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PloS One 2021The purpose of this study was to biomechanically compare the stability of first metatarsophalangeal (MTP1) joint arthrodesis with dorsally and medially positioned plates.
OBJECTIVE
The purpose of this study was to biomechanically compare the stability of first metatarsophalangeal (MTP1) joint arthrodesis with dorsally and medially positioned plates.
METHODS
A physical model of the MTP1 joint consists of printed synthetic bones, a titanium locking plate and screws. In the experiments, samples with dorsally and medially positioned plates were subjected to loading of ground load character in a universal testing machine. Force-displacement relations and relative displacements of bones were recorded. The obtained results were used to validate the corresponding finite element models of the MTP1 joint. Nonlinear finite element simulations of the toe-off phase of gait were performed to determine the deformation and stress state in the MTP1 joint for two positions of the plate.
RESULTS
In numerical simulations, the maximum displacement in the dorsal direction was noticed at the tip of the distal phalanx and was equal to 19.6 mm for the dorsal plate and 9.63 mm for the medial plate for a resultant force of 150 N. Lower relative bone displacements and smaller plastic deformation in the plate were observed in the model with the medial plate. Stress values were also smaller in the medially positioned plate and locking screws compared to fixation with the dorsal plate.
CONCLUSIONS
A medially positioned locking plate provides better stability of the MTP1 joint than a dorsally positioned plate due to greater vertical bending stiffness of the medial plate. Smaller relative bone displacements observed in fixation with the medial plate may be beneficial for the bone healing process. Moreover, lower stress values may decrease the risk of complications associated with hardware failure.
Topics: Arthrodesis; Biomechanical Phenomena; Bone Plates; Bone and Bones; Finite Element Analysis; Humans; Metatarsophalangeal Joint; Models, Anatomic; Stress, Mechanical
PubMed: 34852005
DOI: 10.1371/journal.pone.0260572 -
Orthopaedics & Traumatology, Surgery &... Feb 2017Alternatives to internal fixation of long-bone fracture comprise, depending on location, external fixation or joint replacement. Limitations comprise risk of infection... (Review)
Review
Alternatives to internal fixation of long-bone fracture comprise, depending on location, external fixation or joint replacement. Limitations comprise risk of infection and functional outcome quality, which vary according to technique. The present study examines these limitations, based on comparative or large-scale studies from which certain significant results emerge. Four main questions are dealt with: (1) the present role of locking plates; (2) conditions for intramedullary nailing in Gustilo grade IIIb open fracture; (3) the limitations of conversion from external fixation to intramedullary nailing in open lower leg fracture; (4) and the limitations of definitive anterograde femoral nailing in multiple trauma. Locking plate fixation has yet to prove clinical superiority in any of the anatomic sites for which good-quality comparative analyses are available. Infection risk in Gustilo grade IIIb open lower leg fracture is equivalent when treated by intramedullary nailing or external fixation, if wound care and debridement are effective, antibiotherapy is initiated rapidly and skin cover is restored within 7days. Conversion from primary external fixation to intramedullary nailing is possible if the external fixator was fitted less than 28days previously and skin cover was restored within 7days. The pulmonary and systemic impact of peripheral lesions or definitive anterograde intramedullary nailing of femoral fracture in multiple trauma calls for caution and what is known as "damage-control orthopedics" (DCO), a term covering the general consequences of both the initial trauma and its treatment. Femoral intramedullary nailing is thus contraindicated in case of hemorrhagic shock (blood pressure<90mmHg), hypothermia (<33°C), coagulation disorder (platelet count<90,000) or peripheral lesions such as multiple long-bone fractures, crushed limb or primary pulmonary contusion. In such cases, external fixation or retrograde nailing with a small-diameter nail and without reaming are preferable.
Topics: Bone Plates; Decision Support Techniques; Femoral Fractures; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humans; Injury Severity Score; Multiple Trauma
PubMed: 28082050
DOI: 10.1016/j.otsr.2016.11.006 -
BMC Surgery Feb 2022After severe trauma of lower limbs, bone, tendon or plate graft exposure is common. The traditional repair method is to use a variety of skin flap transplantation to...
Analysis of the therapeutic effect of artificial leather embedding combined with fascial sleeve flap transplantation on chronic wounds of lower limbs with bone and plate exposure.
