Locking compression plate is part of a new plate generation requiring an adapted surgical technique and new thinking about commonly used concepts of internal fixation using plates. They offer a number of advantages in fracture fixation combining angular stability through the use of locking screws with traditional fixation techniques. This makes the implant suitable for poor bone stock and for fractures in metaphyseal areas. However the system is complex and cases of plate loosening and plate breakage reported by many authors recently, many of these authors believe it is attributed to the choice of inappropriate plate and/or fixation technique rather than to the features of locking compression plate system. We are reporting 2 cases of plate breakage after using it to fix diaphyseal femoral shaft fractures; in each case we discuss the pitfalls in the fixation method. The locking plate manual did not highlight the important pitfalls, which was published later on in the literature as guidelines for their clinical application. Careful and detailed attention to the biomechanical principles of locking compression is crucial to the success of implant in fixing fractures in diaphyseal areas

Summary. Biomechanically, a 2° screw deviation from the nominal axis in the PFLCP leads to significantly earlier implant failure. Screw deviation relies on a technical error on insertion, but in our opinion cannot be controlled intraoperatively with the existing instrumentation devices. Background. Several cases of clinical failure have been reported for the Proximal Femoral Locking Compression Plate (PFLCP). The current study was designed to investigate the failure mode and to explore biomechanically the underlying mechanism. Specifically, the study sought to determine if the observed failure was due to technical error on insertion or due to implant design. Methods. To exclude patient and fracture type related factors, an abstract foam block model simulating an unstable pertrochanteric fracture was created for three study groups with six specimens each (n=6). Group 1 was properly instrumented according to the manufacturer's guidelines. In Group 2 and 3, the first or second screw was placed in a posterior or anterior off-axis orientation by 2° measured in the transversal plane, respectively. Each construct was tested cyclically until failure using a test setup and protocol simulating complex axial and torsional loading. Radiographs were taken prior to and after the tests. Force, number of cycles and failure mode were compared. Results. The 2° screw deviation from the nominal axis led to significantly earlier construct failure in Group 2 and 3. The failure mode consisted of loosening of the off-axis screw due to disengagement with the plate, resulting in loss of construct stiffness and varus collapse of the fracture. Conclusions. In our biomechanical test setup, a screw deviation of only 2° from the nominal axis consistently led to the failure mode observed clinically. In our opinion, screw deviation mostly relies on technical error on insertion. But, proper screw insertion may be difficult or impossible with the existing instrumentation devices, especially as it cannot be controlled or guaranteed intraoperatively

Objective: To determine the success of 20 cases treated with TomoFix high tibial medial opening wedge osteotomy.

Study design: Retrospective review of 20 cases with 6 months of follow up including; indications for treatment, surgical technique, results, complications and patient satisfaction.

Background: High Tibial Osteotomy is an established technique for the treatment of unicompartmental osteoarthritis of the varus malaligned knee. Corrections are usually achieved by closed wedge osteotomy from a lateral exposure. This technique has associated risks of; peroneal nerve injuries, instability of the osteotomy and secondary loss of correction. Open wedge osteotomy of the medial side eliminates these risks. TomoFix allows stable fixation of the osteotomy without the need to fill the osteotomy gap with bone grafts.

Results: Full weight bearing after 6 weeks. No implant failures, delayed unions, nerve injuries or compartment syndromes. Complications included 1 infection, 1 over correction and 1 with metalwork pain.

Conclusions: TomoFix allows for early mobilisation and avoids loss of correction with reduced risk of nerve injuries and compartment syndrome.

Relevance: The surgical technique needs careful attention. Disorders of normal bone healing and inadequate axial correction may lead to failure of treatment. Early rehabilitation is possible and long term follow up is necessary.

Background: Displaced proximal humeral fractures (PHF) remain a challenge to the orthopedic surgeon. Conservative treatment yield poor results in the majority of these fractures. Surgical treatment, although preferable, lacks the proper exposure and fixation technique.

The locking compression plate (LCP), which is inserted in a minimal invasive technique, utilizing an anterolateral approach to the proximal humerus, allows adequate reduction and fixation, while minimizing the risk for complications derived from extensive exposure and poor fixation.

Methods: All patients admitted to our department with a complicated PHF between Jan 2004 and May 2005 were included. After obtaining informed consent, open reduction and internal fixation was performed through an anterolateral minimal invasive approach. After exposure and reduction with or without acromioplasty and rotator cuff repair, the fracture was fixated with a LCP 3.5mm. Patients were encouraged to perform pendular movements on the first post-operative day.

