Volar Locking Plates (VLP) have revolutionised the treatment of distal radius fractures allowing the anatomic reduction and stable fixation of the more comminuted and unstable of fractures. The benefits of this in terms of range of movement (ROM), pain and earlier return to work and daily activities is documented. However we were interested in was what improvements in wrist function patients made from 6 to 12 months after injury? We retrospectively looked at a series of 34 consecutive patients that had undergone VLP fixation through a standard anterior approach followed by early physiotherapy. We documented standard demographics and assessed function in terms of Range of Movement, Grip strength (GS), Modified Gartland and Werley score (MGWS), Patient Rated Wrist Evaluation (PRWE) and the quick DASH questionnaire at six and twelve months Two patients were excluded from analysis as they failed to make both assessments. Of the 32 remaining (26 female:6 male) the mean age was 53.2yrs; range (26–78). On average GS, PGS, VAS function and pain did not improve. There was a modest improvement in Movement; Wrist Flexon-13 deg, Wrist Extension-14deg, Radial Deviation-7deg, Ulnar Deviation-9deg. There was no improvement in pronation and supination. There was little improvement in qDASH, PRWE and mGW Scores with only a mean 1.8, 5.6 and 3.6 point improvement respectively.Methods
Results
Aims. To report the outcomes of patients with a fracture of the distal tibia who were treated with intramedullary nail versus locking plate in the five years after participating in the Fixation of Distal Tibia fracture (FixDT) trial. Methods. The FixDT trial reported the results for 321 patients randomized to nail or
Objectives. Secondary fracture healing is strongly influenced by the stiffness of the bone-fixator system. Biomechanical tests are extensively used to investigate stiffness and strength of fixation devices. The stiffness values reported in the literature for locked plating, however, vary by three orders of magnitude. The aim of this study was to examine the influence that the method of restraint and load application has on the stiffness produced, the strain distribution within the bone, and the stresses in the implant for locking plate constructs. Methods. Synthetic composite bones were used to evaluate experimentally the influence of four different methods of loading and restraining specimens, all used in recent previous studies. Two plate types and three screw arrangements were also evaluated for each loading scenario. Computational models were also developed and validated using the experimental tests. Results. The method of loading was found to affect the gap stiffness strongly (by up to six times) but also the magnitude of the plate stress and the location and magnitude of strains at the bone-screw interface. Conclusions. This study demonstrates that the method of loading is responsible for much of the difference in reported stiffness values in the literature. It also shows that previous contradictory findings, such as the influence of working length and very large differences in failure loads, can be readily explained by the choice of loading condition. Cite this article: A. MacLeod, A. H. R. W. Simpson, P. Pankaj. Experimental and numerical investigation into the influence of loading conditions in biomechanical testing of
Distal third clavicle (DTC) fractures are increasing in incidence. Due to their instability and nonunion risk, they prove difficult to treat. Several different operative options for DTC fixation are reported but current evidence suggests variability in operative fixation. Given the lack of consensus, our objective was to determine the current epidemiological trends in DTC as well as their management within the UK. A multicentre retrospective cohort collaborative study was conducted. All patients over the age of 18 with an isolated DTC fracture in 2019 were included. Demographic variables were recorded: age; sex; side of injury; mechanism of injury; modified Neer classification grading; operative technique; fracture union; complications; and subsequent procedures. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages.Aims
Methods
Purpose: The purpose of this study is to compare two fixation methods for surgical neck proximal humeral fractures with medial calcar comminution:.
