scholarly journals Dorsal bridge plating or transarticular screws for Lisfranc fracture dislocations

2018 ◽  
Vol 100-B (4) ◽  
pp. 468-474 ◽  
Author(s):  
N. Kirzner ◽  
P. Zotov ◽  
D. Goldbloom ◽  
H. Curry ◽  
H. Bedi
Keyword(s):  
Screw Fixation ◽  
Combination Group ◽  
Anatomical Reduction ◽  
Aofas Score ◽  
Combination Technique ◽  
Plate Group ◽  
Bridge Plate ◽  
Fracture Dislocations ◽  
Bridge Plating ◽  
Screw Group

AimsThe aim of this retrospective study was to compare the functional and radiological outcomes of bridge plating, screw fixation, and a combination of both methods for the treatment of Lisfranc fracture dislocations.Patients and MethodsA total of 108 patients were treated for a Lisfranc fracture dislocation over a period of nine years. Of these, 38 underwent transarticular screw fixation, 45 dorsal bridge plating, and 25 a combination technique. Injuries were assessed preoperatively according to the Myerson classification system. The outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the validated Manchester Oxford Foot Questionnaire (MOXFQ) functional tool, and the radiological Wilppula classification of anatomical reduction.ResultsSignificantly better functional outcomes were seen in the bridge plate group. These patients had a mean AOFAS score of 82.5 points, compared with 71.0 for the screw group and 63.3 for the combination group (p < 0.001). Similarly, the mean Manchester Oxford Foot Questionnaire score was 25.6 points in the bridge plate group, 38.1 in the screw group, and 45.5 in the combination group (p < 0.001). Functional outcome was dependent on the quality of reduction (p < 0.001). A trend was noted which indicated that plate fixation is associated with a better anatomical reduction (p = 0.06). Myerson types A and C2 significantly predicted a poorer functional outcome, suggesting that total incongruity in either a homolateral or divergent pattern leads to worse outcomes. The greater the number of columns fixed the worse the outcome (p < 0.001).ConclusionPatients treated with dorsal bridge plating have better functional and radiological outcomes than those treated with transarticular screws or a combination technique. Cite this article: Bone Joint J 2018;100-B:468–74.

scholarly journals Bridge Plate Fixation Results in Better Functional Outcomes Than Transarticular Screw Fixation for Low-Energy Lisfranc Injuries

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Joseph Bellamy ◽  
Grant Cochran
Keyword(s):  
Plate Fixation ◽  
Low Energy ◽  
Categorical Variables ◽  
Complication Rates ◽  
Transarticular Screw ◽  
Plate Group ◽  
Bridge Plate ◽  
Lisfranc Injuries ◽  
Bridge Plating ◽  
Screw Group

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Open reduction and internal fixation (ORIF) with transarticular screws or bridge plating is the standard of care for unstable Lisfranc injuries. There are no studies comparing the clinical outcomes of fixation with transarticular screws or bridge plates in young, athletic patients who sustained low-energy injuries. Methods: All low-energy Lisfranc injuries that underwent ORIF between 2010 and 2015 were reviewed. Injuries were classified as low-energy if the occurred during athletic activity, ground level twisting, or a fall from less than three feet (typically stairs or curbs). Tarsometatarsal (TMT) joint fixation with transarticular screws or bridge plating was documented. Transarticular screws were typically removed between four and six months postoperatively. Injury characteristics, complication rates, pain scores, and Foot and Ankle Ability Measure (FAAM) scores were compared. All continuous variables were compared with a two-tailed Student t-test. All categorical variables were compared using the Chi Squared test. Results: Of the fifteen patients identified, nine were fixed with transarticular screws and six with bridge plates. Average patient age was 27 years old. 12 of 15 were primarily ligamentous injuries. Implant removal was performed in the entire transarticular screw group and three out of six in the bridge plate group (p=0.018). Secondary arthrodesis for arthritis was recommended in two of the transarticular screw group and none of the bridge plate group (p=0.21). Mean FAAM scores were significantly higher in all subscales (ADL 96.2 v 76.7 p=.035, ADL SANE 92.5 v 72.6 p=.055, Sport 89.5 v 62.5 p=.027, Sport SANE 90 v 58.7 p=.024) in the bridge plate group at an average of 43 months follow up. Conclusion: In this study, ORIF with bridge plate fixation of the TMT joints had a lower rate of HWR and higher medium term FAAM scores than fixation with transarticular screws. A statistically significant difference in rates of secondary arthritis could not be established in this small cohort. Prospective studies are necessary to confirm these findings.

