateau fractures with meta-diaphyseal comminution. This case series with short-term followup demonstrates acceptable radiographic and clinical outcomes, as well as rates of postoperative infection and implant removal similar to those currently reported in the literature for other techniques used to treat these fractures.
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Affiliation(s)
- David J Wright
- Orthopaedic Resident, University of California, Irvine. Orange, CA USA
| | - Brent Etiz
- Medical Student, University of California, Irvine. Irvine, CA USA
| | - John A Scolaro
- Associate Professor, University of California, Irvine, 101 The City Drive South, Building 29A, Pavilion III - 2nd Floor, Irvine, Orange, CA, 92868, USA.
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Boyer P, Couffignal C, Bahman M, Mylle G, Rousseau MA, Dukan R. Displaced three and four part proximal humeral fractures: prospective controlled randomized open-label two-arm study comparing intramedullary nailing and locking plate. Int Orthop 2021; 45:2917-2926. [PMID: 34554308 DOI: 10.1007/s00264-021-05217-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was (1) to compare clinical and radiological outcomes of 3- and 4-part proximal humeral fractures using either IMN or LP (2) and to report complications related to each technique. METHODS A prospective controlled randomized open-label two-arm study was performed. Ninety-nine consecutive adult patients with a 3- and 4-part displaced acute proximal humeral fractures were randomized to be treated with IMN (n = 49) or LP (n = 50). Constant, ASES and SST scores were recorded by the surgeon. Range of motion was evaluated. A visual analog scale (VAS) was used to assess shoulder pain. Complications and revision surgeries were reported. RESULTS Eighty-five patients were analyzed, nine were lost, and five died during the follow-up period. The mean age was 73.7 years (± 13.3,, and the mean follow-up was 66 months (± 13.5). At last follow-up, VAS was lower in the IMN group (0.9 (± 1.1) vs. 1.9 (± 1.7), p = 0.001). The median Constant score was significantly higher in the IMN group (81.6 (± 10.9) points) vs. in the LP group (75.6 (± 19.5) points) (p = 0.043), and ASES score was also significantly higher in the IMN group (86.3 (± 9.5) vs. 75.2 (± 19.6), p = 0.001). There was no difference in the range of motion or SST scores between the two groups. Complications were seen higher in the LP group (9 (21%) vs. 22 (52%), p = 0.003). Revision surgery was higher in the LP group (37% vs. 21%). CONCLUSION Satisfactory results were accomplished in both groups according to the reported clinical outcomes. Complication and revision rates were higher in LP group.
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Affiliation(s)
- Patrick Boyer
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France
| | - Camille Couffignal
- Clinical Research, Biostatistics and Epidemiology Department, AP-HP, Hôpital Bichat, F-75018, Paris, France
| | - Mohammad Bahman
- Alrazi Hospital, University of Kuwait, Al Sabah Medical Area, Kuwait, Kuwait
| | - Guy Mylle
- Clinique Hartmann, Neuilly Sur Seine, France
| | - Marc-Antoine Rousseau
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France
| | - Ruben Dukan
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France.
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Furuhata R, Matsumura N, Udagawa K, Oki S, Morioka H. Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns. JSES Int 2021; 5:840-845. [PMID: 34505093 PMCID: PMC8411066 DOI: 10.1016/j.jseint.2021.04.017] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Plate fixation is an established treatment for Neer type II and V distal clavicle fractures; however, residual coracoclavicular (C-C) separation after osteosynthesis for unstable distal clavicle fractures has rarely been discussed. This study aimed to reveal the extent of postoperative C-C separation after plate fixation for distal clavicle fractures and to evaluate the relationship between residual C-C separation and the risk of postoperative complications. Methods We retrospectively reviewed 60 patients with a displaced distal clavicle fracture that was treated with a Scorpion plate without C-C reconstruction and successfully united. Distal clavicle fractures were divided as per the Neer classification into type IIA (12 patients), IIB (36 patients), and V (12 patients) groups. The modified C-C distance ratio at the time of injury and after bone union, and the postoperative complications (plate-related pain, delayed union, infection, and contracture) were compared among the three groups. Results The mean postoperative modified C-C distance ratio was 115.0% ± 12.0%; this ratio was significantly larger in the type IIB and V groups than in the type IIA group (P = .021 and P = .006, respectively). However, there was no significant difference in the frequency of postoperative complications among the three groups. Conclusions Our study demonstrated that a certain degree of C-C separation remained after plate fixation for Neer type II and V distal clavicle fractures, even when bone union was achieved. The postoperative residual C-C separation was greater for the type IIB and V groups than for the type IIA group; however, this difference may not affect postoperative complications.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Tokyo, Japan.,Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiko Udagawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopaedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya-shi, Tochigi, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Tokyo, Japan
