This study compares outcomes of fixation of subtrochanteric femoral fractures using a single lag screw (Gamma3 nail, GN) with a dual lag screw device (InterTAN nail, IN). The primary outcome was mechanical failure, defined as lag screw cut-out, back-out, nail breakage or peri-implant fracture. Technical factors associated with mechanical failure were also identified. All adult patients (>18yrs) with a subtrochanteric femoral fracture treated in a single centre were retrospectively identified using electronic records. Included patients underwent surgical fixation using either a long GN (2010–2017) or IN (2017–2022). Cox regression analysis was used to determine the risk of mechanical failure and technical predictors of failure. The study included 587 patients, 336 in the GN group (median age 82yrs, 73% female) and 251 in the IN group (median age 82yrs, 71% female). The IN group exhibited a higher prevalence of osteoporosis (p=0.002) and CKD□3 (p=0.007). There were no other baseline differences between groups. The risk of any mechanical failure was increased two-fold in the GN group (HR 2.51, p=0.020). Mechanical failure comprising screw cut-out (p=0.040), back-out (p=0.040) and nail breakage (p=0.51) was only observed in the GN group. The risk of peri-implant fracture was similar between the groups (HR 1.10, p=0.84). Technical predictors of mechanical included varus >5° for cut-out (HR 15.61, p=0.016), TAD>25mm for back-out (HR 9.41, p=0.020) and shortening >1cm for peri-implant fracture (HR 6.50, p=<0.001). Dual lag screw designs may reduce the risk of mechanical complications for patients with subtrochanteric femoral fractures

Objectives. We aimed to further evaluate the biomechanical characteristics of two locking screws versus three standard bicortical screws in synthetic models of normal and osteoporotic bone. Methods. Synthetic tubular bone models representing normal bone density and osteoporotic bone density were used. Artificial fracture gaps of 1 cm were created in each specimen before fixation with one of two constructs: 1) two locking screws using a five-hole locking compression plate (LCP) plate; or 2) three non-locking screws with a seven-hole LCP plate across each side of the fracture gap. The stiffness, maximum displacement, mode of failure and number of cycles to failure were recorded under progressive cyclic torsional and eccentric axial loading. Results. Locking plates in normal bone survived 10% fewer cycles to failure during cyclic axial loading, but there was no significant difference in maximum displacement or failure load. Locking plates in osteoporotic bone showed less displacement (p = 0.02), but no significant difference in number of cycles to failure or failure load during cyclic axial loading (p = 0.46 and p = 0.25, respectively). Locking plates in normal bone had lower stiffness and torque during torsion testing (both p = 0.03), but there was no significant difference in rotation (angular displacement) (p = 0.84). Locking plates in osteoporotic bone showed lower torque and rotation (p = 0.008), but there was no significant difference in stiffness during torsion testing (p = 0.69). Conclusions. The mechanical performance of locking plate constructs, using only two screws, is comparable to three non-locking screw constructs in osteoporotic bone. Normal bone loaded with either an axial or torsional moment showed slightly better performance with the non-locking construct

Aims. Dual SC Screw (DSCS) is a novel fixation device for the femoral neck fracture. DSCS is comprised of screw and barrel allowing sliding of the screw and preventing protrusion of the screw end. Two types of the barrels are available, threaded barrel (TB) and plate barrel (PB). Ordinarily, both barrels are implanted. Concept of the design is that the PB contributes stability to the screw against the varus force of the femoral head while the additional screw with TB prevents rotational deformity. The aim of this study was to represent clinical results after DSCS operation in patients with femoral neck fracture. Method. Fifty-one patients with femoral neck fractures treated using DSCS and at least 3 months follow up are included and their clinical was evaluated. Result. Most fractures healed uneventfully. Cut out was occurred in two patients, perforation of the femoral head in one, femoral head necrosis in two, subtrochanteric fracture in one and 1backout of screw in one. The cases except that are excellent postoperative results. Discussion and Conclusion. Most complication was associated with some technical problems and all but one patients without that showed excellent results even for displaced fracture. Furthermore, secondary subtrochanteric fracture was rare compared other devices. The plate augmentation for screw fixation contributes to these excellent results

