Helical plates potentially bypass the medial neurovascular structures of the thigh. Recently, two plate designs (90°- and 180°-helix) proved similar biomechanically behaviour compared to straight plates. Aims of this study were: (1) Feasibility of MIPO-technique with 90°- and 180°-helical plates on the femur, (2) Assessment of distances to adjacent anatomical structures at risk, (3) Comparison of these distances to using medial straight plates instead, (4) Correlation of measurements performed in anatomic dissection with CT-angiography. MIPO was performed in ten cadaveric femoral pairs using either a 90°-helical 14-hole-LCP (Group1) or a 180°-helical 15-hole-LCP-DF (Group2). CT angiography was used to evaluate the distances between the plates and the femoral arteries as well as the distances between the plates and the perforators. Subsequently, the specimens were dissected, and the distances were determined again manually. Finally, all helical plates were removed, and all measurements were repeated after application of straight medial plates (Group3). Closest overall distances between plates and femoral arteries were 15 mm (11 − 19 mm) in Group1, 22 mm (15 − 24 mm) in Group2 and 6 mm (1 − 8 mm) in Group3 with a significant difference between Group1 and Group3 (p < 0.001). Distances to the nearest perforators were 24 mm (15 − 32 mm) in Group1 and 2 mm (1 − 4 mm) in Group2. Measurement techniques (visual after surgery and CT-angiography) demonstrated a strong correlation of r2 = 0.972 (p < 0.01). MIPO with 90°- and 180°-helical plates is feasible and safe. Attention must be paid to the medial neurovascular structures with 90°-helical implants and to the proximal perforators with 180°-helical implants. Helical implants can avoid medial neurovascular structures compared to straight plates although care must be taken during their distal insertion. Measurements during anatomical dissection correlate with CT-angiography.
With an aging population and increase in total knee arthroplasty, periprosthetic
Introduction and Objective.
The objective of this study was to use patient-specific finite element modeling to measure the 3D interfragmentary strain environment in clinically realistic fractures. The hypothesis was that in the early post-operative period, the tissues in and around the fracture gap can tolerate a state of strain in excess of 10%, the classical limit proposed in the Perren strain theory. Eight patients (6 males, 2 females; ages 22–95 years) with
Introduction and Objective. Plating of geriatric
Background. Patients suffering a
Background.
Background. Hip fracture care has evolved, largely due to standardisation of practice, measurement of outcomes and the introduction of the Best Practice Tariff, leading to the sustained improvements documented by the National Hip Fracture Database (NHFD). The treatment of
Background. Plate fixation is one of several options available to surgeons for the management of pediatric femur fractures. Recent literature reports distal femoral valgus can be a complication following lateral plate fixation of femur fractures. We report on a case of extreme distal femoral valgus deformity and a lateral dislocation of the patella four years after having plate fixation of a left
Introduction. The treatment of
Introduction. The incidence of
Background. Currently about 4–6% of all femur fractures consist of
Background. Treating fractures is expensive and includes a long post-operative care. Intra-articular fractures are often treated with open surgery that require massive soft tissue incisions, long healing time and are often accompanied by deep wound infections. Minimally invasive surgery (MIS) is an alternative to this but when performed by surgeons and supported by X-rays does not achieve the required accuracy of surgical treatment. Methods. Functional and non-functional requirements of the system were established by conducting interviews with orthopaedic surgeons and attending fracture surgeries at Bristol Royal Infirmary to gain first-hand experience of the complexities involved. A robot-assisted fracture system (RAFS) has been designed and built for a
During the cold snap in the West of Scotland 20 December 2009 to 10 January 2010 there was a cluster of uncommon lower limb injuries in children from sledging accidents. These cases are presented as a series. This retrospective descriptive study details acute orthopaedic admissions for the period of the cold snap. The case-notes for all admissions were reviewed for diagnosis, mechanism of injury. Five (ex 20 ie 1/4) trauma admissions involved sledging: (1) combined avulsion of anterior and posterior cruciate ligaments left knee (2) Lisfranc injury, (3)