Level of Sagittal Plane Fit of Plates on the Radial Shaft: A Cadaveric Study Comparing Precontoured and Straight Titanium Plates

Background: During radial shaft fracture fixation, it is important to contour the plate appropriately to restore the radial bow in order to maintain normal forearm mechanics and motion. The aim of this study was to investigate the fit of precontoured radial shaft plates versus surgeon-contoured plates. Methods: Six 10-hole Acumed® precontoured volar and dorsolateral radius plates and twelve 10-hole Synthes straight titanium 3.5 mm LC-DCP plates were drilled with arrays of 1.5 mm diameter holes to permit measurement of the plate distance off bone. Plates were applied to 6 cadaver radii and secured with a screw on each end. Three plate conditions were tested: precontoured plates, precontoured plates with further surgeon contouring, and straight plates with surgeon contouring. Surgeon contouring time for each plate was recorded. Each plate was divided into 3 equal regions, and the average distance gaps for each region and the entire plate were calculated. Results: For the volar side, precontoured plates had a larger total gap compared to that plate with additional surgeon contouring (1.4 mm difference) and the straight surgeon-contoured plates (1.2 mm difference). On the dorsal side, there was no difference in fit between the 3 plate conditions at any location. No differences were found in plate contouring times. Conclusions: The precontoured dorsal plate fit was as good as the surgeon-contoured plates indicating this plate could potentially be used in fracture surgery without further bending. The precontoured volar plate was under-contoured, on average, and would likely require further bending to restore the radial bow.

Medially positioned plate in first metatarsophalangeal joint arthrodesis

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.

Dorsal Plate Osteosynthesis in Simple and Complex Fractures of the Distal Radius: A Radiological Analysis of 166 Cases

Background To report the radiologic outcome and rate of complications of open reduction and internal fixation (ORIF) using a dorsal plate fixation of simple and complex distal radius fractures in adult patients. Methods Patients treated with dorsal ORIF of simple and complex distal radius fractures between December 2008 and April 2013 were included in this single-center retrospective study. Type of fracture, radiographic measurements, and complications were documented. Results One-hundred and sixty-six patients/fractures were included. Restoration of radial inclination (22° ± 3°) was achieved in 38%. Radial height (14 ± 1 mm) was least likely to be restored to normal values postoperative in 25%. Normal ulnar variance (0.7 ± 1.5 mm) could be observed in 60% and adequate volar tilt (11° ± 5°) was achieved in 50% at final follow-up. We observed one loss of reduction in an AO type C2 fracture and a total of 15 nonimplant-related minor clinical complications. Conclusion Our radiographic findings after dorsal plating are comparable to those published on volar plating. The changes in radial height and volar tilt could be attributed to projection-related differences in the radiographs and did not signify a loss of reduction in all cases. Clinical Relevance Dorsal plating of distal radius fractures is safe and remains an important approach in the treatment of complex distal radius fractures. Complications in our study were even less compared to those reported in the literature. Type of Study/Level of Evidence This is a Type IV study. Level of Experience of Surgeons The level of experience of surgeons is III–V.

Safety and Efficacy of Medial Plate in First Metatarsophalangeal Joint Arthrodesis

Background. Arthrodesis of the first metatarsophalangeal joint (MTP-1) is a recognized and effective procedure in advanced osteoarthritis of this joint. Fixation with a dorsal plate and a compression screw has been described as the most stable. Nevertheless, the frequency of revision procedures after MTP-1 arthrodesis has been reported to exceed 10% in some reports. The need for revision surgery is mostly related to the fixation material used and concern both its destabilization and a conflict between the implants and soft tissues. Therefore, there is still scope for developing new stabilization methods for the MTP-1 joint. Materials and methods. With the approval of the relevant Bioethics Committee, we conducted a pilot clinical trial to assess the safety and efficacy of the use of the medial plate in MTP-1 fusion. Twenty patients qualified for treatment due to osteoarthritis of the metatarsophalangeal joint were evaluated. The clinical results of the surgical treatment were assessed at least one year after the surgery. Results. The mean AOFAS MTP-IP score increased from 35.29±18.76 to 75.59±12.15. The mean EFAS score in­creased from 9.24±5.73 to 18.35±5.66. Pain level as per a VAS decreased from 6.24±1.48 to 1.59±2.58. A total of 18 patients were satisfied with the procedure, with the remaining 2 patients reporting the result as unsatisfactory. Two revision procedures were performed, both due to migration of the fixation material. Conclusions. 1. The clinical results of MTP-1 arthrodesis with the medial plate are comparable to the results in the litera­ture. 2. It can be concluded that the use of the medial plate in arthrodesis of the MTP-1 joint is safe and effective, and is a va­­luable alternative to existing methods.

