Peculiar Periprosthetic Fracture Involving Trochanteric Region Along With Shaft of Femur in a 68-Year Male Treated With Locking Plate Fixation and Additional Augmentation with Cable – A Case Report and Review of Literature

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Comparison between external locking plate fixation and conventional external fixation for extraarticular proximal tibial fractures: a finite element analysis

Background Good clinical outcomes for locking plates as an external fixator to treat tibial fractures have been reported. However, external locking plate fixation is still generally rarely performed. This study aimed to compare the stability of an external locking plate fixator with that of a conventional external fixator for extraarticular proximal tibial fractures using finite element analysis. Methods Three models were constructed: (1) external locking plate fixation of proximal tibial fracture with lateral proximal tibial locking plate and 5-mm screws (ELP), (2) conventional external fixation of proximal tibial fracture with an 11-mm rod and 5-mm Schanz screws (EF-11), and (3) conventional external fixation of a proximal tibial fracture with a 7-mm rod and 5-mm Schanz screws (EF-7). The stress distribution, displacement at the fracture gap, and stiffness of the three finite element models at 30-, 40-, 50-, and 60-mm plate–rod offsets from the lateral surface of the lateral condyle of the tibia were determined. Results The conventional external fixator showed higher stiffness than the external locking plate fixator. In all models, the stiffness decreased as the distance of the plate–rod from the bone surface increased. The maximum stiffness was 121.06 N/mm in the EF-11 model with 30-mm tibia–rod offset. In the EF-7 model group, the maximum stiffness was 40.00 N/mm in the model with 30-mm tibia–rod offset. In the ELP model group, the maximum stiffness was 35.79 N/mm in the model with 30-mm tibia–plate offset. Conclusions Finite element analysis indicated that external locking plate fixation is more flexible than conventional external fixation and can influence secondary bone healing. External locking plate fixation requires the placement of the plate as close as possible to the skin, which allows for a low-profile design because the increased distance from the plate to the bone can be too flexible for bone healing. Further experimental mechanical model tests are necessary to validate these finite element models, and further biological analysis is necessary to evaluate the effect of external locking plate fixation on fracture healing.

Functional and Radiographic Outcomes for Distal Radius Fractures Treated with Volar-Locked Plates and Percutaneous K-Wires: A Comparative Study

Purpose to evaluate and to compare radiological and functional outcomes of the volar locking plate fixation using pronator-sparing approach and K-wire fixation of distal radius fractures. Materials and Methods. We retrospectively analyzed 41 patients with distal radius fractures (27 female and 14 male) treated in the period from 2016 to 2020 using minimally invasive osteosynthesis via pronator-sparing approach. The mean age was 51 years (31-74 years). The control group consists of 37 patients (19 female and 18 male, mean age 61 years (29-76 years)), who underwent minimally invasive percutaneous K-wire fixation of distal radius fractures during the same period of time. Comparative analysis of radiographic and functional outcomes in both groups of minimally invasive osteosynthesis of distal radius fractures was carried out in the period from 1 to 6 months after the surgery. Results. Primary union of distal radius fractures was confirmed in X-rays in all patients within 6 weeks after the surgery. There were no complications in patientstreated by pronator-sparing volar locking plate fixation, whereas in K-wire group we had 6 patients with complications: 4 cases (11%) superficial infection around K-wires and 2 cases (5,4%) intraoperative damage of sensitive branch of radial nerve. There were statistically significant differences in radiographic results (volar tilt, radial inclination, andradial height) between two groups: they all were better in patients treated by pronator-sparing volar locking plate fixation during the whole follow-up period (р0,01). Minimally invasive volar locking plate fixation via pronator-sparing approach also provided significantly better grip strength and range of wrist motion and forearm rotation in the early 6-month postoperative period, compared with percutaneous K-wire fixation (р0,001). Conclusion. Our study demonstrates that both techniques of minimally invasive osteosynthesis of distal radius fractures are effective and relatively safe methodsof surgical treatment, but volar plating via pronator-sparing approach leads to a better reconstruction of the distal radius and better functional outcomes compared to percutaneous K-wiring. Keywords: minimally invasive osteosynthesis, distal radius, volar locking plate, pronator-sparing approach, K-wire.