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Owen DH, Perriman DM, Policinski I, Damiani M, Smith PN, Roberts CJ. Total wrist arthrodesis with and without arthrodesis of the carpoMetacarpal joint (WAWWAM): study protocol. BMC Musculoskelet Disord 2021; 22:766. [PMID: 34496832 PMCID: PMC8425134 DOI: 10.1186/s12891-021-04644-4] [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: 05/03/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background It is controversial whether or not the carpometacarpal joint (CMCJ) should be included in total wrist arthrodesis (TWA). Complications commonly occur at this site and studies examining its inclusion and exclusion are conflicting. A randomised clinical trial comparing wrist arthrodesis with CMCJ arthrodesis and spanning plate to wrist arthrodesis with CMCJ preservation and non-CMCJ spanning plate has not been performed. Method A single centre randomised clinical trial including 120 adults with end-stage isolated wrist arthritis will be performed to compare TWA with and without the CMCJ included in the arthrodesis. The primary outcome is complications in the first post-operative year. Secondary outcomes are Disabilities of the Arm, Shoulder and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) and grip strength measured at 1, 2 and 5 years. Late complications, return to work and satisfaction will also be recorded. Discussion It is unknown whether the CMCJ should be included in TWA. This trial will contribute to an improved understanding of optimal management of the CMCJ in total wrist arthrodesis. Trial registration This trial was prospectively registered with the Australia New Zealand Clinical Trials Registry with identifying number ACTRN12621000169842 on the 16th February 2021. WHO: U1111–12626523. ANZCTR: ACTRN12621000169842 Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04644-4.
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Affiliation(s)
- David H Owen
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia. .,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia.
| | - Diana M Perriman
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia.,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia
| | - Igor Policinski
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia.,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia
| | - Maurizio Damiani
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia.,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia
| | - Paul N Smith
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia.,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia
| | - Chris J Roberts
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia.,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia
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Abstract
PURPOSE OF REVIEW Fracture fixation aims to provide stability and promote healing, but remains challenging in unstable and osteoporotic fractures with increased risk of construct failure and nonunion. The first part of this article reviews the clinical motivation behind finite element analysis of fracture fixation, its strengths and weaknesses, how models are developed and validated, and how outputs are typically interpreted. The second part reviews recent modeling studies of the femur and proximal humerus, areas with particular relevance to fragility fractures. RECENT FINDINGS There is some consensus in the literature around how certain modeling aspects are pragmatically formulated, including bone and implant geometries, meshing, material properties, interactions, and loads and boundary conditions. Studies most often focus on predicted implant stress, bone strain surrounding screws, or interfragmentary displacements. However, most models are not rigorously validated. With refined modeling methods, improved validation efforts, and large-scale systematic analyses, finite element analysis is poised to advance the understanding of fracture fixation failure, enable optimization of implant designs, and improve surgical guidance.
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Affiliation(s)
- Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA.
| | | | - Hwabok Wee
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA
| | - J Spence Reid
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
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Wenger D, Henning H, Bergkvist D, Rogmark C. Fewer reoperations after posterolateral plate positioning compared with lateral plate positioning in ankle fractures-a retrospective study on 453 AO/OTA 44-B injuries. Injury 2021; 52:1999-2005. [PMID: 33879339 DOI: 10.1016/j.injury.2021.04.008] [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: 12/05/2020] [Revised: 03/14/2021] [Accepted: 04/04/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ankle fractures are commonly treated by open reduction and internal fixation with plate and screws. Unplanned return to theatre is common, in many cases to extract prominent osteosynthesis material from the lateral malleolus as swelling subsides. We hypothesised that patients operated with a posterolateral plate placement on the lateral malleolus would have fewer reoperations, and fewer complications, compared to patients with a lateral plate placement. MATERIALS AND METHODS From a prospectively collected database of all orthopaedic surgery performed at our institution, we identified 664 ankle fractures undergoing plate fixation between 2008-01-01 and 2012-04-30. Radiographs were analysed to only include AO/OTA 44-B-fractures (n = 453), and to define study groups based on plate positioning. Hospital files were assessed to identify possible confounding factors, and any unplanned reoperation or complication. Complications were classified according to Dindo-Clavien. RESULTS The risk of reoperation was 13% after posterolateral plating, compared with 24% after lateral plating; absolute risk reduction 10% (95% CI: 2.5-18), p = 0.02. After adjusting for possible confounders, the odds ratio of undergoing reoperation after lateral plating was 2.2 (95% CI: 1.17-4.1), p = 0.01. The two surgical methods did not differ with regard to complication frequency: 31% vs 34%, p = 0.6, but complications following lateral plate fixation were more serious, p = 0.03. Plate positioning depended on surgeon preference. DISCUSSION The two studied methods are both considered standard treatment of ankle fractures, and relatively simple surgical procedures. High rates of secondary surgery after plate fixation have been reported, but no study comparing plate positioning has been previously published to our knowledge. AO Sweden has recently switched to teaching posterolateral plating in group exercises during the AO Basic Fracture Surgery course, based on the belief that it may be safer than lateral plating. Our findings support this change in practice. CONCLUSIONS Posterolateral plate positioning on the lateral malleolus in AO/OTA 44-B-fractures may be preferential to lateral plate positioning, due to a large difference in unplanned secondary surgery.