BACKGROUND
After severe trauma of lower limbs, bone, tendon or plate graft exposure is common. The traditional repair method is to use a variety of skin flap transplantation to cover the exposed part, but the wound often can not heal after operation, or the wound is cracked, ulcer, sinus, bone and steel plate are exposed again after wound healing. The reason for this result is that when the flap is covered, the space around the bone plate is not well closed, forming a dead cavity, blood and exudate accumulation, hematoma formation or infection, and finally the wound ruptures again. In addition, due to the swelling and contracture of the flap after operation, the suture tension between the flap and the receiving area becomes larger, the skin becomes thinner and broken, and then the wound is formed. In order to solve the above problems, we carried out the study of artificial true skin embedding combined with fascial sleeve flap transplantation in the treatment of chronic bone plate exposed wounds of lower limbs.
METHODS
In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion, removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1-2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in nine cases and the lateral superior malleolar artery perforator flap in two case.
RESULTS
The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.
CONCLUSIONS
Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture. It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs.
Topics: Bone Plates; Humans; Lower Extremity; Perforator Flap; Plastic Surgery Procedures; Skin Transplantation; Soft Tissue Injuries; Treatment Outcome
PubMed: 35219291
DOI: 10.1186/s12893-022-01521-2 -
Scientific Reports Sep 2023Conventional cage and plate (CCP) implants usually used in ACDF surgery, do have limitations such as the development of postoperative dysphagia, adjacent segment...
Conventional cage and plate (CCP) implants usually used in ACDF surgery, do have limitations such as the development of postoperative dysphagia, adjacent segment degeneration, and soft tissue injury. To reduce the risk of these complications, zero-profile stand-alone cage were developed. We used finite-element modeling to compare the total von Mises stress applied to the bone, disc, endplate, cage and screw when using CCP and ZPSC implants. A 3-dimensional FE (Finite element) analysis was performed to investigate the effects of the CCP implant and ZPSC on the C3 ~ T1 vertebrae. We confirmed that the maximum von Mises stress applied with ZPSC implants was more than 2 times greater in the endplate than that applied with CCP implants. The 3D analysis of the ZPSC model von Mises stress measurements of screw shows areas of higher stress in red. Although using ZPSC implants in ACDF reduces CCP implant-related sequalae such as dysphagia, we have shown that greater von Mises stress is applied to the endplate, and screw when using ZPSC implants. This may explain the higher subsidence rate associated with ZPSC implant use in ACDF. When selecting an implant in ACDF, surgeons should consider patient characteristics and the advantages and disadvantages of each implant type.
Topics: Humans; Deglutition Disorders; Surgeons; Diskectomy; Bone Plates; Bone Screws
PubMed: 37737299
DOI: 10.1038/s41598-023-43086-x -
Operative Orthopadie Und Traumatologie Apr 2017Corrections for congenital or posttraumatic malrotation of the lower leg, considering alignment of the contralateral leg, with an osteotomy and fixation using locking... (Review)
Review
OBJECTIVE
Corrections for congenital or posttraumatic malrotation of the lower leg, considering alignment of the contralateral leg, with an osteotomy and fixation using locking compression plates (LCP).
INDICATIONS
Posttraumatic deformity due to malunion. Increased tibial torsion in residual clubfoot deformity as long as the foot has been realigned. Idiopathic internal or external rotational deformity if the child is regularly tripping and falling, has psychological problems (other children making fun of the child because of the unusual gait), or is bothered by the deformity (age > 10 years, relative indication).
CONTRAINDICATIONS
Rotational deformities at other levels, mainly the hip. Children under the age of 3 years due to the remodeling potential during growth.
SURGICAL TECHNIQUE
Osteotomy at supramalleolar level and fixation with 3.5 mm 90° locking plate. Perpendicular osteotomy at the intersection of midshaft to distal shaft. After achieving the desired correction, fixation by a straight four-hole 3.5-mm locking plate.
POSTOPERATIVE MANAGEMENT
Following fixation of the osteotomy with the four hole 3.5 mm LCP, a lower leg cast is recommended for 4-5 weeks. Applying the 3.5 mm 90° LCP allows immediate postoperative full weight bearing. Osteotomy material should be removed 1 year postoperatively.
RESULTS
Assuming an uneventful postoperative course, consolidation of the fracture can be expected within 4-6 weeks. The stable fixation with locking plates provides stability without loss of correction at follow-up.
Topics: Adolescent; Bone Plates; Child; Child, Preschool; Evidence-Based Medicine; Female; Humans; Male; Osteotomy; Plastic Surgery Procedures; Tibia; Tibial Fractures; Treatment Outcome
PubMed: 27957593
DOI: 10.1007/s00064-016-0473-5 -
Sensors (Basel, Switzerland) Dec 2022Ultrasonic imaging logging can visually identify the location, shape, dip angle and orientation of fractures and holes. The method has not been effectively applied in...