Osteosynthesis of high-energy metaphyseal proximal tibia fractures is still challenging, especially in patients with severe soft tissue injuries and/or short stature. Although the use of external fixators is the traditional treatment of choice for open comminuted fractures, patients' acceptance is low due to the high profile and therefore the physical burden of the devices. Recently, clinical case reports have shown that supercutaneous locked plating used as definite external fixation could be an efficient alternative. Therefore, the aim of this study was to evaluate the effect of implant configuration on stability and interfragmentary motions of unstable proximal tibia fractures fixed by means of externalized locked plating. Based on a right tibia CT scan of a 48 years-old male donor, a finite element model of an unstable proximal tibia fracture was developed to compare the stability of one internal and two different externalized plate fixations. A 2-cm osteotomy gap, located 5 cm distally to the articular surface and replicating an AO/OTA 41-C2.2 fracture, was virtually fixed with a medial stainless steel LISS-DF plate. Three implant configurations (IC) with different plate elevations were modelled and virtually tested biomechanically: IC-1 with 2-mm elevation (internal locked plate fixation), IC-2 with 22-mm elevation (externalized
Distal radius fractures have an incidence rate of 17.5% among all fractures. Their treatment in case of comminution, commonly managed by volar locking plates, is still challenging. Variable-angle screw technology could counteract these challenges. Additionally, combined volar and dorsal plate fixation is valuable for treatment of complex fractures at the distal radius. Currently, biomechanical investigation of the competency of supplemental dorsal plating is scant. The aim of this study was to investigate the biomechanical competency of double-plated distal radius fractures in comparison to volar
Introduction:. Mayo 2A Olecranon fractures are traditionally managed with a tension band wire device (TBW) but locking plates may also be used to treat these injuries. Objectives:. To compare clinical outcomes and treatment cost between TBW and
There has been a substantial increase in the surgical treatment of unstable chest wall injuries recently. While a variety of fixation methods exist, most surgeons have used plate and screw
There is theoretical concern that volar plating has a disadvantage in cantilever bending when axially loaded dorsal to the neutral axis. This has implications for postoperative rehabilitation protocols and overall outcomes related to maintenance of reduction. Most recent biomechanical studies have compared volar locking plates to traditional dorsal non-locked plates. The purpose of this study was to compare the biomechanical stability of volar and dorsal
Introduction: Several studies have compared various plate constructs for distal intra-articular humerus fractures. In our experience osteoporotic bone and fractures that have a transverse component close to the elbow joint have tenuous fixation with traditional plating systems due to, at most, two screws in the distal fragment through the plate. Therefore, the aim of this study was to obtain objective data on the performance of two plating systems used for fixation of intra-articular distal humerus fractures with a low transverse component with only two screws through a 3.5 LC-DCP distally. It was hypothesized that locked plating would be more stable than standard plating after cyclic loading. Methods: Twenty pairs of fresh matched cadaver humeri of patients older than 65 years old were harvested. DEXA scans of the right forearm from each pair were obtained. Osteotomies were performed to simulate comminuted supracondylar humerus fracture with intercondylar split (OTA 13-C2.3). The specimens were then randomly assigned to locking or non-locking plate fixation. Ten paired specimens were tested in simulated extension and the remaining ten were tested axially. Fragment motion relative to the humeral shaft was measured using kinematic analysis at the fracture gap. Differences in resultant fragment translations and rotations between fixation groups were checked for significance (p<
0.05) using a one-tailed paired t-test. Differences in cycles to failure were checked for significance using a Wilcoxon signed rank test. Results: On average, during extension tests, the humeri with
Aims. A pilon fracture is a severe ankle joint injury caused by high-energy trauma, typically affecting men of working age. Although relatively uncommon (5% to 7% of all tibial fractures), this injury causes among the worst functional and health outcomes of any skeletal injury, with a high risk of serious complications and long-term disability, and with devastating consequences on patients’ quality of life and financial prospects. Robust evidence to guide treatment is currently lacking. This study aims to evaluate the clinical and cost-effectiveness of two surgical interventions that are most commonly used to treat pilon fractures. Methods. A randomized controlled trial (RCT) of 334 adult patients diagnosed with a closed type C pilon fracture will be conducted. Internal
