Analyzing the Fitting of Novel Preformed Osteosynthesis Plates for the Reduction and Fixation of Mandibular Fractures

Purpose: The known preformed osteosynthesis plates for the midface are helpful tools for a precise and fast fixation of repositioned fractures. The purpose of the current study is to analyze the precision of newly developed prototypes of preformed osteosynthesis plates for the mandible. Methods: Four newly designed preformed osteosynthesis plates, generated by a statistical shape model based on 115 CT scans, were virtually analyzed. The used plates were designed for symphyseal, parasymphyseal, angle, and condyle fractures. Each type of plate has three different sizes. For analysis, the shortest distance between the plate and the bone surface was measured, and the sum of the plate-to-bone distances over the whole surface was calculated. Results: A distance between plate and bone of less than 1.5 mm was defined as sufficient fitting. The plate for symphyseal fractures showed good fitting in 90% of the cases for size M, and in 84% for size L. For parasymphyseal fractures, size S fits in 80%, size M in 68%, and size L in 65% of the cases. Angle fractures with their specific plate show good fitting for size S in 53%, size M in 60%, and size L in 47%. The preformed plate for the condyle part fits for size S in 75%, for size M in 85%, and for size L in 74% of the cases. Conclusion: The newly developed mandible plates show sufficient clinical fitting to ensure adequate fracture reduction and fixation.

Arthroscopic treatment for posteromedial talar process fracture (Cedell fracture): a case report

Fracture of the posteromedial talar process (Cedell fracture) is a rare injury and is easily misdiagnosed as a simple ankle sprain. Suspicion should be heightened if specific mechanisms of injury are present, and, in these cases, a CT scan should be performed. Significant ankle pain and disability can result if these injuries are not identified and treated properly. Few cases have been described in the literature, and the efficacy of surgical techniques and approaches for fractures of the posterior talar process remains controversial. We report a 56-year-old man with an acute posteromedial talar fracture treated arthroscopically. This approach provides good access to the posterior ankle compartment, subtalar joint, and extraarticular structures, which may allow fracture reduction and fixation under arthroscopic visualization. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Orthopaedic surgery

This chapter examines orthopaedic surgery. It begins by detailing the examination of a joint and of the limbs and trunk. The chapter then discusses fracture healing and the reduction and fixation of fractures. Fracture healing occurs as either primary or secondary bone union. Primary bone healing does not produce callus, while secondary bone healing does. Modern fracture reduction and treatment centres around four key principles: fracture reduction and fixation to restore anatomical relationships; stability by fixation or splintage as the personality of the fracture and the injury dictates; preservation of the blood supply to the soft tissue and bone by careful handling and gentle reduction techniques; and early and safe mobilization of the part and patient. Finally, the chapter looks at the skeletal radiograph and considers injuries of the phalanges and metacarpals; wrist injuries; dislocations and fractures of the elbow, shoulders, ribs, pelvis, and neck; spinal injuries; bone tumours; osteoarthrosis (osteoarthritis); Paget’s disease (osteitis deformans); and carpal tunnel syndrome.

OLD AND DISPLACED TIBIAL SPINE FRACTURE FIXATION BY OPEN APPROACH-PREFERABLE

In the era of athroscopy all intraarticular knee pathology including tibial spine fracture can be managed satisfactory results.In highly displaced situation and in delayed cases open approach is still a gold standard for managing this complex situation to get a saticfactory fracture reduction and fixation and ultimately good functional results.

Traction screws to reduce a bilateral pedicle fracture of L5: a case report

Pedicle fractures are rare and usually associated with repetitive stress, high-speed trauma, osteoporosis, unilateral spondylolysis, or instrumentation surgery. A review of the current literature on bilateral pedicle fractures of the lumbar spine revealed only a few cases listed as a complication of instrumentation or excessive decompression surgery. The authors present the clinical case of a 49-year-old man with exacerbating low-back pain and intermittent L5 radicular pain. The known comorbidities were rather remarkable for systemic lupus erythematosus and osteopenia. Radiological investigations revealed an acute bilateral pedicle fracture of L5 without any evidence of preexisting spondylolysis. An off-label minimally invasive fracture reduction and fixation was performed using traction screws and intraoperative navigation. The patient reported instant pain relief and did not show any sensorimotor deficits at discharge. The postoperative CT scan revealed an ossification of the former fracture after 3 months, with great 1-year follow-up outcome. This is the first documented report on the effectiveness of traction screws used in a patient with bilateral pedicle fractures of the L5 vertebra. This minimally invasive technique represents a promising treatment option in selected cases by sparing segmental fusion.