A 46-year-old man who suffered from a tissue defect and rupture of tibialis anterior tendon from a motor vehicle accident was reported here (Fig. 1). His preoperative AOFAS ankle-hindfoot score and ankle dorsiflexion strength were 53 and 3/5, respectively. One week later, a complete debridement was performed. We used the plate and screw technique to reconstruct the tendon insertion without tendon grafting (Fig. 2). The defect was recon- structed with anterolateral thigh free flap. After the operation, a short-leg cast was performed. Two weeks later, the flap was stable and the wound healed well. At a 14-month follow-up, both the postoperative AOFAS ankle-hindfoot score (95) and the ankle dorsiflexion strength (5/5) were much more elevated. Furthermore, he was able to walk without a visible limp (Fig. 3).
The rational behind the use of staples and conven- tional tension-band plate and screw system is based on Stevens et al.’s theory . Our newly designed system is also based on the theory. The system can correct angular deformities by arresting growth of the other side of the bone. The plate has two arms and a built-in hinge. Based on the previous studies, we designed the rotation of the two arms ranged from 155° to 170° to better fit the con- tour of the physis in all stages of angular correction. That automatic change can also disperse repeated stress on the surface of periosteum and perichondrium during walking. Therefore, the risk of fixation failure can be re- duced. Because of a better match between the implant and bone surface, residual stress at the rim of metaphy- seal screw hole was lower after implant removal.
The two treatment protocols for choice of fixation methods (MSP/DHS or IMN/DHS) are described in Table 1. In short, DHS was used in fractures considered as stable, whereas treatment protocol: MSP/DHS aimed to use MSP in all pertrochanteric fractures with 3 or more fragments and treatment protocol: IMN/DHS aimed to use IMN in fractures with intertrochanteric comminution or fracture extension below the trochanters. In subtro- chanteric fractures treatment protocol: MSP/DHS used locked MSP and treatment protocol: IMN/DHS used IMN. The implants used were the Medoff sliding plate (MSP) or Hansson plate (DHS) (Swemac Orthopaedics, Linköping, Sweden), or IM nails (Gamma Nail (Stryker, Kalamazoo, MI, USA), Intertan and Trochanteric Anterior Nail (Smith&Nephew, Memphis, TN, USA). The DHS and MSP were combined with either a Twin hook  (n = 697) (Swemac, Orthopaedics, Linköping, Sweden) or a lag screw (n = 5). The Twin hook wings may be retracted, which allowed percutaneous technique with the plate left in situ when adjustment, replacement or removal of the Twin hook was needed. The MSP was used in bi- axial or uniaxial mode (locking screw for the Twin hook/ lag screw). In treatment protocol: MSP/DHS repeat radio- graphs were obtained 10 days postoperatively when MSP was used in uniaxial mode. If axial sliding capacity of the plate was consumed (25 mm), or migration of the Twin
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a 20° angle to the joint surface). The distance between the proximal screws was 3.5 cm, and the screws were inserted 1 cm distal to the joint. The third screw was inserted into the apex of the triangular fragment. The 3D model of the T-shaped plate was created on the basis of a T-shaped surface cut from the tibia model to make the plate perfectly fit to the tibia with the utilization of reverse engineering techniques. Then, the model was imported to ANSYS software for re-meshing and subse- quent establishment of the finite element model. In this study, an eight-node hexahedron three-dimensional elem- ent was utilized in the selection of the unit type because it is more suitable for geometric non-linear analysis than second-order elements. The number of elements and nodes in each component are listed in Table 1.
I declare that the dissertation entitled “ A COMPARTIVE ANALYSIS OF FUNCTIONAL OUTCOME OF TIBIAL PLATEAU FRACTURES TREATED WITH PROXIMAL TIBIAL LOCKING PLATE WITH RAFT SCREW TECHNIQUE AND CONVENTIONAL BUTTRESS PLATING ” submitted by me for the degree of M.S is the record work carried out by me during the period of July 2013 to September 2014 under the guidance of PROF. N.DEEN MUHAMMAD ISMAIL M.S.Ortho.,D.Ortho., Director I/C, Institute of Orthopaedics and Traumatology, Madras Medical College, Chennai. This dissertation is submitted to the Tamilnadu Dr.M.G.R. Medical University, Chennai, in partial fulfillment of the University regulations for the award of degree of M.S.ORTHOPAEDICS (BRANCH-II) examination to be held in April 2015.