First metatarsophalangeal fusion with dorsal plate: clinical outcomes

Background First metatarsophalangeal joint (MTPJ) fusion is the most effective technique for the treatment of MTPJ primary arthritis, severe hallux valgus and failure of primary corrective surgery of these conditions. It can be achieved through different techniques. We evaluated the outcomes in a cohort of patients treated with dorsal plate arthrodesis. Materials and methods We treated 30 feet for 28 patients; the mean follow-up was 35 months. For each foot, we collected radiological and clinical assessment, with the visual analogue scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). The technique consisted in a cup and cone arthrodesis with the application of a low profile dorsal plate. Patients were allowed for immediate weight bearing. Results Consolidation was achieved in all cases; in 29 cases, radiographic union was recorded within 6 months from surgery, in one case after 9 months. Comparison between the preoperative and postoperative of VAS and MOXFQ values showed a statistically significant difference (p < 0.05). Only one case developed wound dehiscence as complication. Conclusions Even if there is still a debate regarding the best system for MTPJ fusion, we believe cup and cone fusion with dorsal plating is an effective method. Moreover, the stability of the osteosynthesis obtained allows for immediate post-operative weight bearing, making patients able to return soon to their normal life. Trial registration We present a retrospective study; all patients enrolled were retrospectively registered.

Description and phylogenetic analysis of a new firefly genus from the Atlantic Rainforest, with five new species and new combinations (Coleoptera: Lampyridae: Lampyrinae)

Here, based on phylogenetic analyses of 18 taxa and 57 morphological characters, we propose a new firefly genus, Costalampysgen. nov., to accommodate eleven species. Five new species are herein described: C. bellasp. nov., C. capixabasp. nov., C delicatasp. nov. (designated as type species), C. joanaesp. nov. and C. minimasp. nov. In addition, six species are redescribed and transferred from other genera: C. bisbinotata (Pic) comb. nov., transferred from Platylampis Motschulsky; C. decorata (Olivier) comb. nov., transferred from Ethra Laporte; C. pauper (Olivier) comb. nov., transferred from Cladodes Solier; as well as C. klugii (Motschulsky) comb. nov., C. quadriguttata (Gorham) comb. nov., and C. tricolor (Gorham) comb. nov., transferred from Lucidota Laporte. Costalampysgen. nov. is tentatively placed in Lampyrinae, and is diagnosed by: antennae with 11 articles, III–X basally flabellate, lacking dense and upright bristles; clypeus connected to frons by membrane, pygidium rounded; sternum VIII mucronate; phallus with dorsal plate enlarged apically, projecting ventrally and partially embracing the internal sac. Our phylogenetic analyses supported both the monophyly of Costalampysgen. nov. and the new combinations proposed. However, the relationship among congeneric species was poorly resolved. Finally, we provide illustrations of diagnostic features, distribution maps, as well as a key to Costalampysgen. nov. species, based on males.

Outcomes of First Metatarsophalangeal Joint Fusion Using a Precontoured Plate

Background: The purpose of this study was to determine the results of an arthrodesis technique of the first metatarsophalangeal joint (MTPJ) using a precontoured dorsal plate to correct the hallux valgus deformity. Methods: This was a retrospective analysis of outcomes for first MTPJ arthrodesis performed using 2 precontoured dorsal plates. Radiographic outcomes (intermetatarsal angle [IMA] and hallux valgus angle [HVA]) and patient-reported functional outcome measures (Short-Form 12 and Foot and Ankle Outcome Score) were recorded and compared. Results: Fifty-five patients underwent 77 first MTPJ arthrodeses for severe hallux valgus deformity with associated degenerative changes at the first MTPJ. The mean reduction of the IMA was 5.67° ( P < .05) and the mean reduction of the HVA was 33° ( P < .05). The Short-Form 12 assessment of global health demonstrated a significant improvement in both the physical and mental health composite scores by 16.4 points and 10.4 points ( P < .05), respectively. The Foot and Ankle Outcome Score demonstrated a cumulative decrease of 35% (59.28; P < .05) in all domains. Conclusions: First MTPJ arthrodesis using a precontoured dorsal plate is a successful procedure with a high union rate, low complication rate, and a high level of patient-reported satisfaction. Levels of Evidence: Level III.

Interventions for Distal Radius Fractures: A Meta-analysis of Comparison Studies

Background Distal radius fractures are one of the most frequent orthopaedic injuries. There are many effective treatment methods, such as volar plate, dorsal plate, percutaneous pins, external fixation, and casting; however, comparison of the treatment outcomes has not been thoroughly investigated. Our purpose is to determine if volar plating is the superior treatment method for distal radius fractures. We will address this through the following questions: First, is volar plating superior to dorsal plating, percutaneous pins, external fixation, or casting in terms of reported complications? Second, does volar plating produce superior functional outcomes to dorsal plating, percutaneous pins, external fixation, or casting? Third, are the radiographic outcomes superior for volar plating when compared with dorsal plating, percutaneous pins, external fixation, or casting? Methods MEDLINE, Academic Search Ultimate, Academic Search Complete, CINAHL Plus, and JSTOR databases, as well as manual search, were used to identify papers comparing complications and functional results of volar plating to other treatment methods for distal radius fractures published after the year 2000. Complication data and function scores were recorded. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data was analyzed for meta-analysis using Cochrane ReviewManager software. Results Compared with dorsal plate, volar plate performed significantly better in Gartland and Werley score. Volar plating outperformed percutaneous pins for loss of reduction, infection, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and ulnar deviation. Loss of reduction, malunion, Patient Related Wrist Evaluation (PRWE) score, DASH score, grip strength, ulnar deviation, and supination were significantly better for volar plating when compared with casting. When compared with external fixation, volar plating had significantly less cases of infection, lower QuickDASH score, and higher range of motion for flexion, pronation, and supination. All other complication and functional outcomes were not significantly different. Conclusions Distal radius fractures treated with volar plating showed relatively better measures of complications, function scores, and range of motion than other treatment methods; however, there was no significant difference in healing time when compared with percutaneous pins. More studies are needed to compare the rest of the treatment methods with each other.

