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Hornung CM, Kramer R, Levine J, Hannink G, Hoogervorst P. Functional outcomes and complications of plate fixation for midshaft clavicle fractures by type and location: a systematic review and meta-analysis. JSES Int 2024; 8:407-422. [PMID: 38707570 PMCID: PMC11064701 DOI: 10.1016/j.jseint.2024.01.007] [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] [Indexed: 05/07/2024] Open
Abstract
Background Various plate types are used in the surgical treatment of displaced midshaft clavicle fractures. These plates can be positioned in different locations on the clavicle, although no studies to date have elucidated optimal plate type and location of fixation. This systematic review compares the functional outcomes and complications in the management of displaced midshaft clavicle fractures using plate fixation by stratifying by both plate type and location. Methods A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to identify all papers reporting functional outcomes, union rates, and/or complications using plates for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until March 2022. A meta-analysis was conducted for functional outcomes and type of complication, stratified by plate type (locking, compression, or reconstruction) and location (superior or anteroinferior). Pooled estimates of functional outcome scores and incidence of complications were calculated using a random effects model. Risk of bias and quality were assessed using the risk of bias version 2 and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tools. The confidence in estimates were rated and described according to the recommendations of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) working group. Results Forty-five studies were included in the systematic review and 43 were included in the meta-analysis. Depending on plate type and location, pooled Constant-Murley Scores ranged from 89.23 to 93.48 at 12 months. Nonunion rates were 3% (95% confidence interval [CI] 1-6) for superior locking plates (GRADE Low). Rates of any complication (nonunion, hardware failure, hardware irritation, wound dehiscence, keloid, superficial infection, deep infection, delayed union, malunion, and/or persistent pain) by plate type and location ranged from 3% to 17% (GRADE Very Low to Moderate). Superior compression plates had the highest incidence of any complications (17% [95% CI 5-44], GRADE Very Low), while anterior inferior compression plates had the lowest incidence of any complication (3% [95% CI 0-15], GRADE Very Low). Hardware irritation was the most reported individual complication for superior locking plates and superior compression plates, 11% (95% CI 7-17, GRADE Low) and 11% (95% CI 3-33, GRADE Very Low), respectively. Conclusion Although most studies were of low quality, studies reporting functional outcomes generally showed good functional results and similar incidence of any complication regardless of plate type and location. There is no evidence of a plate and location combination to optimize patient functional outcomes or complications. We were unable to reliably evaluate union rates or individual complications for most plate types stratified by location.
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Affiliation(s)
- Christopher M. Hornung
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Riley Kramer
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Joshua Levine
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul Hoogervorst
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
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Tosyalı HK, Elibol FKE, Hancıoğlu S, Kaçmaz SE, Çalışkan Öİ, Tolunay T, Demir T, Okçu G. Which implant is better for the fixation of posterior wall acetabular fractures: A conventional reconstruction plate or a brand-new calcaneal plate? Injury 2024; 55:111413. [PMID: 38394707 DOI: 10.1016/j.injury.2024.111413] [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: 12/10/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Increased posterior wall acetabular fractures among older adults, require precise treatment to restore stability to the joint, lower the risk of degenerative arthritis, and enhance overall functional recovery. The purpose of this study was to compare the fixation stability and mechanical characteristics of calcaneal buttress plate and conventional reconstruction plate under different loading condition. METHODS Typical acetabular posterior wall fractures were created on twenty synthetic hemipelvis models. They were fixed with calcaneus plate and reconstruction plate. Dynamic and static tests were performed. Displacements of fracture line and stiffness were calculated. FINDINGS After dynamic loading, calcaneus plate fixation has significantly less displacement than the reconstruction plate on the superior posterior wall. Under static loading condition, the calcaneus plate group has significantly less displacement than the reconstruction plate group on the inferior posterior part of the fracture. The average stiffness values of the calcaneus plate group and the reconstruction plate group were 265.16±53.98 N/mm and 167.48±36.87 N/mm, respectively and a statistically significant difference was found between the two groups. INTERPRETATION The calcaneal plate group demonstrated better stability along the fracture line after dynamic and static loading conditions. Especially when the fragment was on the acetabulum's superior posterior, inferior posterior, and inferior rim, Calcaneal buttress plates offer biomechanically effective choices.
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Affiliation(s)
- Hakan Koray Tosyalı
- Department of Orthopedics and Traumatology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Fatma Kübra Erbay Elibol
- Department of Biomedical Engineering, TOBB University of Economics and Technology, Ankara, Turkey.
| | - Sertan Hancıoğlu
- Department of Orthopedics and Traumatology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Suat Emre Kaçmaz
- Department of Orthopedics and Traumatology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Özde İrem Çalışkan
- Department of Biomedical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
| | - Tolga Tolunay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Teyfik Demir
- Department of Mechanical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
| | - Güvenir Okçu
- Department of Orthopedics and Traumatology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
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Chiu YW, Chen PY, Chen YL, Peng CY, Lu MY, Chen YT, Yang CC. Use of reconstruction plates prebent on three-dimensional models to reduce the complications of mandibular reconstruction. J Dent Sci 2024; 19:473-478. [PMID: 38303842 PMCID: PMC10829746 DOI: 10.1016/j.jds.2023.09.005] [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: 07/22/2023] [Revised: 09/01/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Though the gold standard method for mandible reconstruction of the defect from segmental mandibulectomy is by osseous flap or graft, using reconstruction plates is still indicated in some cases. Traditionally, the plate is bended immediately after the segmental mandibulectomy by freehand. However, it's difficult to fit well to the original position of mandible, which may result in more complications. This study therefore aimed to investigate whether using prebent plates on computer-aided 3D printing models could reduce the complication rate. Materials and methods Patients who received mandible reconstruction by reconstruction plate from 2018 to 2022 were enrolled and evaluated in this study. The data, including demographics, indications for surgery, pre-existed preoperative and postoperative therapies, classification of defects, and postoperative outcomes were collected and analyzed. Results A total of 52 patients were enrolled in our study. The prebent group exhibited a significantly lower complication rate than that of the immediately bent group (P = 0.012). Other risk factors of plate complications included postoperative adjuvant radiotherapy (P = 0.017) and previous surgery (P = 0.047). The complication-free survival rate was also better in the prebent group in a 3-year follow-up period (P = 0.012). Conclusion Prebent plates on computer-aided printing models proved to be an effective approach to reduce the complications for mandibular reconstruction in segmental mandibulectomy.
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Affiliation(s)
- Yu-Wei Chiu
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Yin Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yen-Lin Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chih-Yu Peng
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ming-Yi Lu
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Tzu Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Chieh Yang
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Stomatology, Oral & Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Xiang F, Xiao Y, Wei D, Tan X, He S, Luo L, Yang Y. Finite element analysis of a novel anatomical locking plate for scapular neck fracture. J Orthop Surg Res 2023; 18:262. [PMID: 37004037 PMCID: PMC10067195 DOI: 10.1186/s13018-023-03743-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES Reconstruction plates (RPs) are commonly used in scapular neck fractures (SNFs): however, RPs have many defects. In this study, we evaluated a newly designed scapular neck anatomical locking compression plate (SNALCP). METHODS An SNF finite element model (Miller-type IIB) was constructed. Plates were subsequently implanted into the scapula and fixed with screws that were grouped according to the plate used: SNALCP (A) and RP (B). Finally, loads were applied to record and analyze performance. RESULTS Under lateral, anteroposterior, and vertical compression loads, the maximum von Mises stresses on the scapula and implants of group A were smaller than those of group B. There were some differences in stress distribution between the two groups. CONCLUSIONS SNALCP can effectively reduce the stress of the scapula and implant, making stress distribution more uniform and continuous, and has mechanical conduction advantages. Compared to RP, it provides improved stability and more reliable fixation.
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Affiliation(s)
- Feifan Xiang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, China
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, 999078, China
| | - Yukun Xiao
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, China
| | - Daiqing Wei
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, China
| | - Xiaoqi Tan
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Siyuan He
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Liang Luo
- Department of Joint Surgery, People's Hospital of Chongqing Liang Jiang New Area, Chongqing, 401121, China.
| | - Yunkang Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, China.
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Kurakar M, Joshi U. Comparative Study of Miniplate vs Reconstruction Plate in the Management of Bilateral Parasymphysis Mandible Fracture: FEM Analysis. J Maxillofac Oral Surg 2023; 22:9-17. [PMID: 36703660 PMCID: PMC9871087 DOI: 10.1007/s12663-021-01649-3] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/23/2021] [Indexed: 01/29/2023] Open
Abstract
Aim and Objective The present study compared the stability of fracture fragments in the management of bilateral parasymphysis mandible fracture with Miniplate fixation and Reconstruction plate fixation using finite element analysis. Material and Method 3D FE Mandible model was created using CT scanner. Two bilateral parasymphysis mandible fracture models were created. Model 1 was fixed with Miniplates, and Model 2 was fixed with Reconstruction plate. Loading forces of 120 N at molar region and 62.5 N at incisor region were applied. These two models were imported to ANSY'S Workbench Software. Result Miniplate fixation model showed comparatively reduced gap between fragments than Reconstruction plate. But the gap values of both the models were within the physiologic limit of healing under this specific loading. Analytically Miniplates were superior to Reconstruction plate in the management of bilateral parasymphysis fracture. Conclusion Analytically Miniplates are superior to Reconstruction plate in the management of bilateral parasymphysis fracture. As the masticatory forces were reduced during fracture healing period, both fixations provide satisfactory healing. So both Miniplate and Reconstruction plate can be considered as fixation method for bilateral parasymphysis mandible fracture.