Ultrasonic imaging logging can visually identify the location, shape, dip angle and orientation of fractures and holes. The method has not been effectively applied in the field; one of the prime reasons is that the results of physical simulation experiments are insufficient. The physical simulation of fracture and hole response in the laboratory can provide a reference for the identification and evaluation of the underground geological structure. In this work, ultrasonic scanning experiments are conducted on a grooved sandstone plate and a simulated borehole and the influence of different fractures and holes on ultrasonic pulse echo is studied. Experimental results show that the combination of ultrasonic echo amplitude imaging and arrival time imaging can be used to identify the fracture location, width, depth and orientation, along with accurately calculating the fracture dip angle. The evaluated fracture parameters are similar to those in the physical simulation model. The identification accuracy of the ultrasonic measurement is related to the diameter of the radiation beam of the ultrasonic transducer. A single fracture with width larger than or equal to the radiation beam diameter of the ultrasonic transducer and multiple fractures with spacing longer than or equal to the radiation beam diameter can be effectively identified.
Topics: Humans; Ultrasonography; Computer Simulation; Transducers; Ultrasonics; Bone Plates; Fractures, Bone
PubMed: 36502123
DOI: 10.3390/s22239422 -
European Cells & Materials Aug 2021Single-plate fixation bridging bone defects provokes nonunion and risks plate-fatigue failure due to under- dimensioned implants. Adding a helical plate to bridge the...
Single-plate fixation bridging bone defects provokes nonunion and risks plate-fatigue failure due to under- dimensioned implants. Adding a helical plate to bridge the fracture increases stiffness and balances load sharing. This study compares the stiffness and plate surface strain of different constructs in a transverse contact and gap femoral shaft fracture model. Eight groups of six synthetic femora each were formed: intact femora; intact femora with lateral locking plate; contact and gap transverse shaft osteotomies each with lateral locking plate, lateral locking plate and helical locking plate, and long proximal femoral nail. Constructs underwent non-destructive quasi-static axial and torsional loading. Plate surface strain evaluation was performed under 200 N axial loading. Constructs with both lateral and helical plates demonstrated similar axial and torsional stiffness- independent of the contact or gap situations - being significantly higher compared to lateral plating (p < 0.01). Torsional stiffness of the constructs, with both lateral and helical plates in the gap situation, was significantly higher compared to this situation stabilised by a nail (p < 0.01). Plate surface strain dropped from 0.3 % in the gap situation with a lateral plate to < 0.1 % in this situation with both a lateral and a helical plate. Additional helical plating increases axial and torsional construct stiffness in synthetic bone and seems to provide well-balanced load sharing. Its use should be considered in very demanding situations for gap or defect fractures, where single-plate osteosynthesis provides inadequate stiffness for fracture healing and induces nonunion.
Topics: Biomechanical Phenomena; Bone Plates; Femoral Fractures; Fracture Fixation, Internal; Fracture Healing; Humans
PubMed: 34410680
DOI: 10.22203/eCM.v042a08 -
International Journal of Surgery... Apr 2018The aim of this study was to assess the outcomes of dynamic locking plate (Targon FN) and other alternative implant (cannulated cancellous screws or sliding hip screw)... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The aim of this study was to assess the outcomes of dynamic locking plate (Targon FN) and other alternative implant (cannulated cancellous screws or sliding hip screw) for treating of intracapsular hip fracture.
METHODS
Relevant clinical trials on the dynamic locking plate and alternative implant treatment for intracapsular hip fracture were retrieved through searching the databases, PubMed, Embase and the Cochrane Central Register of Controlled Trials up to August 2017. Studies that investigated the comparing effectiveness or complications between both groups and provided sufficient data of interest were included in this meta-analysis.
RESULTS
Four studies involving 385 intracapsular hip fractures were included. The differences in nonunion [odds ratio (OR) 0.16,95% confidence interval (CI) 0.05-0.49], revision (OR 0.56, 95%CI 0.32-0.96) and replacement rate (OR 0.26, 95%CI 0.10-0.69) were statistically significant between dynamic locking plate and alternative implant group. There was no statistically significant difference in osteonecrosis (OR1.73, 95%CI0.59-5.02), cut-out (OR0.89,95%CI0.23-3.46)and non orthopaedics complication rate (OR0.73, 95% CI 0.38-1.41).
CONCLUSIONS
The available evidence indicate that dynamic locking plate offers a superior outcome in comparison with alternative implants and reduces the nonunion, revision and replacement rates for treating intracapsular hip fractures, but does not affect the osteonecrosis, cutout and non-orthopadeics complication rate. Decisions should be made in accordance with specific conditions for clinical application.