Intramedullary nailing of metaphyseal fractures may be associated with deformity as a result of instability after fixation. Our aim was to evaluate the clinical use of Poller screws (blocking screws) as a supplement to stability after fixation with statically locked intramedullary nails of small diameter. We studied, prospectively, 21 tibial fractures, 10 in the proximal third and 11 in the distal third in 20 patients after the insertion of Poller screws over a mean period of 18.5 months (12 to 29). All fractures had united. Healing was evident radiologically at a mean of 5.4 ± 2.1 months (3 to 12) with a mean varus-valgus alignment of −1.0° (−5 to 3) and mean antecurvatum-recurvatum alignment of 1.6° (−6 to 11). The mean loss of reduction between placement of the initial Poller screw and follow-up was 0.5° in the frontal plane and 0.4° in the sagittal plane. There were no complications related to the Poller screw. The clinical outcome, according to the Karström-Olerud score, was not influenced by previous or concomitant injuries in 18 patients and was judged as excellent in three (17%), good in seven (39%), satisfactory in six (33%), fair in one (6%), and poor in one (6%)

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. The aim of this study was to investigate if there are differences in outcome between sliding hip screws (SHSs) and intramedullary nails (IMNs) with regard to fracture stability. Methods. We assessed data from 17,341 patients with trochanteric or subtrochanteric fractures treated with SHS or IMN in the Norwegian Hip Fracture Register from 2013 to 2019. Primary outcome measures were reoperations for stable fractures (AO Foundation/Orthopaedic Trauma Association (AO/OTA) type A1) and unstable fractures (AO/OTA type A2, A3, and subtrochanteric fractures). Secondary outcome measures were reoperations for A2, A3, and subtrochanteric fractures individually, one-year mortality, quality of life (EuroQol five-dimension three-level index score), pain (visual analogue scale (VAS)), and satisfaction (VAS) for stable and unstable fractures. Hazard rate ratios (HRRs) for reoperation were calculated using Cox regression analysis with adjustments for age, sex, and American Society of Anesthesiologists score. Results. Reoperation rate was lower after surgery with IMN for unstable fractures one year (HRR 0.82, 95% confidence interval (CI) 0.70 to 0.97; p = 0.022) and three years postoperatively (HRR 0.86, 95% CI 0.74 to 0.99; p = 0.036), compared with SHS. For individual fracture types, no clinically significant differences were found. Lower one-year mortality was found for IMN compared with SHS for stable fractures (HRR 0.87; 95% CI 0.78 to 0.96; p = 0.007), and unstable fractures (HRR 0.91, 95% CI 0.84 to 0.98; p = 0.014). Conclusion. This national register-based study indicates a lower reoperation rate for IMN than SHS for unstable trochanteric and subtrochanteric fractures, but not for stable fractures or individual fracture types. The choice of implant may not be decisive to the outcome of treatment for stable trochanteric fractures in terms of reoperation rate. One-year mortality rate for unstable and stable fractures was lower in patients treated with IMN. Cite this article: Bone Joint J 2022;104-B(2):274–282