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Affiliation(s)
- Manju Kurakar
- Department of Oral and Maxillofacial Surgery, Sinhgad Dental College and Hospital, Pune, India
- Affiliated to Maharashtra University of Health Science, Nashik, Maharshtra India
| | - Udupikrishna Joshi
- Department of Oral and Maxillofacial Surgery, HKE Society’s SNijalingappa Institute of Dental Science and Research, Gulbarga, India
- Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka India
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Kahveci K, Ayranci F. Finite element analysis of different internal fixation methods for the treatment of atrophic mandible fractures. J Stomatol Oral Maxillofac Surg 2023; 124:101276. [PMID: 36058534 DOI: 10.1016/j.jormas.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study is to evaluate different plate systems and contribute to revealing the most appropriate treatment option for severe atrophic edentulous mandible fractures. A total of 8 different types of rigid internal fixation methods, which were a 4-hole miniplate on the crest, a 4-hole miniplate on the basis, a 6-hole miniplate on the crest, a 6-hole miniplate on the basis, two 4-hole mini plates on both the crest and basis, two 6-hole mini plates on both crest and basis, a 6-hole reconstruction plate on the crest and a 6-hole reconstruction plate on the basis, were simulated. Stress analysis on plates and screws and the displacement between fragments were evaluated using finite element analysis. The lowest von Mises stress was observed on the basis plate in Group 6. The highest von Mises stresses were measured on the screws closes to the fracture line. Values exceeding the boundary conditions were observed only in Groups 3 and 4 under molar loading. The highest compressive stresses were measured in Group 1, and the lowest compressive stresses were measured in Group 6. Under molar loading, the highest displacement was observed in Group 3, and the lowest displacement was observed in Group 6. When all groups are evaluated in terms of stress distributions and stability, a 1.5 mm thick six-hole reconstruction plate can be a reliable method in the treatment of severe atrophic edentulous mandible fractures.
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Affiliation(s)
- Kadircan Kahveci
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Giresun University, Giresun, Turkey.
| | - Ferhat Ayranci
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ordu University, Ordu, Turkey
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Vishal, Rohit, Prajapati VK, Shahi AK, Prakash O. Evaluation of Functional and Esthetic Outcome of Patients After Reconstruction with Mandibular Reconstruction Plates Preceded by Resection of Benign Odontogenic Neoplasms of Mandible: A Cohort Study. Indian J Otolaryngol Head Neck Surg 2022; 74:2350-2355. [PMID: 36452572 PMCID: PMC9702307 DOI: 10.1007/s12070-020-02172-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022] Open
Abstract
Large benign odontogenic neoplasms of mandible are not rare in developing countries such as India. Treatment of choice depends not only on extent and size of the lesion but also the socio-economic status, resources and available armamentarium. Whenever resection of segment mandible is planned for these patients, goal of the treatment should not be to restore function of the mandible alone but also to give esthetic visual appearance of the face. The present study was performed to determine postoperative functional and esthetic outcome in such patients. A total of 18 patients (20-35 years) with benign odontogenic neoplasm of mandible were enrolled for the study. After surgical intervention i.e., resection and reconstruction of mandible with mandibular reconstruction plate, all the patients were evaluated post-operatively for functional and esthetic outcome at the end of 1st and 4th week. Functional outcome were assessed based on Quality of life questionnaire and esthetic outcome based on vancouver scar assessment scale, clinical and radiological assessment. The mean scores of all the functional outcomes was improved significantly like pain, drooling of saliva, eating solid and liquid and speech except deglutition. The mean score of scar was recorded as 4.67. Occlusion was achieved in 100% and lips competency in 89% of patients. It is advised to immediately reconstruct the mandible after segmental mandibulectomy which eventually helps to improve the quality of life post-operatively of patients being treated for benign odontogenic neoplasm of mandible.
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Affiliation(s)
- Vishal
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
| | - Rohit
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
| | - V. K. Prajapati
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
| | - Ajoy Kumar Shahi
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
| | - Om Prakash
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
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Martin JR, Saunders PE, Phillips M, Mitchell SM, Mckee MD, Schemitsch EH, Dehghan N. Comparative effectiveness of treatment options for displaced midshaft clavicle fractures : a systematic review and network meta-analysis. Bone Jt Open 2021; 2:646-654. [PMID: 34402306 PMCID: PMC8384438 DOI: 10.1302/2633-1462.28.bjo-2021-0112.r1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims The aims of this network meta-analysis (NMA) were to examine nonunion rates and functional outcomes following various operative and nonoperative treatments for displaced mid-shaft clavicle fractures. Methods Initial search strategy incorporated MEDLINE, PubMed, Embase, and the Cochrane Library for relevant randomized controlled trials (RCTs). Four treatment arms were created: nonoperative (NO); intramedullary nailing (IMN); reconstruction plating (RP); and compression/pre-contoured plating (CP). A Bayesian NMA was conducted to compare all treatment options for outcomes of nonunion, malunion, and function using the Disabilities of the Arm Shoulder and Hand (DASH) and Constant-Murley Shoulder Outcome scores. Results In all, 19 RCTs consisting of 1,783 clavicle fractures were included in the NMA. All surgical options demonstrated a significantly lower odds ratio (OR) of nonunion in comparison to nonoperative management: CP versus NO (OR 0.08; 95% confidence interval (CI) 0.04 to 0.17); IMN versus NO (OR 0.07; 95% CI 0.02 to 0.19); RP versus NO (OR 0.07; 95% CI: 0.01 to 0.24). Compression plating was the only treatment to demonstrate significantly lower DASH scores relative to NO at six weeks (mean difference -10.97; 95% CI -20.69 to 1.47). Conclusion Surgical fixation demonstrated a lower risk of nonunion compared to nonoperative management. Compression plating resulted in significantly less disability early after surgery compared to nonoperative management. These results demonstrate possible early improved functional outcomes with compression plating compared to nonoperative treatment. Surgical fixation of mid-shaft clavicle fractures with compression plating may result in quicker return to activity by rendering patients less disabled early after surgery. Cite this article: Bone Jt Open 2021;2(8):646–654.
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Affiliation(s)
- John R Martin
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Patrick E Saunders
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | | | - Sean M Mitchell
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Michael D Mckee
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | | | - Niloofar Dehghan
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA.,The CORE Institute, Phoenix, Arizona, USA
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Song IS, Ryu JJ, Choi YJ, Lee UL. Pre-contoured reconstruction plate fabricated via three-dimensional printed bending support. J Korean Assoc Oral Maxillofac Surg 2021; 47:233-236. [PMID: 34187965 PMCID: PMC8249193 DOI: 10.5125/jkaoms.2021.47.3.233] [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: 01/22/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/12/2022] Open
Abstract
A mandibular continuity defect can be repaired using either a prosthetic device or autogenous bone. A titanium reconstruction plate can be used with a localized or vascularized flap over the defect of the mandible. Unfortunately, the plate may fail due to plate exposure, screw loosening, fracture, or infection, and will need to be removed. Plate exposure though the skin or mucosa is one of the main reasons for failure. In the present work, the authors introduced a lingually positioned reconstruction plate fabricated via three-dimensional printed bending support. This custom reconstruction plate can avoid plate re-exposure as well as reduce surgical errors and operation time.
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Affiliation(s)
- In-Seok Song
- Department of Dentistry, Korea University Anam Hospital, Seoul, Korea
| | - Jae-Jun Ryu
- Department of Dentistry, Korea University Anam Hospital, Seoul, Korea
| | - Young-Jun Choi
- Department of Oral and Maxillofacial Surgery, Chung-Ang University School of Medicine, Seoul, Korea.,Department of Oral and Maxillofacial Surgery, Dental Center, Chung-Ang University Hospital, Seoul, Korea
| | - Ui-Lyong Lee
- Department of Oral and Maxillofacial Surgery, Dental Center, Chung-Ang University Hospital, Seoul, Korea
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Böger D, Hartmann R, Sauer M. [Critical aspects of the transmandibular approach to the oral cavity and oropharynx]. HNO 2021; 70:110-116. [PMID: 34170338 DOI: 10.1007/s00106-021-01073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the context of tumor surgery, the median mandibulotomy as an access route to the oral cavity and oropharynx provides an excellent overview of the surgical site. However, it is not regarded entirely unproblematic with regard to early and later complications that may arise. OBJECTIVE The results and complications of the median mandibulotomy will be presented based on data collected from our own patient collective. MATERIALS AND METHODS A total of 21 patients who had undergone a median mandibulotomy as part of tumor surgery at the Department of Otorhinolaryngology of the SRH Zentralklinikum Suhl were examined over a period from 01 January 2010 to 31 December 2020. The patient files were retrospectively evaluated. RESULTS A stair-step median mandibulotomy was performed in all 21 patients. Reconstruction was performed using a 2.8 mm thick angled mandibular plate and bicortical locking screws. The mean follow-up period was 29.8 months. In all, 7 patients (33%) had a recurrence at the time of surgery; 5 patients (24%) had already undergone pre-radiation. Furthermore, 18 patients (85.7%) received adjuvant radiotherapy. We found plate loosening or extrusion in 0 of 21 cases. A salivary fistula (4.7%) was observed in 1 patient. Trismus was found in 4 (19%) cases during follow-up. Osteoradionecrosis was found in 2 (9.5%) of 21 cases. Cosmetic deficits were not observed. CONCLUSION Our results show that the stair-step median mandibulotomy in combination with a 2.8 mm thick reconstruction plate and bicortical locking screws leads to a stable and safe reconstruction even with pre-irradiated situations. Plate loosening or extrusion did not occur.