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Affiliation(s)
- Daniel Wenger
- Department of Orthopaedics, Skåne University Hospital, Inga Marie Nilssons gata 22, 205 02 Malmö, Sweden; Faculty of Medicine, Lund University, Box 117, 221 00 Lund, Sweden.
| | - Hampus Henning
- Faculty of Medicine, Lund University, Box 117, 221 00 Lund, Sweden
| | - Dan Bergkvist
- Department of Orthopaedics, Skåne University Hospital, Inga Marie Nilssons gata 22, 205 02 Malmö, Sweden; Faculty of Medicine, Lund University, Box 117, 221 00 Lund, Sweden.
| | - Cecilia Rogmark
- Department of Orthopaedics, Skåne University Hospital, Inga Marie Nilssons gata 22, 205 02 Malmö, Sweden; Faculty of Medicine, Lund University, Box 117, 221 00 Lund, Sweden
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Xu X, Zhu Q, Yang Y, Yang H, Wang L, Chen X, Chen Y, Lin P. Investigation of perioperative blood loss of femoral shaft fractures treated with intramedullary nail or locking compression plate. Injury 2021; 52:1891-1896. [PMID: 33853738 DOI: 10.1016/j.injury.2021.04.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/08/2021] [Accepted: 04/03/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral shaft fractures (FSFs) are associated with significant blood loss, resulting in anemia and hemorrhagic shock. However, there has been limited data for the blood loss of FSFs during the whole perioperative period. Our primary aim is to quantify the blood loss associated with FSFs treated with intramedullary nail or locking compression plate fixation, as well as to identify the relative affecting factors for perioperative hidden blood loss (HBL). PATIENTS AND METHODS 131 consecutive patients with FSFs were enrolled in the retrospective study between January 2009 and January 2020, including 90 cases for intramedullary nail (Nail group) and 41 cases for locking compression plate fixation (Plate group). Demographics and perioperative data were collected and analyzed. Total blood loss (TBL), visible blood loss (VBL), HBL, and percentage of HBL (PHBL) were calculated based on hematocrit (Hct) changes. RESULTS There was a large drop of hemoglobin (Hb) during the perioperative time. Of all 131 patients, the average HBL was 1445.5 ± 443.2 mL, accounting for 78.7% of TBL (1815.1 ± 446.3 mL). TBL and HBL in Nail group were 1886.1 ± 438.6 mL and 1546.0 ± 424.7 mL; while TBL and HBL in Plate group were 1659.5 ± 427.9 mL and 1225.1 ± 405.7 mL. The differences between the two groups were statistically significant (p = 0.007, p < 0.001, respectively). Besides, statistical significance (p< 0.05, p< 0.05, respectively) was also reported in HBL between Type-A and Type-C, and between Type-B and Type-C (1395.8 ± 444.8 mL vs. 1651.6 ± 495.7 mL; and 1411.2 ± 383.4 mL vs. 1651.6 ± 495.7 mL, respectively). CONCLUSIONS Patients of FSFs had significant TBL and HBL, the amount of which was much larger than that observed intra-operatively. Moreover, two readily available preoperative factors for nail fixation and Type-C were associated with a higher likelihood of more HBL. Therefore, it was argued that regular perioperative monitoring and timely blood transfusion were crucially important for patients to avoid possible risks of anemia and facilitate recovery.
