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Background and Objectives: Hook plate fixation has been widely used for unstable distal clavicle fractures, but concerns remain regarding implant-related complications and the need for secondary removal. Locking plate fixation with supplementary cerclage wiring has been proposed as an alternative that may provide stability while reducing complications. This study compared the clinical and radiologic outcomes of locking plate fixation with cerclage wiring versus hook plate fixation. Materials and Methods: A retrospective review was performed on patients who underwent open reduction and internal fixation for unstable distal clavicle fractures (Cho’s classification type II) between 2015 and 2024. Patients with at least 6 months of follow-up were included. Two techniques were evaluated: locking plate with cerclage wiring (Group 1) and hook plate fixation (Group 2). Clinical outcomes, including complications, range of motion, and patient satisfaction, were compared at the final follow-up. Results: A total of 52 patients met the inclusion criteria: 27 in Group 1 and 25 in Group 2. The overall mean follow-up period was 13.17 ± 8.46 months. The distribution of fracture types was not significantly different between groups (p = 0.287). Complications were more frequent in Group 2 (40%), including postoperative stiffness requiring capsular release (70%), nonunion requiring revision (20%), and peri-implant fracture (10%). The overall union rate was 100% in Group 1 and 80% in Group 2. In contrast, Group 1 had only one complication (3.7%), a peri-implant fracture (p = 0.002). Shoulder range of motion at the final follow-up showed no significant difference between groups. Conclusions: Hook plate fixation was associated with a significantly higher complication rate compared with locking plate fixation with cerclage wiring. Locking plate fixation with supplementary cerclage wiring appears to be a better surgical option for unstable distal clavicle fractures.

There is an unmet need for improved, clinically relevant methods to longitudinally quantify bone healing during fracture care. Here we develop a smart bone plate to wirelessly monitor healing utilizing electrical impedance spectroscopy (EIS) to provide real-time data on tissue composition within the fracture callus. To validate our technology, we created a 1-mm rabbit tibial defect and fixed the bone with a standard veterinary plate modified with a custom-designed housing that included two impedance sensors capable of wireless transmission. Impedance magnitude and phase measurements were transmitted every 48 h for up to 10 weeks. Bone healing was assessed by X-ray, µCT, and histology. Our results indicated the sensors successfully incorporated into the fracture callus and did not impede repair. Electrical impedance, resistance, and reactance increased steadily from weeks 3 to 7—corresponding to the transition from hematoma to cartilage to bone within the fracture gap—then plateaued as the bone began to consolidate. These three electrical readings significantly correlated with traditional measurements of bone healing and successfully distinguished between union and not-healed fractures, with the strongest relationship found with impedance magnitude. These results suggest that our EIS smart bone plate can provide continuous and highly sensitive quantitative tissue measurements throughout the course of fracture healing to better guide personalized clinical care.

A total of 66 smart implants were included. As a measure of bony stability, the relative elastic compliance of the osteosynthesis was determined from the gradient between the applied external load and the measured implant load over the entire healing process. The healing process of non-unions of the femur with a smart implant was tracked by telemetric measurements over a timespan of up to 10 years. The measurements of the longest healing process show a very slow but constant decrease in force transmission over the implant, radiological findings over 10 years show corresponding consolidation until bony healing. The use of a telemetrically instrumented bone plate, a so-called smart implant, to monitor the healing process is a successful procedure to support the clinician in his decision to take further surgical measures or to wait until healing occurs.

Background Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage. Objective We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture. Materials and methods We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups. Results The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively. Conclusion Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

Background Finite element analysis (FEA) could advance the understanding of fracture fixation and guide the choice of surgical treatment. This study aimed to compare two internal fixation methods in the treatment of displaced proximal humeral fracture (PHF) through FEA. Methods Three-dimensional FEA model based on the left shoulder joint of a 67-year-old female patient with PHFs and osteoporosis was adopted, in order to analyze the fixation effect and load stress distribution of internal fixation plates with open reduction and intramedullary nails without opening the fracture in the treatment of Neer III-VI PHF. Results The displacement of the distal humerus with intramedullary nail fixation was more obvious than that of the distal humerus with bone plate fixation, and the resistance of intramedullary nail fixation was less than that of bone plate fixation under the same stress load. Maximum stress on the screw when adopting the intramedullary nail fixation was smaller than that when adopting the internal fixation with the internal fixation plates. The strain data indicate that the strain of both the fixation device and the bone when adopting the internal fixation with the intramedullary nails is less than that when adopting the internal fixation with the internal fixation plates. Conclusions Biomechanical analysis demonstrated that for complex fracture types with osteoporosis intramedullary nail system without opening the fracture had better stress dispersion than internal fixation plates with open reduction, and the risk of failure of central fixation was lower.

