Experimental investigation of ultrasonic assisted coating on three-point bending behavior of 3D printed polymeric bone plates for biomedical applications

3D printed Poly Lactic Acid (PLA) bone plates exhibit limited three-point bending strength, restricting their viability in biomedical applications. The application of polydopamine (PDM) enhances the three-point bending strength by undergoing covalent interactions with PLA molecular structure. However, the heavy nature of PDM particles leads to settling at the container base at higher coating solution concentrations. This study investigates the impact of ultrasonic-assisted coating parameters on the three-point bending strength. Utilizing Response Surface Methodology (RSM) for statistical modeling, the study examines the influence of ultrasonic vibration power (UP), coating solution concentration (CC), and submersion time (TIME). RSM optimization recommended 100 % UP, 6 mg/ml CC, and 150 min TIME, resulting in maximum three-point bending strength of 83.295 MPa. Microscopic images from the comparative analysis revealed non-uniform coating deposition with mean thickness of 6.153 µm under normal coating. In contrast, ultrasonic-assisted coating promoted uniform deposition with mean thickness of 18.05 µm. The results demonstrate that ultrasonic-assisted coating induces PDM particle collision, preventing settling at the container base, and enhances three-point bending strength by 7.27 % to 23.24 % compared to the normal coating condition. This study emphasizes on the potential of ultrasonic-assisted coating to overcome the limitations of direct immersion coating technique.

Effect of different composite plates on the healing of femoral fractures

In this paper, the effects of different composite plates on the healing of femoral fractures were studied by numerical simulation. The healing model of femoral fracture was established by ABAQUS display solver. Based on the fuzzy logic theory, the process of callus differentiation at femoral fracture was considered under the joint action of biological variables and mechanical stimulation, and the healing process of femur was simulated. Compare the stress on the screw, concentration of callus bone and cartilage, and callus healing performance of the carbon/epoxy composite (WSN3k) plate, glass/polypropylene composite (Twintex) plate, and stainless steel plate at various stages of bone healing, and investigate the impact of composite plates on the bone healing process. The results showed that the modulus of the plate had a notable impact on bone healing. Compared to stainless steel plate, the composite plate (due to its lower stiffness) exhibiting superior healing performance. Altering the sequence of composite laminates may modify the bone healing efficiency, and the wsn3k [0]18 composite plate exhibits superior healing performance.

Response surface methodology and machine learning based tensile strength prediction in ultrasonic assisted coating of poly lactic acid bone plates manufactured using fused deposition modeling

Poly Lactic Acid (PLA) based bone plates fabricated using Fused Deposition Modeling have poor mechanical strength which can be improved by biocompatible polydopamine (PDM) coating. However, PDM particles, being heavy in nature, settle at the container bottom with increase in coating solution concentration at the time of bone plate coating using dip coating technique. Thus, the present work aims to witness the effect of ultrasonic assisted coating parameters on tensile strength of coated bone plates. The coating parameters involving power of ultrasonic vibrations, coating solution concentration and immersion time were varied. The standard Response Surface Methodology (RSM) was applied and experimental trials were performed for obtaining tensile strength of bone plates under varied coating parameters. The objective of the present study was to compare the values of tensile strength predicted using RSM and machine learning (ML) models. Based on the obtained experimental values, gradient boosting regression (GBReg), linear regression (LReg) and random forest regression (RFReg) were trained and tested for predicting tensile strength of bone plates. The accuracy and prediction errors corresponding to RSM and ML based models were compared with respect to R2, Mean Squared Error (MSE), Mean Absolute Error (MAE) and Root Mean Squared Error (RMSE). The findings revealed that GBReg exhibited R2, MSE, RMSE and MAE values as 0.9312, 1.7142, 1.2877 and 1.0861 respectively, while RSM showed R2, MSE, RMSE and MAE values as 0.882, 2.13, 1.4595 and 1.258 respectively. RSM model has shown minimum accuracy with high prediction errors amongst the four models. GBReg has outperformed other ML models in terms of their accuracy and error metrics. The present study therefore suggests the application of GBReg based ML model for predicting tensile strength of PDM coated bone plates in response to its accurate and robust prediction performance.

Design considerations for patient-specific bone fixation plates: a literature review

In orthopedic surgery, patient-specific bone plates are used for fixation when conventional bone plates do not fit the specific anatomy of a patient. However, plate failure can occur due to a lack of properly established design parameters that support optimal biomechanical properties of the plate.This review provides an overview of design parameters and biomechanical properties of patient-specific bone plates, which can assist in the design of the optimal plate.A literature search was conducted through PubMed and Embase, resulting in the inclusion of 78 studies, comprising clinical studies using patient-specific bone plates for fracture fixation or experimental studies that evaluated biomechanical properties or design parameters of bone plates. Biomechanical properties of the plates, including elastic stiffness, yield strength, tensile strength, and Poisson's ratio are influenced by various factors, such as material properties, geometry, interface distance, fixation mechanism, screw pattern, working length and manufacturing techniques.Although variations within studies challenge direct translation of experimental results into clinical practice, this review serves as a useful reference guide to determine which parameters must be carefully considered during the design and manufacturing process to achieve the desired biomechanical properties of a plate for fixation of a specific type of fracture.