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Affiliation(s)
- D Böger
- Klinik für Hals‑, Nasen- und Ohrenkrankheiten/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland.
| | - R Hartmann
- Klinik für Hals‑, Nasen- und Ohrenkrankheiten/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland
| | - M Sauer
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland
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Anusitviwat C, Samphao S, Dissaneewate P, Yuenyongviwat V. Surgical treatment of osteochondroma on the first rib by double clavicle osteotomy and internal fixation with a reconstruction plate: A case report and literature review. Int J Surg Case Rep 2021; 79:184-7. [PMID: 33482445 DOI: 10.1016/j.ijscr.2021.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/23/2022] Open
Abstract
The solitary osteochondroma of the first rib is rare. There is no standard approach for removing the tumor of the first rib. The double clavicular osteotomy approach can provide wide surgical exposure. Excellent clinical outcomes are obtained from plate fixation of the clavicle following osteotomy.
Introduction The accepted indication for surgical removal of osteochondroma is when a lesion becomes symptomatic. There have been no established standard surgical approaches to remove osteochondroma on the first rib and no report on management after that. This report aims to present a novel approach by double clavicle osteotomy followed with internal fixation. Case presentation A 17-year-old female presented with a gradually enlarged bony mass with tenderness at the supraclavicular area. Radiographic images revealed a bony mass attached to the first rib. The provisional diagnosis is osteochondroma. The tumor was approached by osteotomy at the proximal and distal shaft of the clavicle. After removing the entire tumor, the direct reduction and internal fixation of the clavicle were performed. Discussion Both, size of the mass and mobilization of the clavicle are factors in determining the surgical approach. Clavicular osteotomy, especially two sites, is considered when the lesion is extremely large. A possible complication after the clavicular osteotomy is nonunion or malunion. A proper technique of reduction and method of fixation contributes to reducing complications. Conclusion The double clavicle osteotomy is an effective route for removing a large tumor at the first rib. Plate fixation following clavicular osteotomy contributes to bone union and excellent functional outcomes postoperatively.
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Yanev P, Zderic I, Pukalski Y, Enchev D, Rashkov M, Varga P, Gehweiler D, Richards G, Gueorguiev B, Baltov A. Two reconstruction plates provide superior stability of displaced midshaft clavicle fractures in comparison to single plating - A biomechanical study. Clin Biomech (Bristol, Avon) 2020; 80:105199. [PMID: 33129563 DOI: 10.1016/j.clinbiomech.2020.105199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/05/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Displaced midshaft fractures are the most common surgically treated clavicle fractures. However, they are associated with high complication rates following plating due to fixation failure in terms of plate breakage, screw breakage and/or screw loosening. The aim of this study was to compare the biomechanical competence of three different plating techniques for fixation of displaced midshaft clavicle fractures. METHODS Displaced midshaft fractures type 2B according to the Robinson classification were simulated by standardized osteotomy gap in 18 synthetic clavicles, assigned to three groups (n = 6) for plating with either superiorly placed Dynamic Compression Plate (width/thickness 11.0/4.0 mm), locked Superior Anterior Clavicle Locking Compression Plate (width/thickness 10.2/2.0 mm), or two non-locked Reconstruction Plates placed superiorly and anteriorly (width/thickness 10.0/2.8 mm). Each specimen was cyclically tested at 3 Hz under craniocaudal cantilever bending, superimposed with torsion around the shaft axis over 720'000 cycles or until failure occurred. The latter was defined by plate breakage, screw breakage or screw loosening. FINDINGS Initial construct stiffness (N/mm) and cycles to failure in group Reconstruction Plates (22.30 ± 4.07; 712'778 ± 17'691) were significantly higher compared with both groups Compression Plate (12.53 ± 2.09; 348'541 ± 212'941) and Locking Plate (4.19 ± 0.46; 19'536 ± 3'586), p ≤ 0.019. In addition, these two outcomes were significantly higher in group Compression Plate versus Locking Plate, p ≤ 0.029. INTERPRETATION Double plating of unstable midshaft clavicle fractures with reconstruction plates seems to provide superior fixation stability under dynamic loading, when compared to single compression or locked plating, whereas the latter is associated with inferior performance.
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Affiliation(s)
- Parvan Yanev
- AO Research Institute Davos, Davos, Switzerland; University Multiprofile Hospital for Active Treatment and Emergency Medicine "N. I. Pirogov", Sofia, Bulgaria.
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Yavor Pukalski
- AO Research Institute Davos, Davos, Switzerland; University Multiprofile Hospital for Active Treatment and Emergency Medicine "N. I. Pirogov", Sofia, Bulgaria
| | - Dian Enchev
- University Multiprofile Hospital for Active Treatment and Emergency Medicine "N. I. Pirogov", Sofia, Bulgaria
| | - Mihail Rashkov
- University Multiprofile Hospital for Active Treatment and Emergency Medicine "N. I. Pirogov", Sofia, Bulgaria
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
| | | | | | | | - Asen Baltov
- University Multiprofile Hospital for Active Treatment and Emergency Medicine "N. I. Pirogov", Sofia, Bulgaria
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Konstantinidis GA, Smithers T, Hong TF. Postoperative results of Ogawa type IIB meta-acromion fracture fixation with a 90° twisted reconstruction plate. Arch Orthop Trauma Surg 2020; 140:1181-1189. [PMID: 31989246 DOI: 10.1007/s00402-020-03351-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acromion fractures are rare and difficult to treat. There is no consensus on type of fixation. Due to the rarity of the injury, it is difficult to compare different techniques of osteosynthesis. OBJECTIVES The aim of this study was to present the long-term results of an alternative method of plating Ogawa type IIB meta-acromion fractures and to review the literature. DESIGN Retrospective study. MATERIALS AND METHODS We present a case series of 11 consecutive patients with displaced Ogawa type IIB meta-acromion fracture, treated with open reduction internal fixation using a 3.5-mm contoured pelvic reconstruction plate with a 90° twist. Patients' mean age was 53.3 years (23-80 years) and the mean follow-up was 48.3 months (15 months-9 years). The outcomes related to pain and shoulder function were evaluated by Modified American Shoulder and Elbow Surgeons Score (ASES) and SF-36 score. All patients were asked about their satisfaction level. RESULTS Nine out of eleven patients were included in this study. Eight of them obtained union and all were satisfied with the final outcome. The mean ASES and SF-36 score were 69.75 (42.4-98.14) and 61.37 (41.64-94.99), respectively, with poor scores to be largely associated with comorbidities and concomitant injuries. CONCLUSIONS The use of 3.5-mm reconstruction plate with a 90° twist for open reduction internal fixation (ORIF) of meta-acromion fractures presents satisfactory results and could be technically a more stable biomechanical construct in comparison to the existing surgical techniques.
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Affiliation(s)
- George A Konstantinidis
- Orthopaedic Department, Royal Darwin Hospital, 105 Rockland drive, TiWi, Darwin, NT, 0810, Australia.
| | - Troy Smithers
- Orthopaedic Department, Hutt Hospital, Wellington, New Zealand
| | - Thin Foo Hong
- Orthopaedic Department, Waikato Hospital, Hamilton, Waikato, New Zealand
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Wang Z, Sun J, Yan J, Gao P, Zhang H, Yang Y, Jin Q. Comparison of the efficacy of posterior-anterior screws, anterior-posterior screws and a posterior-anterior plate in the fixation of posterior malleolar fractures with a fragment size of ≥ 15 and < 15. BMC Musculoskelet Disord 2020; 21:570. [PMID: 32828121 PMCID: PMC7443295 DOI: 10.1186/s12891-020-03594-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/17/2020] [Indexed: 01/22/2023] Open
Abstract
Background Different fixation methods have been used to treat posterior malleolar fractures (PMFs), but the clinical efficacy of different fixation methods in the treatment of PMF with different fragmentation has rarely been reported. The purpose of this study was to investigate the efficacy of posterior-anterior (PA), anterior-posterior (AP) screws and PA plate in the fixation of PMFs with a fragment size of ≥15 and < 15%. Methods This is a retrospective study of the clinical data of 243 patients with a unilateral ankle fracture involving the posterior malleolar ankle fracture. All patients were divided into two groups based on their fragment size, ≥15% (n = 136) and < 15% (n = 107). After reduction of PMF under direct vision via a posterolateral approach, posterior-anterior (PA), anterior-posterior (AP) screws and PA plate were used for fixation of PMF in the two groups. Briefly, for fixation of PMF with PA screw, two to three 3.5-mm (Depuy Synthes, Switzerland) cannulated screws were placed from the posterior to anterior direction; for fixation with PA plate, a 3.5-mm reconstruction plate (Depuy Synthes, Switzerland) was placed from the posterior to anterior direction, and for fixation of PMF with an AP screw, two to three 3.5-mm screws were placed from the anterior to posterior direction. All patients were followed up at 1, 3, 6, and 12 months after surgery and thereafter at 6-month intervals. The primary outcomes were AOFAS and ROM, which were recorded at the final follow-up. Results The average follow-up time for all patients was 18.9 months (range 12–36 months), and all fractures healed. In fragment size ≥15% group, the average AOFAS score of patients treated with PA, AP screws and posterior plate were 91.5, 91.8, and 90.8, respectively, and the average limited ankle-dorsiflexion ROM was 5.0 °, 5.4 ° and 5.6°, respectively, at the last follow-up, there was no significant difference between the three fixation methods in terms of AOFAS scores and ankle ROM (P > 0.05). In fragment size < 15% group, the average AOFAS score of patients treated with PA, AP screws and posterior plate were 92.3, 91.9, and 84.1, respectively, the average limited ankle-dorsiflexion ROM were 5.1 °, 4.7 °, and 6.3 °, respectively, at the last follow-up. There were statistically significant differences in AOFAS scores and ankle ROM between posterior plate fixation and PA, AP screw fixation (P < 0.05); while no significant difference was found between PA and AP screw fixation (P > 0.05). Conclusion For PMFs with fragment size ≥15%, there was no significant difference in the outcomes between the three fixation methods. For PMF with fragmentation < 15%, the PA and AP screws both provided good fixation.
