Explore the vast range of titles available.

IntroductionCoronal plane fractures of the distal humerus are relatively rare and can be challenging to treat due to their complexity and intra-articular nature. There is no gold standard for surgical management of these complex fractures. The purpose of this study was to compare the biomechanical stability and strength of two different internal fixation techniques for complex coronal plane fractures of the capitellum with posterior comminution.Materials and methodsFourteen fresh frozen, age- and gender-matched cadaveric elbows were 3D-navigated osteotomized simulating a Dubberley type IIB fracture. Specimens were randomized into one of two treatment groups and stabilized with an anterior antiglide plate with additional anteroposterior cannulated headless compression screws (group antiGP + HCS) or a posterolateral distal humerus locking plate with lateral extension (group PLP). Cyclic testing was performed with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure.ResultsThere was no significant difference in displacement during 2000 cycles (p = 0.291), stiffness (310 vs. 347 N/mm; p = 0.612) or ultimate load to failure (649 ± 351 vs. 887 ± 187 N; p = 0.140) between the two groups.ConclusionsPosterolateral distal humerus locking plate achieves equal biomechanical fixation strength as an anterior antiglide plate with additional anteroposterior cannulated headless compression screws for fracture fixation of complex coronal plane fractures of the capitellum. These results support the use of a posterolateral distal humerus locking plate considering the clinical advantages of less invasive surgery and extraarticular metalware.Level of evidenceBiomechanical study.

Background Interest in less invasive surgeries for Weber type B distal fibular fracture has increased recently. This study aimed to demonstrate that nitinol staple-only fixation is less invasive compared to antiglide plate fixation. Materials and methods This retrospective review involved 59 patients with Weber type B fibular fractures who underwent surgery between 2018 and 2023. Twenty-eight patients underwent antiglide plate fixation, whereas 31 underwent multiple nitinol staple-only fixation. The intraoperative assessment included skin incision length and operative time. The radiographic outcomes were bone union and fibular length. The clinical outcomes included delayed wound healing, infection, discomfort from the implant, implant removal, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score administered at the last visit. Results The mean skin incision length and operative time of nitinol staple-only fixation were 3.8 ± 0.5 cm and 19.6 ± 3.6 min, compared with 8.7 ± 1.3 cm and 48.8 ± 10.6 min for plate fixation, respectively. Bone union was confirmed in all patients without fibular shortening. Although no significant differences in patients with delayed wound healing, infection, or postoperative SAFE-Q scores were found between the two groups, more patients with plate fixation reported discomfort from the implant (71.4% vs. 32.3%) and requested its removal (75.0% vs. 35.5%). Conclusion Multiple nitinol staple-only fixations offer the advantages of a smaller skin incision, shorter operative time, lesser discomfort from the implants, and a reduced need for implant removal compared with antiglide plate fixation. Furthermore, staple-only fixation could achieve bone union without loss of correction. This suggests that multiple nitinol staple-only fixation may be less invasive and more beneficial for patients than antiglide plate fixation.

Displaced fractures (> 2 mm) of the lateral malleolus, without medial or syndesmotic injuries, are often the subject of controversy regarding the best treatment option. In the past, these fractures were usually treated conservatively using a cast for 6 to 8 weeks without weightbearing. Currently, most of the patients desire a quick return to their previous activities, what makes surgical treatment a reasonable choice. It has benefits as earlier ankle mobilization and weightbearing. It also restores ankle biomechanics, preventing secondary osteoarthritis. However, postoperative complications with the standard lateral incision exist such as implant discomfort, dehiscence and infection. Minimally invasive techniques have been described to help avoiding these complications. This technical note described a short single-incision approach for the surgical treatment of displaced oblique fibular fractures type AO/OTA 44-B1 with an antiglide plate that presents the advantage of less risk of damaging the soft tissues, periosteal stripping and disturbance of the fracture hematoma.

Objectives The goal of this study is to determine the efficacy of the surgical treatment of lateral Hoffa fracture with a locking plate and cannulated or lag screws through the lateral approach. Materials and methods A total of 12 isolated lateral Hoffa fractures were identified during the study period (February 2005 to February 2010). All fractures were treated by open reduction through the lateral approach. Internal fixation was performed with a contoured locking plate and cannulated or lag screws introduced from the non-weight-bearing area of the cartilage surface of the lateral femoral condyle. Radiological and functional outcome analysis was performed using Knee Society scores. Results Bony union of Hoffa fracture was achieved in all patients. The articular surface of lateral femoral condyle was anatomically reduced. There was no loss of reduction and fixation. Functional outcome of knee measurements showed a continuous significant improvement over the follow-up period. Conclusion Fixation with a locking plate and cannulated or lag screws for lateral Hoffa fracture seemed to be effective and reliable. The lateral approach had advantages for reduction and fixation of lateral Hoffa fracture during operation.