scholarly journals Outcomes of Bridge Plating Versus Standard Fixation in Geriatric Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Russell E Holzgrefe ◽  
Amalie Erwood ◽  
Samuel Maidman ◽  
William Runge ◽  
Michael Gottschalk ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Lag Screw ◽  
Plate Group ◽  
Bridge Plate ◽  
Sf 36 ◽  
One Year ◽  
Bridge Plating

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures represent one of the most common injuries encountered by foot and ankle specialists. Internal fixation of the lateral malleolus can be achieved by several different techniques, most commonly by lag screw and neutralization plating. However, ankle fractures in older patients often present technical challenges as osteoporotic bone is more commonly encountered which may require bridge plating techniques. This study compares outcomes in patients over age 50 years who underwent ORIF of the lateral malleolus with either a bridge plate or lag screw and neutralization plate technique. Methods: This retrospective study evaluated 56 patients with closed ankle fractures, aged over 50 years who underwent open reduction internal fixation of the lateral malleolus. These were divided into two groups: 36 patients had fixation with one or more lag screws and a neutralization plate, and 20 patients had fixation with a bridge plate technique. Fractures were stabilized with lag screw fixation when feasible, while bridge plating was utilized in patients where lag screw fixation was not possible. SF-36 scores were attained at a minimum one-year post-op. Final radiographs and complications were recorded. Results: The lag group had a mean age of 63 years, 17% men, 61% with syndesmotic screw fixation, and 56% with medial malleolus fixation. The bridge group had a mean age of 65 years, 15% men, 60% with syndesmotic screw fixation, and 70% with medial malleolus fixation. At minimum one-year, SF-36 physical component summary score was 74.2 ± 19.4 in the lag group vs 63.2 ± 24.8 in the bridge plate group (p=0.049). The SF-36 mental component summary score was 89.2 ± 12 in the lag group vs 75.5 ± 22.7 in the bridge plate group (p=0.009). One patient in each group required return to the OR for irrigation and debridement for infection. No patients experienced fixation failure and all fractures demonstrated union on final radiograph. Conclusion: In the present study of patients over age 50 years who underwent ORIF of an ankle fracture, as compared with bridge plating, lag screw and neutralization plating is associated with superior one-year SF-36 physical and mental summary scores with similar rates of complications. However, additional research is needed to determine to what degree this difference is causative or correlative with confounding variables as fixation technique was not found to be an independent predictor of SF-36 outcomes in this small cohort.

Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint

2020 ◽  
Vol 52 (01) ◽  
pp. 18-24
Author(s):  
Jun-Ku Lee ◽  
Yoon Seok Kim ◽  
Jin-Hyun Lee ◽  
Gyu-Chol Jang ◽  
Soo-Hong Han
Keyword(s):  
Range Of Motion ◽  
Screw Fixation ◽  
Plate Fixation ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Joint Fracture ◽  
Plate Group ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Screw Group

Abstract Purpose The purpose of this study was to investigate and compare the clinical and radiological results of ORIF with inter-fragment screw or buttress plate fixation of acute PIP joint fracture dorsal dislocation. Patients and Methods Between January 2007 to December 2016, nineteen patients – 14 men and 5 women with an average age of 40.9 (19 to 64) years – were included in this study; 9 patients underwent small sized interfragmentary screw fixation and 10 patients underwent small buttress plating. The average follow-up period was 45.1 (13 to 78) months. Clinical assessment included measurement of range of motion (ROM) of the proximal and distal interphalangeal joint (PIP, DIP), grip and pinch strength, and pain with use of the Visual Analog Scale (VAS). At the postoperative X-ray, articular step off, gap, and degree of dorsal subluxation was measured, and maintenance of the reduction, fracture union, and the presence of degenerative changes were assessed. Results All patients achieved solid unions without instability. The overall average range of motion of PIP joint were from 9° to 85° (10–83° in the screw group, 8–87° in the plate group without significant difference). However, the screw group (average: 53°) presented more flexion in the distal interphalangeal joint than the plate group (average: 34°). Plate fixation can cause limited DIP flexion. Six of the ten patients from the plate group, underwent implant removal and two of these patients required PIP joint arthrolysis due to the PIP flexion contracture of more than 30°. Three of the nine patients in screw group underwent implant removal and two of the three patients required PIP joint arthrolysis. Conclusion Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favorable clinical and radiographic outcomes through stable fixation and early range of motion exercise. Screw fixation, if possible, is probably preferable to plate fixation because of better DIP joint ROM and lower incidence of hardware removal. If there is a need for plate fixation the use of a short plate is recommended to avoid joint stiffness.

