Biomechanical analysis of two medial buttress plate fixation methods to treat Pauwels type III femoral neck fractures

Background Femoral neck fractures in young people are usually Pauwels Type III fractures. The common treatment method are multiple parallel cannulated screws or dynamic hip screw sliding compression fixation. Due to the huge shear stress, the rate of complications such as femoral head necrosis and nonunion is still high after treatment. The aim of our study was to compare the stabilities of two fixation methods in fixating pauwels type III femoral neck fractures. Methods All biomimetic fracture samples are fixed with three cannulated screws combined with a medial buttress plate. There were two fixation groups for the buttress plate and proximal fracture fragment: Group A, long screw (40 mm); Group B, short screw (6 mm). Samples were subjected to electrical strain measurement under a load of 500 N, axial stiffness was measured, and then the samples were axially loaded until failure. More than 5 mm of displacement or synthetic bone fracture was considered as construct failure. Results There were no significant differences in failure load (P = 0.669), stiffness (P = 0.842), or strain distribution (P > 0.05) between the two groups. Conclusions Unicortical short screws can provide the same stability as long screws for Pauwels Type III Femoral Neck Fractures.

A Locking Plate Designed With Cluster of Head Screws Would Be Biomechanically Superior Than Conventional Buttress Plate For The Fixation of Posteromedial Tibial Plateau Fractures: A Computational Assessment

Background: Dealing with high-energy fractures of the tibial plateau remains a challenge despite advances in implants, surgical approaches, and imaging methods. Posterior buttress plate is most commonly used implant but the fixation stability is still a challenge. Recently, a newly designed tibial locking plate was introduced that aims to provide better fixation strength for tibial plateau split fracture. This study compared the biomechanical strength of three different posteromedial tibial plateau split fracture fixation methods. Methods: The tibial plateau fractures were simulated using a human tibiae model. Each fracture model was virtually implanted with one of the three following constructs, proximal medial tibial plate (PMT), proximal posterior medial tibial plate (PPMT), and posterior T-shaped buttress plate (TBP). Posteromedial fragment vertical subsidence was measured under 2000 N joint contact force. The maximum Equivalent stress on the bone plate and bone screw and the construct stiffness were determined.Results: The proximal medial tibial plate (PMT) allowed the least posteromedial fragment subsidence and produced higher construct stiffness than each of the other two constructs. However, the proximal posterior medial tibial plate (PPMT) showed higher stiffness than the T-shaped buttress plate (TBP). The maximum Equivalent stress was the smallest for the proximal medial tibial plate (PMT).Conclusion: This study showed that the proximal medial tibial locking plate or proximal posterior medial tibial locking plate were biomechanically more stable fixation methods for posteromedial split tibial plateau fractures.

Treatment of Geriatric Acetabular Anterior Fractures: Role of “Frame and Buttress”

Background: As the rate of geriatric acetabular fractures was increasing gradually and accompanied with the quadrilateral surface(QLS) involved resulting by impacting from the head of femur, which usually leaded to the dislocation/subluxation of the head of femur and intra-pelvic medial displacement of the QLS. Traditionally, applying an infra-pectineal buttress plate in the true pelvis to resist the protrusive fragments of the QLS, however, these plates with small contact area could not provide enough buttress effect to age-related fractures. This study was to evaluate the “frame and buttress” fixation strategy for treatment of geriatric acetabular anterior fractures(GAAF).Methods: A cohort of 28 patients with acetabular fractures involving QLS were managed operatively with the “frame and buttress” fixation strategy with a single pelvic anterior approach. 7 cases were transverse, 3 cases were posterior column, 8 cases were associated both columns, 4 cases were anterior posterior hemi-transverse and 6 cases were T-type patterns fracture. The quality of reduction, functional outcomes and complicates were recorded for analyzing.Results: Functional outcomes were 15 cases in excellent; 9 cases were good; 3 cases were fair, and 1 case was poor. The quality of surgical reduction was evaluated by the Matta score system, which was graded as excellent in 17 cases, good in 9 cases and poor in 2 cases, respectively. No loss or failure of internal fixation, no second dislocation/subluxation of femoral head and no complications like infection were observed.Conclusions: The “frame and buttress” fixation strategy provided firm method for treating GAAF, the “frame” formed rigid fixation structure for acetabular fractures and the “buttress” resisted protrusive QLS.