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Affiliation(s)
- Zheng Wang
- Department of Orthopaedic, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Jianbin Sun
- Department of Orthopaedic, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Jun Yan
- Department of Orthopaedic, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Pengcheng Gao
- Department of Orthopaedic, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Hao Zhang
- Department of Orthopaedic, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Yong Yang
- Department of Orthopaedic, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Qunhua Jin
- Department of Orthopaedic, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.
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Peters F, Kniha K, Möhlhenrich SC, Bock A, Hölzle F, Modabber A. Evaluation of a novel osteosynthesis plate system for mandibular defects. Br J Oral Maxillofac Surg 2020; 58:e109-e114. [PMID: 32800607 DOI: 10.1016/j.bjoms.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022]
Abstract
Continuity defects of the jaw can be reconstructed with titanium plates or microvascular bone flaps; osteosynthesis plates are necessary for both. In this study we performed a retrospective review of patients treated with Medartis MODUS® Mandible Trauma/Reco 2.0-2.5, TriLock bridging plates, mandibulectomy and soft tissue free flap or reconstruction with a bony free flap and TriLock mandibular plates from the same system from January 2015 to August 2019. The variables recorded were sex, age, diagnosis, radiotherapy, date of implantation, date of explantation or death of patient, size of mandibular defect, Jewer classification of defect, number of screws used, segments of bony reconstruction, screws per segment, plate exposure, plate breakage, and pseudarthrosis. The bridging plate group consisted of 41 patients, while the mandibular plate group consisted of 24 patients. The percentage of plate exposure was 17.07% for the bridging plate group and 4.17% for the mandibular plate group. Plate breakage was 0 in both groups. Pseudarthrosis was 4.17% in the mandibular plate group. In the bridging plate group, an anterolateral thigh flap covered all exposures. Of 7 plate exposures, 4 were found in a C defect. The complication rate of the investigated plates was lower than the complication rates of other plate systems.
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Affiliation(s)
- F Peters
- Department of Oral, Maxillofacial and Facial Plastic Surgery, School of Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen Germany.
| | - K Kniha
- Department of Oral, Maxillofacial and Facial Plastic Surgery, School of Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen Germany
| | - S C Möhlhenrich
- Department of Orthodontics, University Witten/Herdecke, Private Universität Witten/Herdecke GmbH, Alfred-Herrhausen-Straße 45, 58448 Witten, Germany
| | - A Bock
- Department of Oral, Maxillofacial and Facial Plastic Surgery, School of Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen Germany
| | - F Hölzle
- Department of Oral, Maxillofacial and Facial Plastic Surgery, School of Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen Germany
| | - A Modabber
- Department of Oral, Maxillofacial and Facial Plastic Surgery, School of Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen Germany
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Wu H, Shang R, Liu X, Song C, Chen Y, Cai X. A novel anatomically pre-contoured side-specific titanium plate versus the reconstruction plate for quadrilateral plate fractures of the acetabulum: a propensity-matched cohort study. J Orthop Surg Res 2020; 15:172. [PMID: 32408887 PMCID: PMC7222331 DOI: 10.1186/s13018-020-01659-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022] Open
Abstract
Background Surgical treatment of acetabular fractures involving a quadrilateral plate is a challenge to orthopedic surgeons. We have developed a novel fixation technique using a specially shaped reconstruction plate combined with several buttress screws of a quadrilateral plate which was also called a dynamic anterior plate-screw system for quadrilateral plate (DAPSQ) to treat acetabular fractures involving quadrilateral plate since 2005 (RP group). And the long-term follow-up results have confirmed the effectiveness and safety of this technique. After 2016, standardized titanium plate (STP group) of DAPSQ have been designed and applied. The aim of the study was to compare the clinical efficacy of anatomical plate and the reconstruction plate of DAPSQ in the treatment of quadrilateral plate fractures. Methods We led a propensity-matched cohort study of quadrilateral plate fractures. Twenty-two patients were included in the STP group during the inclusion period (2016–2018) and were matched to 22 cases in our database of the RP group (2008–2016). The primary outcome measures were the quality of reduction and functional outcomes. Intraoperative conditions were also compared. Results Of these 22 consecutive patients in the STP group, the mean age was 46.7 years and the most common fracture pattern was a both-column fracture (12 cases, 54.5%) according to Letournel-Judet classification. The mean follow-up period was 23.1 months (range 12–37). There were no significant differences between the two groups with regard to the quality of reduction using the Matta radiological criteria and functional outcomes evaluated by the modified Merle d’Aubigné score (P > 0.05). Compared with the RP group, the STP group had a shorter operation time (245.1 min vs. 286.8 min, P = 0.020), less intraoperative blood loss (1136.4 mL vs. 1777.3 mL, P = 0.014), and transfusion (780.9 vs. 1256.8 mL, P = 0.035). The complication rate was 18.2% in the STP group, and there was no significant difference compared with the RP group (36.4%) (P > 0.05). None of the cases in the two groups had quadrilateral screws entering the hip or implant failure. Conclusions The fixation of standardized titanium plate in quadrilateral plate fractures showed a similar result to the reconstruction plate, in terms of quality of reduction and functional outcome. The standardized titanium plate of DAPSQ has the advantages of a short operation time, less intraoperative bleeding, and blood transfusion, and it is worth further promotion and research.
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Affiliation(s)
- Haiyang Wu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.,Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Ranran Shang
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Ximing Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Chengjing Song
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Yanzhao Chen
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Xianhua Cai
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
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Kalwagadda S, Kumar B, Nair SC, Shah AK, Shroff SS. Management of Ameloblastoma with Free Tissue Flap in Comparison with Other Reconstructive Options Available. J Maxillofac Oral Surg 2020; 19:283-288. [PMID: 32346241 DOI: 10.1007/s12663-019-01203-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 02/13/2019] [Indexed: 11/25/2022] Open
Abstract
Aim To review the management and reconstruction of ameloblastoma of mandible in different age groups over a period of 11 years. Methodology This retrospective study includes 51 cases operated in the Maxillofacial Unit, Bhagwan Mahaveer Jain Hospital, Bangalore, from the year 2007 to 2017. The data of these patients were collected to record demographic data such as age, gender with site of tumour and type of reconstruction after resection, follow-up period and incidence of complications. This study evaluated the outcome in terms of aesthetics, function and choice of reconstruction in different age groups. Results Most patients were of 21-40 age group. 37 (72.5%) were found to be unicystic ameloblastoma. 41 (80.3%) patients underwent reconstruction following the resection. There was a change in trend seen over a period of time with free grafts and reconstruction plate being historical, except in special situations like old age and unfit patients. According to one-way ANOVA and Tukey's post hoc analysis, free flaps were known to take a longer duration (mean = 503 min) compared to other modes of reconstruction. However, free grafts and free flaps were demonstrated to have a good facial contour and speech with most cases dentally rehabilitated with implants. Among the complications, 1 (16%) case with reconstruction plate showed screw loosening, 2 (28%) cases with free grafts showed graft exposure, and 1 (3.5%) case with free flap had venous congestion, making free flaps the most reliable option. Conclusion Free fibula is the gold standard of mandible reconstruction, but depending on age, medical condition, economic status and size of the defect other modes of reconstruction can be chosen with the acceptance of suboptimal results.
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Affiliation(s)
- Sowjanya Kalwagadda
- Department of Oral and Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, 17, Millers Road, Kaverappa Layout, Vasanthnagar, Bengaluru, Karnataka 560052 India
| | - Balasubramanya Kumar
- Department of Oral and Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, 17, Millers Road, Kaverappa Layout, Vasanthnagar, Bengaluru, Karnataka 560052 India
| | - Sanjiv C Nair
- Department of Oral and Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, 17, Millers Road, Kaverappa Layout, Vasanthnagar, Bengaluru, Karnataka 560052 India
| | - Anjan Kumar Shah
- Department of Oral and Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, 17, Millers Road, Kaverappa Layout, Vasanthnagar, Bengaluru, Karnataka 560052 India
| | - Sunil S Shroff
- Department of Oral and Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, 17, Millers Road, Kaverappa Layout, Vasanthnagar, Bengaluru, Karnataka 560052 India
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Hong KDG, Kim SG, Park YW. The effect of fixation plate use on bone healing during the reconstruction of mandibular defects. J Korean Assoc Oral Maxillofac Surg 2019; 45:276-284. [PMID: 31728335 PMCID: PMC6838356 DOI: 10.5125/jkaoms.2019.45.5.276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 11/12/2022] Open
Abstract
Objectives This study sought to compare efficiency results between the use of a customized implant (CI) and a reconstruction plate (RP) in mandibular defect reconstruction in an animal model. Materials and Methods Fifteen rabbits underwent surgery to create a defect in the right side of the mandible and were randomly divided into two groups. For reconstruction of the mandibular defect, the RP group (n=5) received five-hole mini-plates without bone grafting and the CI group (n=10) received fabricated CIs based on the cone-beam computed tomography (CBCT) data taken preoperatively. The CI group was further divided into two subgroups depending on the time of CBCT performance preoperatively, as follows: a six-week CI (6WCI) group (n=5) and a one-week CI (1WCI) group (n=5). Daily food intake amount (DFIA) was measured to assess the recovery rate. Radiographic images were acquired to evaluate screw quantity. CBCT and histological examination were performed in the CI subgroup after sacrifice. Results The 1WCI group showed the highest value in peak average recovery rate and the fastest average recovery rate. In terms of reaching a 50% recovery rate, the 1WCI group required the least number of days as compared with the other groups (2.6±1.3 days), while the RP group required the least number of days to reach an 80% recovery rate (7.8±2.2 days). The 1WCI group showed the highest percentage of intact screws (94.3%). New bone formation was observed in the CI group during histological examination. Conclusion Rabbits with mandibular defects treated with CI showed higher and faster recovery rates and more favorable screw status as compared with those treated with a five-hole mini-plate without bone graft.
