Clinical Application and Outcomes of Upper Extremity Double Plating

2019 ◽  
Vol 158 (02) ◽  
pp. 227-237 ◽  
Author(s):  
J. Christoph Katthagen ◽  
Benedikt Schliemann ◽  
Philipp A. Michel ◽  
Lukas F. Heilmann ◽  
Felix Dyrna ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Mechanical Stability ◽  
Distal Humerus ◽  
Fixation Strength ◽  
Anterior Plate ◽  
Proximal Ulna ◽  
Lesser Tuberosity ◽  
Dual Plating ◽  
Fixation Techniques ◽  
Complex Proximal Humeral Fractures

AbstractDual plating in fractures of the upper extremity is well established for the distal humerus. The indication for the use of dual plating has been expanded over the last few years. While dual plating was originally frequently used in revisions of non-unions, it is nowadays also used in primary fixation of diverse complex fractures of the upper extremity. The high biomechanical fixation strength of dual plating is advantageous in regions with high bending and torsional stresses, such as the humeral shaft. An additional anterior plate provides high fixation strength and reduces the risk of loss of reduction in complex proximal humeral fractures and allows for direct fixation of lesser tuberosity fragments. Low-profile plates have been introduced for complex proximal ulna fractures. In dual plating the improved mechanical stability is combined with a reduced risk of implant related soft tissue irritations. The present article provides an overview of current indications for dual plating of upper extremity fractures and outlines technical aspects as well as advantages over conventional fixation techniques.

scholarly journals Biomechanical stability of complex coronal plane fracture fixation of the capitellum

2021 ◽  
Author(s):  
Paul Borbas ◽  
Rafael Loucas ◽  
Marios Loucas ◽  
Maximilian Vetter ◽  
Simon Hofstede ◽  
...  
Keyword(s):  
Fracture Fixation ◽  
Ultimate Load ◽  
Locking Plate ◽  
Distal Humerus ◽  
Coronal Plane ◽  
Fixation Strength ◽  
Biomechanical Stability ◽  
Significant Difference ◽  
Load To Failure ◽  
Headless Compression Screws

Abstract Introduction Coronal plane fractures of the distal humerus are relatively rare and can be challenging to treat due to their complexity and intra-articular nature. There is no gold standard for surgical management of these complex fractures. The purpose of this study was to compare the biomechanical stability and strength of two different internal fixation techniques for complex coronal plane fractures of the capitellum with posterior comminution. Materials and methods Fourteen fresh frozen, age- and gender-matched cadaveric elbows were 3D-navigated osteotomized simulating a Dubberley type IIB fracture. Specimens were randomized into one of two treatment groups and stabilized with an anterior antiglide plate with additional anteroposterior cannulated headless compression screws (group antiGP + HCS) or a posterolateral distal humerus locking plate with lateral extension (group PLP). Cyclic testing was performed with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure. Results There was no significant difference in displacement during 2000 cycles (p = 0.291), stiffness (310 vs. 347 N/mm; p = 0.612) or ultimate load to failure (649 ± 351 vs. 887 ± 187 N; p = 0.140) between the two groups. Conclusions Posterolateral distal humerus locking plate achieves equal biomechanical fixation strength as an anterior antiglide plate with additional anteroposterior cannulated headless compression screws for fracture fixation of complex coronal plane fractures of the capitellum. These results support the use of a posterolateral distal humerus locking plate considering the clinical advantages of less invasive surgery and extraarticular metalware. Level of evidence Biomechanical study.

scholarly journals Study of clinical outcome in intra articular distal humerus fractures treated with dual plating

2017 ◽  
Vol 5 (6) ◽  
pp. 2438
Author(s):  
Riyaz B. Shaik ◽  
Venugopala Reddy P. ◽  
Ashok Naidu K.
Keyword(s):  
Clinical Outcome ◽  
Road Traffic ◽  
Distal Humerus ◽  
Complex Nature ◽  
Lateral Column ◽  
Dual Plating ◽  
Surgical Fixation ◽  
Humerus Fractures ◽  
Distal Humerus Fractures ◽  
Fracture Humerus

Background: In adults, distal humerus fractures are uncommon and intra-articular, oftenly involve both the medial and lateral columns. Open reduction and surgical fixation with plating gives good results. The aim of this study is to evaluate clinical outcome in intra articular distal humerus fractures treated with dual plating.Methods: This is a prospective type of study of 20 cases of supra condylar fracture humerus with inter condylar extension treated surgically with dual plating one on the medial boarder and another on posterior surface of lateral column using standard dorsal approach, olecranon osteotomy.Results: The range of age was between 18-52 years, with mean age of 32.55 years. The maximum incidence was between 18 to 40 years i.e. 16 cases (80%). With road traffic accident (RTA) as major cause of injury. Most   of the patients were males 14 (70%) with right upper limb was involved in 12 (60%) cases. According   to MEP score clinical outcome was excellent in 4(20%) good in 10(50%) fair in 5(25%) and poor in one (10%).Conclusions: Distal humerus fractures are known for their complex nature and technical difficult in surgical management. Proper anatomical articular reconstruction and stable fixation helps in restoring painless and functional elbow.

