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Medicina (Kaunas, Lithuania) Jun 2022: Fracture healing is currently assessed through qualitative evaluation of radiographic images, which is highly subjective in nature. Radiographs can only provide...
: Fracture healing is currently assessed through qualitative evaluation of radiographic images, which is highly subjective in nature. Radiographs can only provide snapshots in time, which are limited due to logistics and radiation exposure. We recently proposed assessing the bone healing status through continuous monitoring of the implant load, utilizing an implanted sensor system, the Fracture Monitor. The device telemetrically transmits statistically derived implant parameters via the patient's mobile phone to assist physicians in diagnostics and treatment decision-making. This preclinical study aims to systematically investigate the device safety and performance in an animal setting. : Mid-shaft tibial osteotomies of different sizes (0.6-30 mm) were created in eleven Swiss mountain sheep. The bones were stabilized with either a conventional Titanium or stainless-steel locking plate equipped with a Fracture Monitor. Data were continuously collected over the device's lifetime. Conventional radiographs and clinical CT scans were taken longitudinally over the study period. The radiographs were systematically scored and CTs were evaluated for normalized bone volume in the defect. The animals were euthanized after 9 months. The sensor output was correlated with the radiologic parameters. Tissue samples from the device location were histologically examined. : The sensors functioned autonomously for 6.5-8.4 months until energy depletion. No macroscopic or microscopic adverse effects from device implantation were observed. The relative implant loads at 4 and 8 weeks post-operation correlated significantly with the radiographic scores and with the normalized bone volume metric. : Continuous implant load monitoring appears as a relevant approach to support and objectify fracture healing assessments and carries a strong potential to enable patient-tailored rehabilitation in the future.
Topics: Animals; Bone Plates; Fracture Fixation, Internal; Fracture Healing; Osteotomy; Sheep; Titanium
PubMed: 35888576
DOI: 10.3390/medicina58070858 -
Acta Orthopaedica Et Traumatologica... Sep 2020The aim of this study was to compare the clinical outcomes and operative cost of a locked compression plate (LCP) and a nonlocked reconstruction plate in the treatment...
OBJECTIVE
The aim of this study was to compare the clinical outcomes and operative cost of a locked compression plate (LCP) and a nonlocked reconstruction plate in the treatment of displaced midshaft clavicle fracture.
METHODS
From January 2013 till March 2018, a total of 55 patients with acute unilateral closed midshaft clavicle fracture were treated with either a 3.5-mm pre-contoured LCP [32 patients; 25 men and 7 women; mean age: 35 years (range: 19-63 years)] or a 3.5-mm nonlocked reconstruction plate [23 patients; 20 men and 3 women; mean age: 31.4 years (range: 17-61 years)]. The clinical outcomes in terms of fracture union, Quick Disability of Arm, Shoulder and Hand (DASH) score, implant irritation, failure rate, and reoperation rate were evaluated retrospectively. The patient billing records were reviewed to obtain primary operation, reoperation, and total operative cost for midshaft clavicle fracture. These values were analyzed and converted from Malaysia Ringgit (RM) to United States Dollar (USD) at the exchange rate of RM 1 to USD 0.24. All patients were followed up for at least one-year duration.
RESULTS
The mean time to fracture union, implant irritation, implant failure, and reoperation rate showed no significant difference between the two groups of patients. The mean Quick DASH score was significantly better in the reconstruction plate group with 13 points compared with 28 points in the LCP group (p=0.003). In terms of total operative cost, the LCP group recorded a cost of USD 391 higher than the reconstruction plate group (p<0.001).
CONCLUSION
The 3.5-mm reconstruction plate achieved not only satisfactory clinical outcomes but was also more cost-effective than the LCP in the treatment of displaced midshaft clavicle fractures.
LEVEL OF EVIDENCE
Level III, Therapeutic study.
Topics: Adult; Bone Plates; Clavicle; Costs and Cost Analysis; Female; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Fractures, Malunited; Humans; Male; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 33155556
DOI: 10.5152/j.aott.2020.19219 -
BMC Musculoskeletal Disorders Jan 2022Combined medial and lateral plate fixation is recommended for complex tibial plateau fractures with medial fragments or no cortical bone contact. Although such fixation...
BACKGROUND
Combined medial and lateral plate fixation is recommended for complex tibial plateau fractures with medial fragments or no cortical bone contact. Although such fixation is adequate to resist forces during range of motion, it may be insufficient to support immediate postoperative weightbearing. Here, we analyzed displacement, stiffness, and fixation failure during simulated full weightbearing of bicondylar tibial plateau fractures treated with combined medial and lateral locking plate fixation.