scholarly journals Fixation stability and implant-associated complications in periacetabular osteotomy: a comparison of screw and K-wire fixation

2021 ◽  
Author(s):  
Vincent Justus Leopold ◽  
Juana Conrad ◽  
Robert Karl Zahn ◽  
Christian Hipfl ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Screw Fixation ◽  
Periacetabular Osteotomy ◽  
Implant Migration ◽  
Major Complications ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Wire Fixation ◽  
Fixation Stability ◽  
Screw Group

Abstract Aims The aim of this study was to compare the fixation stability and complications in patients undergoing periacetabular osteotomy (PAO) with either K-wire or screw fixation. Patients and methods We performed a retrospective study to analyze a consecutive series of patients who underwent PAO with either screw or K-wire fixation. Patients who were treated for acetabular retroversion or had previous surgery on the ipsilateral hip joint were excluded. 172 patients (191 hips: 99 K-wire/92 screw fixation) were included. The mean age at the time of PAO was 29.3 years (16–48) in the K-wire group and 27.3 (15–45) in the screw group and 83.9% were female. Clinical parameters including duration of surgery, minor complications (soft tissue irritation and implant migration) and major complications (implant failure and non-union) were evaluated. Radiological parameters including LCE, TA and FHEI were measured preoperatively, postoperatively and at 3-months follow-up. Results Duration of surgery was significantly reduced in the K-wire group with 88.2 min (53–202) compared to the screw group with 119.7 min (50–261) (p < 0.001). Soft tissue irritation occurred significantly more often in the K-wire group (72/99) than in the screw group (36/92) (p < 0.001). No group showed significantly more implant migration than the other. No major complications were observed in either group. Postoperative LCE, TA and FHEI were improved significantly in both groups for all parameters (p = < 0.0001). There was no significant difference for initial or final correction for the respective parameters between the two groups. Furthermore, no significant difference in loss of correction was observed between the two groups for the respective parameters. Conclusion K-wire fixation is a viable and safe option for fragment fixation in PAO with similar stability and complication rates as screw fixation. An advantage of the method is the significantly reduced operative time. A disadvantage is the significantly higher rate of implant-associated soft tissue irritation, necessitating implant removal. Level of evidence III, retrospective trial.

scholarly journals Short Plate with Screw Angle over 20 Degrees Improves the Radiologic Outcome in ACDF: Clinical Study

2021 ◽  
Vol 10 (9) ◽  
pp. 2034
Author(s):  
Kathryn-Anne Jimenez ◽  
Jihyeon Kim ◽  
Jaenam Lee ◽  
Hwan-Mo Lee ◽  
Seong-Hwan Moon ◽  
...  
Keyword(s):  
P Value ◽  
X Rays ◽  
Common Procedure ◽  
Fusion Surgery ◽  
Post Surgery ◽  
Plate Group ◽  
Vas Scores ◽  
Short Plate ◽  
Degenerative Cervical Spine ◽  
Screw Group

Background: Anterior cervical discectomy and fusion surgery is a common procedure for degenerative cervical spine. This describes allospacer and implant-related outcomes, comparing medium plate–low screw angle and short plate–high screw angle techniques. Methods: From January 2016 to June 2019, 79 patients who underwent ACDF were prospectively enrolled. Patients were divided, depending on the plate–screw system used: medium plate–low screw angle (12.3 ± 2.5 to 13.2 ± 3.2 degrees), and short plate–high screw angle (22.8 ± 5.3 to 23.3 ± 4.7 degrees). Subsidence, ALOD, and sagittal cervical balance were analyzed using lateral cervical X-rays. NDI and VAS scores were also evaluated. Results: Age for medium plate–low-angled screw group is 58.0 ± 11.3 years, and 55.3 ± 12.0 in the short plate–high-angled screw group (p-value = 0.313). Groups were comparable in mean NDI (p-value = 0.347), VAS (p-value = 0.156), C2–C7 SVA, (p-value = 0.981), and lordosis angle (p-value = 0.836) at 1-year post-surgery. Subsidence was higher in the medium plate–low-angled screw than in the short plate–high-angled screw (25% and 8.5%, respectively, p-value = 0.045). ALOD is also more common in the medium plate group (p-value = 0.045). Conclusion: Use of a short plate and insertion of high-angled screws (more than 20 degrees) has less chance of subsidence and occurrence of ALOD than the traditional technique of using medium plate and low angle.

Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint

2021 ◽  
pp. 175319342110593
Author(s):  
Atsuhiko Murayama ◽  
Kentaro Watanabe ◽  
Hideyuki Ota ◽  
Shigeru Kurimoto ◽  
Hitoshi Hirata
Keyword(s):  
External Fixation ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Volar Plating ◽  
Distal Interphalangeal Joint ◽  
Active Flexion ◽  
Plate Group ◽  
Fracture Dislocations ◽  
Distal Interphalangeal

We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of –6° and –9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and –5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating. Level of evidence: IV

scholarly journals Comparison of Bioabsorbable Magnesium versus Titanium Screw Fixation for Modified Distal Chevron Osteotomy in Hallux Valgus

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Baver Acar ◽  
Ozkan Kose ◽  
Adil Turan ◽  
Melih Unal ◽  
Yusuf Alper Kati ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Screw Fixation ◽  
Clinical Results ◽  
Significant Loss ◽  
Compression Screw ◽  
Titanium Screw ◽  
Chevron Osteotomy ◽  
Valgus Angle ◽  
Significant Difference ◽  
Screw Group

Objective. The purpose of this retrospective study was to compare the clinical and radiological results of magnesium versus titanium screw fixation for modified distal chevron osteotomy in hallux valgus (HV). Materials and Methods. A total of 31 patients who underwent modified distal chevron osteotomy for HV deformity between 2014 and 2017 were reviewed retrospectively. Headless magnesium (Mg) compression screw fixation was applied in 16 patients (17 feet) and headless titanium (Ti) compression screw in 15 patients (17 feet). Patients were followed up for at least 12 months with a mean of 19.0 ± 6.8 months in the Mg screw group and 16.2 ± 6.19 in the Ti screw group, respectively (p: 0.234). Clinical results were evaluated using the American Orthopedic Foot and Ankle Society Hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale and a visual analogue scale (VAS). The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured before and after surgery. Time to osteotomy union and any complications were recorded and compared between the groups. Results. An improvement in the AOFAS-MTP-IP scale and VAS points were recorded in both groups with no statistically significant difference between the groups (p: 0.764 and 0.535, resp.). At the final follow-up examination, HVA and IMA were similar (p: 0.226 and 0.712, resp.). There was no significant loss of correction between the early and final radiographs in respect of HVA and IMA in both groups (p: 0.321 and p: 0.067). Full union of the osteotomy was obtained in all patients. Prolonged (1.5 months) swelling and mild hyperemia around the surgical incision were observed in 1 patient in the Mg group but there was a good response to physical and medical therapy, and the complaints were completely resolved. There were no other significant complications in either group. Conclusion. The results of this study showed that bioabsorbable Mg compression screw fixation has similar therapeutic efficacy to Ti screw fixation in respect of functional and radiological outcomes. Bioabsorbable Mg screw is an alternative fixation material that can be safely used for modified distal chevron osteotomy in HV surgery.

Dorsal Fracture Dislocations of the Proximal Interphalangeal Joint Treated by Open Reduction and Interfragmentary Screw Fixation: Indications, Approaches and Results

2006 ◽  
Vol 31 (2) ◽  
pp. 138-146 ◽  
Author(s):  
J. Y. L. LEE ◽  
L. C. TEOH
Keyword(s):  
Open Reduction ◽  
Screw Fixation ◽  
Early Mobilization ◽  
Proximal Interphalangeal Joint ◽  
Patient Comfort ◽  
Joint Function ◽  
Fracture Dislocations ◽  
Pip Joint ◽  
Joint Congruity

Many operative and non-operative treatments of dorsal fracture dislocations of the proximal interphalageal (PIP) joint have been described. Return of good joint function requires anatomical reduction of the articular fragments and restoration of joint congruity and a stable functional arc of motion, with the fixation construct stable enough for early mobilization. To prevent recurrent dorsal subluxation, the attachments of the ligamentous palmar restraints and the bony buttress provided by the palmar lip of the middle phalanx base must be restored. Open reduction and internal interfragmentary screw fixation using 1.5 or 1.3 mm screws was employed in 12 fingers in 10 patients with unstable dorsal fracture dislocations of the PIP joints of Schenck grades III and IV. At an average follow-up of 8.7 months, all patients in this series achieved good to excellent results and an average total active interphalangeal motion of 132° (range 105°–165°). Additional benefits over non-operative techniques included improved patient comfort and simplified nursing care and therapy supervision.

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