Functional Outcome of Distal End of Radius Fractures Treated with Buttress Plating at a Tertiary Care Centre in Central Kerala, India

BACKGROUND Distal radius fractures are one of the most common injuries that orthopaedic surgeons will face during their trauma practice. Despite this, many aspects in distal radius fracture management like the definition of what constitutes an acceptable reduction and when or even whether to operate a patient with a distal radius fracture remain a poignant subject of debate even to this day. We wanted to evaluate the functional outcome of fractures of distal end of radius managed with buttress plate. The importance of anatomical reduction in attaining a good functional outcome and post-operative complications of the procedure are also studied. METHODS A prospective study of cases of distal end of radius fractures meeting the inclusion criteria who were admitted in Thrissur Government Medical College, Kerala between 1 – 01 - 2016 to 1 – 06 - 2017 was carried out. Fractures were classified according to Frykman system and anatomical reduction of fragments attempted using buttress plate and screws. After a minimum follow up period of 3 months, the anatomical and functional outcomes were standardised using Lindstorms anatomical and functional scoring system. RESULTS A series of 32 cases with distal end of radius fracture were studied comprising of 24 males and 8 females. Majority were in the age group of 20 to 29 years (50 %). Road Traffic Accidents was the commonest cause of injury (62.5 %). Type III Frykman made the largest contribution with 11 (34 %) cases. A total of 7 cases were found to develop complications including blisters, joint stiffness, infection and paraesthesia. Postoperatively, excellent anatomical reduction was achieved in 75 % of cases and good results in 12.5 % cases. Functionally 68.75 % cases had an excellent outcome and 18.75 % had a good result. CONCLUSIONS Good to excellent results were seen in majority of patients after buttress plate fixation of the distal radius, with outcomes and complications comparable to other studies in literature. This study supports the finding that precise identification of unstable lower radial fractures, and satisfactory anatomical restoration results in improved functional outcome. KEYWORDS Distal End Radius Fracture, Buttress Plating, Functional Outcome, Frykman Classification, Lindstorm Scoring System

Treatment with Buttress Plate Technique for Symptomatic Ulnar Styloid Base Nonunion

Background Surgical treatment options for symptomatic ulnar styloid base nonunion can be divided into two groups: styloid excision and styloid fixation methods. Styloid fixation is commonly performed using tension band wiring or distal ulna hook plate. However, these methods are more suitable for large styloids than small ones. For this reason, fixation of small styloids still remains a problem. Purpose To present the surgical details and results of patients operated using the buttress plate technique, due to the symptomatic ulnar styloid base nonunion. Patients and Methods In this study, 11 patients who underwent surgery for symptomatic ulnar styloid base nonunion using buttress plate technique were evaluated retrospectively. The patients were evaluated with the help of forearm and wrist range of motion, grip strength, disabilities of the arm, shoulder, and hand (DASH) score and visual analogue pain score. Results The mean follow-up period was 15 months (range: 13–21 months). Union was achieved in 10 patients. At the final follow-up, the forearm supination and pronation active range of motions were significantly higher than those in the preoperative period, the visual analogue pain score mean value was 0.7 (range: 0–5), and the DASH score mean value was 7 (range: 1–32). Conclusion We conclude that good results can be achieved with the buttress plate technique in patients with both large and small fragmented ulnar styloid base nonunions and no distal radioulnar joint instability. Level of Evidence This is a Level IV, therapeutic study.

Open Reduction and Internal Fixation of Intra-articular Distal Radius Fracture by Buttress Plate: An Outcome Assessment

This study aims to evaluate the surgery outcomes of distal radius fractures using open reduction and internal fixation (ORIF) with buttress plate in our hospital. 200 patients were included with age above 18 years, having distal radius fractures and who were treated by ORIF buttress plate. The patients who had intraarticular distal radius fractures were included in this study. Data was collected from hospital records. Mean age of our patients was 38.5 ± 8.3 years. Patients were assessed functionally using Gartland and Werley point system and anatomically (radiologically) using Sarmiento’s modification of Lindstrom criteria. Among study participants, 140 patients had excellent restoration (70%), 20 patients had good restoration (10%) and the rest had fair restoration. There were some complications among patients like superficial infection and injury to superficial branch of radial nerve. In the follow up, we notice stiffness in one case with reduced range of movement of wrist and fingers. In our study, we had good to excellent results in 80% cases, anatomically and functionally. We conclude from our study ORIF using buttress plate is the best method for managing displaced intra-articular distal radius fractures.