METHODS
We used 10 fresh-frozen adult human cadaveric tibias and mated femurs. Osteotomies were performed with an oscillating saw and cutting template to simulate an AO Foundation and Orthopaedic Trauma Association (AO/OTA) 41-C2 fracture (simple articular, multifragmentary metaphyseal fracture). Specimens were anatomically reduced and stabilized with combined medial and lateral locking plates (AxSOS, Stryker, Mahwah, NJ). Specimens were loaded axially to simulate 4 weeks of walking in a person weighing 70 kg. The specimens were cyclically loaded from 200 N to a maximum of 2800 N. Then, if no failure, loading continued for 200,000 cycles. We measured displacement of each bone fragment and defined fixation failure as ≥5 mm of displacement. Construct stiffness and load at failure were calculated. Categorical and continuous data were analyzed using Chi-squared and unpaired t-tests, respectively.
RESULTS
Mean total displacement values after 10,000 loading cycles were as follows: lateral, 0.4 ± 0.8 mm; proximal medial, 0.3 ± 0.7 mm; distal medial, 0.3 ± 0.6 mm; and central 0.4 ± 0.5 mm. Mean stiffness of the construct was 562 ± 164 N/mm. Fixation failure occurred in 6 of 10 specimens that reached 5 mm of plastic deformation before test completion. In the failure group, the mean load at failure was 2467 ± 532 N, and the mean number of cycles before failure was 53,155. After test completion, the greatest displacement was found at the distal medial fracture site (2.3 ± 1.4 mm) and lateral fracture site (2.2 ± 1.7 mm).
CONCLUSIONS
Although combined medial and lateral plate fixation of complex tibial plateau fractures provides adequate stability to allow early range of motion, immediate full weightbearing is not recommended.
Topics: Adult; Biomechanical Phenomena; Bone Plates; Fracture Fixation, Internal; Humans; Tibial Fractures; Weight-Bearing
PubMed: 35078451
DOI: 10.1186/s12891-022-05024-2 -
Journal of Orthopaedic Research :... Jul 2019This study evaluated the implementation and effectiveness of an iterative process aimed to quantify and enhance the anatomical fit of an osteosynthesis plate design for...
This study evaluated the implementation and effectiveness of an iterative process aimed to quantify and enhance the anatomical fit of an osteosynthesis plate design for the fifth metacarpal bone regarding a defined shape-based acceptance criterion (SAC) while complying with basic clinical requirements and engineering limitations. The process was based on employing virtual tools (a database of individual three-dimensional bone models, statistical analysis of the bone geometry, and proprietary software tools) to evaluate conformity between plate designs and bone shape. The conformity was quantified by the mean distance between plate and bone (MBP). The enhancement was completed when the median MBP of the population was below the SAC threshold. This was fulfilled by the third plate design (two enhancement iterations). The intentionally abstract enhancement process may serve as a guideline for development of plate designs for other indications. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1508-1517, 2019.
Topics: Bone Plates; Fracture Fixation, Internal; Humans; Prosthesis Design
PubMed: 30977547
DOI: 10.1002/jor.24299 -
Orthopaedics & Traumatology, Surgery &... Dec 2022There appears to be a paucity of knowledge about the biomechanics of locking plates for the fixation of metacarpal shaft fractures. A thorough understanding of the...
BACKGROUND
There appears to be a paucity of knowledge about the biomechanics of locking plates for the fixation of metacarpal shaft fractures. A thorough understanding of the biomechanics of locking plates is needed to apply them correctly, optimize outcomes, and avoid complications. The purpose of this study is to investigate the biomechanics of the fixation of metacarpal fractures using locking plate-screw constructs with different numbers of screws.
HYPOTHESIS
The difference in the number of screws in the locking plate influenced the biomechanical outcome of the metacarpal fracture.
METHODS
Finite element models of third metacarpal fractures with locking plate-screw constructs were established, and the magnitude and distribution of their stresses and displacements were investigated when a vertical load of 100N was applied.
RESULTS
For the metacarpal fracture with a locking plate and screws, the stress in the metacarpal was largely shared by the plate-screw construct. For the plate-screw construct, the stress is concentrated in the area close to the fracture line, and the 6-screw Group has the lowest failure risk since it has the lowest plate stress and the second-lowest screw stress. The implant-bone construct with 8 screws has better biomechanical stability because of minimal displacement, but increased stress on both the metacarpal bone and the screws, leading to increased failure rates.
DISCUSSION
The stresses in the metacarpal were mostly shared by the plate-screw constructs and the screws closest to the fracture line were the most likely to break or loosen. For the implant-bone constructs, the locking plate with 2 screws was the most vulnerable to break or loosen, whereas the locking plate with 6 screws was the least likely to break or loosen. The implant-bone construct with 8 screws had better biomechanical stability, but the stresses in both the metacarpal and the screws were increased, which increased the risk of failure.