The use of precontoured plates for midshaft clavicle fractures is not always the best course of treatment

Plate fixation has become the preferred approach for treating displaced midshaft clavicle fractures. However, plate fixation of the clavicle presents several unique challenges, including its complex bony architecture and its immediate subcutaneous location. In many cases, we have observed that precontoured implants do not conform to the clavicular anatomy, and many patients complain of postoperative implant-related discomfort. A total of 111 clavicles, both left and right sides, were examined to match two commonly used designs of anatomical pre-contoured superior anterior clavicle plates, with and without lateral extension. The anteroposterior (AP) plane congruence of the plate to the underlying bone, the vertical gap between the bone and plate, and the length of the plate that was off the bone either anteriorly and/or posteriorly at both ends of the clavicle were measured. The scoring system was used to determine the fit of the implant on the clavicle as anatomic, good, or poor. We found that the maximum superior bow of the clavicle was lateral to the midline by 30.75 mm and 30.5 mm on the right and left sides, respectively. The magnitude of the bow was 4.28 mm and 4.46 mm on the right and left sides, respectively. We also found that the plate was a poor fit in 75.86% of cases on the left side and 73.5% of cases on the right side. Manipulating the plates during surgery was very difficult in the AP plane.

Investigation of lattice infill parameters for additively manufactured bone fracture plates to reduce stress shielding

BACKGROUND

Stress shielding is a detrimental phenomenon caused by the stiffness mismatch between metallic bone plates and bone tissue, which can hamper fracture healing. Additively manufactured plates can decrease plate stiffness and alleviate the stress shielding effect.

METHODS

Rectilinear lattice plates with varying cell sizes, wall thicknesses, and orientations are computationally generated. Finite element analysis is used to calculate the four-point bending stiffness and strength of the plates. The mechanical behaviors of three different lattice plates are also simulated under a simple diaphyseal fracture fixation scenario.

RESULTS

The study shows that with different combinations of lattice infill parameters, plates with up to 68% decrease in stiffness compared to the 100% infill plate can be created. Moreover, in the fixation simulations, the least stiff lattice plate displays 53% more average stress distribution at the healing callus region compared to the 100% infill plate.

CONCLUSIONS

Using computational techniques, it has been demonstrated that additively manufactured stiffness-reduced bone plates can successfully address stress shielding with the strategic modulation of lattice infill parameters. Lattice plates with design versatility have the potential for use in various fracture fixation scenarios.

The comparison of stress and strain between custom-designed bone plates (CDBP) and locking compression plate (LCP) for distal femur fracture

BACKGROUND

Distal femur fracture is considered one of the most common fractures due to high-energy traumas such as car accidents or low-energy traumas such as osteoporosis. Locking plates are orthopedic implants used for stabilized femur fracture. Thus, designing a bone plate fitted exactly with the patient's bone and correctly fixing bone segments are required for better fracture healing.

OBJECTIVES

This study aims to design a bone plate based on anthropometric characteristics of patients' femurs and compare performing custom-designed bone plates (CDBP) with the locking compression plate (LCP) by finite element method.

MATERIALS AND METHODS

In this analytical study, a 3D model of four patients' femur and CDBP were firstly designed in MIMICS 19.0 based on the patient's femur anatomy. After designing the bone plate, the CDBPs and LCP were fixed on the bone and analyzed by finite element method (FEM) in ANSYS, and stress and strain of bone plates were also compared.

RESULTS

The maximum principal stress for all 3D models of patients' fracture femur by CDBPs was stabilized better than LCP with a decrease by 39.79, 12.54, 9.49, and 20.29% in 4 models, respectively. Also, in all models, the strain of CDBPs is less than LCP. Among the different thicknesses considered, the bone plate with 5 mm thickness showed better stress and strain distribution than other thicknesses.

CONCLUSION

Customized bone plate designed based on patient's femur anatomical morphology shows better bone-matching plate, resulting in increasing the quality of the fracture healing and fails to any need for additional shaping.

TRIAL REGISTRATION NUMBER

Design and analysis of an implant were investigated in this study. There was no intervention in the diagnosis and treatment of patients and the study was not a clinical trial.

In-vivo bone remodeling potential of Sr-d-Ca-P /PLLA-HAp coated biodegradable ZK60 alloy bone plate

Magnesium and its alloys are widely applied biomaterials due to their biodegradability and biocompatibility. However, rapid degradation and hydrogen gas evolution hinder its applicability on a commercial scale. In this study, we developed an Mg alloy bone plate for bone remodeling and support after a fracture. We further coated the Mg alloy plate with Sr-D-Ca-P (Sr dopped Ca-P coating) and Sr-D-Ca-P/PLLA-HAp to evaluate and compare their biodegradability and biocompatibility in both in vitro and in vivo experiments. Chemical immersion and dip coating were employed for the formation of Sr-D-Ca-P and PLLA-HAp layers, respectively. In vitro evaluation depicted that both coatings delayed the degradation process and exhibited excellent biocompatibility. MC3T3-E1cells proliferation and osteogenic markers expression were also promoted. In vivo results showed that both Sr-D-Ca-P and Sr-D-Ca-P/PLLA-HAp coated bone plates had slower degradation rate as compared to Mg alloy. Remarkable bone remodeling was observed around the Sr-D-Ca-P/PLLA-HAp coated bone plate than bare Mg alloy and Sr-D-Ca-P coated bone plate. These results suggest that Sr-D-Ca-P/PLLA-HAp coated Mg alloy bone plate with lower degradation and enhanced biocompatibility can be applied as an orthopedic implant.

Evaluation of Ulnar Setting of Volar Locking Plates for Distal Radius Fractures Using Modified Skyline View

Purpose

Volar lunate facet fragments in distal radius fractures are located at the center of the load in the wrist joint and, therefore, should be properly supported by the distal ulnar setting of volar locking plates to obtain better postoperative outcomes. This study evaluated the usefulness of the modified skyline view (MSV) in intraoperative fluoroscopy for the ulnar setting of volar locking plates by comparing it with that of the anteroposterior view (APV).

Methods

Sixty-five patients with distal radius fractures who underwent open reduction and plate fixation as well as follow-up intraoperative fluoroscopy and postoperative computed tomography (CT) at our institution between April 2019 and March 2022 were included. The distance between the ulnar edge of the plate and the distal radius (d-value) was measured retrospectively using intraoperative fluoroscopy (distance measured from MSV and distance measured from APV) or postoperative CT (distance measured using postoperative CT). The distance measured from MSV and that measured from APV were compared with those measured using CT as the true values. Each measurement was performed twice by 2 examiners at an interval of 1 month. The comparison scores were evaluated using the intraclass correlation coefficient.