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Affiliation(s)
- Khang Do Gia Hong
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Young-Wook Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
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Mathew N, Gandhi S, Singh I, Solanki M, Bedi NS. 3D Models Revolutionizing Surgical Outcomes in Oral and Maxillofacial Surgery: Experience at Our Center. J Maxillofac Oral Surg 2019; 19:208-216. [PMID: 32346229 DOI: 10.1007/s12663-019-01275-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/13/2019] [Indexed: 05/30/2023] Open
Abstract
Introduction New technological advances have revolutionized the field of oral and maxillofacial surgery. The three-dimensional (3D) models are new technological breakthroughs which have equipped the oral and maxillofacial surgeon to effectively reproduce or improve preoperative form and function. They have also allowed the surgeon to achieve minimal operative and postoperative morbidity. Materials and methods In this case series, we present the clinical application and benefits of 3D models that are used for the surgical planning and execution of surgery in treating a case of mid-face deficiency and for the treatment of extensive jaw pathologies using reconstruction plate bent preoperatively, which contributed to improved surgical outcomes and patient satisfaction.
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Affiliation(s)
- Nancy Mathew
- Department of Oral and Maxillofacial Surgery, Christian Dental College, CMC, Ludhiana, Punjab 141008 India
| | - Sumir Gandhi
- Department of Oral and Maxillofacial Surgery, Christian Dental College, CMC, Ludhiana, Punjab 141008 India
| | - Inderjot Singh
- Department of Oral and Maxillofacial Surgery, Christian Dental College, CMC, Ludhiana, Punjab 141008 India
| | - Manisha Solanki
- Department of Oral and Maxillofacial Surgery, Christian Dental College, CMC, Ludhiana, Punjab 141008 India
| | - Navpreet Singh Bedi
- Department of Oral and Maxillofacial Surgery, Christian Dental College, CMC, Ludhiana, Punjab 141008 India
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Chiu YC, Huang KC, Shih CM, Lee KT, Chen KH, Hsu CE. Comparison of implant failure rates of different plates for midshaft clavicular fractures based on fracture classifications. J Orthop Surg Res 2019; 14:220. [PMID: 31311567 PMCID: PMC6636002 DOI: 10.1186/s13018-019-1259-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 07/04/2019] [Indexed: 11/23/2022] Open
Abstract
Backgrounds The aim of our study was to investigate failure rates of reconstruction plate and non-reconstruction plate, and find the best strategy for implant selection for different fracture types for midshaft clavicular fractures. Patients and methods Two hundred twenty-six consecutive patients with midshaft clavicular fractures who received open reduction and plate fixation during Jan 2012 to July 2017 were reviewed. The correlations between implant failure rates and risk factors including demographic data, fracture classifications, and implant types were analyzed. Results AO/OTA fracture classification and plate types are the most important factors affecting implant failure for midshaft clavicular fractures. Reconstruction plate had a significantly higher failure rate (53%) than that of non-reconstruction plates (3%) in comminuted midshaft clavicular (AO/OTA 15-2C) fractures (P value < 0.01). However, the difference was not significant in AO/OTA 15-2A and 2B classifications. Conclusion Patients with comminuted midshaft clavicular (AO/OTA 15-2C) fractures treated with reconstruction plates had very high implant failure rates compared to non-reconstruction plates. We suggested that patients with comminuted midshaft clavicular (AO/OTA 15-2C) fractures treated with reconstruction plates need more protection and more frequent follow-up in the postoperative period.
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Affiliation(s)
- Yung-Cheng Chiu
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Kui-Chou Huang
- Department of Orthopedics, Asia University Hospital, Taichung, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Kun-Tsan Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Biomedical Engineering, Hung Kuang University, Taichung, Taiwan
| | - Cheng-En Hsu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan. .,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan.
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Bede SYH, Ismael WK, Hashim EA. Reconstruction plate-related complications in mandibular continuity defects. Oral Maxillofac Surg 2019; 23:193-199. [PMID: 31044342 DOI: 10.1007/s10006-019-00762-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the complications associated with the use of reconstruction plates with or without non-vascularized bone graft in reconstruction of mandibular segmental defects caused by trauma and tumor resection and to analyze various factors that are associated with the development of complications. METHODS A retrospective observational study was conducted, and the investigated variables included the age and gender of the patients, etiology of the defect, the site of the defect, the size of the defect, whether bone graft was used or not, type of plate used, and whether the reconstruction was immediate or delayed. The outcome variables were the postoperative complications and the success rate. RESULTS Fifty-one patients were enrolled in this study; the etiology of mandibular defect was trauma in 39 patients (76.5%) and resection of benign or malignant tumors in 12 patients (23.5%). The complication rate was (58.8%) and the success rate was (94.1%); the only factor that significantly increased the incidence of postoperative complications was the size of the defect. CONCLUSION Reconstruction plates demonstrated a high success rate despite the high complication rate. Segmental defects caused by trauma were smaller than those created after tumor resection and the only factor that increased complication rate was the size of the defect; other factors did not affect the complication rate.
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Affiliation(s)
- Salwan Yousif Hanna Bede
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Baghdad, Bab-Almoadham, Baghdad, Iraq.
| | | | - Ehssan Ali Hashim
- Oral and Maxillofacial Surgery Unit, Alyarmook Teaching Hospital, Baghdad, Iraq
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Poxleitner P, Steybe D, Bublitz B, Schlager S, Fuessinger MA, Voss PJ, Schmelzeisen R, Cornelius CP, Metzger M. Analysis of the accuracy of a novel preformed osteosynthesis plate for the reduction and fixation of zygomaticomaxillary complex fractures. J Craniomaxillofac Surg 2019; 47:951-958. [PMID: 30935849 DOI: 10.1016/j.jcms.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION There has been a shift toward surgical treatment of ZMC (zygomaticomaxillary complex) fractures with open reduction and subsequent fixation in the past decades. Anatomically preformed osteosynthesis plates, already used in the field of craniomaxillofacial surgery for the treatment of fractures of the mandible and the orbit, might be a suitable option for ZMC fractures as well. MATERIAL AND METHODS A statistical shape model was created from 179 cranial CT scans. Based on this surface model, an anatomically preformed plate for the reduction and fixation of ZMC fractures was developed in 3 sizes (S, M, L). Virtual analysis of the accuracy of the plate was performed on a dataset consisting of 120 CT scans. RESULTS Within a determined tolerance range of 0-1.5 mm, analysis revealed a high accuracy of the plate in 70-87 % of the CT scans. The S-sized plate has the highest overall accuracy, whereas the L-sized plate has highest accuracy at the "base" region which is essential for the placement of the plate. DISCUSSION The newly developed plate can be placed via an intraoral approach and analysis of the plate has confirmed its accuracy to be sufficient to ensure an adequate fracture reduction and fixation. It thus might allow for a less extensive approach and less approaches/incisions necessary overall to reduce and fixate ZMC fractures.
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Affiliation(s)
- Philipp Poxleitner
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany; Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Germany.
| | - David Steybe
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Britta Bublitz
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Stefan Schlager
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Marc Anton Fuessinger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Pit Jacob Voss
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Carl-Peter Cornelius
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstr. 2a, 80337, Munich, Germany
| | - Marc Metzger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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Kawasaki G, Imayama N, Yoshitomi I, Furukawa K, Umeda M. Clinical Study of Reconstruction Plates Used in the Surgery for Mandibular Discontinuity Defect. In Vivo 2018; 33:191-194. [PMID: 30587622 DOI: 10.21873/invivo.11458] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Postresective mandibular reconstruction is common in cases of oral and mandibular tumors. However, complications such as plate fracture and/or plate exposure can occur. The purpose of this study was to analyze complications and survival of reconstructive plates used to correct mandibular defects caused by oral cancer. PATIENTS AND METHODS Clinical and radiological data from 34 patients were analyzed. Only discontinuous mandibular defect cases were included in this study. All cases were classified using the Hashikawa's CAT and Eichner's classification methods. Then, we determined whether these classifications and clinical treatment methods were significantly related to complications. RESULTS Complications after mandibular reconstruction occurred in 10 of 34 patients, specifically, two plate fractures, one screw fracture, and seven plate exposures occurred. The plate fractures occurred 5 and 6 months after operation, and the screw fracture occurred 39 months after operation. Using the Hashikawa's CAT classification, the two cases of plate fracture were one of AT type and the other of T type, and the screw fracture was AT type. Using Eichner's classification, all three cases of plate and screw fractures were B2 type. CONCLUSION We suggest that plate and screw fractures were caused by the type of mandibular defect and bite force.