Volar Radiocarpal Ligament Repair with Suture Anchors for Radiocarpal Fracture Dislocations: Case Series

Background Radiocarpal fracture dislocations cause significant intraarticular disruption and instability difficult to treat with traditional plating methods. Description of Technique Suture anchor fixation of the volar radiocarpal ligaments through an extended carpal tunnel approach, supplemented with radial styloid fixation, restores stability to the radiocarpal joint. Patients and Methods We performed a retrospective review of 14 consecutive radiocarpal fracture-dislocations (RCFDs) treated at two-level one trauma center from 2011 to 2015. In all cases, the volar radiocarpal ligaments were repaired to the distal radius with suture anchors. Results We reviewed 14 Dumontier Group 2 RCFDs in 14 patients (10 males, four females) with an average age of 39 years (range 22–53 years). Final follow-up averaged 288 days (range 7–1,364 days). Surgeons performed volar ligament repair with suture anchors in all cases, radial styloid fixation in 79% (11/14), and dorsal plate fixation in 29% (4/14). Eight of 14 patients (57%) had a “flipped” volar lip fragment of the distal radius. Three patients had forearm compartment syndrome and two patients had acute carpal tunnel syndrome. No patients experienced radiocarpal subluxation after volar ligament repair. Conclusion No recurrent subluxation or dislocation occurred after primary repair of the volar radiocarpal ligaments using suture anchors in this series of radiocarpal fracture dislocations. Volar radiocarpal ligament repair also addressed the “flipped” volar rim fragment that could not be addressed through a dorsal approach alone. Level of Evidence: This is a Level IV, case series therapeutic study.

Results of Hallux Metatarsophalangeal Joint Arthrodesis with and without Calcaneus Autograft

Category: Bunion; Other Introduction/Purpose: Hallux rigidus is the most common degenerative arthropathy of the foot. Primary hallux metatarsophalangeal (MTP) joint arthrodesis is the most common surgical treatment for end-stage hallux rigidus and can also be utilized for correction of hallux valgus. Though satisfaction rates following hallux MTP joint arthrodesis are very favorable, nonunion rates have been reported as high as 12%. Several studies have investigated how pathology, fixation techniques and joint preparation affect hallux MTP arthrodesis union rates. Many surgeons use orthobiologics and/or autograft to augment arthrodeses about the foot and ankle in an effort to increase union rates. The purpose of this study is to retrospectively compare union rates of hallux MTP joint arthrodesis with and without calcaneus autograft. Methods: A query of our institution’s administrative database was performed to identify patients who underwent a primary hallux MTP joint arthrodesis between February 2016 and February 2017. We compared patients who underwent arthrodesis with and without calcaneus autograft. Surgeon preference dictated use of autograft, as some in our group routinely use graft while others do not. Patients 18 years and older who underwent a primary hallux MTP arthrodesis were included. Patients were excluded if they had radiographic evidence of significant bone loss or if allograft or biologic therapies were used. Patient charts and final radiographs were reviewed. The primary outcome was successful union of the hallux MTP joint arthrodesis. Secondary outcomes included preoperative diagnosis, type of surgical fixation and surgical complications. Data was compared using a student T-test. Results: There were 130 feet included in the final analysis, and 55 underwent hallux MTP arthrodesis with calcaneus autograft. Mean follow-up time was 14.8 weeks. Among all patients, 90.8% had a successful union. There was no difference in union rates between those who underwent arthrodesis with calcaneus autograft (90.9%) compared to without autograft (90.7%; p = 0.96). Hallux valgus was the preoperative diagnosis in 46.1% of cases followed by hallux rigidus (34.6%). The most common fixation method was a lag screw with a dorsal plate (83.8%). Overall, 19 patients (14.6%) had a complication requiring a reoperation with painful hardware (10 patients) being most common. In the autograft group, there were no complications related to the calcaneus autograft donor site. Conclusion: As orthobiologics and local bone autograft gain popularity in foot and ankle surgery, it is important to report clinical outcomes and establish evidence-based guidelines for use. In this relatively large retrospective comparison, the use of calcaneal graft was noted to be safe (no complications from graft site). However, there was no difference in union rate when comparing hallux MTP arthrodesis with and without calcaneus autograft.