Results

The distance measured from MSV showed a difference of 0.6 ± 0.5 mm from that measured using CT, which was significantly smaller than that measured from APV (1.2 ± 0.9 mm; P < .001). Neither postoperative volar subluxation nor dislocation of bone fragments was found during the study period. Both intraclass correlation coefficient (1,1) and intraclass correlation coefficient (2,1) reliabilities were substantial to almost perfect.

Conclusions

Modified skyline view is an effective and versatile imaging method for estimating the ulnar setting of volar locking plates; it provides measurements more similar to those provided by postoperative CT compared with APV. The use of MSV may reduce postoperative complications, such as volar subluxation and dislocation of bone fragments, especially in cases with volar lunate facet fragments in which the ulnar setting of the plate is significant.

Type of study/level of evidence

Diagnostic III.

Aseptic nonunion of the tibia treated by plating and bone grafting: retrospective study about 40 cases

Objective

The objective of this study was to evaluate the clinical and radiological results of the treatment of aseptic nonunion of the tibia by plating and bone grafting.

Material and Methods

This retrospective study included 40 patients with aseptic nonunion of the tibia, treated in the Trauma-Orthopedic department B4 of CHU Hassan II in Fez-Morocco. The average age was 41 years (range 25–60 years). The initial fractures were in the middle third of the tibia for the majority of our patients. We used the ASAMI criteria to assess the results.

Results

We found 45 patients with aseptic nonunion of the tibia who were treated by the same surgical team and followed in postoperative consultation for a fixed period of 10 months. Three patients lost to follow-up and two patients refused the treatment. In 37 patients (92.5%), union was obtained after a mean delay of 4.3 months (range 3–7 months). The average time from initial treatment to treatment for nonunion was eight months (range 6–10 months). According to the ASAMI classification, bone results were excellent in 26, good in 8, fair in 3 and poor in 3; functional results were excellent in 10, good in 16, fair in 11 and poor in 3.

Conclusions

Our study suggests that the combination of screwed plate and autograft in the treatment of aseptic nonunion of the tibia has provided satisfactory results. A well-codified management of the initial fracture remains the gold key to prevent the occurrence of pseudarthrosis.

In silico analysis of modular bone plates

BACKGROUND

Inventory management or immediate availability of fracture plates can be problematic since for each surgical intervention a specific plate of varying size and functionality must be ordered. Modularization of the standard monolithic plate is proposed to address this issue.

METHODS

The effects of four different unit module design parameters (type, degree of modularization, connector screw diameter, sandwich ratio) on the plate bending stiffness and failure are investigated in a finite element four-point-bending analysis. A chosen, best-performing modular plate is then tested in silico for a simple diaphyseal tibial fracture scenario under anatomical compressional, torsional, and bending loads.

RESULTS

A modularization strategy is proposed to match the monolithic plate bending properties as closely as possible. With the best combination of design parameters, a fully modularized equivalent length plate with a 42.3% decrease in stiffness and 46.2% decrease in strength could be assembled. The chosen modular plate also displayed sufficient mechanical performance under the fracture fixation scenarios for a potentially successful osteosynthesis.

CONCLUSIONS

Via computational methods, the viability of the modularization strategy as an alternate to the traditional monolithic plate is demonstrated. As a further realized advantage, the modular plates can alleviate stress shielding thanks to the reduced stiffness.

Peri-implant distal clavicle fracture: Case report (overlaying plate fixation: Solution for peri-implant clavicle fractures)

Introduction and importance

Surgical treatment for clavicle injuries is indicated for displaced and shortened fractures. Osteosyntheses with plate fixation may present with complications in 6.3% to 8.5% of patients. Peri-implant clavicle fractures (PIF) are rare, and we have not found any previous cases in our literature search.

Case presentation

A 25-year-old male with previously (six years earlier) surgically treated clavicle fracture presented with a peri-implant clavicle fracture requiring surgical treatment. The management involved overlaying an implant to fix the lateral clavicle fracture without removing the previous plate. Complete bone healing was observed without any further complication.

Clinical discussion

Despite the low rate of implant failure in clavicle fractures, this complication occurs mainly in elderly patients with poor bone quality. No PIF have been described in the literature prior to this. This case report demonstrates a young patient with good bone quality and previous fracture fixation presenting with PIF which has now shown complete bone healing.

Conclusion

In this case, overlying an additional plate on the lateral clavicle portion without removing the previous plate increased the stability of the fracture. It demonstrates the value of overlaying plate osteosyntheses for patients with clavicle PIF.

•

Peri-implant clavicle fracture is a rare situation.

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The management of peri-implant fracture is challenging.

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Overlaying plate fixation can be the solution for peri-implant clavicle fractures.

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Background

Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side.

Objective

The purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture.

Materials and methods

Thirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test.

Results

The maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm).