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Affiliation(s)
- Xiaodong Xu
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qianzheng Zhu
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yurun Yang
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China
| | - Huan Yang
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China
| | - Liqiang Wang
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xingzuo Chen
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ying Chen
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Peng Lin
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China.
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García-Virto V, Santiago-Maniega S, Llorente-Peris A, Simón-Pérez C, Álvarez-Ramos BA, García-Florez L, Aguado HJ. MIPO helical pre-contoured plates in diaphyseal humeral fractures with proximal extension. Surgical technique and results. Injury 2021; 52 Suppl 4:S125-S130. [PMID: 33678466 DOI: 10.1016/j.injury.2021.01.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/12/2020] [Accepted: 01/24/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to determine the feasibility of applying the MIPO technique with a helical-shaped plate in the treatment of humeral shaft fractures with proximal extension. PATIENTS AND METHODS We present an observational prospective study of patients with a humeral shaft fracture involving the proximal humerus fixed with a long proximal humerus polyaxial locking plate with an anterior curvature and helical shape (ALPS® Zimmerbiomet, Warsaw, Indianapolis, USA), using a MIPO technique. Between January 2017 and July 2020, 15 patients were treated at our institution. Proximally a 4-5 cm anterolateral transdeltoid approach was made. And distally, a 5-7 cm incision was made 4 cm proximal to the elbow crease. At each follow-up, radiographs were taken to evaluate fracture healing. Funtional scales were applied to evaluate clinical results. RESULTS Ten women and five men were included, with a mean age of 62 yo (range 26-86). All but one fracture healed uneventfully. The mean time to union was 28 weeks (range 12-48 weeks). Two out of 15 patients presented complications (an atrophic nonunion and a peri‑implant distal fracture). None of the patients had a nerve palsy prior neither after the surgery. No other complications, including infection, were registered during follow-up. Shoulder range of motion showed the following means: abduction of 147° (range 50°-180°), anterior flexion of 144° (range 80°-180°), external rotation of 77,5 ° (range 70°-80°) and internal rotation of 54.5° (range 45°-60°). All patients recovered their pre-fracture elbow range of motion. All patients presented less than 10° of angular deviation in varus/valgus or ante/recurvatum after the surgical procedure. At the end of the follow-up, all final functional scores were "good" or "excellent": mean Constant-Murley score was 72 ± 13 (range 38-91), ASES score was 73 ± 12 (range 41-88), UCLA shoulder scale was 30 ± 3,5 (range 10-35), and Q-DASH score was 16.5 ± 0,11 (range 4-57). CONCLUSION When applied correctly, the treatment of diaphyseal humeral fractures involving the proximal humerus using a polyaxial locking helical plate with a MIPO technique is a reliable treatment method. It has high union rates with low complications.
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Affiliation(s)
| | | | | | - Clarisa Simón-Pérez
- Trauma Unit, Hospital Clínico Universitario de Valladolid, 47003 Valladolid (Spain).
| | | | - Luis García-Florez
- Trauma Unit, Hospital Clínico Universitario de Valladolid, 47003 Valladolid (Spain)
| | - Héctor J Aguado
- Trauma Unit, Hospital Clínico Universitario de Valladolid, 47003 Valladolid (Spain)
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Saccomanno MF, Sircana G, Cardona V, Vismara V, Scaini A, Salvi AG, Galli S, Marchi G, Milano G. Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2021; 29:2175-93. [PMID: 32797247 DOI: 10.1007/s00167-020-06217-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/31/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To systematically review the outcomes of surgical treatments of acute acromioclavicular joint dislocation. METHODS Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of acute acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications, and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist. RESULTS One hundred and thirty-three studies were included for a total of 4473 shoulders. Mean age of participants was 36.9 years. Mean follow-up was 42.06 months. Arthroscopy showed better ASES (p < 0.0001) and lower VAS pain score (p = 0.0249) compared to an open approach. Biologic and synthetic reconstructions demonstrated better results over osteosynthesis techniques. Biologic techniques showed overall better Constant (p = 0.0001) and DASH (p = 0.0215) scores, while synthetic reconstruction showed better UCLA score (p = 0.0001). Among suture buttons, triple button showed overall better results in Constant (p = 0.0001) and VAS (p = 0.0001) scores, while better results in DASH score (p = 0.0003) were achieved by 2 double button techniques. Overall, the level of evidence was low. CONCLUSION Biological and synthetic reconstructions achieved better functional scores compared to osteosynthesis. Among suture buttons, the triple button showed better functional performance. LEVEL OF EVIDENCE IV.
