scholarly journals Studies on Bending Limitations for the Optimal Fit of Orthopaedic Bone Plates

2012 ◽  
Vol 602-604 ◽  
pp. 1181-1185 ◽  
Author(s):  
Javad Malekani ◽  
Beat Schmutz ◽  
Prasad Gudimetla ◽  
Yuan Tong Gu ◽  
Michael Schuetz ◽  
...  
Keyword(s):  
Stainless Steel ◽  
Comparative Analysis ◽  
Postoperative Complications ◽  
Large Deformations ◽  
Plate Fixation ◽  
Tibial Fractures ◽  
Patient Specific ◽  
Bone Morphology ◽  
Stainless Steel 316L ◽  
Distal Tibial Fractures

Distal tibial fractures are now commonly treated via intermedullary plate fixation due to higher rates of union and lower rates of postoperative complications. However, patient specific bone morphology demands manual deformation of the plate to ensure appropriate fit along the bone contours, and depending on the material of the plate, different outcomes have been reported along with postoperative complications. A comparative analysis of Stainless Steel 316L and Ti-6Al-4V alloys was carried to estimate the safe bending limit for appropriate fits. The results from the ANSYS FEA simulations were validated with experiments based on ASTM F382-99. It is found that SS316L is better suited for large deformations (up to 16˚ in proximal tip and 7.5˚ in distal end) and Ti for smaller deformation contours (up to 3˚ in proximal tip and 1.8˚ in distal end). The results of this study have profound implications for the choice of plates based on preliminary radiographical fracture examinations to ensure better fixation and higher rates of union of distal tibial fractures.

Percutaneous Plating of Distal Tibial Fractures

2002 ◽  
Vol 23 (9) ◽  
pp. 818-824 ◽  
Author(s):  
Amal Khoury ◽  
Meir Liebergall ◽  
Eli London ◽  
Rami Mosheiff
Keyword(s):  
Sagittal Plane ◽  
Dynamic Compression ◽  
Plate Fixation ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Tibial Fractures ◽  
Superficial Infection ◽  
Distal Tibial Fractures ◽  
Type Fracture ◽  
Anatomical Fixation

This article presents our experience with 24 patients who had distal tibial fractures and were treated by percutaneous plate fixation. Distribution of the fractures according to the AO/OTA classification was as follows: five patients suffered from a 43 A type fracture, six from a 43 B type fracture, and 13 from a 43 C type fractures. Four of the fractures were open. Exclusion criteria included 43 C3 fractures and Gustilo III open fractures. All fractures showed radiographic signs of union enough to enable full weightbearing within an average time of 12.3 weeks. All patients showed a good range of motion (average dorsiflexion 12° and average plantiflexion 18°). Two fractures united with mal-union: one with an 8° valgus deformity and another with a 7° varus deformity. Both cases, which had a metaphyseal component, were treated by means of a “soft” (flexible and manually adjustable) AO 3.5 mm reconstruction plate. Except for one case of superficial infection, no infections were detected in any of the patients. The biological percutaneous plate fixation of distal tibial fractures with no extensive intra-articular involvement is a good soft tissue preserving technique. It provides a rigid and anatomical fixation in most cases. We conclude that type B fractures with one intact column can be fixed with either “soft” or “rigid” plates, and type A and C fractures with a metaphyseal component should be fixed with “rigid” plates (AO 4.5 mm Dynamic Compression Plate). In these fractures the reduction should be performed cautiously due to the tendency of sagittal plane mal-reduction.

scholarly journals Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

2018 ◽  
Vol 28 (8) ◽  
pp. 1617-1624
Author(s):  
Maketo Molepo ◽  
Annette-Christi Barnard ◽  
Franz Birkholtz ◽  
Kevin Tetsworth ◽  
Vaida Glatt ◽  
...  
Keyword(s):  
External Fixator ◽  
Functional Outcomes ◽  
Plate Fixation ◽  
Tibial Fractures ◽  
Distal Tibial Fractures

scholarly journals Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis

2020 ◽  
pp. 145749692095783
Author(s):  
E. Ekman ◽  
K. Lehtimäki ◽  
J. Syvänen ◽  
M. Saltychev
Keyword(s):  
Confidence Interval ◽  
Risk Ratio ◽  
Intramedullary Nail ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Weight Bearing ◽  
Tibial Fractures ◽  
Controlled Trials ◽  
Complication Rates ◽  
Distal Tibial Fractures

Background and Aims: To evaluate evidence on the superiority of plate fixation over intramedullary nail fixation in the treatment of distal tibial fractures regarding functional outcomes and complication rates. Material and Methods: Cochrane Controlled Trials Register, Medline, Embase, CINAHL, Scopus, and Web of Science databases were searched in December 2019. The risk of systematic bias was assessed according to the Cochrane Collaboration’s domain-based evaluation framework. Results: The search resulted in 514 records, the final sample included 10 randomized controlled trials (782 patients). There were statistically significant differences in operating time (−11.2, 95% confidence interval: −16.3 to −6.1 min), time to partial weight bearing (−0.96, 95% confidence interval: −1.8 to −0.1 weeks), time to full weight bearing (−2.2, 95% confidence interval: −4.32 to −0.01 weeks), the rates of deep infections (risk ratio = 0.37, 95% confidence interval: 0.19 to 0.69), and the rates of soft-tissue complications (risk ratio = 0.52, 95% confidence interval: 0.33 to 0.82) favoring intramedullary nail. Intraoperative blood loss (127.2, 95% confidence interval: 34.7 to 219.7 mL) and postoperative knee pain and stiffness (relative risk = 5.6, 95% confidence interval: 1.4–22.6) showed significant differences favoring plate fixation. When combining all complication rates, the difference was risk ratio = 0.77 (95% confidence interval: 0.63 to 0.95) favoring intramedullary nail. No significant differences in radiation time, length of incision, length of hospital stay, time to return to work, time to union, the rates of healing complications or secondary procedures, ankle pain or stiffness, or functional scores were found. Conclusion: This meta-analysis suggests that intramedullary nail might be slightly superior in reducing postoperative complications and result in slightly faster healing when compared to plate fixation.

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