Background Locked plating of femur fractures is associated with secondary peri-implant fractures which may be a result of stress concentrations at the proximal plate end region. The aim of this study was to investigate whether the strength of healed femoral bone-locking-compression-plate constructs can be increased by modifying the screw configurations and plate length to minimize the risks of peri-implant femur fractures. Methods The detached shaft of a variable angle condylar locking compression plate (VA-LCP Condylar Plate; Johnson & Johnson MedTech) was fixed to the proximal two-third of twenty-four intact artificial femurs in four different configurations ( n  = 6) distinguished by either using a short plate with cortical or locking screws whereby the most proximal screw was inserted in the femoral shaft 50 mm below the lesser trochanter, or using a long plate with either cortical or locking screws whereby the most proximal screw was positioned in the femoral neck. Simulating a situation after fracture healing, constructs were cyclically tested under progressively increased loading until catastrophic failure. Results Long plates fixed with a cortical screws demonstrated the highest failure load (1091 N ± 142 N) which was significantly higher compared to long plates fixed with locking screws (888 N ± 80 N), short plates fixed with cortical screws (471 N ± 42 N), and short plates fixed with locking screws (450 N ± 19 N). In addition, whereas the locking screw construct with a long plate was associated with a significantly higher failure load compared to both short plate constructs, there were no significant differences between the latter two. The failure modes were predominantly characterized by neck screw pull-out in both long plate constructs and peri-implant bone fractures at the most proximal screw in both constructs with short plates. None of the specimens exhibited a femoral neck fracture. Conclusion The findings of this study performed on synthetic bones indicate that from a biomechanical perspective long plates that extend into the femoral neck sustained higher failure loads compared to short plates. In addition, long plates fixed with a cortical neck screw further enhanced the construct strength and reduced the risk of peri-implant fractures compared to the use of a locking neck screw. Therefore, this study supports the use of long locking plates combined with use of cortical neck screws, particularly in high-risk patients, such as those with severe osteoporosis.

Background and Objectives: Adolescent diaphyseal clavicle fracture surgery has increased in recent years. However, the optimal operative method remains debated, particularly between elastic stable intramedullary nailing (ESIN) and plate fixation. This study compared postoperative outcomes and complication rates between ESIN and plate fixation for treating diaphyseal clavicle fractures in adolescent patients. Materials and Methods: We conducted a retrospective review of 35 adolescents who underwent surgery for diaphyseal clavicle fractures between 2010 and 2024. Patients were assigned to either the ESIN group (n = 18) or the plate fixation group (n = 17). Postoperative outcomes assessed included the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, intraoperative time, time to complete fracture union, and clavicle shortening at 1 year postoperatively. Postoperative complications were also evaluated. Results: Fracture union occurred significantly faster with ESIN than with plate fixation, specifically 3 weeks earlier (11.0 weeks vs. 14.0 weeks; p < 0.001). No significant differences were observed between the groups in QuickDASH scores, intraoperative time, or clavicle shortening at 1 year. The overall postoperative complication rate was 25.7% (9/35), with no statistically significant difference between the ESIN (27.8%) and plate fixation groups (23.5%) (p = 0.774). Refractures occurred exclusively in the plate fixation group (n = 2), while one patient in the ESIN group required early nail removal due to insertion site irritation. Conclusions: ESIN provided functional and radiographic outcomes comparable to plate fixation in adolescents with diaphyseal clavicle fractures, with a 3-week shorter time to union and a less-invasive surgical approach.

Locking Plates in Veterinary Orthopedics is a comprehensive and state-of-the-art guide to all aspects of using locking plates to treat orthopedic conditions in dogs, cats, and large animals. • Offers a proven approach to using locking plates in veterinary practice • Highlights practical clinical applications with illustrative clinical cases • Includes information on the history, principles, and materials as well as specific techniques • Presents data on both traumatic and non-traumatic applications • Provides instructive color photographs to demonstrate the procedures