scholarly journals Management of Distal Humerus Fractures With Jess Fixator

2015 ◽  
Vol 3 (4) ◽  
pp. 16-20
Author(s):  
Prakriti Raj Kandel ◽  
Kishor Man Shrestha ◽  
Laxmi Pathak
Keyword(s):  
Distal Humerus ◽  
Humerus Fracture ◽  
Medical Sciences ◽  
Distal Humerus Fracture ◽  
Fixation Technique ◽  
Fixation Techniques ◽  
Humerus Fractures ◽  
The Mean ◽  
Distal Humerus Fractures

INTRODUCTION: Fractures of distal humerus are rare comprising approximately 2% of all fractures and a third of all humerus fractures. Even with the development of newer fixation techniques, the treatment of distal humerus fractures remains a great challenge to any orthopaedic surgeon. Thus this present study was conducted to evaluate the results of Joshi's External Stabilization System (JESS) in the management of distal humerus fracture with or without intercondylar extension. MATERIALS AND METHODS: This retrospective study was conducted by collecting records of thirty two adult patients who sustained distal humerus fracture and were managed with JESS fixation under anaesthesia over a period of two years in Universal College of Medical Sciences Teaching Hospital (UCMSTH) after obtaining permission from Institutional ethical committee. RESULTS: According to AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification, 2 patients had C1 fracture and 30 patients had C2 fractures. The mean duration of JESS application was 16 weeks. The mean follow up was 8 months. The functional outcome was evaluated by using Cassebaum's functional rating system. Among C1 fractures, 50% showed fair and 50% showed good result whereas among C2 fractures, 40% showed good, 46.66% showed fair and 13.33% showed poor results.  CONCLUSIONS: JESS fixation technique represents a viable option in the management of open as well as close intercondylar fractures of the distal humerus.

Osseous anatomy of the distal humerus and proximal ulna: Implications for total elbow arthroplasty

2007 ◽  
Vol 16 (3) ◽  
pp. S39-S46 ◽  
Author(s):  
Steven H. Goldberg ◽  
Reza Omid ◽  
Ahmad N. Nassr ◽  
Robert Beck ◽  
Mark S. Cohen
Keyword(s):  
Distal Humerus ◽  
Total Elbow Arthroplasty ◽  
Proximal Ulna ◽  
Elbow Arthroplasty

scholarly journals Evaluation of Short Term Outcomes of Transportal Femoral Cross Pin Fixation in Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0012
Author(s):  
Sinan Zehir ◽  
Ercan Şahin ◽  
Murat Çalbıyık ◽  
Mahmut Kalem ◽  
Deniz İpek ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Fixation Strength ◽  
Short Term ◽  
Fixation Techniques ◽  
Anterior Cruciate ◽  
Double Cross

Objectives: Many fixation techniques are currently in use for femoral side graft fixation at ACL reconstruction surgery. Short term success following ACL reconstruction highly depends on fixation strength of the graft. In this study we report short term results of anterior cruciate ligament reconstruction using double hamstring tendon autograft using double cross pin for femoral tunnel fixation. Methods: Between years 2009 and 2013, 51 male adult anterior cruciate ligament injury cases treated surgically, in a single center, with at least one year follow up were investigated. Professional athletes, multi-ligamentous instability cases, cases requiring meniscus repair or further treatment for chondral injuries and cases with concomitant medial and lateral meniscus lesions were not included in the study. Femoral tunnel was prepared anatomically through accessory medial portal, opened medially and distally. Reconstruction was performed using double loop hamstring tendon autograft. Femoral side was fixed using double cross pin, whereas tibial side was secured using single biodegradable interference screw and titanium staple. No external immobilization method such as brace was administered. Patients were encouraged to bear weight as tolerated. Standard physiotherapy was instructed to all patients postoperatively. All cases were evaluated clinically at the end of at least one year follow-up. Clinical and functional evaluation consisted of pivot shift and Lysholm, International Knee Documentation Committee (IKDC) scores and Tegner activity evaluation systems. Results: Mean age was 28.4 (18-39) years. Mean time between the injury and reconstruction was 13 (3-21) weeks. Average duration of surgery was 48 (35-70) minutes. No case of graft failure or posterior cortical fracture was encountered. In two cases, infection was treated successfully with local debridement and antibiotics with retention of the graft. At the end of follow-up period, none of the cases demonstrated positive pivot shift test. Pre-operative and follow-up Lysholm scores were 58.3±6.7 and 87.1±5.3 (p<0.001) respectively. Pre-operative IKDC scores were evaluated as C at 37 cases and D at 14, whereas, follow-up IKDC scores were evaluated as A at 42 cases, B at 8 and C at 1 case. Pre-operative and follow-up Tegner scores were 3.7±0.6 and 6.7±0.4 (p<0.001) respectively. Conclusion: Although fixation strength of transcondylar graft fixation techniques has been questioned over loop systems with cortical fixation, it was reported that transcondylar fixation causes less tunnel widening at long term. Our study revealed successful short term results, with femoral tunnel preparation using accessory medial portal and double cross pin femoral fixation, allowing early weight bearing and rehabilitation without graft and fixation failure.