The patients were followed closely beginning 2 weeks post-operatively and afterwards on a bi-monthly basis. Immediate complications, radiographic and functional outcome were noted.

Results: 22 patients have been treated according to the treatment protocol during the study period. Minimal follow up of three months is available. A single complication was noted (deep wound infection which necessitated hardware removal). No nerve injury or hardware failures were noted.

Functional outcome was good, patients regained 120°±25 of flexion, 112°±27 of abduction and 17°±8 of external rotation.

Conclusions: The anterolateral approach to the shoulder and fixation with a LCP plate is a safe technique in our hospital. Rigid stabilization allows for early shoulder activation which results in a good range of motion and functional outcome on short-term follow up. Further study and long-term follow up are needed to validate this technique in treating complex proximal humerus fractures.

Introduction: Previously, we noticed loss of initial reduction with conventional palmar plate osteosynthesis for dorsally displaced distal radius fractures. Locking Compression T plate may provide more stable fixation and we report our early experience. Materials and methods: Between November 2002 and April 2003, 23 patients (15 women, 8 men), mean age 55, (17–80) underwent open reduction and internal fixation using 3.5 mm locking compression oblique T plate (SYNTHES) through a Henry ‘s approach and a 2 weeks plaster cast immobilisation. All fractures were dorsally displaced. According to AO classification there were 15 A3 and 8 C1 and C2 fracture. 18 patients could be reviewed with a mean follow up of 16 months (6 to 30) Pre operatively, radial inclination was 11.7 ° (0–20), dorsal angulation 25.9 ° (8–48) and ulnar variance:4 mm (0–10). Results: Post-operatively, radial inclination was 23,2. ulnar variance: 1,2 mm and ventral angulation 4,6 °. At one year follow-up, there was no loss of post-operative reduction. According to SOFCOT ‘s criteria, there were 13 anatomical results and 5 moderate malunion. According to Green and O ‘Brien’s criteria, there were 9 excellent, 6 good, 3 fair and no poor results. Mean DASH score was 22.8 (5.8 – 62.5). Strengh and pinch were respectively 95 % and 91 % when compared with the opposite side. There were 6 complications concerning 4 reflex sympathetic dystrophy, one carpal tunnel syndrome and one hypertrophic scar. Discussion: In our experience, classic palmar plate fixation showed inability for maintaining reduction during time. Locking Compression 3,5 T plate by a palmar approach which is a demanding technique, avoids loss of post-operative recution. Conclusion Locking Compression 3.5 T Plate by palmar approach is an effective treatment for dorsally displaced distal radius fracture but the plate itself and ancillary tools have to be improved to reduce operatively difficulty

Objectives

To investigate the differences of open reduction and internal fixation (ORIF) of complex AO Type C distal radius fractures between two different models of a single implant type.

Distal femur fractures (DFF) are common, especially in the elderly and high energy trauma patients. Lateral locked osteosynthesis constructs have been widely used, however non-union and implant failures are not uncommon. Recent literature advocates for the liberal use of supplemental medial plating to augment lateral locked constructs. However, there is a lack of proprietary medial plate options, with some authors supporting the use of repurposing expensive anatomic pre-contoured plates. The aim of this study was to investigate the feasibility of a readily available cost-effective medial implant option. A retrospective analysis from January 2014 to June 2022 was performed on DFF (primary or revision) managed with supplemental medial plating with a Large Fragment Locking Compression Plate (LCP) T-Plate (~$240 AUD) via a medial sub-vastus approach. The T-plate was contoured and placed superior to the medial condyle. A combination of 4.5mm cortical, 5mm locking and/or 6.5mm cancellous screws were used, with oblique screw trajectories towards the distal lateral cortex of the lateral condyle. All extra-articular fractures and revision fixation cases were allowed to weight bear immediately. The primary outcome was union rate. This technique was utilised on sixteen patients; 3 acute, 13 revisions; mean age 52 years (range 16-85), 81% male, 5 open fractures. The union rate was 100%, with a median time to union of 29 weeks (IQR 18-46). The mean follow-up was 15 months. There were two complications: a deep infection requiring two debridements and a prominent screw requiring removal. The mean range of motion was 1–108. o. . Supplemental medial plating of DFF with a Large Fragment LCP T-Plate is a feasible, safe, and economical option for both acute fixation and revisions. Further validation on a larger scale is warranted, along with considerations to developing a specific implant in line with these principles

Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and optimized plate-to-bone fit design. On the other hand, mini-fragment plates used in dual plating mode have demonstrated promising clinical results. However, these two bone-implant constructs have not been investigated biomechanically in a human cadaveric model. Therefore, the aim of the current study was to compare the biomechanical competence of single superior plating using the new generation plate versus dual plating with low-profile mini-fragment plates. Sixteen paired human cadaveric clavicles were assigned pairwise to two groups for instrumentation with either a 2.7 mm Variable Angle Locking Compression Plate placed superiorly (Group 1), or with one 2.5 mm anterior plate combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture AO/OTA15.2C was simulated by means of a 5 mm osteotomy gap. All specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking. Initial stiffness was significantly higher in Group 2 (9.28±4.40 N/mm) compared to Group 1 (3.68±1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of craniocaudal and shear displacement, fracture gap opening and torsion were significantly bigger over the course of 12500 cycles in Group 1 compared to Group 2; p≤0.038. Cycles to 2 mm shear displacement were significantly lower in Group 1 (22792±4346) compared to Group 2 (27437±1877), p=0.047. From a biomechanical perspective, low-profile 2.5/2.0 dual plates demonstrated significantly higher initial stiffness, less interfragmentary movements, and higher resistance to failure compared to 2.7 single superior variable-angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in unstable fracture configurations

Introduction and Objective. Plating of geriatric distal femoral fractures with Locking Compression Plate Distal Femur (LCP–DF) often requires augmentation with a supplemental medial plate to achieve sufficient stability allowing early mobilization. However, medial vital structures may be impaired by supplemental medial plating using a straight plate. Therefore, a helically shaped medial plate may be used to avoid damage of these structures. Aim of the current study was to investigate the biomechanical competence of augmented LCP–DF plating using a supplemental straight versus helically shaped medial plate. Materials and Methods. Ten pairs of human cadaveric femora with poor bone quality were assigned pairwise for instrumentation using a lateral anatomical 15-hole LCP–DF combined with a medial 14-hole LCP, the latter being either straight or manually pre-contoured to a 90-degree helical shape. An unstable distal femoral fracture AO/OTA 33–A3 was simulated by means of osteotomies. All specimens were biomechanically tested under non-destructive quasi-static and destructive progressively increasing combined cyclic axial and torsional loading in internal rotation, with monitoring by means of optical motion tracking. Results. Initial axial stiffness and torsional stiffness in internal and external rotation for straight double plating (548.1 ± 134.2 N/mm, 2.69 ± 0.52 Nm/° and 2.69 ± 0.50 Nm/°) was significantly higher versus helical double plating (442.9 ± 133.7 N/mm, 2.07 ± 0.32 Nm/° and 2.16 ± 0.22 Nm/°), p≤0.04. Initial interfragmentary axial displacement and flexural rotation under 500 N static loading were significantly smaller for straight plating (0.11 ± 0.14 mm and 0.21 ± 0.10°) versus helical plating (0.31 ± 0.14 mm and 0.68 ± 0.16°), p<0.01. However, initial varus deformation under this loading remained not significantly different between the two fixation methods (straight: 0.57 ± 0.23°, helical: 0.75 ± 0.34°), p=0.08. During dynamic loading, within the course of the first 4000 cycles the movements of the distal fragment in flexion were significantly bigger for helical over straight plating (1.03 ± 0.33° versus 0.40 ± 0.20°), p<0.01. However, no significant differences were observed between the two fixation methods in terms of varus, internal rotation, axial and shear displacements at the fracture site, and number of cycles to failure. Conclusions. Augmented lateral plating of unstable distal femoral fractures with use of supplemental helically shaped medial plate was associated with more elastic bone-implant construct behavior under static and dynamic loading compared to straight double plating. Both fixation methods resulted in comparable number of cycles to failure. From a biomechanical perspective, the more elastic helical double plating may be considered as useful alternative to straight plating, potentially reducing stress risers at the distal bone-implant interface due to its ameliorated damping capacities