Conclusion

According to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

Enhanced biomechanical performance of additively manufactured Ti-6Al-4V bone plates

As the global trauma fixation devices market expands rapidly, it is imperative to improve the production of fixation devices through enhanced design accuracy and fit for best performance and maximum patient comfort. Selective laser melting (SLM) is one of the mature additive manufacturing methods, which provides a viable route for the rapid production of such devices. In this work, the ability of SLM to produce near-net-shape parts, as desired for medical implants, was utilized for the fabrication of bone plates from Ti-6Al-4V alloy powder. Martensitic microstructure obtained after the printing of alloy resulted in poor ductility, limiting its application in the field of orthopedics. A specially designed repeated cyclic heating and cooling close to but below the β-transus was used to transform from acicular to a bimodal microstructure without the need for plastic deformation prior to heat treatment for improving the ductility. Bone plates subjected to this heat treatment were mechanically tested by means of tensile and 3-point bend tests and demonstrated large improvement in ductility, and the values were comparable to those similar plates prepared from wrought alloy. Other important properties required for implants were assessed, such as corrosion resistance in simulated body fluid and cytocompatibility in vitro using MC3T3-E1 cells. These results for the bone plate after heat treatment were excellent and similar to those of the additively manufactured and wrought plates. Taken together, the performance of the additively manufactured bone plates after subjecting to heat treatment was similar to those of bone plate manufactured using wrought alloy. These results have important implications for the fabrication of patient-specific metallic orthopedic devices using SLM without compromising their biomechanical performance by subjecting them to a tailored heat treatment.

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

Background

Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage.

Objective

We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture.

Materials and methods

We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups.

Results

The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively.

Conclusion

Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

Bone plate repositioned over the antrostomy after sinus floor elevation: an experimental study in sheep

The objective of this study was to compare the healing of the augmented sinus at which the antrostomy was covered with a membrane or the repositioned bone plate.Eight sheep underwent bilateral maxillary sinus floor augmentation. The control site was covered with a resorbable membrane, while at the experimental site the bone plate was repositioned, and both were secured with cyanoacrylate. Animals were euthanised after 4 months and histomorphometric analysis was performed.A large amount of the graft appeared to be partially interpenetrated by the newly formed bone. Statistical analysis demonstrated different percentages of the new bone and bone interpenetrated to the graft between test and control site in the close-to-window area respectively 22.1 ± 12.6 vs 7.5 ± 4.5 (P = 0.028) and 66.1 ± 14.7 vs 44.2 ± 15.1 (P = 0.046). Other areas showed no difference in the bone and graft amount. More bone was found at the edges of the antrostomy in the experimental site, without statistical significance. In the centre of the antrostomy, the replaced bony window appeared bonded to the newly formed bone. No remnants and no biological response to cyanoacrylate were observed.The repositioning of the bony window after sinus floor elevation in sheep led to a larger amount of newly formed bone in the close-to-window zone of the grafted area. The bony window appeared partially bonded to the new bone. Newly formed bone was found interpenetrating the graft granules.

A novel adjustable locking plate (ALP) for segmental bone fracture treatment

A novel Ti6Al4V adjustable locking plate (ALP) is designed to provide enhanced bone stability for segmental bone fractures and to allow precise positioning of disconnected segments. The design incorporates an adjustable rack and pinion mechanism to perform compression, distraction and segment transfer during plate fixation surgery. The aim of this study is to introduce the advantages of the added feature and computationally characterize the biomechanical performance of the proposed design. Structural strength of the novel plate is analyzed using numerical methods for 4-point bending and fatigue properties, following ASTM standards. An additional mechanical failure finite element test is also conducted on the rack and pinion to reveal how much torque can be safely applied to the mechanism by the surgeon. Simulation results predict that the new design is sufficiently strong to not fail under regular anatomical loading scenarios with close bending strength and fatigue life properties to clinically used locking compression plates. The novel ALP design is expected to be a good candidate for addressing problems regarding fixation of multi-fragmentary bone fractures.

Exotic Mammal Orthopedics

Orthopedic disorders are a common clinical presentation for the exotic clinician. Before treating the fracture it is vital to stabilize the patient. Small exotic mammals are characterized by relatively thinner bones, adding to the difficulty the small size already represents. A combination of conservative and surgical treatment options are available. The principles of orthopedic surgery and ideas behind the treatment options remain the same as for small mammals, but not all techniques can be directly extrapolated. Historically, the tie-in fixator has been the preferred surgical choice whenever feasible, but further development in bone plates represents a promising advancement.

Biocompatible Porous Tantalum Metal Plates in the Treatment of Tibial Fracture

Fractures of the tibia represent a common class of injuries in orthopedics. The blood supply to the tibia is poor due to the small subcutaneous muscle tissues inside. Consequently, the tibia is prone to delayed fracture healing and nonunion of the fracture after surgery. In this case, we used porous tantalum metal plate to treat nonunion of a tibial fracture and achieved satisfactory therapeutic effects. For the first time in the field, we used 3D printing technology to fabricate porous tantalum metal plates for the treatment of tibial fractures. The resulting porous tantalum metal exhibited excellent mechanical and biological properties, and improved the therapeutic effects for the treatment of a tibial fracture nonunion. Porous tantalum metal plates have great application potential as a new implant material for internal fixation.

HIGH TIBIAL OSTEOTOMY USING A LOCKING TITANIUM PLATE WITH OR WITHOUT AUTOGRAFTING

Objective:

To postoperatively evaluate knee scores, radiological assessment results, deficit correction, patellar height change, bone healing time, and weight bearing time in patients undergoing high tibial osteotomy (HTO) with/without autologous iliac bone grafting.

Methods:

This retrospective examination of treated controls from a randomized controlled study included 63 knees of 58 patients aged 46–59 years who underwent HTO with locking open wedge osteotomy plates. The patients were divided into two groups: Group A, HTO with autologous iliac bone grafts (n = 31); and Group B, HTO without autologous iliac bone grafts (n = 32). Clinical and radiological data were evaluated prospectively at the preoperative consultation and again at 6, 9, and 12 weeks, 6 months, and 1 year after the surgery (and annually thereafter).

Results:

There were no significant intergroup differences in the radiological assessment, deficit correction, patellar height change, bone-healing time, and weight-bearing time at any time after surgery. The knee scores changed positively in both groups (p < 0.001).

Conclusions:

There was no difference in the results of patients undergoing HTO with open wedge osteotomy titanium locking plates with or without autografting, and comorbidities resulting from autografts were eliminated with the use of locking plates. Level of evidence III, Retrospective Study.

