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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XV | Pages 20 - 20
1 Apr 2012
A BIOMECHANICAL COMPARISON OF DIFFERENT SCREW CONFIGURATIONS IN DISTAL TIBIAL LOCKING PLATES
Bonner T Green S McMurty I
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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.

Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 230 - 230
1 Jul 2008
DO WE NEED THE CT-SCAN IN MANAGING FRACTURES OF THE CALCANEUM ?
Kumar V Bhattacharyam R Attar F Hameed A McMurty I
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CT- scan as an management tool is being used extensively in managing calcaneal fractures. We set out to see if a CT-scan makes any difference to the management plan as obtained by looking at the plain radiograph. We also looked at the correlation with the actual management.

Methodology: This was a retrospective study involving 24 patients with fracture of the calcaneum. These patients had both a plain radiograph and a CT- scan to help decide on management. The actual management that each of these patients had was documented. Three consultants who were blinded to the actual management and names of the subjects were independently asked to grade the radiographs, as operative or non-operative. They were then similarly, asked to decide on operation or no-operation based on blinded CT- scans. The data obtained from the three observers were compared to the actual management and were subjected to statistical analysis.

Results: As the data was categorical and matched, the Mcnemars test was used to test the association between the management plan obtained from the radiographs and the management plan obtained from the CT scans, for each consultant. They were also compared with the actual management. The statistical analysis showed that there was no statistically significant association between the management decision obtained from the radiographs and the CT san, for all three observers. Radiograph and CT scan based management decisions also did not correlate with the actual management.

Conclusion: The CT scan should only be done when a definite decision is made to operate on a patient, based on plain radiographs. Calcaneal fractures which are decided not to operate, based on X rays, should not have a CT scan as a routine as it provides no valuable additional information.