1. A technique for internal fixation of the disrupted symphysis pubis by an angled four-hole plate is described. 2. In five patients in whom internal fixation was used rapid relief of the severe discomfort caused by symphysial disruption was noted.
1. One hundred and eighty-one fractures of the tibial shaft were treated by rigid fixation using conventional plates. 2. Comparison is made with series of fractures treated by the closed method. 3. The incidence of non-union, or delayed union requiring a long period of plaster immobilisation, was found to be less with the open method of treatment. 4. Plating was also found to give better functional results with a shorter period of disability except in severe open fractures. 5. Plating is a valuable method of treatment for tibial fractures in the elderly.
This edition of Cochrane Corner looks at some of the work published by the Cochrane Collaboration, covering interventions for treating distal femur fractures in adults; ultrasound and shockwave therapy for acute fractures in adults; and local corticosteroid injection versus placebo for carpal tunnel syndrome.
The design and use of a prong plate for the treatment of displaced fractures of the femoral neck is described. The prongs hold the femoral head, and the plate is screwed to the anterior cortex of the femoral neck and trochanteric region. The new plate has been used in 32 patients with Garden stage III or IV fractures and 29 had a good result. Bony union was seen within 11 weeks in all patients in whom bleeding of the femoral head was noted at operation, but was much delayed in patients without bleeding. Late segmental aseptic necrosis was seen in four patients after follow-up of at least two years, and successfully treated. The prong plate allows accurate reduction, impaction and strong rigid fixation with less disturbance of the intramedullary blood flow than other fixation methods.
1. A simple method of internal fixation of adult forearm fractures which gives consistent good results is necessary because the closed method of treatment is of limited application. 2. Open reduction of fractures without rigid internal fixation gives a high proportion of non-union and poor results. 3. Rigid internal fixation with standard plates and screws has been shown to give a low incidence of non-union in this series. 4. A three and a half inch long plate with six screws is suitable for most fractures, but if there is moderate or severe comminution, or if there is a segmental fracture, longer plates and more screws should be used to provide sound fixation. 5. Severely comminuted fractures with large avascular bone fragments should have the addition of a bone graft at the time of the plating operation in order that union may be assured. Thin strips of iliac bone are preferred. 6. Rigid plating is considered to be the most satisfactory treatment for open fractures. 7. Immobilisation of the limb after operation is not necessary and is undesirable if the fixation is rigid. 8. The functional results of this treatment are good and seemingly better than those achieved by other methods. 9. Serious complications of the plating operation are few and avoidable.
This paper describes the preliminary results of a proximal tibial endoprosthesis which spares the knee joint and enables retention of the natural articulation by replacing part of the tibial metaphysis and diaphysis. In eight patients who had a primary malignant bone tumour of the proximal tibia, the distal stem, which had a hydroxyapatite-coated collar to improve fixation, was cemented into the medullary canal. The proximal end had hydroxyapatite-coated extracortical plates which were secured to the remaining proximal tibial metaphysis using cortical screws. The mean age of the patients at operation was 28.9 years (8 to 43) and the mean follow-up was for 35 months (4 to 48). The mean Musculoskeletal Tumour Society score was 79% (57% to 90%), the mean Oxford Knee score was 40 points of 48 (36 to 46) and the mean knee flexion was 112° (100° to 120°). In one patient, revision to a below-knee amputation through the prosthesis was required because of recurrence of the tumour. Another patient sustained a periprosthetic fracture which healed with a painful malunion. This was revised to a further endoprosthesis which replaced the knee. In the remaining six patients the prosthesis allowed preservation of the knee joint with good function and no early evidence of loosening. Further follow-up is required to assess the longevity of these prostheses.