Morphometric Variations in the Volar Aspect of the Distal Radius

Background

Significant discrepancy exists between anatomical plate designs and the anatomy of the native distal radius, which may be attributable to considerable morphometric variations in the volar aspect of the distal radius. We aimed to evaluate the degree of variability in the morphometry of the distal radius and identify factors associated with this variability.

Methods

We measured the volar surface angle (VSA) of the intermediate and lateral columns and the volar surface width (VSW) in the distal radius from three-dimensional computed tomography scans acquired from 81 cadaveric forearms. These morphometric parameters were compared between the lateral and intermediate columns, between males and females, and between Koreans and Caucasians. Caucasian morphometric data were obtained and pooled from the previous studies. The coefficient of variation was used to assess the variability of the parameters and Cohen's d to estimate the effect size of the difference between groups.

Results

The average VSA of the lateral column was 22° ± 6°, and that of the intermediate column was 29° ± 8° in Koreans (p < 0.001). The variability was high for both VSAs. The VSA of the intermediate column was significantly larger in males than in females (p < 0.001) and in Caucasians than in Koreans (p < 0.001). The average VSW of distal radius was 30 ± 3 mm at the watershed line, and it became narrower proximally. The VSW was significantly larger in males than in females (p < 0.001) and in Koreans than in Caucasians (p < 0.001). The effect sizes of the difference for the VSA and VSW between sexes, races and columns were medium to large.

Conclusions

Considerable variability exists in the morphometry of the volar distal radius, with sex, race, and column as contributing factors. These results suggest that surgeons should carefully choose an anatomical volar locking plate with appropriate angulation characteristics for each patient to achieve patient-specific alignment of the distal radius.

Rotational evaluation of humeral shaft fractures with proximal extension fixed using the MIPO technique

INTRODUCTION

Diaphyseal fractures with proximal humeral extension can be treated using a helical model, so it is lateral on the proximal aspect and on the diaphyseal segment in the anterior surface.

OBJECTIVE

Our objective was to evaluate possible rotational deviations using minimally invasive plate osteosynthesis (MIPO) and to determine how it affects upper limb function.

METHODS

We followed 11 patients for a period of two years. The proximal approach was anterior-lateral, and the distal approach was anterior, dividing the brachial muscle. For rotational evaluation, we used the semi-axial incidence described by Oztuna et al., assessing the degree of retroversion of the humeral head in relation to the elbow. During follow-up, we measured bilateral range of motion, shoulder function (UCLA), and upper limb function (DASH).

RESULTS

For patients whose final result was an increase in retroversion, there was an average difference of 9°, with an increase in the final difference of external rotation of 3° compared with the other shoulder, and no difference between the final levels of internal rotation. In the patients whose final result was a decrease in retroversion, where the distal fragment was fixed in internal rotation, the difference observed was an average of 6°. These patients had an average decrease of the external rotation of 5° with an increase of the internal rotation by two levels. The final functional scores were "good" and "excellent" in all patients, with a mean UCLA of 31.8 points (28-34) and a mean DASH of 9.11 points (0.83-22.2).

CONCLUSION

In all patients, there was a difference in the humeral head retroversion compared to the contralateral limb, but with little clinical repercussion and good or excellent functional scores.

New fixation approach for transverse metacarpal neck fracture: a biomechanical study

Background

Fifth metacarpal neck fracture, also known as boxer’s fracture, is the most common metacarpal fracture. Percutaneous Kirschner-wire (K-wire) pinning has been shown to produce favorable clinical results. However, the fixation power of K-wires is a major concern. Plate fixation is also a surgical option, but it has the disadvantages of tendon adhesion, requirement of secondary surgery for removal of the implant, and postoperative joint stiffness. A fixation method that causes little soft tissue damage and provides high biomechanical stability is required for patients with fifth metacarpal neck fracture for whom surgical intervention is indicated. The present study proposed fixation using K-wires and a cerclage wire to treat fifth metacarpal neck fracture. The fixation power of this new method was compared with that of K-wires alone and plates.

Methods

We used a saw blade to create transverse metacarpal neck fractures in 16 artificial metacarpal bone specimens, which were then treated with four types of fixation as follows: (1) locking plate with five locking bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two K-wires (K group), and (4) two K-wires and a figure-of-eight cerclage wire (KW group). The specimens were tested by using cantilever bending testing on a material testing system. The stiffness of the four fixation types was determined by observing force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the Mann–Whitney exact test was performed to conduct paired comparison between the fixation types.

Results

The fixation strength levels of the four fixation approaches for treating fifth metacarpal neck fracture were ranked in a descending order of LP group (24.6 ± 5.1 N/mm, median ± interquartile range) > RP group (22.2 ± 5.8 N/mm) ≅ KW group (20.1 ± 3.2 N/mm) > K group (16.9 ± 3.0 N/mm).

Conclusion

The fixation strength of two K-wires was significantly higher when reinforcement was provided using a figure-of-eight cerclage wire. The strength of the proposed approach is similar to that of a regular plate with five bicortical screws but weaker than that of a locking plate with the same amount of bicortical screws. Cerclage wire-integrated K-wires can be an alternative method that avoids the excessive soft tissue dissection required for plating in open reduction internal fixation for fifth metacarpal neck fracture.