scholarly journals Biomechanical Comparison of Plantar-To-Dorsal and Dorsal-To-Plantar Screw Fixation Strength for Subtalar Arthrodesis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Ramon Rodriguez ◽  
Schouchen Dun ◽  
Jun Kit He ◽  
Haley McKissack ◽  
Glenn S. Fleisig ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Statistical Significance ◽  
Fixation Strength ◽  
Hard Data ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Fixation Techniques ◽  
The Difference ◽  
Student’S T ◽  
Dorsal Fixation

Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Arthrodesis of the subtalar joint is performed for various arthritic and instability problems to correct alignment and relieve pain. For talocalcaneal pathologies, isolated subtalar arthrodesis has been advocated with the advantages of lower risk of adjacent joint arthritis and nonunion of the transverse tarsal joint. Internal fixation techniques have varied over time and use of compression screws is common. The screws may be oriented from dorsal to plantar or plantar to dorsal. Arguments favoring one approach over another are based more on “expert opinion” than hard data. The goal of this study was to compare the biomechanical stability of these two constructs to evaluate which creates a more stable construct. Methods: Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3-mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP group), and the other foot plantar to dorsal orientation (PD group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD groups using Student’s T-test, with p = 0.05 used to determine statistical significance. Results: The force to failure was 585.9 ± 201.1 N for the plantar-to-dorsal fixation and 667.2 ± 449.4 N for the dorsal-to-plantar fixation. The moment arm was 55.1 ± 4.7 mm for the dorsal-to-plantar fixation and 54.8 ± 3.9 mm for the plantar-to-dorsal fixation. Statistical analysis demonstrated that the mean torque to failure slightly favored the DP group (37.3 N-m) to the PD group (32.2 N-m). However, the difference between the two groups was not statistically significant (p = 0.55). Conclusion: There is no significant difference in strength between subtalar arthrodesis performed with dorsal-to-plantar screw orientation and plantar-to-dorsal screw orientation. This suggests that selection of technique should depend on the situation and the required advantages of each. Placing the screw from the heel up has the benefit of being an easier approach, allows access to tenser talar bone once the screw is through, and has less risk of neurovascular injury. The dorsal-to-plantar technique allows simple supine positioning of the patient, needs only two fluoroscopic views to check pin position, and allows the surgeon to manipulate the foot more easily.

The effect of the anatomy of the distal humerus and proximal ulna on the positioning of the components in total elbow arthroplasty

2015 ◽  
Vol 97-B (11) ◽  
pp. 1539-1545 ◽  
Author(s):  
H. Lenoir ◽  
M. Chammas ◽  
J. P. Micallef ◽  
C. Lazerges ◽  
T. Waitzenegger ◽  
...  
Keyword(s):  
Distal Humerus ◽  
Total Elbow Arthroplasty ◽  
Proximal Ulna ◽  
Elbow Arthroplasty

scholarly journals Biomechanical evaluation of an integrated fixation cage during fatigue loading: a human cadaver study

2017 ◽  
Vol 26 (4) ◽  
pp. 524-531 ◽  
Author(s):  
Vivek Palepu ◽  
Jonathan H. Peck ◽  
David D. Simon ◽  
Melvin D. Helgeson ◽  
Srinidhi Nagaraja
Keyword(s):  
Mechanical Stability ◽  
Fatigue Testing ◽  
Plate Fixation ◽  
Fatigue Loading ◽  
Axial Rotation ◽  
Cadaver Study ◽  
Anterior Plate ◽  
Stability Parameters ◽  
Loading Mode ◽  
Flexion Extension