Introduction and Objective. Distal femoral fractures are commonly treated with a straight plate fixed to the lateral aspects of both proximal and distal fragments. However, the lateral approach may not always be desirable due to persisting soft-tissue or additional vascular injury necessitating a medial approach. These problems may be overcome by pre-contouring the plate in helically shaped fashion, allowing its distal part to be fixed to the medial aspect of the femoral condyle. The objective of this study was to investigate the biomechanical competence of medial femoral helical plating versus conventional straight lateral plating in an artificial distal femoral fracture model. Materials and Methods. Twelve left artificial femora were instrumented with a 15-hole Locking Compression Plate – Distal Femur (LCP-DF) plate, using either conventional lateral plating technique with the plate left non-contoured, or the medial helical plating technique by pre-contouring the plate to a 180° helical shape and fixing its distal end to the medial femoral condyle (n=6). An unstable extraarticular distal femoral fracture was subsequently simulated by means of an osteotomy gap. All specimens were tested under quasi-static and progressively increasing cyclic axial und torsional loading until failure. Interfragmentary movements were monitored by means of optical motion tracking. Results. Initial axial stiffness was significantly higher for helical (185.6±50.1 N/mm) versus straight (56.0±14.4) plating, p<0.01. However, initial torsional stiffness in internal and external rotation remained not significantly different between the two fixation techniques (helical plating:1.59±0.17 Nm/° and 1.52±0.13 Nm/°; straight plating: 1.50±0.12 Nm/° and 1.43±0.13Nm/°), p≥0.21. Helical plating was associated with significantly higher initial interfragmentary movements under 500 N static compression compared to straight plating in terms of flexion (2.76±1.02° versus 0.87±0.77°) and shear displacement under 6 Nm static rotation in internal (1.23±0.28° versus 0.40±0.42°) and external (1.21±0.40° versus 0.57±0.33°) rotation, p≤0.01. In addition, helical plating demonstrated significantly lower initial varus/valgus deformation than straight plating (4.08±1.49° versus 6.60±0.47°), p<0.01. Within the first 10000 cycles of dynamic loading, helical plating revealed significantly bigger flexural movements and significantly lower varus/valgus deformation versus straight plating, p=0.02. No significant differences were observed between the two fixation techniques in terms of axial and shear displacement, p≥0.76. Cycles to failure was significantly higher for helical plating (13752±1518) compared to straight plating (9727±836), p<0.01. Conclusions. Although helical plating using a pre-contoured LCP-DF was associated with higher shear and flexion movements, it demonstrated improved initial axial stability and resistance against varus/valgus deformation compared to straight lateral plating. Moreover, helical plate constructs demonstrated significantly improved endurance to failure, which may be attributed to the less progressively increasing lever bending moment arm inherent to this novel fixation technique. From a biomechanical perspective, helical plating may be considered as a valid alternative fixation technique to standard straight lateral plating of unstable distal femoral fractures

Introduction and Aims: Locking plates represent a major change in the way we stabilise fractures. The distal radius Locking Compression Plate (LCP, Synthes) theoretically enables palmar plating of dorsally comminuted and intra-articular wrist fractures. All current methods (Dorsal plates, K wires and external fixators) have considerable disadvantages. This is the first study to assess the clinical and biomechanical results of this new implant. Method: We created a synthetic bone fracture model to compare three plates (the LCP, Buttress and Pi). We tested 24 plates, eight in each group, using the Instrom biomechanical testing machine, axially loading the model to 200 Newtons for 500 cycles. The results show significantly less displacement for the LCP plate (p< 0.05). Results: Early clinical results are reported following a prospective study of the LCP plate to stabilise dorsally comminuted and intra-articular. The average age was 32 years. We report our results at an average follow-up of six months (range four to nine months). There were no complications. The Gartland & Werley scores were at least satisfactory in all patients and good in 75%. Conclusion: Both our biomechanical and early clinical results support the clinical use of the palmarly applied LCP for intra-articular and dorsally comminuted wrist fractures

New concepts in plate fixation have led to an evolution in plate design for olecranon fractures. The purpose of this study was. to compare the stiffness and strength of a contoured Locking Compression Plate (LCP) with a conventional plating method (one-third tubular plate) in a cadaveric comminuted olecranon fracture model with standardized osteotomy, and. to evaluate the LCP fixation method in a prospectively included group of patients with complex olecranon fractures using validated outcome scores. In the biomechanical study, five matched pairs of cadaveric elbows were randomly assigned for fixation by either LCP or a conventional plating method. Specimens were mounted to a custom-made testing bench and subjected to cyclic loading until failure occurred while measuring gapping at the osteotomy site. In the clinical study, twenty-one patients treated with LCP for complex olecranon fractures had a mean follow up of 20 months (3–39 months) and functional and patient rated outcome were evaluated. In the biomechanical study, there was no significant difference in fixation stiffness and strength between one third tubular plating and LCP (p > 0.05). In the clinical study, the mean time to union of the fracture was 6 months (2–28 months). According to the Mayo Elbow Performance Index (MEPI) most patients had a good or excellent outcome. No patients reported difficulty with activities of daily living. Physical capacity showed minimal loss of stability and strength. Six patients had their hardware removed. Technical ease of application and advantageous features of the LCP -such as unicortical screw fixation and improved holding power in osteopenic bone- make it a good alternative implant for comminuted olecranon fractures