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Lee W, Cooper MT, Perumal V, Tran S, Park JS. Does the length of the plate affect the failure rate of hallux MTP joint arthrodesis for severe hallux valgus? Foot (Edinb) 2021; 47:101773. [PMID: 33946000 DOI: 10.1016/j.foot.2020.101773] [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: 05/25/2020] [Revised: 12/09/2020] [Accepted: 12/26/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to investigate the effect of the length of the dorsal locking plate on the failure rate of first MTP joint arthrodesis for severe hallux valgus deformities. METHODS A retrospective review was conducted for all patients who underwent first MTP joint arthrodesis using solely a specific locked plating system (Depuy-Synthes, Raynham, MA) for severe hallux valgus deformities between January 2014 to June 2017. Patients were divided into subgroups according to the length of the plate and the failure rate was investigated. Furthermore, radiographic parameters including intermetatarsal angle (IMA) and hallux valgus angle (HVA) were evaluated in weightbearing AP foot radiographs. RESULTS A total of 25 patients were included in this study. There were 16 (64%) patients in the medium-sized plate cohort and 9 (36%) patients in the small-sized plate cohort. We found a significant difference in the failure rate between the two groups; only 1 (6.25%) failure case occurred in the medium-sized plate cohort while 4 (44.44%) failure cases occurred in the small-sized plate cohort (P = .040, Odds ratio (OR) = 12.000, 95% Confidence Interval (CI) = 1.074, 134.110). The mean postoperative IMA and HVA were significantly improved in both cohorts. However, significant differences were found between the two cohorts in final follow-up IMA and HVA (P = .002 and P < .001, respectively). CONCLUSIONS For severe hallux valgus deformities, the use of longer plates to gain additional purchase in the diaphyseal bone may help mitigate the increased stresses placed on the fixation constructs for first MTP joint arthrodesis and decrease failure rate. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Wonyong Lee
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 801016 Charlottesville, VA, USA.
| | - Minton T Cooper
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 801016 Charlottesville, VA, USA.
| | - Venkat Perumal
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 801016 Charlottesville, VA, USA.
| | - Sterling Tran
- University of Virginia School of Medicine, UVA School of Medicine, Office of Financial Aid Box 800730, Charlottesville, VA 22908-0730, USA.
| | - Joseph S Park
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 801016 Charlottesville, VA, USA.
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Li J, Tang SP, Mei HB, Shao JF, Shi BJ, Wang HQ, Tang X. Comparison of two methods in the treatment of congenital pseudarthrosis of clavicle: multicenter experience. J Orthop Surg Res 2021; 16:301. [PMID: 33964943 PMCID: PMC8106166 DOI: 10.1186/s13018-021-02438-x] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background Congenital pseudoarthrosis of the clavicle (CPC) is an uncommon entity. Owing to its scarce presentation, treatment of this disorder has not been well established. This study aimed (1) to compare surgical treatment methods that included excision of pseudoarthrosis and iliac crest bone graft and fixate with either the elastic stable intramedullary nail (ESIN) or K-wires or plate and screws, and (2) to assess the clinical outcomes of two different surgical methods. Methods A multi-central retrospective study was performed between 2013 and 2017 in four tertiary teaching hospitals. Fifteen clavicles of 11 children were identified as CPC. All patients underwent pseudarthrosis resection and iliac crest bone autograft. They were divided into two groups as per the surgical treatment they underwent—plate stabilization as group A and elastic stable intramedullary nailing (ESIN) or K-wires as group B. Nine clavicles in 6 patients in group A and 6 clavicles in 5 patients in group B, were included. The Quick Disabilities of the Arm and Shoulder (QuickDASH) score was used to assess patients’ satisfaction and function following treatment at each follow-up. Results There were eight boys and three girls, with an average age of 4.7 years. All patients, except one with intellectual impairments, had radiological healing. Implant removal time was significantly shorter in group B compared to group A. No statistically significant differences existed in terms of age at surgery, time of radiological healing, complication, and clinical outcome between different groups. Conclusion Surgical resection of pseudoarthrosis with an iliac crest bone graft was an effective means of surgical treatment in CPC. However, ESIN or K-wires can achieve shorter union time compared to the plate. Hence, surgical treatment is recommended for congenital pseudarthrosis of clavicular in pediatric patients. Level of evidence Retrospective comparative study; Level III
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Affiliation(s)
- Jin Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Sheng Ping Tang
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Shenzhen, 518046, China
| | - Hai Bo Mei
- Department of Orthopedics, Hunan Children's Hospital, Changsha, 410007, China