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DOI: 10.4236/ojo.2019.94008 82 Open Journal of Orthopedics Plate application is the most common surgical technique for unstable lateral malleolus fracture treatment . Nowadays, among the orthopedic surgeons, locking compression plate (LCP) use has an increasing popularity for fracture fixation with plates . LCP are commonly used for various fracture types  as well as lateral malleolus fracture. Locking plates have different application op- tions such as a compression plate or a neutralization plate     . In the neutralization plate technique, firstly fracture line is compressed with a lag screw, then LCP is applied. Fracture line is compressed with an LCP without using a lag srew in the compression plate technique    . In the li- terature, there are several biomechanical studies comparing different plate types and techniques for lateral malleolus fractures. They found similar construct sta- bility and strength to the compression and locking plates   .
Although various biomechanical parameters associated to failure of the osteosynthesis have been assessed, the actual failure mode has not. Possible failure modes include screw-bone, screw-plate, or plate failure. These could be influenced by distal screw length. First, shorter screws reduce the screw-bone contact area, which might increase the local damage around the screws during loading and therefore influence total plastic deformation. In this study, residual tilt was chosen as a surrogate parameter to quan- tify total plastic deformation . Other studies attempted to quantify residual deformation by the displacement at the fracture gap  or along the loading axis . Both parameters are considered less reliable than residual tilt due to their dependence on the specimen's geometry. The herein observed gender differences could be associated to gender differences in BMC or bone geometry. Second, shorter distal screws reduce the screws’ lever arm acting on the plate. This could have an impact on the screw- plate interface. Screw-plate failure, i.e. screw push-out, is a known complication following polyaxial VLPO [36, 37]. To our best knowledge, no biomechanical study has yet analysed this failure mode. In order to get a first insight, we conducted pre- and post-testing lateral radiographs and photographs to visually evaluate screw push-out (Additional file 1). For group A, five screw push-outs (screws 1 (×1), 5 (×2), 8 (×2)) occurred in three specimens. For group B, two screw push-outs (screws 5 (×2)) oc- curred in two specimens. Still, screw-plate failure is not only influenced by screw length, but by various parame- ters, including screw orientation and bone quality. Com- putational analyses are needed to assess the actual load distribution within the screw-plate construct. This would help to optimize the actual load distribution and thereby increase the construct’s overall stability.
Regarding the SHFZ plate, our main findings were that the average peak stress on the fracture zone (FZ-M and FZ-L) was higher than the average stress on the medial (M1–3) and lateral clavicle (L1–3) in all three loading conditions. Moreover, we found that the peak von Mises stress on the reference points nearest to the SHFZ (M3 and L1) were much higher than the other reference points for the medial and lateral clavicle (M1–2 and L2– 3) in all three loading conditions. Concerning the effect of different loads on the fracture zone, the average peak stress from the cantilever bending load (1194.45 MPa) was also much greater than the peak stress from the axial compression and axial torsion loads (182.57 MPa and 107.64, respectively). The highest peak stress value (maximal stress point) from the cantilever bending con- dition occurred at the FZ-M location in the SHFZ plate, as 1257.10 MPa (Table 2). These results imply that the screw holes above the comminuted fracture zone (FZ-M and FZ-L) have the greatest risk for implant failure in all Table 1 Material properties utilized in the finite element model
A total of 68 patients with proximal humeral fracture underwent angular stable plate fixation within the obser- vation period. One patient died shortly after surgery because of non-related diagnoses. Six patients were lost to follow-up as they did not appear at their outpatient- clinic appointments for unknown reasons. One patient (group C+) presented with an early wound infect which made it necessary to remove the plate just 13 days post- operatively. Thus, follow-up was possible only in 60 patients (mean age: 57.9 ± 17.5 years). Twenty-one patients formed group C- (mean age 54 ± 20). Thirty nine patients formed the Group C+ (mean age 60 ± 16). A short delta-split (minimally-invasive) approach was used in twelve patients (57.1%) of group C- but in only one patient (2.6%) of group C+. Mean follow-up was 6.1 ± 4.8 months (range C+ 6.7 ± 5.6 months/C- 5.0 ± 2.8 months). Out of these, humeral head necrosis occurred in 6 (15.4%) cases in patients with calcar screws and 3 (14.3%) without calcar screws (p = 1). It could be noticed that fracture morphology differed between both groups and group C+ included considerably more com- plex fractures (Table 1). Head necrosis, in fact, was seen only in three- or four-part fractures. Cut-out of the proximal screws (Figure 3) was observed in 3 (C+, 7.7%) and in 1 (C-, 4.8%) cases (p = 1). In each group one patient showed delayed fracture union (p = 1). Implant failure or loosening of the screw heads in the plate was not observed. Revision surgery due to the complications