Arthrodesis of the first metatarsophalangeal joint (MTPJ) is the most reliable surgical option, for hallux rigidus from end-stage osteoarthritis. The aim of the study was to compare the functional outcomes of memory nickel-titanium staples versus a compression plate with a cross screw construct for first MTPJ arthrodesis using the Manchester–Oxford Foot Questionnaire (MOXFQ). Patients who underwent MTPJ arthrodesis using either memory nickel-titanium staples or a compression plate with a cross screw construct were identified from the surgical lists of two orthopaedic consultants. Pre and post-operative MOXFQ questionnaire, a validated patient-reported outcome measure, was administered, and responses were analysed to derive the MOXFQ summary index. The study included 38 patients (staple group N=12 and plate and cross screw group N=26). 23 patients were female and 15 were male. Mean age was 64.8 years (SD 9.02; 40 to 82). Initial analysis showed no significant difference in preoperative MOXFQ scores between the groups (p = 0.04). Postoperatively, the staple group exhibited a mean improvement of 36.17, surpassing the plate group's mean improvement of 23. Paired t-test analysis revealed a statistically significant difference (t-score= 2.5, p = 0.008), favouring the use of staples. The findings indicate that the use of staples in MTPJ arthrodesis resulted in a significantly greater improvement in MOXFQ scores compared to plates. Further research is needed to explore the underlying factors contributing to this difference and to evaluate long-term effects on patient outcomes

Aims. This study evaluated variation in the surgical treatment of stable (A1) and unstable (A2) trochanteric hip fractures among an international group of orthopaedic surgeons, and determined the influence of patient, fracture, and surgeon characteristics on choice of implant (intramedullary nailing (IMN) versus sliding hip screw (SHS)). Methods. A total of 128 orthopaedic surgeons in the Science of Variation Group evaluated radiographs of 30 patients with Type A1 and A2 trochanteric hip fractures and indicated their preferred treatment: IMN or SHS. The management of Type A3 (reverse obliquity) trochanteric fractures was not evaluated. Agreement between surgeons was calculated using multirater kappa. Multivariate logistic regression models were used to assess whether patient, fracture, and surgeon characteristics were independently associated with choice of implant. Results. The overall agreement between surgeons on implant choice was fair (kappa = 0.27 (95% confidence interval (CI) 0.25 to 0.28)). Factors associated with preference for IMN included USA compared to Europe or the UK (Europe odds ratio (OR) 0.56 (95% CI 0.47 to 0.67); UK OR 0.16 (95% CI 0.12 to 0.22); p < 0.001); exposure to IMN only during training compared to surgeons that were exposed to both (only IMN during training OR 2.6 (95% CI 2.0 to 3.4); p < 0.001); and A2 compared to A1 fractures (Type A2 OR 10 (95% CI 8.4 to 12); p < 0.001). Conclusion. In an international cohort of orthopaedic surgeons, there was a large variation in implant preference for patients with A1 and A2 trochanteric fractures. This is due to surgeon bias (country of practice and aspects of training). The observation that surgeons favoured the more expensive implant (IMN) in the absence of convincing evidence of its superiority suggests that surgeon de-biasing strategies may be a useful focus for optimizing patient outcomes and promoting value-based healthcare. Cite this article: Bone Joint J 2021;103-B(4):775–781

