Anatomical Considerations for Appropriate Mini-plate Positioning in Open-Door Laminoplasty To Avoid Plate Impingement and Screw Facet Violation

Objective This study aimed to describe a safe zone for mini-plate positioning that can avoid instrument-related complications in laminoplasty. Methods The posterior surface length and inferior pole angle of the lateral mass were measured at each level using computed tomography. The safe zone was defined based on these measurements. Incidences of screw facet violation and plate impingement were recorded. Results Among 40 patients included, 15 (37.5%) had inappropriate plate positioning, causing screw facet violation or plate impingement, which more commonly occurred at distal (C5, C6) and proximal (C3, C4) levels, respectively. Lateral mass posterior surface length was shorter at the proximal levels, and the inferior pole angle of the lateral mass was smaller at the distal levels, signifying that the lateral mass became thin and long at the distal levels. Inserting the mini-plate with plate-to-lateral mass inferior pole distances of 4–5 mm and 5–6 mm at the C3–C5 and C6–C7 levels, respectively, would avoid instrument-related complications. Conclusion The risk of plate impingement was higher at the proximal level, whereas the risk of screw facet violation was higher at the distal level in open-door cervical laminoplasty. These risks coincide with anatomical differences at each level.

Reconstruction and repair, using mini-plate and bone graft for persons living with HIV with giant cell tumor of long bone: retrospective analysis of a single-center experience

Background To evaluate the effect of reconstruction and repair, using a mini-plate and bone graft for HIV -positive patients with giant cell tumor of long bone. Methods We conducted a retrospective analysis of 12 HIV positive patients with giant cell tumor of long bone. A non-HIV-positive cohort of patients, matched for age, sex, and disease type, was selected as the control group. From June 2012 to August 2020, curettage by ultrasonic scalpel was performed in all patients, combined with min- plate and bone graft treatment. All patients were followed- up for 18 to 60 months. Limb function was evaluated, using the MSTS93 scoring system, and any examples of postoperative recurrence, distant metastasis, complications, MSTS93 score, and fracture prognosis were recorded. Results The mean age of HIV group was 43.5 years. The ratio of men to women was 11: 1. In all cases the histopathological diagnosis was clear, except the patients with primary malignant giant cell tumor of bone, including five, three, two, and two cases in the proximal tibia, distal femur, distal tibia, and talus, respectively. Following their surgery, all patients were followed up with an average of 31.24 ± 11.84 months. No local recurrence or pulmonary metastases were observed. Post-surgery, all the 12 patients showed good bone morphologic repair and reconstruction, good bone healing, good joint function, and no pathological fractures around their lesion. In the HIV group, one case of giant cell tumor in the proximal tibia showed mild articular surface collapse and mild valgus deformity of the knee joint but retained good joint function. The MSTS scores of excellent or good in the two groups comprised 83.3%, thus, there was no significant difference between them (P > 0.05). Compared with preoperatively, the MSTS scores in the HIV group were significantly improved, ranging from 7 to 11 points preoperatively to 24 to 27 points postoperatively; this difference was statistically significant (P < 0.05). Conclusion Reconstruction and repair, using a mini-plate and bone graft for HIV -positive patients with giant cell tumor of long bone can achieve satisfactory results. The mini- plate requires little space and is flexible during reconstruction and fixation, significantly reducing complications such as surgical site infection, as well as preserving joint function and avoiding amputation; therefore, it is a safe and effective treatment method.

The Use of Titanium 3D Mini-Plates in the Surgical Treatment of Fractures of the Mandibular Condyle: A Systematic Review and Meta-Analysis of Clinical Trials