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Affiliation(s)
- Goro Kawasaki
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naomi Imayama
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Izumi Yoshitomi
- Department of Oral and Maxillofacial Surgery, Isahaya General Hospital, Isahaya, Japan
| | - Kohei Furukawa
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Bauer DE, Hingsammer A, Schenk P, Vlachopoulos L, Imam MA, Fürnstahl P, Meyer DC. Are commercially-available precontoured anatomical clavicle plating systems offering the purported superior optimum fitting to the clavicle? A cadaveric analysis and review of literature. Orthop Traumatol Surg Res 2018; 104:755-8. [PMID: 29555558 DOI: 10.1016/j.otsr.2018.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/03/2017] [Revised: 11/08/2017] [Accepted: 01/15/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The indication for operative treatment of displaced midshaft clavicle fractures remains controversial. However, if plate fixation is considered, implant prominence and skin irritation are the most common causes for re-operation. Low profile implants as well as closely contouring plates to the individual anatomy may reduce these complications. The aim of this study was to compare the fitting accuracy and implant prominence of 3.5mm pelvic reconstruction plates (PRP) with pre-contoured anatomical clavicle plates (PACP) for midshaft clavicle fractures. METHODS Three-dimensional data of the largest, median and smallest male and female clavicle of an existing database of 89 cadaveric clavicles were included for analysis. A three-dimensional model of a commercially available PACP was used for digitally positioning of the plate on the segmented clavicles. Three-dimensional printouts of each clavicle were produced and the 3.5mm reconstruction plates were manually bent and positioned by the senior author. Computed tomography scans and three-dimensional reconstructions were then obtained to digitally compare the fitting accuracy and implant prominence. RESULTS Pelvic reconstruction plates offered superior fitting accuracy and lower implant prominence compared to PACP. The largest difference in implant prominence was observed in large sized female clavicles and measured 3.6mm. CONCLUSION Both, the less costly PRP plates and commercially available PACP for midshaft fractures of the clavicle demonstrated a clinically acceptable fitting accuracy. The manually bent pelvic-reconstruction plates demonstrated reduced implant prominence with superior fitting. Hypothetically this might contribute to a reduced rate of reoperation. LEVEL OF EVIDENCE Level IV cadaveric study.
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Isler SC, Keskin Yalcin B, Cakarer S, Cansiz E, Gumusdal A, Keskin C. The use of reconstruction plates to treat benign mandibular pathological lesions: A retrospective clinical study. J Stomatol Oral Maxillofac Surg 2018; 119:379-383. [PMID: 29723657 DOI: 10.1016/j.jormas.2018.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this retrospective clinical study was to evaluate the indications for and the utility of reconstruction plates in the management of benign mandibular pathological lesions. The complications associated with plate use were also assessed. PATIENTS AND METHODS The clinical and radiological data of 23 patients (16 males, 7 females) with large, benign mandibular pathologies were evaluated. During operations, reconstruction plates were used to prevent mandibular fracture or to allow for bone reconstruction after segmental or disarticulation resection. The mean follow-up time was 11.2months. RESULTS Condylar sag was observed in one patient who had undergone disarticulation resection. A reconstruction plate was removed from one patient because of pain. A plate became exposed in one patient who had undergone a disarticulation resection. Two patients reported slight paraesthesia. Screw-loosening was observed in one patient who had received a non-locking plate. CONCLUSION Reconstruction plates can be safely used to manage benign mandibular lesions. Preoperative bending of the plates on individualised models is useful for reducing the time required for plate adaptation during operation. Locking reconstruction plates are preferable for preventing screw-loosening. All complications can be managed with careful follow up.
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Affiliation(s)
- S C Isler
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - B Keskin Yalcin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - S Cakarer
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
| | - E Cansiz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - A Gumusdal
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - C Keskin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Xie P, Ouyang H, Deng Y, Yang Y, Xu J, Huang W. Comparison of conventional reconstruction plate versus direct metal laser sintering plate: an in vitro mechanical characteristics study. J Orthop Surg Res 2017; 12:128. [PMID: 28865455 PMCID: PMC5581440 DOI: 10.1186/s13018-017-0628-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 08/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Additive manufacturing (AM) technology has helped to achieve several advances in the medical field, particularly as far as fabrication of implants is concerned. But the application of direct metal laser sintering (DMLS) bone plate is quite limited due to the indeterminate mechanical property. The purposes of this study were to characterize the biomechanical properties of the polished DMLS reconstruction plate and to compare these with the properties of commonly applied implants and to find whether the mechanical performance of DMLS plate meets the requirements for clinical application. METHODS In this study, we fabricated two groups of plates by DMLS and computer numerical control (CNC) techniques. After that, we polished all samples and investigated their roughness, components, hardness, static bending, and torsional performance. Moreover, cyclic bending tests and fractographic analysis were conducted. Statistical comparisons of the group by means of monotonic test data were made, and a qualitative comparison was performed to assess failures in fatigue. RESULTS We found no differences in surface roughness or components after polishing, but the DMLS plate hardness is 7.42% (p < 0.01) greater than that of the CNC plates. Compared with the CNC plates, the DMLS plate static bending and torsional performance were significantly greater. In a dynamic test, the DMLS plates survived 106, 106, 32,731, and 33,264 cycles under 0.6, 0.8, 0.9, and 1 kN cyclic loads, respectively, while the CNC plates survived 106, 106, 106, and 283,714 cycles. CONCLUSIONS These results indicate that the mechanical performances of the DMLS plate are stronger, and the strength under fatigue tests is sufficient. DMLS implant has great potential and may become a better choice for clinical use in the future. However, direct application of these AM instruments in the operating room requires further validation including animal and clinical experiment.
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Affiliation(s)
- Pusheng Xie
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Hanbin Ouyang
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Yuping Deng
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Yang Yang
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Jing Xu
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Wenhua Huang
- Guangdong Provincial Key laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medicine Science, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
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Meeuwis MA, Pull Ter Gunne AF, Verhofstad MHJ, van der Heijden FHWM. Construct failure after open reduction and plate fixation of displaced midshaft clavicular fractures. Injury 2017; 48:715-719. [PMID: 28129880 DOI: 10.1016/j.injury.2017.01.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 09/24/2016] [Revised: 01/16/2017] [Accepted: 01/21/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Worldwide, implants mostly used for fixation of displaced midshaft clavicular fractures (DMCF) are the easily to bend reconstruction plate and the stiffer small fragment locking compression plate. Construct failure rates after plate fixation of DMCF are reported around 5 percent. Possible risk factors for construct failure are implant type and fracture type. However, little is known about the influence of fracture fixation method on construct failure. The aim of this study was to assess construct failure in plate fixation of DMCF and to identify possible risk factors. METHODS All consecutive patients treated in a level 1 trauma centre with open reduction and fixation of DMCF using a 3.5-mm reconstruction plate or 3.5-mm small fragment locking compression plate between 2007 and 2015 were evaluated. Potential risk factors for construct failure were analysed using univariate analysis. RESULTS Two hundred and fifty-nine patients were analysed. Fifty DMCF (19%) were fixated with a reconstruction plate and 209 (81%) with a small fragment locking compression plate. Construct failure was seen in 18 patients (6.9%), including 5 broken plates and 13 with screw loosening. Eight percent of all reconstruction plates broke in contrast to 0.5 percent of all small fragment locking compression plates (p=0.001). All broken implants were used as a bridging plate. Loosening of screws was seen in older patients and when the plate was fixated with less than three bicortical screws on one side of the fracture (p=0.002). CONCLUSIONS Overall construct failure after open reduction and plate fixation of DMCF occurred in 6.9 percent. Risk factors for plate breakage were the use of a reconstruction plate and a bridging method for fracture fixation. Risk factors for screw loosening were an increasing patient age and plate fixation with less than three bicortical screws on one side of the fracture. RECOMMENDATIONS Based on the results of this study our recommendation is to use a small fragment locking compression plate for open reduction and internal fixation of DMCF. The surgeon should always strive to fixate the plate on both sides of the fracture with at least three bicortical screws.
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Affiliation(s)
- M A Meeuwis
- Dept. of Surgery, St. Elisabeth Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
| | - A F Pull Ter Gunne
- Dept. of Surgery, St. Elisabeth Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - M H J Verhofstad
- Dept. of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Kwon IJ, Eo MY, Park SJ, Kim SM, Lee JH. Newly designed retentive posts of mandibular reconstruction plate in oral cancer patients based on preliminary FEM study. World J Surg Oncol 2016; 14:292. [PMID: 27871294 PMCID: PMC5117542 DOI: 10.1186/s12957-016-1043-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reconstruction of a large mandibular defect poses a challenging issue in oral cancer ablation surgery. One popular option for mandibular continuity reconstruction after tumor resection involves the use of a reconstruction plate (R-plate), which maintains space and contour without bone harvesting. An R-plate, however, cannot provide final functional loading rehabilitation with implants or dentures. METHODS We suggest a new method of functional mandibular reconstruction using retentive posts and an upper prosthesis. The finite element method (FEM) was used to optimize the design. Surgery was needed to adapt the retentive posts. Prosthodontic procedures were required for the upper prosthesis. RESULTS Eight patients were treated with retentive posts and prostheses. All patients underwent wide resections of the mandible, and reconstruction with an R-plate and microvascular soft tissue transfer. We adapted the retentive posts on an R-plate and fabricated the upper prostheses with a flexible denture or a fixed resin prosthesis. Finally, the patients had functional rehabilitation, which restored proper mastication. CONCLUSIONS The retentive posts of the R-plate and upper prosthesis allow functional dental rehabilitation without the need for a bone graft. Virtual simulation using FEM will help to design and optimize the retentive posts. Two or three regular size posts are suitable for the quadrant jaw. This first preliminary step will allow improved patient-specific retentive post designs in the near future.