LEVEL OF EVIDENCE
IV, basic science study.
Topics: Humans; Finite Element Analysis; Metacarpal Bones; Fracture Fixation, Internal; Bone Plates; Fractures, Bone; Biomechanical Phenomena; Hand Injuries
PubMed: 35643362
DOI: 10.1016/j.otsr.2022.103340 -
Injury Jun 2018Most locked plating failures are due to inappropriate device configuration for the fracture pattern. Several studies cite screw positioning variables such as the number... (Review)
Review
Most locked plating failures are due to inappropriate device configuration for the fracture pattern. Several studies cite screw positioning variables such as the number and spacing of screws as responsible for occurrences of locking plate breakage, screw loosening, and peri-prosthetic re-fracture. It is also widely accepted that inappropriate device stiffness can inhibit or delay healing. Careful preoperative planning is therefore critical if these failures are to be prevented. This study examines several variables which need to be considered when optimising a locking plate fixation device for fracture treatment including: material selection; screw placement; the effect of the fracture pattern; and the bone-plate offset. We demonstrate that device selection is not straight-forward as many of the variables influence one-another and an identically configured device can perform very differently depending upon the fracture pattern. Finally, we summarise the influence of some of the key parameters and the influence this can have on the fracture healing environment and the stresses within the plate in a flowchart.
Topics: Biomechanical Phenomena; Bone Plates; Bone Screws; Decision Making; Equipment Failure Analysis; Finite Element Analysis; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Humans; Materials Testing; Preoperative Care
PubMed: 29929685
DOI: 10.1016/S0020-1383(18)30296-1 -
Journal of Orthopaedic Surgery (Hong... 2020We consider dual-plate fixation to improve construct rigidity in cases with fracture complexity. The purpose of this study is to compare the rate of nonunion, prognosis,... (Comparative Study)
Comparative Study
BACKGROUND
We consider dual-plate fixation to improve construct rigidity in cases with fracture complexity. The purpose of this study is to compare the rate of nonunion, prognosis, and complications at 6-12 months for surgically treated acute mid-shaft clavicle fractures when extra-periosteal dual-plate fixation is used in place of the conventional single-plate fixation.
MATERIALS AND METHODS
The comparative study was conducted on 47 patients who received acute mid-shaft clavicular fracture treatment in our hospital from March 2015 to July 2018. All patients were divided into dual-plate fixation treatment (group A) and single-plate fixation (group B). Patients undergoing single-plate fixation were compared to dual-plate fixation. Patients were followed up for 6-12 months. Charts were reviewed to assess union rates, prognosis, and complications.
RESULTS
Forty-seven clavicles (30 single plates and 17 dual plates) were evaluated. All patients (100%) in dual plating group and 128 (93.3%) in single plating group obtained bony union by 1 year. When comparing groups at 3 months, radiographic union was present in 50.0% of single plates and 64.7% in the dual plating group ( = 0.032). However, at 6 months, no significant difference existed (90.0% vs. 94.1%, = 0.297). Comparing groups at 1.5 and 6 months, Constant-Murley outcome scores were present with no significant difference ( = 0.129, = 0.054) between single plates and dual plating group. However, at 3 months, significance difference existed.
DISCUSSION
Three months after the operation, patients with dual-plate fixation showed good functional recovery. Extra-periosteal dual plating for acute mid-shaft clavicle fractures can be safely considered for the treatment of complex acute mid-shaft clavicle fractures without increasing the risk of nonunion or revision.
CONCLUSIONS
Open reduction and internal fixation with an extra-periosteal dual plating technique is a reliable option for treatment of acute mid-shaft clavicle fractures, especially in the setting of severely comminuted fractures and in situations where bone quality is questionable and additional fixation is desired.
Topics: Adult; Aged; Bone Plates; Clavicle; Female; Fracture Fixation, Internal; Fractures, Bone; Fractures, Comminuted; Humans; Male; Middle Aged; Open Fracture Reduction; Prognosis; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 32301391
DOI: 10.1177/2309499020915797 -
The Laryngoscope Sep 2021To determine the frequency and management of short- and long-term complications related to oromandibular free flap reconstruction and identify potentially predictive...
OBJECTIVES/HYPOTHESIS
To determine the frequency and management of short- and long-term complications related to oromandibular free flap reconstruction and identify potentially predictive factors of hardware complications.
STUDY DESIGN
Retrospective chart review.
METHODS
A retrospective database from chart review was formed consisting of 266 oromandibular free flap reconstructions performed at a single institution over a 15-year period. Data were collected on demographics, surgical treatment, complications, and management of complications. Subgroup univariate and multivariate analyses were performed to compare patients with hardware complications and those without.
