Dynamic Locked Plating of Distal Femur Fractures

Background Distal femur fractures account for less than 1% of all fractures and 3%– 6% of all femur fractures. Epidemiological studies indicate 2 primary distributions of patients: elderly individuals with low energy mechanisms such as a fall from standing, and younger patients with high-energy mechanisms such as motor vehicle accidents. Fixation of the distal femur fracture with lateral locked plate had a nonunion rate between 0 to 32%. The concept of “Dynamic” Locked Plates, has been proposed to decrease construct stiffness & improve callus formation. Objective A systematic review and meta-analysis of literature to assess the outcomes of dynamic locked plate of distal femora fractures. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2018. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion Our systematic review and meta-analysis showed different method of distal femur locked plate dynamyzation. DLP of distal femur increased interfragmentery micro motion, decrease construct stiffness and improve healing & union rate of distal femur fractures. Finally it should be noticed that the orthopedic surgeon should be qualified to utilize either techniques & the choice depends on the preoperative planning & method of fixation available which leads to fracture union on time without complications.

Functional Outcome of Distal End of Radius Fractures Treated With Volar Plating

In this study we evaluated the functional outcomes of open reduction and internal fixation of distal radius fractures by plate osteosynthesis in considering the parameters like radiological,clinical, and functional outcome in all types of fractures. There blood loss for volar locked plating cases was around 200ml. the pain after the surgery was present equally in all and responses was good to analegesics. It was observed that the plating distal radius is very effective in maintaining length in all types. Good alignment was observed in allmtype of fractures, in case of communited fractures as well. The early recovery and movement in the patients treated with volar locked plating gives a better outcome and good working capacity.

Promising Mid-Term Outcomes after Humeral Head Preserving Surgery of Posterior Fracture Dislocations of the Proximal Humerus

Background: The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus. Methods: Patients with a posterior fracture dislocation of the proximal humerus that were operatively treated in two level-1 trauma centers within a timeframe of 8 years were identified. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination. Results: 19/24 fractures (79.2%; mean age 43 years) were examined with a mean follow-up of 4.1 ± 2.1 years. Of these, 12 fractures were categorized as posteriorly dislocated impression type fractures, and 7 fractures as posteriorly dislocated surgical neck fractures. Most impression type fractures were treated by open reduction, allo- or autograft impaction and screw fixation (n = 11), while most surgical neck fractures were treated with locked plating (n = 6). Patients with impression type fractures showed significantly better ASES scores (p = 0.041), Simple Shoulder Test scores (p = 0.003), Rowe scores (p = 0.013) and WOSI scores (p = 0.023), when compared to posteriorly dislocated surgical neck fractures. Range of motion was good to excellent for both groups with no significant difference. Conclusions: This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment.

Operative Treatment of Distal Radius Fractures in Patients With Parkinson Disease

Background: Owing to the many unique disease characteristics of Parkinson disease (PD)—namely resting tremors, muscular rigidity, and poor bone quality—we hypothesized that this patient population would have inferior outcomes with surgical management of acute distal radius fractures (DRFs) compared with the literature available on the general population. Methods: This is a retrospective observational study performed at a single, level 1, academic center from 2001 to 2020 capturing all adult patients with an isolated, acute, and closed DRF that ultimately underwent operative treatment. International Classification of Diseases 10 codes were used to identify 30 patients for manual chart review. Several patient and fracture characteristics were accounted for and complications, reoperations, and failures of surgical intervention were recorded. Results: There was a total of 7/30 failures (23%), 6/30 reoperations (20%), and 12 complications in 9/30 wrists (complication rate, 30%) at a mean latest follow-up of 11 months (1.2-158 months). Of the 7 failures, 5 were due to loss of reduction, and 2 of them were deep infections with mean time to failure of 8.3 weeks (range, 11 days-5.2 months). Conclusions: This study found a high rate of complications, reoperations, and early failure despite a short follow-up period and a small cohort of patients with PD treated surgically for a DRF. We recommend locked plating if suitable for the fracture type and early involvement of a multidisciplinary team to assist with medical optimization of PD to increase chances of a successful outcome.

Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis

Objective: This meta-analysis aimed to systematically compare the clinical outcomes of intramedullary nailing (IMN) fixation and percutaneous locked plating (PLP) fixation in the treatment of proximal tibial fractures. Methods: We searched PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wan Fang to select relevant articles up to March 29, 2020 without language limit. Continuous variables were estimated by weighted mean difference (WMD) with a 95% confidence interval (CI) and dichotomous outcomes were calculated by relative risk (RR) with 95% CI. Moreover, heterogeneity analysis was evaluated. Furthermore, publication bias assessment and sensitivity analysis were conducted. Stata 11.0 software was used to perform the statistical analysis. Results: Ten studies involving 667 cases (321 from IMN fixation group and 346 from PLP fixation group) were included. The type of fractures involved in the included articles was extra-articular proximal tibia fractures. IMN fixation method achieved significantly shorter union time ( WMD = −2.88, 95% CI: −3.23 to −2.53, p < 0.001) and full weight-bearing time ( WMD = −2.81, 95% CI: −3.64 to −1.97, p < 0.001) than PLP fixation method. Meanwhile, IMN fixation resulted in lower risks of infection ( RR = 0.50, 95% CI: 0.27 to 0.91, p = 0.02) and total complications ( RR = 0.36, 95% CI: 0.22 to 0.60, p < 0.001) than PLP fixation. No significant differences were found in the incidence of nonunion ( p = 0.33), malunion ( p = 0.38), and osteofascial compartment syndrome (OCS, p = 0.62) between the two groups. Conclusions: Compared to PLP fixation, IMN fixation had several advantages in treating proximal tibial fractures, including the short time of union and full weight-bearing, as well as a low risk of infection and total complications.