Evolution of fracture treatment with bone plates

Internal fixation of bone fractures by plate osteosynthesis has continuously evolved for more than 100 years. The aim of internal fracture fixation has always been to restore the functional capacity of the broken bone. The principal requirements of operative fracture management, those being anatomical fracture reduction, durable fixation, preservation of biology, promotion of fracture healing and early patient mobilization, have always been crucial but were accomplished to different extents depending on the focus of the specific fracture fixation principle employed. The first successful approach for internal fracture fixation was anatomic open reduction and interfragmentary compression. This secured the fracture fragments, maintained alignment and enabled direct healing of the fracture fragments. However, the highly invasive approach inflicted an immense amount of biologic stress to the area surrounding the fracture site. Modern preferably anatomically pre-contoured locking plates with relative stability of the bone-implant construct enable durable fixation while allowing a less invasive approach that preserves the biology at the fracture site. In contrast to conventional plating, locked plating provides a certain amount of flexibility, which is required to induce the formation of periosteal callus through interfragmentary motion. Most recently the concept of dynamic plating was introduced, which aims to induce more controlled interfragmentary motion and active stimulation of periosteal callus formation. This review article describes the historic development of plating from conventional plating to locked and dynamic plating.

A Prospective Study with Cage-Only or Cage-with-Plate Fixation in Anterior Cervical Discectomy and Interbody Fusion of One and Two Levels

Objective

The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes.

Methods

A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs: subsidence, C2–C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain.

Results

In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups: however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425); fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31).

Conclusion

Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

Success rates of a skeletal anchorage system in orthodontics: A retrospective analysis

OBJECTIVES

To evaluate the premise that skeletal anchorage with SAS miniplates are highly successful and predictable for a range of complex orthodontic movements.

MATERIALS AND METHODS

This retrospective cross-sectional analysis consisted of 421 bone plates placed by one clinician in 163 patients (95 female, 68 male, mean age 29.4 years ± 12.02). Simple descriptive statistics were performed for a wide range of malocclusions and desired movements to obtain success, complication, and failure rates.

RESULTS

The success rate of skeletal anchorage system miniplates was 98.6%, where approximately 40% of cases experienced mild complications. The most common complication was soft tissue inflammation, which was amenable to focused oral hygiene and antiseptic rinses. Infection occurred in approximately 15% of patients where there was a statistically significant correlation with poor oral hygiene. The most common movements were distalization and intrusion of teeth. More than a third of the cases involved complex movements in more than one plane of space.

CONCLUSIONS

The success rate of skeletal anchorage system miniplates is high and predictable for a wide range of complex orthodontic movements.

Digital design of functional surgery for odontogenic cyst intruding into maxillary sinus

INTRODUCTION

Traditional Caldwell-Luc approach needs modifications for odontogenic cysts intruding into the maxillary sinus, to preserve sinus mucosa and bony contour. Recently, digital technology has been widely applied to the field of maxillofacial surgery, guiding the surgical plan and improving its accuracy.

OBJECTIVE

This study attempted to present and evaluate the functional surgery of odontogenic cysts intruding into the maxillary sinus using a computer-assisted pre-surgical design.

METHODS

Consecutive patients with odontogenic cysts intruding into the posterior part of the maxillary sinus were enrolled. Method I "Bony wall reimplantation method" was performed for large lesions exceeding the zygomatic alveolar crest but without apparent bone destruction of the anterior wall of the sinus, while Method II "bone removal method" was more convenient for small lesions near to the zygomatic alveolar crest. The gap was filled with a pedicled buccal fat pad after lesion removal and all cases were without inferior meatal antrostomy.

RESULTS

A total of 45 cases were included in the study. 22 were operated using method I while 23 were operated with method II. Operations were completed in 20min. Pain disappeared in 3.62 days on average, and swelling 6.47 days. Nasal bleeding occurred in 8 patients lasting 1-3 days. Suppurative inflammation was observed in 1 patient, and infection occurred after bone reposition. Other repositioned free bony wall was without resorption in CT images.

CONCLUSIONS

Sinus mucosa and bony wall should be conserved. Preoperative digital design can guide osteotomy effectively during the surgery. Bone reposition is not suitable for suppurative inflammation. The pedicled buccal fat pad is enough for drainage and inferior meatal antrostomy is not necessary.

[Rotation or derotation osteotomy of the tibia]

OBJECTIVE

Corrections for congenital or posttraumatic malrotation of the lower leg, considering alignment of the contralateral leg, with an osteotomy and fixation using locking compression plates (LCP).

INDICATIONS

Posttraumatic deformity due to malunion. Increased tibial torsion in residual clubfoot deformity as long as the foot has been realigned. Idiopathic internal or external rotational deformity if the child is regularly tripping and falling, has psychological problems (other children making fun of the child because of the unusual gait), or is bothered by the deformity (age > 10 years, relative indication).

CONTRAINDICATIONS

Rotational deformities at other levels, mainly the hip. Children under the age of 3 years due to the remodeling potential during growth.

SURGICAL TECHNIQUE

Osteotomy at supramalleolar level and fixation with 3.5 mm 90° locking plate. Perpendicular osteotomy at the intersection of midshaft to distal shaft. After achieving the desired correction, fixation by a straight four-hole 3.5-mm locking plate.

POSTOPERATIVE MANAGEMENT

Following fixation of the osteotomy with the four hole 3.5 mm LCP, a lower leg cast is recommended for 4-5 weeks. Applying the 3.5 mm 90° LCP allows immediate postoperative full weight bearing. Osteotomy material should be removed 1 year postoperatively.

RESULTS

Assuming an uneventful postoperative course, consolidation of the fracture can be expected within 4-6 weeks. The stable fixation with locking plates provides stability without loss of correction at follow-up.