OBJECTIVE Lumbar cages with integrated fixation screws offer a low-profile alternative to a standard cage with anterior supplemental fixation. However, the mechanical stability of integrated fixation cages (IFCs) compared with a cage with anterior plate fixation under fatigue loading has not been investigated. The purpose of this study was to compare the biomechanical stability of a screw-based IFC with a standard cage coupled with that of an anterior plate under fatigue loading. METHODS Eighteen functional spinal units were implanted with either a 4-screw IFC or an anterior plate and cage (AP+C) without integrated fixation. Flexibility testing was conducted in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) on intact spines, immediately after device implantation, and post-fatigue up to 20,000 cycles of FE loading. Stability parameters such as range of motion (ROM) and lax zone (LZ) for each loading mode were compared between the 2 constructs at multiple stages of testing. In addition, construct loosening was quantified by subtracting post-instrumentation ROM from post-fatigue ROM. RESULTS IFC and AP+C configurations exhibited similar stability (ROM and LZ) at every stage of testing in FE (p ≥ 0.33) and LB (p ≥ 0.23) motions. In AR, however, IFCs had decreased ROM compared with AP+C constructs at pre-fatigue (p = 0.07) and at all post-fatigue time points (p ≤ 0.05). LZ followed a trend similar to that of ROM in AR. ROM increased toward intact motion during fatigue cycling for AP+C and IFC implants. IFC specimens remained significantly (p < 0.01) more rigid than specimens in the intact condition during fatigue for each loading mode, whereas AP+C construct motion did not differ significantly (p ≥ 0.37) in FE and LB and was significantly greater (p < 0.01) in AR motion compared with intact specimens after fatigue. Weak to moderate correlations (R2 ≤ 56%) were observed between T-scores and construct loosening, with lower T-scores leading to decreased stability after fatigue testing. CONCLUSIONS These data indicate that a 4-screw IFC design provides fixation similar to that provided by an AP+C construct in FE and LB during fatigue testing and better stability in AR motion.

scholarly journals Sociodemographic, health and fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures in Ontario.

2020 ◽  
Author(s):  
Joy Christine MacDermid ◽  
J Andrew McClure ◽  
Lucie Richard ◽  
Susan Jaglal ◽  
Kenneth J. Faber
Keyword(s):  
Rheumatoid Arthritis ◽  
Upper Extremity ◽  
Radial Head ◽  
Social Deprivation ◽  
Distal Humerus ◽  
Tendon Injury ◽  
Fracture Type ◽  
Multiple Fractures ◽  
Social Risks ◽  
Multiple Regions

Abstract Background The purpose of this study was to describe 1st incident fractures of the upper extremity in terms of fracture characteristics, demographics, social deprivation and comorbid health profiles. Methods:Cases with a 1st adult upper extremity fracture from the years 2013 to 2017 were extracted from administrative data in Ontario, (population 14.3M). Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve or tendon injury) were described by fracture type, age category and sex. Fracture comorbidity characteristics were described in terms of the prevalence of diabetes, rheumatoid arthritis; and the Charlson Comorbidity Index. Social marginalization was expressed using the Ontario Marginalization Index (ON-Marg) for material deprivation, dependency, residential instability, ethnic concentration. ResultsFrom 266,324 first incident UE fractures occurring over 4 years, 51.5% were in women and 48.5% were in men. This masked large differences in age-sex profiles. Most commonly affected were the hand (93K), wrist/forearm(80K), shoulder (48K) or elbow (35K). The highest number of fractures: distal radius (DRF, 47.4K), metacarpal (30.4K), phalangeal (29.9K), distal phalangeal (24.4K), proximal humerus (PHF, 21.7K), clavicle (15.1K), radial head (13.9K), and scaphoid fractures (13.2K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8K), fractures occurring in multiple regions of the upper extremity (8.7K), or multiple regions in the forearm (8.4K). Fractures most common in 18 – 40-year-old men included metacarpal and finger fractures. A large increase in fractures in women over the age of 50 occurred for: DRF, PHF and radial head. Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries (0.3% overall, 1.5% in distal humerus) were rarely reported. Fractures were open in 4.7%, highest for distal phalanx (23%). Diabetes occurred in 15.3%, highest in PHF (29.7%). Rheumatoid arthritis occurred more commonly in women (2.8% vs 0.8% men). The Charlson Index indicated low comorbidity (mean=0.2; median=0: 2.4% 3+), highest in PHF (median=0; 6.6% 3+). Higher fracture burden was related to instability (excess of fractures in lower 2 quartiles 4.8%), although social indices varied by fracture type. ConclusionsFracture specific prevention strategies should consider fracture-specific age-sex interactions, health, behavioural and social risks

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