We evaluated the biomechanical properties of two different methods of fixation for unstable fractures of the proximal humerus. Biomechanical testing of the two groups, locking plate alone (LP), and locking plate with a fibular strut graft (LPSG), was performed using seven pairs of human cadaveric humeri. Cyclical loads between 10 N and 80 N at 5 Hz were applied for 1 000 000 cycles. Immediately after cycling, an increasing axial load was applied at a rate of displacement of 5 mm/min. The displacement of the construct, maximum failure load, stiffness and mode of failure were compared. The displacement was significantly less in the LPSG group than in the LP group (p = 0.031). All maximum failure loads and measures of stiffness in the LPSG group were significantly higher than those in the LP group (p = 0.024 and p = 0.035, respectively). In the LP group, varus collapse and plate bending were seen. In the LPSG group, the humeral head cut out and the fibular strut grafts fractured. No broken plates or screws were seen in either group. We conclude that strut graft augmentation significantly increases both the maximum failure load and the initial stiffness of this construct compared with a locking plate alone.
The purpose of this study was to evaluate the
risk of late displacement after the treatment of distal radial fractures with
a locking volar plate, and to investigate the clinical and radiological
factors that might correlate with re-displacement. From March 2007
to October 2009, 120 of an original cohort of 132 female patients
with unstable fractures of the distal radius were treated with a
volar locking plate, and were studied over a follow-up period of
six months. In the immediate post-operative and final follow-up
radiographs, late displacement was evaluated as judged by ulnar
variance, radial inclination, and dorsal angulation. We also analysed
the correlation of a variety of clinical and radiological factors
with re-displacement. Ulnar variance was significantly overcorrected
(p <
0.001) while radial inclination and dorsal angulation were
undercorrected when compared statistically (p <
0.001) with the unaffected
side in the immediate post-operative stage. During follow-up, radial
shortening and dorsal angulation progressed statistically, but none
had a value beyond the acceptable range. Bone mineral density measured
at the proximal femur and the position of the screws in the subchondral
region, correlated with slight progressive radial shortening, which
was not clinically relevant. Volar locking plating of distal radial fractures is a reliable
form of treatment without substantial late displacement. Cite this article:
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 locking
The April 2023 Trauma Roundup. 360. looks at: Displaced femoral neck fractures in patients aged 55 to 70 years: internal fixation or total hip arthroplasty?; Tibial plateau fractures: continuous passive motion approves range of motion; Lisfranc fractures: to fuse or not to fuse, that is the question; Is hardware removal after clavicle fracture
Aims. The optimal management of posterior malleolar ankle fractures, a prevalent type of ankle trauma, is essential for improved prognosis. However, there remains a debate over the most effective surgical approach, particularly between screw and
The August 2024 Trauma Roundup. 360. looks at: Does topical vancomycin prevent fracture-related infections in closed fractures undergoing open reduction and internal fixation? A randomized controlled trial; Is postoperative splinting advantageous after upper limb fracture surgery?; Does suprapatellar nailing resolve knee pain?; Locking versus non-locking
The April 2023 Foot & Ankle Roundup. 360. looks at: Outcomes following a two-stage revision total ankle arthroplasty for periprosthetic joint infection; Temporary bridge
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 locking
The April 2024 Wrist & Hand Roundup. 360. looks at: Lunocapitate versus four-corner fusion in scapholunate or scaphoid nonunion advanced collapse: a randomized controlled trial; Postoperative scaphoid alignment, smoking, and avascular necrosis determine outcomes; Grip strength signals broader health concerns in females with distal radius fractures; Clearing the smoke: how smoking status influences recovery from open carpal tunnel release surgery; Age matters: assessing the likelihood of corrective surgery after distal radius fractures; Is pronator quadratus muscle repair required after anterior
The August 2023 Shoulder & Elbow Roundup360 looks at: Motor control or strengthening exercises for rotator cuff-related shoulder pain? A multi-arm randomized controlled trial; Does the choice of antibiotic prophylaxis influence reoperation rate in primary shoulder arthroplasty?; Common shoulder injuries in sport: grading the evidence; The use of medial support screw was associated with axillary nerve injury after