Aim: The pylon tibial fractures are a challenge for the orthopaedic surgeons. The purpose of this study was comparative analysis of different surgical methods of the pylon fractures. Methods: From 1994 to 2003 143 pylon fractures were treated. There were 87 men and 56 women from 15 to 74 years old. In 45 cases we used only external fixation (Ilizarov apparatus), in 29 open reduction and screw fixation was combined with external fixations. Sixty eight fractures were treated by ORIF according AO principles. In 51 cases “clover leaf” and 1/3 tubular plates were used, in 18 cases stable fixation was realized by LCP-plates. Follow-up results were analyzed through 9 and 12 months. Results: The good and excellent results (no pain, deformities and good function) were received in 72,7% patients, the satisfactory results – at 23,8 % cases. In 9 patients the superficial and in 4 the deep wound infection took place. The best results are received in cases of Locking Compression Plate (LCP) application. Conclusions: Full restoration of axis and articular surface (with or without bone grafting), stable fixation and early mobilization of the joint is essential in successful treatment of pylon fractures. Indirect reduction and external fixation can be applied only in A and B1-type of fractures. At types B2,3 and C good results can be received only at use of a stable internal osteosynthesis

Introduction: Standard treatment for distal tibia fractures is the fixation with locking compression plates. Locking plate fixation has revolutionized fracture treatment in the last decade and may be ideally suited for a bridging plate osteosynthesis. This technique allows some controlled axial fracture motion, what essential for secondary bone healing is. A disadvantage of the locking plate technique seems to be an unsymmetrical micro motion along the fracture gap. The micromotion at the far cortex side is much larger than at the near cortex side (near the plate). It is supposed to be that the fracture movement on the near cortex is too small. To increase the motion at the near cortex side a new kind of screws has been developed. In this study we examined the micromotion using normal locking head screws versus the new dynamic locking head screws. Materials and Methods: A simplified fracture model was created by connecting 2 plastic cylinders (POM C, EModul: 3.1GPa) with a standard 11-holes Locking Compression Plate (Synthes). The fracturegap (between the two cylinders) amounted 3mm. Three kinds of fracture models were constructed: The model of a transverse fracture, an oblique fracture and a spiral fracture. An axial load from 0N up to 200N was applied with a testing machine (Zwick). The motion of the fracture model was measured in three dimensions using the optical measurement system PONTOS 5M (GOM, Braunschweig, Germany). The accuracy of the optical measurement system was about 5 micrometers. Results: A total of 72 measurements were compared. Using the new screw, axial stiffness was decreased for 16% and micromotion was up to 200 μm higher in comparison to the old screw. Discussion: Using the new dynamic locking head screw it’s possible to increase interfragmentary motion up to 200μm on the near cortex side (plate side)

Background: There is no consensus on the best treatment of complex intraarticular fractures and high energy diaphyseal fractures of the long bones. The Locking Compression Plate (LCP) and the Less Invasive Stabilization System (LISS) are the new implants with angular stability developed by the AO/ASIF. The new screw-plate systems seem to offer an excellent alternative for the operative fixation in these cases. Patients and methods: In a prospective study the new system was used to treat 20 patients (8 women, 12 men; average age 39.3 yrs) with 23 high – energy injuries (multifragmentary shaft fractures or complex intraarticular) from december 2001. During a mean period of 20 (13–30) months, complications, clinical and radiographic findings were followed prospectively. One patient was lost to follow-up. 19 patients underwent a standardized follow-up examination. According to the AO classification, 6 were proximal tibial fractures 41-C; 4 distal tibial 43-C; 6 distal femoral 33-C; 3 humerus 12-C and 4 distal radius 23-C. Ten of the fractures were open, 6 grade II, and 4 grade III. Because of severe concomitant injuries, 4 fractures were first treated with an external fixator and definitively stabilized more than two weeks after the injury. 2 patients were operated on after failure of others implants and non-union. Results: The outcome correlated with the severity of the fracture, anatomic reduction, exact positioning of the plate and concomitant injuries. Despite the large number of open and comminuted fractures no serious complications as deep infections, vascular lesions, DVT or non-unions were presented. Conclusions: We found the new internal fixator system to be a safe and reliable procedure. The new system offers numerous fixation possibilities and has proven its worth in complex fracture situations and in revision operation. A good knowledge of biomechanics is essential as well as precise preoperative planning