Introduction: Fixing fractures of the base and neck of mandibular condyles is demanding due to the difficulties in surgical access and the various shapes of bone fragments. Classic fixation techniques assume the use of straight mini-plates, utilized for other craniofacial bone fractures. Three dimensional mini-plates may provide a reasonable alternative due to their ease of use and steadily improved mechanical properties. The multitude of different shapes of 3D mini-plates proves the need for their evaluation. Aim: This paper aims to summarize the clinical trials regarding the use of various types of 3D condylar mini-plates in terms of need for reoperation and the incidence of loosening and damage to the osteosynthetic material. Materials and Methods: A systematic review was conducted in accordance with PICOS criteria and PRISMA protocol. The risk of bias was assessed using ROBINS-I and RoB 2 Cochrane protocols. The obtained data series was analyzed for correlations (Pearson’s r) respecting statistical significance (Student’s t-test p > 0.05) and visualized using OriginLab. Results: 13 clinical trials with low overall risk of bias regarding 6 shapes of 3D mini-plates were included in the synthesis. The number of reoperations correlates with the number of fixations (r = 0.53; p = 0.015) and the total number of screw holes in the mini-plate (r = −0.45; p = 0.006). There is a strong correlation between the number of loosened osteosynthetic screws and the total number of fractures treated with 3D mini-plates (r = 0.79; p = 0.001 for each study and r = 0.99; p = 0.015 for each mini-plate shape). A correlation between the percentage of lost screws and the number of distal screw holes is weak regarding individual studies (r = −0.27; p = 0.000) and strong regarding individual mini-plate shape (r = −0.82; p = 0.001). Three cases of 3D mini-plate fractures are noted, which account for 0.7% of all analyzed fixation cases. Discussion: The reasons for reoperations indicated by the authors of the analyzed articles were: mispositioning of the bone fragments, lack of bone fragment union, secondary dislocation, and hematoma. The known screw loosening factors were poor bone quality, bilateral condylar fractures, difficulties in the correct positioning of the osteosynthetic material due to the limitations of the surgical approach, fracture line pattern, including the presence of intermediate fragments, and mechanical overload. Fractures of the straight mini-plates fixing the mandibular condyles amounts for up to 16% of cases in the reference articles. Conclusions: There is no convincing data that the number of reoperations depends on the type of 3D mini-plate used. The frequency of osteosynthetic screw loosening does not seem to depend on the 3D mini-plate’s shape. Clinical fractures of 3D mini-plates are extremely rare.

Open Reduction and Internal Fixation with Mini-plate and Screws for Management of Unstable Metacarpal Fracture among Hand Injuries in a Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: Hand injuries metacarpal fractures are common and it accounts about 14 to 28%. Mini-plate fixation in unstable metacarpal fractures provides absolute stability and early mobilization of fingers to reduce complications. The purpose of this study is to find out the prevalence of open reduction and internal fixation with mini-plate and screws for management of unstable metacarpal fracture among hand injuries done in a tertiary care center. Methods: This was a descriptive cross-sectional study done from February 2019 and January 2021 in a tertiary care center with unstable isolated metacarpal fracture treated with mini-plate fixation and were followed up for six months duration. Ethical approval and informed written consent were taken from all patients. The outcome was assessed by the American Society for Surgery of the Hand Total Active Flexion Score. Convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Statistical Package for Social Sciences used for analysis. Results: Out of 250 patients who underwent hand surgeries, open reduction and internal fixation with mini-plate and screws for unstable metacarpal fracture were done in 32 (12.8%) (8.66-16.94 at 95% Confidence Interval). The mean time of fracture union was 6.78±1.008 weeks. Functional outcome according to American Society for Surgery of the Hand Total Active Flexion score was excellent in 25 (78.2%), good in 6 (18.8%), and poor in 1 (3%) patient. Conclusions: Fixation of metacarpal fracture by mini-plate and screws was required in fewer patients. Mini-plate fixation provides better stability and early mobilization for unstable metacarpal fractures to achieve a good functional outcome.

Compare the Outcomes of Mini-Plate versus K-Wire Fixation in Patients with Shaft of Metacarpal Fractures