RESULTS
Eighty-one of 266 patients (30.5%) that underwent oromandibular reconstruction had an early complication (<4 weeks after surgery), and the most common complications were cervical wound dehiscence (11.3%) and fistulas (9.40%). Eighty of 266 patients (30.1%) had a long-term complication (>4 weeks after surgery) and the most common complication was plate exposure (26.7%). Univariate and multivariate analyses showed no association between whether there was hardware extrusion and fibula versus scapula, smoking history, virtual surgical planning (VSP), and dental implantation (P > .05). Only early complications (OR, 3.59, 95% CI, 1.83-7.05, P < .01) and patients undergoing oromandibular reconstruction for osteoradionecrosis (OR, 2.26, 95% CI, 1.10-4.64, P = .03) were strongly and independently associated with subsequent hardware extrusion on univariate analysis.
CONCLUSIONS
Both short- and long-term complications are common after oromandibular reconstruction. The most important predictive factor for a late complication is an early complication and prior radiation. There was no difference of plate complications among the various free flap types. Dental implantation and use of VSP were not associated with hardware complications.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:1997-2005, 2021.
Topics: Adult; Aged; Bone Plates; Case-Control Studies; Comorbidity; Female; Fibula; Fistula; Free Tissue Flaps; Humans; Male; Mandibular Reconstruction; Middle Aged; Multivariate Analysis; Osteoradionecrosis; Postoperative Complications; Predictive Value of Tests; Plastic Surgery Procedures; Retrospective Studies; Scapula; Surgical Wound Dehiscence
PubMed: 33571385
DOI: 10.1002/lary.29430 -
Medicina (Kaunas, Lithuania) Feb 2022: Flail chest typically results from major trauma to the thoracic cage and is accompanied by multiple rib fractures. It has been well documented that surgical fixation...
: Flail chest typically results from major trauma to the thoracic cage and is accompanied by multiple rib fractures. It has been well documented that surgical fixation of rib fractures can decrease both morbidity and mortality rates. This study aimed to evaluate the effectiveness of a dedicated APS Rib Fixation System, which features a pre-contoured design based on anatomical rib data of the Asian population. : We reviewed 43 consecutive patients, who underwent surgical stabilization for flail chest with the traditional Mini bone plate ( = 20), APS plate ( = 13), or Mini + APS ( = 10). Demographic and injury variables were documented. We used X-ray radiography to determine plate fractures and screw dislocations after surgical fixation. : No statistical differences were noted in the demographic or injury variables. APS plates demonstrated fewer cases of plate fractures and screw dislocations than Mini plates (OR = 0.091, = 0.008). : The pre-contoured design of the APS plate demonstrated a superior rib implant failure rate as compared to the traditional Mini bone plate. Our study indicates that the APS plate may serve as an effective surgical tool for the treatment of flail chest.
Topics: Bone Plates; Flail Chest; Humans; Retrospective Studies; Rib Fractures; Ribs
PubMed: 35334521
DOI: 10.3390/medicina58030345 -
Medicine Nov 2018We studied the safety and efficacy of dynamic locking plate vs. other implants (cannulated cancellous screws [CCS] or sliding hip screw [SHS]) in patients undergoing... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We studied the safety and efficacy of dynamic locking plate vs. other implants (cannulated cancellous screws [CCS] or sliding hip screw [SHS]) in patients undergoing intracapsular hip fracture (ICHF).
METHODS
We searched Pubmed, Embase, Web of Science, Cochrane library and Google database from inception to March 25, 2018. We selected any studies comparing dynamic locking plate for treatment ICHF. Non-union rate, osteonecrosis rate, cutout rate, revision rate, the replacement rate, and Harris hip scores were the outcomes. Stata 12.0 was used for meta-analysis.
RESULTS
Four studies involving 419 patients (143 patients in the dynamic locking plate group and 276 patients in the other implants group) were finally included. Compared with CCS or SHS, dynamic locking plate was associated with a reduction of nonunion rate, revision rate, replacement rate (P <.05). Furthermore, dynamic locking plate was also associated with an increase of the Harris hip scores (P <.05). There was no significant difference between the osteonecrosis rate and cutout rate (P >.05).
CONCLUSIONS
Current meta-analysis revealed that dynamic locking plate has a benefit role in improving postoperative clinical outcome than CCS or SHS in ICHF patients. Further high quality and large-scale randomized controlled trials (RCTs) are needed to further identify the efficacy of dynamic locking plate for ICHF.
Topics: Bone Plates; Fracture Fixation, Internal; Fractures, Ununited; Hip Fractures; Humans; Osteonecrosis; Postoperative Complications; Prosthesis Design; Reoperation
PubMed: 30461606
DOI: 10.1097/MD.0000000000013001