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Affiliation(s)
- Ik Jae Kwon
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768, South Korea
| | - Mi Young Eo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768, South Korea
| | | | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768, South Korea.
| | - Jong Ho Lee
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768, South Korea
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Wang X, Wang G, Meng C, Liu X, Cai X. [ISO-C 3D NAVIGATION FOR PERCUTANEOUS SACROILIAC JOINT SCREW INTERNAL FIXATION FOR TREATMENT OF PELVIC POSTERIOR RING INJURIES]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2016; 30:1338-1343. [PMID: 29786382 DOI: 10.7507/1002-1892.20160274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the advantages and effectiveness of ISO-C3D guided percutaneous sacroiliac joint screw internal fixation for treatment of pelvic posterior ring injuries by comparing with anterior opened reduction and reconstruction plate internal fixation. METHODS A retrospective analysis was made on the clinical data of 54 patients with posterior ring injury treated between June 2013 and January 2016. Of 54 patients, 33 underwent ISO-C3D guided percutaneous sacroiliac joint screws internal fixation (group A), and 21 underwent anterior opened reduction and reconstruction plate internal fixation (group B). There was no significant difference in gender, age, cause of injuries, injury to operation time, fractures type, combined injuries, and injury severity score (ISS) between 2 groups (P>0.05). The operation time, intraoperative blood loss, length of operative incision, hospitalization time, postoperative pain degree, reduction evaluation, and functional evaluation were compared between 2 groups. RESULTS Group A was significantly better than group B in operation time, length of operative incision, and hospitalization time (P<0.05). The intraoperative blood loss of group A (10-20 mL) was significantly less than that of group B[(524.1±160.1) mL]. All patients of the 2 groups were followed up 7 to 24 months with an average of 11.6 months. No injury of vessel or nerve occurred in group A; worse neurological symptoms of lower limbs and incision infection were observed in 2 patients of group B respectively, and the other patients achieved primary healing of incision. At 48 hours after operation, the visual analogue scale (VAS) score of group A (1.7±0.7) was significantly lower than that of group B (8.2±0.8) (t=-30.463, P=0.000). Radiological examination showed fracture reduction. According to the Matta score standard, the reduction results were excellent in 21 cases (63.6%), good in 10 cases (30.3%), and fair in 2 cases (6.1%) in group A; the reduction results were excellent in 16 cases (76.2%), good in 4 cases (19.1%), and fair in 1 case (4.7%) in group B; and there was no significant difference between 2 groups (χ2=0.961, P=0.618). Fracture or dislocation healed well in 2 groups, and the walking function was restored. According to the Majeed standard for evaluation, the results were excellent in 23 cases (69.7%), good in 9 cases (27.3%), and fair in 1 case (3.0%) in group A; the results were excellent in 14 cases (66.7%), good in 5 cases (23.8%), and fair in 2 cases (9.5%) in group B; no significant difference was shown between 2 groups (χ2=1.501, P=0.591). CONCLUSIONS Compared with anterior opened reduction and reconstruction plate internal fixation, ISO-C3D navigation percutaneous sacroiliac joint screw internal fixation is an ideal surgical method to treat pelvic posterior ring injury, with the characteristics of less trauma, less pain, precise screw implant and safety.
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Affiliation(s)
- Xiaozhen Wang
- Department of Orthopeadic Surgery, Wuhan General Hospital of Chinese PLA, Wuhan Hubei, 430070, P.R.China
| | - Guodong Wang
- Department of Orthopeadic Surgery, Wuhan General Hospital of Chinese PLA, Wuhan Hubei, 430070, P.R.China
| | - Chengfei Meng
- Department of Orthopeadic Surgery, Wuhan General Hospital of Chinese PLA, Wuhan Hubei, 430070, P.R.China
| | - Ximing Liu
- Department of Orthopeadic Surgery, Wuhan General Hospital of Chinese PLA, Wuhan Hubei, 430070, P.R.China
| | - Xianhua Cai
- Department of Orthopeadic Surgery, Wuhan General Hospital of Chinese PLA, Wuhan Hubei, 430070, P.R.China
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Maini L, Sharma A, Jha S, Sharma A, Tiwari A. Three-dimensional printing and patient-specific pre-contoured plate: future of acetabulum fracture fixation? Eur J Trauma Emerg Surg 2016. [PMID: 27785534 DOI: 10.1007/s00068-016-0738-6.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Due to the complexity of acetabulum, achieving anatomical contouring intra-operatively is difficult for surgeon. A 3D (dimensional) real model can facilitate us both in contouring the plate pre-operatively and in better pre-operative planning. Patient-specific pre-contoured plate in acetabular fracture has been studied by few researchers but randomized case-control study was lacking. Hence, we conducted a case-control study to evaluate the accuracy of patient-specific pre-contoured plate. MATERIALS AND METHODS Prospective randomized case control study was conducted. 21 patients were included. 10 patients were distributed in "case" group and remaining 11 in "control" group. INCLUSION CRITERIA Displaced acetabulum fractures with displacement of ≥3 mm in adults who reported within 3 weeks of injury. Exclusion criteria were: Open fractures, associated Morel-Lavallée lesion and patients with >3 weeks old fracture. In case group, patient-specific real 3D model of fractured acetabulum was generated using rapid prototyping technology and plates were contoured pre-operatively. Control group was treated using intra-operative contoured plates. Both the groups were compared using parameters: Blood loss, Surgery time, post-operative reduction on X-ray, post-surgical residual displacement and reduction achieved as evaluated by CT scan. RESULTS Reduced blood loss (100 ml less in case group) and surgical time (12 min less in case group) and better post-operative reduction were observed in case than control. In control group, 4 patients even had step of 2-3 mm, which was not seen in case group. All the pre-contoured plates fitted well to the pelvis intra-operatively. Reduction achieved as evaluated by CT was more in "case" group with statistically significant outcomes (p < 0.05). CONCLUSION Patient-specific pre-contoured plate made using 3D model is a better implant than intra-operatively contoured plate. Real-time 3D pelvis model is an accurate technique for pre-operative planning in acetabular fractures.
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Affiliation(s)
- L Maini
- Maulana Azad Medical College, Delhi, India
| | - A Sharma
- Maulana Azad Medical College, Delhi, India. .,, E-31, Radha Kunj, Brij Vihar, Ghaziabad, Uttar Pradesh, 201011, India.
| | - S Jha
- Indian Institute of Technology, Delhi, India
| | - A Sharma
- Maulana Azad Medical College, Delhi, India
| | - A Tiwari
- Maulana Azad Medical College, Delhi, India
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Maini L, Sharma A, Jha S, Sharma A, Tiwari A. Three-dimensional printing and patient-specific pre-contoured plate: future of acetabulum fracture fixation? Eur J Trauma Emerg Surg 2016; 44:215-224. [PMID: 27785534 DOI: 10.1007/s00068-016-0738-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [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: 05/10/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Due to the complexity of acetabulum, achieving anatomical contouring intra-operatively is difficult for surgeon. A 3D (dimensional) real model can facilitate us both in contouring the plate pre-operatively and in better pre-operative planning. Patient-specific pre-contoured plate in acetabular fracture has been studied by few researchers but randomized case-control study was lacking. Hence, we conducted a case-control study to evaluate the accuracy of patient-specific pre-contoured plate. MATERIALS AND METHODS Prospective randomized case control study was conducted. 21 patients were included. 10 patients were distributed in "case" group and remaining 11 in "control" group. INCLUSION CRITERIA Displaced acetabulum fractures with displacement of ≥3 mm in adults who reported within 3 weeks of injury. Exclusion criteria were: Open fractures, associated Morel-Lavallée lesion and patients with >3 weeks old fracture. In case group, patient-specific real 3D model of fractured acetabulum was generated using rapid prototyping technology and plates were contoured pre-operatively. Control group was treated using intra-operative contoured plates. Both the groups were compared using parameters: Blood loss, Surgery time, post-operative reduction on X-ray, post-surgical residual displacement and reduction achieved as evaluated by CT scan. RESULTS Reduced blood loss (100 ml less in case group) and surgical time (12 min less in case group) and better post-operative reduction were observed in case than control. In control group, 4 patients even had step of 2-3 mm, which was not seen in case group. All the pre-contoured plates fitted well to the pelvis intra-operatively. Reduction achieved as evaluated by CT was more in "case" group with statistically significant outcomes (p < 0.05). CONCLUSION Patient-specific pre-contoured plate made using 3D model is a better implant than intra-operatively contoured plate. Real-time 3D pelvis model is an accurate technique for pre-operative planning in acetabular fractures.