Aims. This study aimed to compare mortality in trochanteric AO/OTA A1 and A2 fractures treated with an intramedullary nail (IMN) or sliding hip screw (SHS). The primary endpoint was 30-day mortality, with secondary endpoints at 0 to 1, 2 to 7, 8 to 30, 90, and 365 days. Methods. We analyzed data from 26,393 patients with trochanteric AO/OTA A1 and A2 fractures treated with IMNs (n = 9,095) or SHSs (n = 17,298) in the Norwegian Hip Fracture Register (January 2008 to December 2020). Exclusions were made for patients aged < 60 years, pathological fractures, pre-2008 operations, contralateral hip fractures, fractures other than trochanteric A1/A2, and treatments other than IMNs or SHSs. Kaplan-Meier and Cox regression analyses adjusted for type of fracture, age, sex, cognitive impairment, American Society of Anesthesiologists (ASA) grade, and time period were conducted, along with calculations for number needed to harm (NNH). Results. In unadjusted analyses, there was no significant difference between IMN and SHS patient survival at 30 days (91.8% vs 91.1%; p = 0.083) or 90 days (85.4% vs 84.5%; p = 0.065), but higher one-year survival for IMNs (74.5% vs 73.3%; p = 0.031) compared with SHSs. After adjustments, no significant difference in 30-day mortality was found (hazard rate ratio (HRR) 0.94 (95% confidence interval (CI) 0.86 to 1.02(; p = 0.146). IMNs exhibited higher mortality at 0 to 1 days (HRR 1.63 (95% CI 1.13 to 2.34); p = 0.009) compared with SHSs, with a NNH of 556, but lower mortality at 8 to 30 days (HRR 0.89 (95% CI 0.80 to 1.00); p = 0.043). No differences were observed in mortality at 2 to 7 days (HRR 0.94 (95% CI 0.79 to 1.11); p = 0.434), 90 days (HRR 0.95 (95% CI 0.89 to 1.02); p = 0.177), or 365 days (HRR 0.97 (95% CI 0.92 to 1.02); p = 0.192). Conclusion. This study found no difference in 30-day mortality between IMNs and SHSs. However, IMNs were associated with a higher mortality at 0 to 1 days and a marginally lower mortality at 8 to 30 days compared with SHSs. The observed differences in mortality were small and should probably not guide choice of treatment. Cite this article: Bone Joint J 2024;106-B(6):603–612

Aims. We compared the accuracy, operating time and radiation exposure of the introduction of iliosacral screws using O-arm/Stealth Navigation and standard fluoroscopy. Materials and Methods. Iliosacral screws were introduced percutaneously into the first sacral body (S1) of ten human cadavers, four men and six women. The mean age was 77 years (58 to 85). Screws were introduced using a standard technique into the left side of S1 using C-Arm fluoroscopy and then into the right side using O-Arm/Stealth Navigation. The radiation was measured on the surgeon by dosimeters placed under a lead thyroid shield and apron, on a finger, a hat and on the cadavers. Results. There were no neuroforaminal breaches in either group. The set-up time for the O-Arm was significantly longer than for the C-Arm, while total time for placement of the screws was significantly shorter for the O-Arm than for the C-Arm (p = 0.001). The mean absorbed radiation dose during fluoroscopy was 1063 mRad (432.5 mRad to 4150 mRad). No radiation was detected on the surgeon during fluoroscopy, or when he left the room during the use of the O-Arm. The mean radiation detected on the cadavers was significantly higher in the O-Arm group (2710 mRem standard deviation (. sd. ) 1922) than during fluoroscopy (11.9 mRem . sd 14.8). (p < 0.01). Conclusion. O-Arm/Stealth Navigation allows for faster percutaneous placement of iliosacral screws in a radiation-free environment for surgeons, albeit with the same accuracy and significantly more radiation exposure to cadavers, when compared with standard fluoroscopy. Take home message: Placement of iliosacral screws with O-Arm/Stealth Navigation can be performed safely and effectively. Cite this article: Bone Joint J 2016;98-B:696–702

Aims. The aim of this study was to investigate the association between the type of operation used to treat a trochanteric fracture of the hip and 30-day mortality. Patients and Methods. Data on 82 990 patients from the National Hip Fracture Database were analyzed using generalized linear models with incremental case-mix adjustment for patient, non-surgical and surgical characteristics, and socioeconomic factors. Results. The use of short and long intramedullary nails was associated with an increase in 30-day mortality (adjusted odds ratio (OR) 1.125, 95% confidence interval (CI) 1.040 to 1.218; p = 0.004) compared with the use of sliding hip screws (12.5% increase). If this were causative, it would represent 98 excess deaths over the four-year period of the study and one excess death would be caused by treating 112 patients with an intramedullary nail rather than a sliding hip screw. Conclusion. There is a 12.5% increase in the risk of 30-day mortality associated with the use of an intramedullary nail compared with a sliding hip screw in the treatment of a trochanteric fractures of the hip