Mechanical evaluation of six techniques for stable fixation of the sagittal split osteotomy after counterclockwise mandibular advancement

We have evaluated the resistance to displacement of six stable methods of fixation of a sagittal split ramus osteotomy (SSRO) in the mandibular advancement with counterclockwise rotation. We tested 60 synthetic hemimandibles in six groups of 10 each: Group I - fixation with a straight four-hole 2.0mm miniplate; Group II - a straight six-hole 2.0mm miniplate; Group III - two straight 2.0mm four-hole miniplates; Group IV - an eight-hole 2.0mm (grid plate); Group V - a 2.0mm four-hole straight miniplate and 2.0×12mm bicortical screw; and Group VI - a straight four-hole 2.0mm locking miniplate. We applied a linear force in the region between the canine and the first premolar using a universal testing machine (EMIC- DL2000) with a loading cell of 10 KN. The loads at 1, 3, and 5mm displacement were recorded (N) and the data transmitted from the load cell to a computer. Results were analysed using analysis of variance (ANOVA) (p<0.001) and the Tukey post-test for comparison of the significance of the differences between the groups. For the three degrees of displacement, fixation with two straight 2.0mm plates and with the grid plate gave higher load values.

Auxetic polymeric bone plate as internal fixator for long bone fractures: Design, fabrication and structural analysis

INTRODUCTION

Injuries cover about 11% of World's Disease Burden depicting fractures to be the leading severe consequence of trauma. Fractures occur due to force impact or osteoporosis. Fracture healing is a complicated process. Fracture fixation techniques focus on imparting reduction to fractured fragments and induce healing. When considering possible fixation methods, the aspect of micro-movement is an important one, as this induces callus formation which tends to be a crucial step for fracture healing. Internal fixation of long bone fractures using metallic plates has been carried out since decades and recently advancements have been in synthesizing biodegradable plates as well. The purpose of this research was to fabricate an Auxetic Polymeric Bone Plate that can be used as an internal fixator for long bone fracture; this bone plate renders micro-movement due to its counter intuitive behavior, has the potential to reduce the effect of stress shielding and allow the same range of motion as that of natural bone.

METHODS

Polyurethane was chosen as a material for the fabrication of the Auxetic device because of its biocompatibility and non-toxic effects. The plate was then tested for mechanical properties such as Tensile and Compression testing to determine the strength.

RESULTS AND DISCUSSION

The tensile testing of the Auxetic polyurethane specimens showed that the mean of the Poisson's ratio of the samples lies between -0.68 and -0.87 at different uni-axial tensile load values. The Auxetic structure of our device has the potential to allow for efficient fixation because its negative Poisson's ratio offers micro-movement, thereby causing fixation with relative stability rather than absolute stability. The Auxetic bone plate can be superior to contemporary plate fixation systems, as it demands meaningfully small contact points. The suitable mechanical properties might lessen stress shielding effects that are normally caused by rigid bone plates. The Auxetic nature of the bone will help align and sustain the bone fragments with small fracture gaps in order to impart appropriate assembly to accomplish bone healing.

Comparative in vitro mechanical evaluation of techniques using a 2.0 mm locking fixation system for simulated fractures of the mandibular body

PURPOSE

To perform a comparative evaluation of the mechanical resistance of simulated fractures of the mandibular body which were repaired using different fixation techniques with two different brands of 2.0 mm locking fixation systems.

MATERIALS AND METHODS

Four aluminum hemimandibles with linear sectioning simulating a mandibular body fracture were used as the substrates and were fixed using the two techniques and two different brands of fixation plate. These were divided into four groups: groups I and II were fixed with one four-hole plate, with four 6 mm screws in the tension zone and one four-hole plate, with four 10 mm screws in the compression zone; and groups III and IV were fixed with one four-hole plate with four 6 mm screws in the neutral zone. Fixation plates manufactured by Tóride were used for groups I and III, and by Traumec for groups II and IV. The hemimandibles were submitted to vertical, linear load testing in an Instron 4411 servohydraulic mechanical testing unit, and the load/displacement (3 mm, 5 mm and 7 mm) and the peak loads were measured. Means and standard deviations were evaluated applying variance analysis with a significance level of 5%.

RESULTS

The only significant difference between the brands was seen at displacements of 7 mm. Comparing the techniques, groups I and II showed higher mechanical strength than groups III and IV, as expected.

CONCLUSION

For the treatment of mandibular linear body fracture, two locking plates, one in the tension zone and another in the compression zone, have a greater mechanical strength than a single locking plate in the neutral zone.

Anchor Plate Efficiency in Postoperative Orthodontic Treatment Following Orthognathic Surgery via Minimal Presurgical Orthodontic Treatment

Purpose:

The efficiency of an anchor plate placed during orthognathic surgery via minimal presurgical orthodontic treatment was evaluated by analyzing the mandibular relapse rate and dental changes.

Methods:

The subjects included nine patients with Class III malocclusion who had bilateral sagittal split osteotomy at the Division of Oral and Maxillofacial Surgery, Department of Dentistry in Ajou University Hospital, after minimal presurgical orthodontic treatment. During orthognathic surgery, anchor plates were placed at both maxillary buttresses. The anchor plates were used to move maxillary teeth backward and for maximum anchorage of Class III elastics to minimize mandibular relapse during the postoperative orthodontic treatment. The lateral cephalometric X-ray was taken preoperatively (T0), postoperatively (T1), and one year after the surgery (T2). Seven measurements (distance from Pogonion to line Nasion-Nasion perpendicular [Pog-N Per.], angle of line B point-Nasion and Nasion-Sella [SNB], angle of line maxilla 1 root-maxilla 1 crown and Nasion-Sella [U1 to SN], distance from maxilla 1 crown to line A point-Nasion [U1 to NA], overbite, overjet, and interincisal angle) were taken. Measurements at T0 to T1 and T1 to T2 were compared and differences tested by standard statistical methods.

Results:

The mean skeletal change was posterior movement by 13.87±4.95 mm based on pogonion from T0 to T1, and anterior movement by 1.54±2.18 mm from T1 to T2, showing relapse of about 10.2%. There were significant changes from T0 to T1 for both Pog-N Per. and SNB (P <0.05). However, there were no statistically significant changes from T1 to T2 for both Pog-N Per. and SNB. U1 to NA that represents the anterior-posterior changes of maxillary incisor did not differ from T0 to T1, yet there was a significant change from T1 to T2 (P <0.05).