Knee joint stability following fixation of tibial plateau fracture by angular locking plate fixation

<p class="abstract"><strong>Background:</strong> Injuries to the tibial plateau generally occur because of a force directed either medially or laterally an axial compressive force or both an axial force and force from the side. Tibial plateau fractures resulting frequently in functional impairment.</p><p class="abstract"><strong>Methods: </strong>The total of cases included in the study was 47 in number. More than 20 years old patients of both sexes with tibial plateau fractures attended in the study. Proper informed consent was taken from the patients under the study and purpose of the study was explained. Ethical approval was obtained from the Institutional Ethics Committee. All data were processed, analyzed, and disseminated by MS Office and Statistical package for social sciences (SPSS) version 26 as per need.</p><p class="abstract"><strong>Results: </strong>In this study, for majority (51%) patients &lt;12 weeks were in needed for union. Besides these, for 23.40% and 21.28% patients, time for union were 12-14 and &gt;14 weeks respectively. Unfortunately, in 4.26%% cases (n=2) incidence of non-union was occur. The mean period of radiological union was 12.75 weeks (12-16 weeks). Most of the patients were allowed complete weight bearing at 11 to 14 weeks. Average time gap for complete weight bearing was 13.5 weeks. In assessing the knee stability of the participants, we observed, the mean (±SD) angle of knee joints was 112.08 ±12.32 degree. The mean (±SD) Knee Society Score (KSS) was found 77.51 ± 8.16. As per the functional outcomes among all the participants, majority of them (57.45%) got ‘good’ results whereas 29.79% got ‘Excellent’ and 8.51% got ‘Poor’ results.</p><p class="abstract"><strong>Conclusions:</strong> Satisfactory knee joint stability for patients with tibial plateau fracture angular locking plate fixation technic may be considered as an effective treatment method for orthopedic surgeons. </p>

Comparison between External Locking Plate Fixation and Conventional External Fixation for Extraarticular Proximal Tibial Fractures: A Finite Element Analysis

BackgroundGood clinical outcomes for locking plates as an external fixator to treat tibial fractures have been reported. However, external locking plate fixation is still generally rarely performed. This study aimed to compare the stability of external locking plate fixator with that of conventional external fixator for extraarticular proximal tibial fractures, using finite element analysis. MethodsThree models were constructed: (1) external locking plating of proximal tibial fracture with lateral proximal tibial locking plate and 5-mm screws (ELP), (2) conventional external fixation of proximal tibial fracture with an 11-mm rod and 5-mm Schanz screws (EF-11), and (3) conventional external fixation of proximal tibial fracture with a 7-mm rod and 5-mm Schanz screws (EF-7). The stress distribution, displacement at the fracture gap, and stiffness of the three finite element models at 30-, 40-, 50-, and 60-mm plate–rod offset from the lateral surface of the lateral condyle of the tibia were determined. ResultsThe conventional external fixator showed higher stiffness than did the external locking plate fixator. In all models, the stiffness decreased as the distance of the plate–rod from the bone surface increased. The maximum stiffness was 121.06 N/mm in the EF-11 model with 30-mm tibia–rod offset. In the EF-7 model group, the maximum stiffness was 40.00 N/mm in the model with 30-mm tibia–rod offset. In the ELP model group, the maximum stiffness was 35.79 N/mm in the model with 30-mm tibia–plate offsetConclusionsExternal locking plate fixation is more flexible than conventional external fixation, which can influence secondary bone healing. External locking plate fixation requires the placement of the plate as close as possible to the skin, which allow low-profile design, because the increased distance of the plate from bone can be too flexible for bone healing.