system was developed, allowing surgeons to choose among 4.5-, 5.5-, and 6.5-mm solid stainless steel screws. However, it was difficulty to fix the small avulsion frac- tures with screws and there were several complications associated with them, such as irritability of screws head, injury of peripheral nerve, bone nonunion because of small diameter, and secondary fractures because of large diameter . Alternatively, LCP distal ulna hook plate may be a good choice. This plate has several advantages: (1) the fifth metatarsal tuberosity can be grasped tightly by the plate hook to maintain the stability of the peroneal tendons adhesion; (2) as a checkered plate, the re-displaced of fractures can be reduced. Joint surface collapse can be prevented by the support function of this plate; (3) this plate had good histocompatibility; (4) the fifth metatarsal’s bending curvature fitted to the LCP distal ulna hook plate; and (5) low profile, obtuse edge and polishing surface can reduce the irritability of the soft tissue . Vorlat, Achtergael and Haentjens reported that the most significant predictor of a poor functional outcome after these injuries was a prolonged period of non-weight-bearing . The advantage func- tional outcome of LCP distal ulna hook plate was related to the early weight-bearing.
10 patients were treated with 2mm 4 hole locking plates and 12 fracture sites in 10 patients were treated with 2mm miniplate fixation. Anatomic distribution of fracture sites was 13 angle, 11 parasymphysis and 2 body (Table II).Minor complications occurred in both groups though no significant difference in success rate was seen between groups treated with 2mm locking plate and screw and standard 2mm miniplate and scrws (Table III).
(SCAP-FN). The plate was a pre-contoured plate. The surface of the plate was designed to fit the morphology of the proximal femur, and the distribution of the three screws was also considered the geometrical morphology of the femoral neck. The data set we used included over 400 Chinese femurs, it was also used in our prior work. The angle between screws and plate was designed to fit the average of Chinese population. The neck shaft angle of Chinese femur was about 122° on average, and the angle between screws and plate was designed based on this data. Due to the screw of SCAP-FN could provide sliding after surgery, the interface of the plate and screw was designed as a locking mechanism, which could have better angular stability.
reduction is indicated we often prefer the use of more stable methods of fixation that is micro or mini plates and screws. Advantages of plate and screw fixation that are especially beneficial in the pediatric age group are no need for maxillomandibular fixation, decreased necessity for tracheostomy for airway management in polytrauma cases, early mobilization of patients with associated condylar fractures, minimal chance of damaging tooth buds compared to transosseous wiring, early return to normal oral feeding especially in an age group where metabolic and nutritional demands are high, and early mobilization of patients leading to less risk of ankylosis in cases of condylar fracture.
This over pressure is avoided when locking systems are used Although reports of the use of locking plate and screw systems for maxillofacial reconstruction have existed for more than three decades, their clinical use has not become popular until the last decade  Herford and Ellis concluded that “the use of a locking plate/ screw system was found to be simple and it offers advantages over conventional bone plates by not requiring the plate to be compressed to the bone to provide stability [6, 22].
Abstract: Background: Ankle arthrodesis is the gold standard and most commonly used method for the treatment of post-traumatic ankle arthritis. Aims: This study is to investigate the biomechanical safety and stability of four ankle fusion models through three-dimensional finite element analysis. Methods: Four ankle fusion models were established, including anterior plate ankle fusion model, lateral plate ankle fusion model, anterior plate plus pos- terolateral screw ankle fusion model and lateral plate plus posterolateral screw ankle fusion model. The four move- ment modes of the ankle internal rotation, external rotation, dorsiflexion and neutral mode were respectively simu- lated. The maximum displacement of the fusion surface and the stress of four movement modes were measured and analyzed. Results: The anterior plate plus posterolateral screw ankle fusion model had significantly decreased maximum surface displacement at all four movement modes than the anterior plate ankle fusion model (P<0.05). The maximum surface displacement of the lateral plate plus posterolateral screw plate ankle fusion model was sig- nificantly reduced at all four movement modes than that of the lateral plate ankle fusion model (P<0.05). Similarly, the stress peak of bone, plate and screw in the anterior/lateral plate plus posterolateral screw ankle fusion model was significantly reduced than that in the anterior/lateral plate ankle fusion model at the internal rotation state, the external rotation state and the dorsiflexion state, respectively (P<0.05). There was no significant difference at the neural state. Conclusion: The anterior/lateral plate plus posterolateral screw ankle fusion models have better fusion safety and higher fusion stability.