Topics: Bone Plates; Bone Screws; Fracture Fixation, Internal; Hip Fractures; Hip Joint; Humans; Postoperative Complications; Treatment Outcome
PubMed: 29427750
DOI: 10.1016/j.ijsu.2018.01.044 -
BMC Musculoskeletal Disorders Apr 2023There is a great debate on the routine use of open reduction and internal fixation (ORIF) for midshaft clavicle fractures, and one concern is the adverse events after...
INTRODUCTION
There is a great debate on the routine use of open reduction and internal fixation (ORIF) for midshaft clavicle fractures, and one concern is the adverse events after ORIF, such as implant removal after bone union. In this retrospective study, we assessed the incidence, risk factors, management and outcomes of refracture after plate removal of midshaft clavicle fractures after bone union.
MATERIALS AND METHODS
Three hundred fifty-two patients diagnosed with acute midshaft clavicle fractures who had complete medical records from primary fractures to refracture were recruited. Details of imaging materials and clinical characteristics were carefully reviewed and analysed.
RESULTS
The incidence rate of refracture was 6.5% (23/352), and the average interval from implant removal to refracture was 25.6 days. Multivariate analysis showed that the risk factors were Robinson type-2B2 and fair/poor reduction. Females were 2.4 times more likely to have refracture, although it was not significant in multivariate analysis (p = 0.134). Postmenopausal females with a short interval (≤ 12 months) from primary surgery to implant removal had a significant risk for refracture. Tobacco use and alcohol use during bone healing were potential risk factors for male patients, although they were not significant in multivariate analysis. Ten patients received reoperation with or without bone graft, and they had a higher rate of bone union than 13 patients who refused reoperation.
CONCLUSION
The incidence of refracture following implant removal after bone union is underestimated, and severe comminute fractures and unsatisfactory reduction during primary surgery are risk factors. Implant removal for postmenopausal female patients is not recommended due to a high rate of refracture.
Topics: Humans; Male; Female; Incidence; Fracture Fixation, Internal; Clavicle; Retrospective Studies; Fractures, Bone; Risk Factors; Bone Plates; Treatment Outcome
PubMed: 37076821
DOI: 10.1186/s12891-023-06391-0 -
Biomedical Engineering Online Apr 2018Proximal humerus fractures are the third most common in the human body but their management remains controversial. Open reduction and internal fixation with plates is... (Review)
Review
BACKGROUND
Proximal humerus fractures are the third most common in the human body but their management remains controversial. Open reduction and internal fixation with plates is one of the leading modes of operative treatment for these fractures. The development of technologies and techniques for these plates, during the recent decades, promise a bright future for their clinical use. A comprehensive review of in vitro biomechanical studies is needed for the comparison of plates' mechanical performance and the testing methodologies. This will not only guide clinicians with plate selection but also with the design of future in vitro biomechanical studies. This review was aimed to systematically categorise and review the in vitro biomechanical studies of these plates based on their protocols and discuss their results. The technologies and techniques investigated in these studies were categorised and compared to reach a census where possible.
METHODS AND RESULTS
Web of Science and Scopus database search yielded 62 studies. Out of these, 51 performed axial loading, torsion, bending and/or combined bending and axial loading while 11 simulated complex glenohumeral movements by using tendons. Loading conditions and set-up, failure criteria and performance parameters, as well as results for each study, were reviewed. Only two studies tested four-part fracture model while the rest investigated two- and three-part fractures. In ten studies, synthetic humeri were tested instead of cadaveric ones. In addition to load-displacement data, three-dimensional motion analysis systems, digital image correlation and acoustic emission testing have been used for measurement.
CONCLUSIONS
Overall, PHILOS was the most tested plate and locking plates demonstrated better mechanical performance than non-locking ones. Conflicting results have been published for their comparison with non-locking blade plates and polyaxial locking screws. Augmentation with cement [calcium phosphate or poly(methyl methacrylate)] or allografts (fibular and femoral head) was found to improve bone-plate constructs' mechanical performance. Controversy still lies over the use of rigid and semi-rigid implants and the insertion of inferomedial screws for calcar region support. This review will guide the design of in vitro and in silico biomechanical tests and also supplement the study of clinical literature.
Topics: Biomechanical Phenomena; Bone Plates; Humans; Mechanical Phenomena; Shoulder Fractures
PubMed: 29703261
DOI: 10.1186/s12938-018-0479-3