Introduction. Locking compression plate (LCP) fixation is an established method of treatment of distal third tibial fractures. No biomechanical data exists in the literature regarding their use. Additionally no data exists on the biomechanical advantage of locking screw fixation over non-locking screw fixation for these fractures. In this study the axial and torsional stiffness, axial load to failure and fatigue performance of a 3.5 mm LCP medial distal tibia Synthes plate was evaluated for the stabilisation of distal third tibial fractures. Additionally the performance of the plate in uni and bicortical locked mode as well as non-locked mode was evaluated. Methods. A standardized oblique fracture pattern was created in the tibial metaphysis of 3rd generation composite tibias, 40 mm from the distal end of the tibia (AO 43-A2.3). A 10mm fracture gap was used to model a comminuted metaphyseal fracture. A 3.5 mm medial distal tibia LCP was applied with bi or unicortical locking or bicortical non-locking screws to 5 tibias respectively. All the bio-mechanical tests were performed on a Bose 3510 Electroforce material testing machine. A ramp to load, loading profile was used to determine the static axial and torsional performance of the construct. Fatigue testing simulated a 6 week gradual weight bearing régime with the load increasing every two weeks by 400N until either 250,000 cycles were completed or the construct failed. Results. The non-locked plate demonstrated a significantly higher load to failure than both the bicortical and unicortical locked plates, 683N vs. 575N vs. 483N respectively(p<0.01). The non locked plate also demonstrated significantly higher mean axial stiffness than the bicortical locked plate and unicortical locked plate 632±13 N/mm, 337±12N/mm and 266±6 N/mm respectively (p <0.01). The non locked plate demonstrated the highest torsional stiffness followed by the bi and unicortical locking plates 1.16 ±.08 Nmm vs. 0.79 ± .06 Nmm vs.0.40 ± 0.02 Nmm respectively (p < 0.01). The non locked plate demonstrated higher endurance than the bi and unicortical locking plates over a 6 week simulated fatigue cycle with 1.75mm, 2.10mm and 2.3mm residual displacement at 1600N respectively (p < 0.01). Discussion. This is the first study that has examined the biomechanical properties of the LCP when used for distal third tibial fractures. A review of the literature suggests LCPs outperform dynamic compression plates in osteoporotic bone but demonstrates no clear biomechanical advantage in using a locking construct in non-osteoporotic bone. In our study the non locked construct outperformed the locked constructs in all parameters assessed. We conclude there is no advantage in using a locking construct for distal third tibial fractures in good quality bone

Aims

Proximal humeral fractures are the third most common fracture among the elderly. Complications associated with fixation include screw perforation, varus collapse, and avascular necrosis of the humeral head. To address these challenges, various augmentation techniques to increase medial column support have been developed. There are currently no recent studies that definitively establish the superiority of augmented fixation over non-augmented implants in the surgical treatment of proximal humeral fractures. The aim of this systematic review and meta-analysis was to compare the outcomes of patients who underwent locking-plate fixation with cement augmentation or bone-graft augmentation versus those who underwent locking-plate fixation without augmentation for proximal humeral fractures.

Aims

The aim of the present study was to assess the outcomes of the induced membrane technique (IMT) for the management of infected segmental bone defects, and to analyze predictive factors associated with unfavourable outcomes.

Aims

Fracture-related infection (FRI) is commonly classified based on the time of onset of symptoms. Early infections (< two weeks) are treated with debridement, antibiotics, and implant retention (DAIR). For late infections (> ten weeks), guidelines recommend implant removal due to tolerant biofilms. For delayed infections (two to ten weeks), recommendations are unclear. In this study we compared infection clearance and bone healing in early and delayed FRI treated with DAIR in a rabbit model.

Aims

The aim of this study was to compare outcomes of guided growth and varus osteotomy in treating Kalamchi type II avascular necrosis (AVN) after open reduction and Pemberton acetabuloplasty for developmental dysplasia of the hip (DDH).