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Affiliation(s)
- L Maini
- Maulana Azad Medical College, Delhi, India
| | - A Sharma
- Maulana Azad Medical College, Delhi, India. .,, E-31, Radha Kunj, Brij Vihar, Ghaziabad, Uttar Pradesh, 201011, India.
| | - S Jha
- Indian Institute of Technology, Delhi, India
| | - A Sharma
- Maulana Azad Medical College, Delhi, India
| | - A Tiwari
- Maulana Azad Medical College, Delhi, India
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Chen L, Zhang W, Shi K, Han A, Zhou X, Han Z. [EFFICACY COMPARISON OF RECONSTRUCTION BELT AND RECONSTRUCTION PLATE FOR COMPLICATED ACETABULAR FRACTURE BY COMBINED ANTERIOR AND POSTERIOR APPROACHES]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2016; 30:680-684. [PMID: 29786275 DOI: 10.7507/1002-1892.20160138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the advantage of reconstruction belt for treating complicated acetabular fracture by combined anterior and posterior approaches through the comparison with reconstruction plate. METHODS A retrospective analysis was made on the clinical data of 39 patients with acetabular fractures who met the selection criteria. After open reduction by combined anterior and posterior approaches was performed, fracture was fixed by reconstruction belt in 20 cases (trial group), and by reconstruction plate in 19 cases (control group). There was no significant difference in gender, age, cause of injury, time from injury to hospital, type of fracture, and preoperative visual analogue scale (VAS) score between 2 groups (P > 0.05). The number of plate shaping, plate shaping time, operation time, bleeding amount, perspective times, VAS score, modified Merled'Aubigne-Postel hip score, and related complications were recorded and compared. According to Matta standard, the fracture displacement was measured to evaluate the fracture reduction and fracture healing. RESULTS The number of plate shaping, plate shaping time, operation time, bleeding amount, and perspective times in the trial group were significantly less than those in the control group (P < 0.05). The patients were followed up 12-29 months (mean, 21.1 months) in the trial group, and 12-27 months (mean, 20.5?months) in the control group. The VAS score was significantly lower at 7 days and 6 months after operation than at pre-operation, and at 6 months than at 7 days in 2 groups (P < 0.05), but difference was not significant between 2?groups (P > 0.05). At 6?months after operation, the Merled'Aubigne-Postel score of hip function in the trial group was 15.950±1.504, showing no significant difference when compared with the control group (15.895±1.629) (t= -0.110, P=0.913). The fracture displacement was (0.750±1.070) mm in the trial group and was (0.842±1.068) mm in the control group, showing no significant difference (t= -0.269, P=0.789). The X-ray films showed that all fractures healed in 2?groups. The healing time was (16.10±2.07) weeks in the trial group and was (15.84±2.14) weeks in the control group, showing no significant difference (t =0.382, P=0.075). CONCLUSIONS Reconstruction belt for complicated acetabular fracture by combined anterior and posterior approaches has similar effectiveness to reconstruction plate, but the number of plate shaping, plate shaping time, and perspective times are fewer.
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Affiliation(s)
- Lin Chen
- Department of Orthopedics, the First Affiliated Hospital, China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Wei Zhang
- Department of Orthopedics, the First Affiliated Hospital, China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Ke Shi
- Department of Orthopedics, the First Affiliated Hospital, China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Anping Han
- Department of Orthopedics, the First Affiliated Hospital, China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Xiaoshu Zhou
- Department of Orthopedics, the First Affiliated Hospital, China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Zhuang Han
- Department of Orthopedics, the First Affiliated Hospital, China Medical University, Shenyang Liaoning, 110001, P.R.China
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Woltz S, Duijff JW, Hoogendoorn JM, Rhemrev SJ, Breederveld RS, Schipper IB, Beeres FJ. Reconstruction plates for midshaft clavicular fractures: A retrospective cohort study. Orthop Traumatol Surg Res 2016; 102:25-9. [PMID: 26768774 DOI: 10.1016/j.otsr.2015.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 03/17/2015] [Revised: 09/07/2015] [Accepted: 11/02/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND For the fixation of displaced midshaft clavicular fractures different plates are available, each with its specific pros and cons. The ideal plating choice for this lesion remains subject to ongoing discussion. Reconstruction plates are cheap and easily bendable, but their strength and stability have been questioned. The aim of this study was to evaluate the failure rate of reconstruction plates in the fixation of clavicular fractures. MATERIALS AND METHODS A multicenter, retrospective cohort study of all consecutive patients with a displaced, midshaft clavicular fracture (Robinson type 2a/2b) treated with a 3.5-mm reconstruction plate between 2006 and 2013 were evaluated. The primary outcome measure was reoperation rate due to implant failure. Secondary outcome measures were nonunion, symptomatic malunion and elective plate removal. RESULTS One hundred and eleven patients were analyzed. During a median follow-up of 8 months, 14 patients (12.6%) had implant failure, of which 7 (6.3%) required a reoperation. Three nonunions (2.7%) and no symptomatic malunions occurred. Plate removal was indicated in 37.8% of patients because of implant irritation. DISCUSSION The incidence of reoperation due to implant failure following clavicular plate fixation with a reconstruction plate is 6.3%. Although comparison with other plate types is difficult since rates in literature vary greatly, reoperation rates in other plates are reported around 2-3%, suggesting that reconstruction plates have a higher incidence of implant failure warranting reoperation. Therefore, especially in patients with known risk factors for complications (e.g. smoking, osteoporosis, comminuted fractures), a stronger plate than a reconstruction plate should be considered. LEVEL OF EVIDENCE Level IV. Retrospective study.
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Schaaf AC, Morscher MA, Weiner DS. The use of the reconstruction plate in multiplanar tibial osteotomies in children. J Child Orthop 2011; 5:127-33. [PMID: 22468156 PMCID: PMC3058200 DOI: 10.1007/s11832-011-0331-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/11/2010] [Accepted: 02/17/2011] [Indexed: 02/03/2023] Open
Abstract
PURPOSE External fixation and cross-pin fixation appear to be the two most commonly used forms of fixation after a tibial osteotomy in children described in the literature. The purpose of this study is to describe our experience using a properly bent and contoured reconstruction plate for mismatched surfaces after a multiplanar tibial osteotomy. METHODS A retrospective review was conducted of 37 multiplanar tibial osteotomy surgeries in 23 children performed by a single surgeon using a reconstruction plate for internal fixation. A low fibular osteotomy and tibial osteotomy that required contouring and shaping of the plate were performed in all cases. A proximal tibial osteotomy was performed in 30 cases and a distal osteotomy in seven cases. All cases were reinforced with a long-leg cast. All charts were reviewed for intra- and postoperative complications. The surgery using the reconstruction plate internal fixation was considered to be a success if there was healing of the osteotomy and no hardware failure. RESULTS A properly bent and contoured reconstruction plate conformed well to the mismatched surfaces after tibial osteotomy. Hardware was removed in all but two cases, on average 7 months after surgery. There were no hardware failures. No child developed a deep wound infection or neurovascular complication, including compartment syndrome. Only two complications in 37 surgeries (5%) were encountered and were typical of any type of internal fixation. One child required an exploratory procedure because of screw extrusion and one child developed a post-plate removal fracture. CONCLUSIONS The reconstruction plate is very malleable and can be contoured to fit in nearly every direction to accommodate mismatched appositional surfaces. It has been successfully employed in 37 consecutive cases of multiplanar tibial osteotomy in children with relatively few complications, none directly related to the plate.
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Affiliation(s)
- Adam C. Schaaf
- />Department of Orthopaedic Surgery, Akron Children’s Hospital and Summa Health System, Akron, OH 44302 USA
| | - Melanie A. Morscher
- />Pediatric Orthopaedic Research, Akron Children’s Hospital, Akron, OH 44302 USA
| | - Dennis S. Weiner
- />Department of Pediatric Orthopaedic Surgery, Akron Children’s Hospital, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, 300 Locust Street, Ste. 160, Akron, OH 44302-1821 USA
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Cho CH, Song KS, Min BW, Bae KC, Lee KJ. Operative treatment of clavicle midshaft fractures: comparison between reconstruction plate and reconstruction locking compression plate. Clin Orthop Surg 2010; 2:154-9. [PMID: 20808586 PMCID: PMC2915394 DOI: 10.4055/cios.2010.2.3.154] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [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: 11/27/2008] [Accepted: 08/03/2009] [Indexed: 11/29/2022] Open
Abstract
Background To compare the outcomes of reconstruction plate and reconstruction locking compression plate (LCP) for the treatment of clavicle midshaft fractures. Methods Forty one patients with a clavicle midshaft fracture were treated by internal fixation with a reconstruction plate (19 patients) or reconstruction LCP (22 patients). The clinical and radiological results were evaluated according to the Quick Disability of the Arm, Shoulder, and Hand (DASH) score and plain radiographs. Results The mean time to union was 14.6 weeks in the reconstruction plate group compared to 13.2 weeks in the reconstruction LCP group (p > 0.05). The mean score to Quick DASH was 33.85 points in the reconstruction plate group compared to 34.81 points in the reconstruction LCP group (p > 0.05). The complications in the reconstruction plate were hypertrophic scarring in 2 cases, painful shoulder in 2 cases, limitation of shoulder motion in 2 cases, and screw loosening in 3 cases. In addition, the complications in the reconstruction LCP group was hypertrophic scarring in 4 cases, painful shoulder in 1 case and a limitation of shoulder motion in 1case (p > 0.05). Conclusions This study showed radiologically and clinically satisfactory results in both groups. Overall, operative treatment with a Reconstruction plate or reconstruction LCP for clavicle shaft fractures can be used to obtain stable fixation.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopaedic Surgery, Dongsan Medicial Center, Keimyung University School of Medicine, Daegu, Korea.
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