Introduction. Conventional screws achieve sufficient insertion torque in healthy bone. In poor bone screw stripping can occur prior to sufficient torque generation. It was hypothesized that a screw with a larger major/minor diameter ratio would provide improved purchase in poor bone as compared to conventional screws. We evaluated the mechanical characteristics of such a screw using multiple poor bone quality models. Methods. Testing groups included: conventional screws, osteopenia screws used in bail-out manner (ie, larger major/minor diameter screws inserted into a hole stripped by a conventional screw), and osteopenia screws used in a preemptive manner (ie, no screw stripping occurrence). Stripping Torque: Screws were inserted through standard straight plates into a low density block of foam with a predrilled hole. Stripping torque was defined as maximum insertion torque reached by the screw before the screw began to spin freely in the foam. Pullout. Pullout tests were conducted on screws inserted into the same test media. Axial pull-out testing was then conducted by applying a tensile load to the screws. Compression. Screws were inserted through standard straight plates by hand while the amount of compression achieved between plate and bone was measured using a pressure sensor. The same foam test media was utilized in addition to osteoporotic fresh-frozen femoral diaphyseal cadaver (bone mineral density<0.60 g/cm2). The screws were tightened across a range of possible insertion torques with pressure measurements taken at multiple intervals. Results. The osteopenia bone screws showed a 67% increase in torque before stripping occurred (p<0.01) when compared to the conventional screw. The osteopenia screw used in a bail-out manner showed a 57% increase in stripping torque (p<0.01) and a 76% increase in pullout strength (p<0.01) when compared to the conventional screw. Additionally, the bail-out screw showed a minimal decrease in both stripping torque (6%, p = 0.45) and pullout strength (11%, p<0.01) when compared to the osteopenia screw tested in preemptive manner. There was a linear relationship between applied torque and compressive force generation for both osteopenia and conventional screws. The osteopenia screws were able to gain greater compression against bone across a range of insertion values as compared to conventional bone screws. Discussion. The osteopenia screw achieved superior stripping torque, pullout strength, and compressive forces when compared to conventional screws in simulated poor quality bone and osteoporotic cadaver bone. When used as a bail-out screw, it also achieved superior stripping torque and pullout strength. The results of this study indicate that a screw of larger major/minor diameter ratio could be an effective bail-out option for screw stripping associated with osteopenic fracture fixation

We compared a new fixation system, the Targon Femoral Neck (TFN) hip screw, with the current standard treatment of cannulated screw fixation. This was a single-centre, participant-blinded, randomised controlled trial. Patients aged 65 years and over with either a displaced or undisplaced intracapsular fracture of the hip were eligible. The primary outcome was the risk of revision surgery within one year of fixation. A total of 174 participants were included in the trial. The absolute reduction in risk of revision was of 4.7% (95% CI 14.2 to 22.5) in favour of the TFN hip screw (chi-squared test, p = 0.741), which was less than the pre-specified level of minimum clinically important difference. There were no significant differences in any of the secondary outcome measures. We found no evidence of a clinical difference in the risk of revision surgery between the TFN hip screw and cannulated screw fixation for patients with an intracapsular fracture of the hip. Cite this article: Bone Joint J 2014;96-B:652–7

We investigated the static and cyclical strength of parallel and angulated locking plate screws using rigid polyurethane foam (0.32 g/cm. 3. ) and bovine cancellous bone blocks. Custom-made stainless steel plates with two conically threaded screw holes with different angulations (parallel, 10° and 20° divergent) and 5 mm self-tapping locking screws underwent pull-out and cyclical pull and bending tests. The bovine cancellous blocks were only subjected to static pull-out testing. We also performed finite element analysis for the static pull-out test of the parallel and 20° configurations. In both the foam model and the bovine cancellous bone we found the significantly highest pull-out force for the parallel constructs. In the finite element analysis there was a 47% more damage in the 20° divergent constructs than in the parallel configuration. Under cyclical loading, the mean number of cycles to failure was significantly higher for the parallel group, followed by the 10° and 20° divergent configurations. In our laboratory setting we clearly showed the biomechanical disadvantage of a diverging locking screw angle under static and cyclical loading