Objective: To compare the functional outcomes of K-wire versus mini plate fixation for the treatment of fractures shaft of metacarpal. Study Design: Randomized controlled trial Place and Duration of Study: Department of Orthopaedic, Sahara Medical College, Narowal from 1st August 2020 to 31st January 2021. Methodology: Fifty six patients of both genders presented with fractures shaft of metacarpal were included. Patient’s ages were ranging between 15 to 60 years. Radiographic assessment was done to all the patients. Patients were categorized in to two equal groups. 28 patients treated with mini plates (group A) and 28 patients treated with K-wire fixation (group B). Post-operative complications were examined and compare between both groups. DASH scoring system was used for analyzing functional outcomes. Results: Mean age in group A was 34.57±7.84 years and in group B it was 34.95±7.76 years. Majority of patients 18 (64.29%) and 17 (60.71%) were males in group A and B. Mean time of union in group A was 9.58±2.24 weeks while in group B it was 12.33±2.85 weeks, the difference was statistically significant (p-value <0.05). As per DASH criteria, 15 (57.14%), 11 (39.29%) and 2 (7.14%) patients had excellent, good and fair functional outcomes who treated with mini plates internal fixation, while in group B 12 (42.86%), 13 (46.43%), 2 (7.14%) and 1 (3.57%) patients had excellent, good, fair and poor functional outcomes. Postoperative complications were more in group B as compared to group A but the difference was not statistically significant (p-value >0.05). Conclusion: Both procedures mini-plate internal fixation and K-wire fixation are effective for fractures shaft of metacarpal. However, mini-plates showed better functional outcomes with fewer rate of postoperative complications and earlier union as compared to K-wire internal fixation. Keywords: Shaft of metacarpal fracture, Internal fixation, Mini-plate, K-wire, DASH scoring system

Reconstruction and Repairment With Mini-plate and Bone Graft for HIV Positive Patients of Giant Cell Tumor of Long Bone: Retrospective Analysis of a Single-center Experience

Background: To evaluate the effect of reconstruction and repairment with mini-plate and bone graft for HIV positive patients of giant cell tumor of long bone.Methods: This research retrospectively analyzed 12 HIV positive patients with giant cell tumor of long bone, 11 male and 1 female, with a age range 16 to 68 years old (43.5 years old on average) were included. There were 5 cases of proximal tibia，3 cases of distal femur, 2 case of distal tibia, and 2 case of talus. From June 2012 to August 2020, curettage by ultrasonic scalpel were performed in all patients, combined with min- plate and bone graft treatment. All patients were followed up for 18-60 months. Limb function was evaluated by MSTS93 scoring system, and postoperative recurrence and distant metastasis, complications, MSTS93 score and fracture prognosis were observed.Results: No local recurrence and pulmonary metastases was observed. After surgery, all the 12 patients showed good bone morphologic repair and reconstruction, good bone healing , good joint function, and no pathological fracture around the lesion. One case of giant cell tumor of proximal tibia showed mild articular surface collapse, and mild valgus deformity of knee joint, but good joint function. The MSTS93 score of the patients 6 months after the operation was 24-27 points (24.5±1.08), with a significant difference (P < 0.05).Conclusion: Reconstruction and repairment with mini-plate and bone graft for HIV positive patients of giant cell tumor of long bone has achieved satisfactory results. The mini- plate takes up little space and is flexible for reconstruction and fixation, significantly reducing complications such as surgical site infection, preserving joint function and avoiding amputation. It is a safe and effective treatment method.

Reconstruction and Repairment with Mini- Plate and Bone Graft for HIV Positive Patients of Giant Cell Tumor of Long Bone: Retrospective Analysis of A Single-Center Experience

Background To evaluate the effect of reconstruction and repairment with mini- plate and bone graft for HIV positive patients of giant cell tumor of long bone. Methods This research retrospectively analyzed 12 HIV positive patients with giant cell tumor of long bone, 11 male and 1 female, with a age range 16 to 68 years old (43.5 years old on average) were included. There were 5 cases of proximal tibia,3 cases of distal femur, 2 case of distal tibia, and 2 case of talus. From June 2012 to August 2020, curettage by ultrasonic scalpel were performed in all patients, combined with min- plate and bone graft treatment. All patients were followed up for 18–60 months. Limb function was evaluated by MSTS93 scoring system, and postoperative recurrence and distant metastasis, complications, MSTS93 score and fracture prognosis were observed. Results No local recurrence and pulmonary metastases was observed. After surgery, all the 12 patients showed good bone morphologic repair and reconstruction, good bone healing, good joint function, and no pathological fracture around the lesion. One case of giant cell tumor of proximal tibia showed mild articular surface collapse, and mild valgus deformity of knee joint, but good joint function. The MSTS93 score of the patients 6 months after the operation was 24–27 points (24.5 ± 1.08), with a significant difference (P < 0.05). Conclusion Reconstruction and repairment with mini- plate and bone graft for HIV positive patients of giant cell tumor of long bone has achieved satisfactory results. The mini- plate takes up little space and is flexible for reconstruction and fixation, significantly reducing complications such as surgical site infection, preserving joint function and avoiding amputation. It is a safe and effective treatment method.