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Three different fixation devices were tested for recon- struction after the osteotomy: a radial head plate and screws (Stryker, Mahwah, NJ, USA) or two different ori- entations (crossed and parallel) of screw fixation (AO, Davos, Switzerland). The plate group included a plate construct involving five bicortical screws. In the crossed-screw group, the screws were placed approxi- mately 60° apart, as described by Smith and Hotchkiss . In the parallel-screw group, the screws were inserted in parallel to each other. The two screws were inserted into the radial head from the outer edge of the top at 45° of the radial head axis. The length of the two screws was uniform, and the distance between the two screws was 5 mm. The plate was placed in the safe zone of the radial head, which lies on the dorsal surface of the radius . The fixations were evaluated using X- ray images. Figure 1 shows X-rays of the reconstructed radial heads with the three different fixation devices de- scribed above. The transversely cut end of the radial shaft was then potted in a metal tube by using poly- methylmethacrylate (PMMA). Figure 2 displays some representative potted specimens. An Electro Force 3510 Tension torsion composite test system (Bose, MA, USA) was used to test the specimens. The testing ma- chine features up to ± 75,000 N of axial force capacity and ± 50 N m of torque capacity.
fractures [5 – 8], a high rate of complications has been re- ported related to the use of plates, of which screw pene- tration is the most frequent [4, 6, 9 – 11]. Patients with screw penetration may experience severe pain and re- quire subsequent revision surgery to remove the internal plate, which has a significant effect on rehabilitation. Screw penetration includes both primary and secondary screw penetration. The incidence of primary screw pene- tration is proximately 14%  it occurs during surgery and is considered to be an avoidable complication, pre- ventable by careful operation and appropriate fluoro- scopic detection during surgery. However, knowledge of the appropriate fluoroscopic detection is inadequate. Spross et al.  found that only the combination of four projections of fluoroscopic detection (neutral, 30° external rotation, 30° internal rotation and axial in 30°)
Eighteen fourth-generation synthetic clavicles (Pacific Research Laboratories, Vashon Island, WA, USA) were assigned to three groups according to fixation method (reconstruction plate, Knowles pin, and can- nulated screw). Previous studies have reported the comparable failure modes, stiffness, and strength of composite bones to cadaveric bones, but without the anatomical variability present in cadaveric models [11, 12]. Transverse osteotomy over the midpoint was performed with an oscillating saw to simulate a midshaft clavicle fracture. Then, the fragments were fixed anatomically by either extramedullary (recon- struction plate) or intramedullary (Knowles pin or cannulated screw) fixation.
efit when compared with other treatment modalities . Intramedullary osteosynthesis is used for fragment fixa- tion less frequently and good radiographic and functional outcomes have been published . However, its range of indications limited to the management of extra-articular and simple intra-articular fractures is a disadvantage of the method . Only a few clinical evaluations are available. Lerch et al.  in an isolated study on a small patient group report comparable results for plate and intramedullary os- teosyntheses (Targon DR, Aesculap Implant Systems, Cen- ter Valley, PA, U.S.A.) and relate the excellent functional scores for nailing to the minimally invasive procedure. Ilyas et al.  have reported that using the intramedullary nail (Micronail, Wright Medical Technologies, Arlington, TN, U.S.A.) in the treatment of displaced distal radius fractures can result in good functional outcome, but is associated with a high incidence of complications, i.e., screw penetra- tion into the distal radioulnar joint, and transient super- ﬁ cial radial sensory neuritis, . No studies evaluating the results of X-screw (Zimmer, Inc., Warsaw, IN, U.S.A.) in- tramedullary osteosynthesis have been published so far. Since for surgical stabilization to all types of dis- tal radius fractures multidirectional angle-stable plates
once implant is inserted; allows angular adjustment of side plate barrel to conform to different neck shaft angle and also allows free hand guide pin insertion and facilitates a centre guide pin location within the femoral head. The study was aimed to assess the functional outcome (clinical and radiological) of Variable hip screw (VHS) in trochanteric fractures of femur.