Background. Controversy persists regarding preference between Herbert and Acutrak screw for internal fixation of scaphoid non-union. Acutrak screw has been shown to have better biomechanical compression properties than Herbert screw in the laboratory setting. The aim of this study was to assess the clinical, radiological and functional outcome of patients treated with the two different screw systems. Methods. A retrospective review of the results of patients with scaphoid non-union treated by a single surgeon. Group 1 comprised of 61 patients treated with Herbert screw between July1996 and June2000 and Group 2 comprised of 71 patients treated with Acutrak screw between July 2000 and December 2005. Union rates were assessed radiologically and clinically. Functional outcome was measured by using modified Mayo wrist score. Results. Both groups of patients were comparable in terms of age (25.3:27.3yrs, Herbert: Acutrak) and their occupations in relation to wrist loading. The mean time interval between injury and surgery was 12.2months for Herbert group (range: 3–144months) and 17months (range: 4–180months) in Acutrak group. Time to union was similar for both groups. Union rate was 93% (66) in Acutrak compared to 77% (47) in Herbert screw. Union rate was related to fracture site (Herbert p=0.01; Acutrak p=0.0001) and higher when the screw had been placed axially (Herbert; p=0.006, Acutrak; p=0.004) in the scaphoid. Ninety seven percent of screws had been placed axially in Acutrak compared to 84% in the Herbert. Functional outcome was satisfactory in 85% of Acutrak group compared to 67% in Herbert. Wrist fusion was performed in 4 patients in Herbert group due to progressive wrist pain and in 1 patient in Acutrak group due to similar reason. Conclusion. Acutrak screw provides more accurate method of screw placement and a higher union rate when compared to Herbert screw

Our aim was to compare polylevolactic acid screws with titanium screws when used for fixation of the distal tibiofibular syndesmosis at mid-term follow-up. A total of 168 patients, with a mean age of 38.5 years (18 to 72) who were randomly allocated to receive either polylevolactic acid (n = 86) or metallic (n = 82) screws were included. The Baird scoring system was used to assess the overall satisfaction and functional recovery post-operatively. The demographic details and characteristics of the injury were similar in the two groups. The mean follow-up was 55.8 months (48 to 66). The Baird scores were similar in the two groups at the final follow-up. Patients in the polylevolactic acid group had a greater mean dorsiflexion (p = 0.011) and plantar-flexion of the injured ankles (p < 0.001). In the same group, 18 patients had a mild and eight patients had a moderate foreign body reaction. In the metallic groups eight had mild and none had a moderate foreign body reaction (p <  0.001). In total, three patients in the polylevolactic acid group and none in the metallic group had heterotopic ossification (p = 0.246). We conclude that both screws provide adequate fixation and functional recovery, but polylevolactic acid screws are associated with a higher incidence of foreign body reactions. Cite this article: Bone Joint J 2014;96-B:548–54

We treated 108 patients with a pertrochanteric femoral fracture using either the dynamic hip screw or the proximal femoral nail in this prospective, randomised series. We compared walking ability before fracture, intra-operative variables and return to their residence. Patients treated with the proximal femoral nail (n = 42) had regained their pre-operative walking ability significantly (p = 0.04) more often by the four-month review than those treated with the dynamic hip screw (n = 41). Peri-operative or immediate post-operative measures of outcome did not differ between the groups, with the exception of operation time. The dynamic hip screw allowed a significantly greater compression of the fracture during the four-month follow-up, but consolidation of the fracture was comparable between the two groups. Two major losses of reduction were observed in each group, resulting in a total of four revision operations. Our results suggest that the use of the proximal femoral nail may allow a faster postoperative restoration of walking ability, when compared with the dynamic hip screw