| | - Jing Fan Shao
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bao Jie Shi
- Department of General Surgery, Xiang'an Hospital of Xiamen University, Xiamen, 361000, China
| | - Hai Qiang Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xi'an, 712046, Xixian District, China
| | - Xin Tang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Jang JH, Cho YJ, Choi YY, Rhee SJ. Hammock plating for comminuted inferior sleeve avulsion fractures of the patella: A surgical technique and clinical results. Orthop Traumatol Surg Res 2021; 107:102866. [PMID: 33677129 DOI: 10.1016/j.otsr.2021.102866] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/24/2020] [Accepted: 10/30/2020] [Indexed: 02/03/2023]
Abstract
Comminuted inferior sleeve avulsion fractures of the patella is a surgical challenge owing to the lack of directly purchasable bone fragments and the vulnerable patellar tendon below the displaced lip fragments. Despite the reports of various techniques to treat this fracture, still there is need for a new surgical technique to improve the reduction construct. The purpose of this article is to introduce Hammock plating, which is a surgical technique for comminuted inferior sleeve avulsion patella fractures that utilizes synthetic suture and a low-profile mini plate. The reduction construct provides an indirect reduction of the inferior sleeve fragments to form a hammock-like construct that embraces and lifts the lip fragments upward altogether that enables a firm bone-to-bone union. The advantages also include relatively simple and easy procedure with less injury to the fractured bone fragments and patellar tendon.
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Affiliation(s)
- Jae Hoon Jang
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University Hospital, Busan, Korea
| | - Yoon Jae Cho
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University Hospital, Busan, Korea
| | - Yoon Young Choi
- Department of Diagnostic Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Joon Rhee
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University Hospital, Busan, Korea.
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Capitani P, Chiodini F, Di Mento L, Cavanna M, Bove F, Capitani D, Berlusconi M. Locking compression plate fixation in humeral shaft fractures: A comparative study to literature conservative treatment. Injury 2021; 54 Suppl 1:S2-S8. [PMID: 33757663 DOI: 10.1016/j.injury.2021.03.027] [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: 01/07/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Humeral shaft fractures represent about 3% of all fractures. While there are several treatment options for this type of fractures, there is no evidence in literature showing which is the best one. This study aims at analysing the outcomes for patients with humeral shaft fractures treated with Locking Compression Plate (LCP) fixation in our hospital and comparing them with the outcome for patients conservatively treated (according to data from Pubmed),in order to determine the best treatment option. MATERIALS AND METHODS We treated surgically 220 humeral shaft fractures in our department from February 2005 to March 2012. Seventy-three of them met all the inclusion criteria for this study. All fractures were then classified according to the AO classification. The follow-up considered the radiographic healing of the fracture. All patients were treated with plate fixation (LCP - DePuySynthes Co). At the end of the four-year follow-up, the function was evaluated by means of the DASH score. A systematic review of the literature of the last 20 years was performed on MEDLINE (PubMed). RESULTS We had 2 infections and 8 patients had postoperative nerve palsy which recovered in average time of 6.7 months. In addition, 4 fractures (5.48%) didn't heal within 6 months and they were considered as nonunions and healed after a second surgery. One of these 4 nonunions was infected. The mean DASH score was 18.24±19.18. No malunions were found. We identified 13 studies that were eligible for our systematic review. The mean non-union rate found was 17% in 2517 fractures with a follow-up that ranging from 67% to 100% of patients and a primary radial nerve palsy ranging from 0 to 115 patients. Malalignment rate ranged from 12.7 to 42%. CONCLUSIONS After taking into account both the conservative and the surgical treatment, for humeral shaft fractures we suggest the operative treatment, because the patient's function of the upper limb recovers quickly in the immediate postoperative period and the incidence of malunions may be avoided.
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Affiliation(s)
- P Capitani
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy; Trauma Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
| | - F Chiodini
- Department of Orthopedics and Traumatology, ASST Ovest Milanese - Ospedale di Legnano, Legnano, Italy
| | - L Di Mento
- Trauma Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Cavanna
- Trauma Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - F Bove
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy
| | - D Capitani
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy
| | - M Berlusconi
- Trauma Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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