Background: Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures. Methods: We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures (PHFs) with a locking plate between September 2007 and June 2013. All cases were then subdivided into one of four groups as follows: 75 patients in the medial cortical support (MCS) group, 26 patients in the medial multiscrew support (MMSS) group, 29 patients in the medial single screw support (MSSS) group, and 51 patients in the no medial support (NMS) group. Clinical and radiographic evaluations included the Constant-Murley score (CM), visual analogue scale (VAS), complications, and revision surgeries. The neck-shaft angle (NSA) was measured in a true anteroposterior radiograph immediately postoperation and at final follow-up. One-way analysis of variance or Kruskal-Wallis test was used for statistical analysis of measurement data, and Chi-square test or Fisher's exact test was used for categorical data. Results: The mean postoperative NSAs were 133.46° ± 6.01°, 132.39° ± 7.77°, 135.17° ± 10.15°, and 132.41° ± 7.16° in the MCS, MMSS, MSSS, and NMS groups, respectively, and no significant differences were found (F = 1.02, P = 0.387). In the final follow-up, the NSAs were 132.79° ± 6.02°, 130.19° ± 9.25°, 131.28° ± 12.85°, and 127.35° ± 8.50° in the MCS, MMSS, MSSS, and NMS groups, respectively (F = 4.40, P = 0.008). There were marked differences in the NSA at the final follow-up between the MCS and NMS groups (P = 0.004). The median (interquartile range [IQR]) NSA losses were 0.0° (0.0-1.0)°, 1.3° (0.0-3.1)°, 1.5° (1.0-5.2)°, and 4.0° (1.2-7.1)° in the MCS, MMSS, MSSS, and NMS groups, respectively (H = 60.66, P < 0.001). There were marked differences in NSA loss between the MCS and the other three groups (MCS vs. MMSS, Z = 3.16, P = 0.002; MCS vs. MSSS, Z = 4.78, P < 0.001; and MCS vs. NMS, Z = 7.34, P < 0.001). There was also significantly less NSA loss observed in the MMSS group compared to the NMS group (Z = −3.16, P = 0.002). However, there were no significant differences between the MMSS and MSSS groups (Z = −1.65, P = 0.225) or the MSSS and NMS groups (Z = −1.21, P = 0.099). The average CM scores were 81.35 ± 9.79, 78.04 ± 8.97, 72.76 ± 10.98, and 67.33 ± 12.31 points in the MCS, MMSS, MSSS, and NMS groups, respectively (F = 18.68, P < 0.001). The rates of excellent and good CM scores were 86.67%, 80.77%, 65.52%, and 43.14% in the MCS, MMSS, MSSS, and NMS groups, respectively (χ2 = 29.25, P < 0.001). The median (IQR) VAS scores were 1 (0-2), 1 (0-2), 2 (1-3), and 3 (1-5) points in the MCS, MMSS, MSSS, and NMS groups, respectively (H = 27.80, P < 0.001). Functional recovery was markedly better and VAS values were lower in the MCS and MMSS groups (for CM scores: MCS vs. MSSS, P < 0.001; MCS vs. NMS, P < 0.001; MMSS vs. MSSS, P = 0.031; and MMSS vs. NMS, P < 0.001 and for VAS values: MCS vs. MSSS, Z = 3.31, P = 0.001; MCS vs. NMS, Z = 4.64, P < 0.001; MMSS vs. MSSS, Z = −2.09, P = 0.037; and MMSS vs. NMS, Z = −3.16, P = 0.003). Conclusions: Medial support screws might help enhance mechanical stability and maintain fracture reduction when used to treat PHFs with medial metaphyseal comminution or malreduction.

To achieve a personalized bio-fixed mandibular bone plate with high matching, mechanical properties, and biocompatibility, this study employed a combination of reverse and forward design methodologies to complete modeling of the mandibular bone plate. Stress analysis was conducted on eight working conditions. Subsequently, under the most extreme condition, topology optimization was applied to refine the shape of the bone plate, followed by filling it with hexahedral lattice structures. Finally, SLM equipment was employed to fabricate the bio-fixed mandibular bone plate, and its performance was evaluated. The results indicate that after topology optimization and porous structure filling, the weight of the plate decreased from 5.47 g to 2.82 g (a reduction of 49%), while the maximum stress increased from 214.1 MPa to 350.9 MPa (an increase of 64%), and the maximum displacement increased from 0.6669 mm to 0.9722 mm (an increase of 45.78%). This enhancement can effectively mitigate stress-shielding effects. The 3D-printed personalized bio-fixed bone plate features a smooth surface, clear pore structure, and excellent bonding. The fit between the bone plate and the mandible model is tight and easy to install, meeting the required standards. This study provides a robust foundation for the application of SLM in manufacturing personalized bio-fixed bone plates.