Background. Locking internal fixation through a relatively small surgical dissection presents an innovative technique for managing distal tibial extra-articular fractures. The aim of this study is to evaluate the biomechanical properties of one locking internal fixation plate used to treat these injuries. Method. An AO/OTA43-A3 fracture was created in synthetic composite tibiae. Locking internal fixation was achieved with an anatomically pre-contoured medial distal tibial locking plate. Comparisons were made between different screw configurations in holes proximal to the fracture and monocortical versus bicortical fixation. Axial stiffness was measured using a universal materials testing machine. Finite element analysis (FEA) was used to model the elastic deformation of the constructs. Outcome measures were axial stiffness under physiological loading conditions and compression load to failure. Results. A trend towards reduced mean axial stiffness from the bicortical to the monocortical fixation constructs was observed. The physical model demonstrated no difference in measured mean axial stiffness between constructs with all screw holes filled and constructs with 2 screws in the holes closest and furthest from the fracture site. There was a 19% reduction in mean measured axial stiffness between constructs with all holes filled and in constructs with 2 screws in adjacent holes furthest from the fracture site (p<0.05). FEA predicted increased plate deflection and reduced construct axial stiffness with increasing distance of screw placement from the osteotomy site. Conclusion. Axial stiffness of distal tibial extra-articular metaphyseal fractures stabilized by locking internal fixation is dependent upon the configuration of the screw in the plate

Aims. To compare the outcomes for trochanteric fractures treated with a sliding hip screw (SHS) or a cephalomedullary nail. Patients and Methods. A total of 400 patients with a trochanteric hip fracture were randomised to receive a SHS or a cephalomedullary nail (Targon PFT). All surviving patients were followed up to one year from injury. Functional outcome was assessed by a research nurse blinded to the implant used. Results. Recovery of mobility, as assessed by a mobility scale, was superior for those treated with the intramedullary nail compared with the SHS at eight weeks, three and nine months (p-values between 0.01 and 0.04), the difference at six and 12 months was not statistically significant (p = 0.15 and p = 0.18 respectively). The mean difference was around 0.4 points (0.3 to 0.5) on a nine point scale. Surgical time for the nail was four minutes less than that for the SHS (p < 0.001). Fracture healing complications were similar for the two groups. There were no statistically significant differences between implants for any other recorded outcomes including the need for post-operative blood transfusion, wound healing complications, general medical complications, hospital stay or mortality. Conclusion. This study confirms the findings of a previous study that both methods of treatment produce similar results, although intramedullary fixation does result in marginally improved regain of mobility in comparison with the SHS. Cite this article: Bone Joint J 2017;99-B:1210–15

Background. pelvic fractures in elderly patients often result in poor prognosis due to immobilization associated complications. Thus, the target of the treatment in this patient group is early mobilization in order to reduce the risk of these complications. We report outcomes of 4 cases of pelvic fracture in elderly patients, who were treated with percutaneous screw fixation. Material and method. We examined medical records and images of 4 elderly patients between January 2012 and May 2012 in our center. Mean age of the patients was 88.8 years old (range 86–92 years). The causes of injury were motor vehicle accident in 3 patients, and a fall in 1 patient. Fracture types were ao type a in 1 patient, type b in 2 patients and type c in 1 patient. Mean injury severity score was 25 (10–57). We assessed functional status after the follow-up period using majeed. s. grading score for pelvic fractures. Result. No major complication including sever infection and deep vein thrombosis was observed during the follow-up period. Minor complication observed was screw loosening in 1 case, and screw prominence in another. Functional outcome by majeed. s. score were excellent in 1 case, and fair in 3 cases. The mean period between the operation and the first ride on the wheel chair was 3.5 (2–6) days. Conclusion. Early mobilization significantly affects the prognosis in multiple trauma patients. Percutaneous screw fixation may improve the prognosis in elderly patients with pelvic fracture