Conclusion:

This study found that the anchor plate minimizes mandibular relapse and moves the maxillary teeth backward during the postoperative orthodontic treatment. Thus, we conclude that the anchor plate is clinically very useful.

Randomized clinical trial on percutaneous minimally invasive osteosynthesis of fractures of the distal extremity of the radius

Objectives

the purpose of this study was to compare the postoperative radiological and clinical outcomes with minimally invasive percutaneous osteosynthesis using three implants: volar locking plate, intramedullary nail system and nonbridging external fixator for distal radius fractures.

Methods

forty-eight patients (A group, 16; B group 16; C group 16) underwent minimally invasive percutaneous osteosynthesis of reductible and unstable displaced (Type IIB by Rayhack Classification) distal radius fractures. In B group intramedullary nail system was used, in A group the patients were treated with volar locking plate and in C group the patients were treated by nonbridging external fixator from January 2011 to December 2012. The mean follow-up period was 12 months. Radiologic parameters, range of motion, grip strength, and disability of the arm, shoulder, and hand score were evaluated at each examination (3rd and 6th week, and 12th months). The visual analog scale of wrist pain and complications were assessed at the final follow-up.

Results

the groups did not differ significantly in radiological outcomes after 12 months, but the clinical results, VAS scale and dash score in group A (volar locking plate) and B (nail intramedullary) were statistically significantly better than that of C group (nonbridging external fixator). One patient underwent an osteosynthesis with nail intramedullary and another with external fixator (C group) developed persistent pain near the site of the superficial radial nerve because of the distal's screw and pins, respectively.

Conclusion

in clinical parameters, significant differences in outcomes were found between groups A and B after six weeks versus C group.

Comparison of compressive strength between three different plates for mandibular angle fractures fixation

The present study aims to compare three types of internal fixation for fractures of the mandibular angle. Mechanical testing was performed on replicas of polyurethane hemimandibles sectioned at the angle region to simulate a fracture and fixed with three different hardwares. Fixation devices enrolled on this survey included the grid plates with and without an intermediate bar and the method described by Champy and colleagues in 1978 and the sample consisted of 10 hemimandibles for each group. Vertical loadings were applied on each hemimandible and recorded after a vertical displacement of 3 and 5 mm. Statistical analysis was made by means of the variance analysis (ANOVA) and the Duncan test with a significance level of 5%. The Champy technique showed a statistically significant increased resistance when compared to the grid plates after vertical displacements of 3 and 5 mm. The results of this survey suggest that the Champy technique, when compared to the grid plate positioned at the middle of the mandibular bone (placement site selected for this study), is more resistant than the grid plate and that the inclusion or not of an intermediate bar to the grid plates does not improve its resistance after linear vertical loadings.

Hallux valgus: comparative study between two surgical techniques of proximal addition osteotomy

OBJECTIVE

TO CLINICALLY AND RADIOGRAPHICALLY COMPARE THE RESULTS OF TREATMENT OF HALLUX VALGUS, BY TWO ADDITION OSTEOTOMY TECHNIQUES: one using resected exostosis, and the other using a plate fixation for addition wedge.

METHODS

We evaluated 24 feet of 19 patients, mean age 51.3 years, affected by hallux valgus, with a mean follow-up of 50.1 months. 13 feet underwent addition osteotomy with resected exostosis (AORE) and 11 patients (11 feet) underwent addition osteotomy with plate (AOP). The AOFAS score, intermetatarsal 1 and 2 angles, and hallux valgus angle were evaluated before and after surgery.

RESULTS

In the AORE technique, the mean preoperative AOFAS was 46.6, with IMA 14(o) and HVA 32o, while in the postoperative AOFAS it was 81.3, with IMA 9(o) and HVA 25(o), and 92.3% satisfactory results. In the AOP technique, the mean preoperative AOFAS was 42.1, with IMA 15(o) and HVA 29(o) while in the postoperative AOFAS it was 77.4, with IMA 11(o) and HVA 23(o) and 81.8% of satisfactory results.

CONCLUSIONS

Both techniques proved to be effective in the treatment of hallux valgus, both clinically and radiografically, with no statistical difference between them. Level of evidence III, Retrospective comparative study.

Spectrum of primary bone grafting in cranio maxillofacial trauma at a tertiary care centre in India

Background:

In past several years, traumas following road traffic accidents and other causes have increased, owing to an increase in mechanization and pace of life. These patients frequently have complicated injuries involving soft tissue and the craniofacial skeleton. Assessment of bony injuries and loss of portions of facial skeleton and their management has proved to be a challenge to the reconstructive surgeon.

Aims:

Primary bone grafting of craniofacial skeletal injuries provides an opportunity for one stage correction of bony defects. The varied spectrum of primary bone grafts for management of craniomaxillofacial injuries are evaluated in this study.

Materials and Methods:

Patients with a history of acute trauma resulting in facial skeletal injuries with or without bone loss were included in the study. Primary bone grafting was undertaken in situations requiring contour correction, replacement of skeletal losses and for rigid fixation of fracture segments. Olecranon, Iliac crest, ribs, Vascularized as well as nonvascularized outer table calvarial grafts and nonvascularized inner table calvarial grafts were used in this study.

Results:

Sixty two patients of craniomaxillofacial injury following trauma requiring primary bone grafting were considered in this study. Fifty seven percent of patients (n=32) required primary bone grafting for replacement of bone loss while bone grafting for contour correction was done in twenty three patients. The parietal calvaria overlying the non-dominant hemisphere was used as a source of bone graft in forty-nine patients. Nearly ninety-two percent of the patients were satisfied with the results of primary bone grafting.

Conclusions:

Functional and aesthetic assessment of each of these patients, managed with primary bone grafting revealed a low rate of disabilities and high percentage of satisfaction in this study.