Debate surrounds the optimum operative treatment of periprosthetic distal femoral fractures (PDFFs) at the level of well fixed femoral components; lateral
Introduction. Locking plates can provide greater stability than conventional plates; however, reports revealed that fractures had a high incidence of failure without medial column support; the mechanical support of medial column could play a significant role in humeral fractures. Recent studies have demonstrated the importance of intramedullary strut in proximal humeral fracture fixation, the relationship to mechanical stability and supporting position of the strut remain unclear. The purpose of this study was to evaluate the influence of position of the intramedullary strut on the stability of proximal humeral fractures using a locking plate. Materials and methods. Ten humeral sawbone (Synbone) and locked plates (Synthes, cloverleaf plate), with and without augmented intramedullary strut (five in each group) for proximal humerus fractures, were tested using material testing machine to validate the finite element model. A 10 mm osteotomy was performed at surgical neck and a strut graft (10 cm in length) was inserted into the fracture region to lift the head superiorly. Each specimen was statically tested at a rate of 5 mm/min until failure. To build the finite element (FE) model, 64-slices CT images were converted to create a 3D solid model. The material properties of screws and plates were modeled as isotropic and linear elastic, with an elastic modulus of 110 GPa, (Poisson's ratio, n=0.3). The Young's moduli of cortical and cancellous bones were 17 GPa and 500 MPa (n=0.4), respectively. Three alter shifting toward far cortex by 1, 2, and 3 mm in humeral canal were installed in the simulating model. Results and discussion. The test result showed stiffness for only locked plate was 149.2±21.3 N/mm; and the plating combined with an intramedullary strut was 336.5±50.4 N/mm. On average, the stiffness was increased by 2.2 times in the augmented fixation relative to the only
Purpose: This study compares clinical and radiological outcomes of K-wire fixation with volar locking plate (i.e. fixed angle) fixation in unstable, dorsally angulated, distal radius fractures. Materials and methodology: Fifty four adult patients with an isolated, closed, unstable, dorsally angulated fracture without articular comminution were randomised to closed reduction and K-wire fixation (3 wires) or volar
Locking plate fixation in proximal humeral fractures has demonstrated good results tempered by a significant rate of loss of fixation. Reported rates of failure are typically around 10% of cases but can be 20% or higher. In addition large series are often made up of a diverse patient population, so we have chosen to focus solely on patients confirmed to have significantly reduced BMD who can be considered a subset at high risk of fixation failure. Twenty-three patients (5 male, 18 female) with a proximal humeral fracture treated by
It is very difficult to perform total knee arthroplasty (TKA) for severe varus bowing deformity of femur. We performed simultaneous combined femoral supra-condyle valgus osteotomy and TKA for the case had bilateral varus knees with bowing deformity of femurs. Case presentation. A 62-year-old woman consulted our clinic with bilateral knee pain and walking distability. She was diagnosed rickets and had bilateral severe varus bowing deformity of femurs from an infant. Her height was 133 cm and body weight was 51 kg. Bilateral femur demonstrated severe bowing and her knee joint demonstrated varus deformity with medial joint line tenderness, no local heat, and no joint effusion. Bilateral knee ROM was 90 degrees with motion crepitus. Bilateral lower leg demonstrated mild internal rotation deformity. Bilateral JOA knee score was 40 Roentgenogram demonstrated knee osteoarthritis with incomplete development of femoral condyle. Mechanical FTA angles were 206 degree on the right and 201 on the left. She was received right simultaneous femoral supra-condyle valgus osteotomy with TKA was performed at age 63. Key points of surgical techniques were to use the intramedullary guide for valgus osteotomy as temporary reduction and fixation then performed mono-cortical
Endoprosthetic replacement is often the preferred treatment for neoplastic lesions as internal fixation has been shown to have a high failure rate. Due to anatomical location, disease factors and patient factors internal fixation may be the treatment of choice. No reports exist in the literature regarding the use of locking plates in the management of neoplastic long bone lesions. Data was collected prospectively on the first 10 patients who underwent
Locking plates have led to important changes in bone fracture management, allowing flexible biological fracture fixation based on the principle of an internal fixator. The technique of
Purpose: To compare the functional outcome and quality-of-life following a displaced extra-articular proximal humerus fracture treated with open reduction and