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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.

Introduction Currently, the T-shaped titanium Tomofix bone plate is the most commonly used internal fixation bone plate in Open-wedge high tibial osteotomy (HTO). However, the modulus of elasticity of the hard titanium alloy plate does not match the modulus of elasticity of the human cortical bone, resulting in a large “stress shielding effect.” At the same time, HTO bone plates have a certain elasticity of demand. Materials and methods In this study, the classical mechanical properties of carbon fibre/Kevlar composite plates were tested in bending, tensile and compression with different weaves ((plain weave/twill weave/W-weave/I-weave) and thicknesses. The biomechanical results after internal fixation of titanium and carbon fibre/Kevlar composite HTO bone plates of three different thicknesses (2.0 mm, 2.5 mm, and 3.0 mm) were analyzed and compared using the finite element analysis (FEA) method, and their biocompatibility was investigated by the cell proliferation assay, and the analysis of live/dead staining activity. Results The combination of mechanical strength and toughness of the 2.0 mm thick twill weave carbon fibre/Kevlar composite bone plate showed the best performance and a modulus of elasticity of 44.5 GPa.The finite element simulation shows that the 2.0 mm thick twill carbon fibre/Kevlar elastic composite bone graft plate has the best effect in reducing the “stress shielding effect”. In addition, the carbon fibre/Kevlar material has good biocompatibility, and it does not react with hemolysis. Conclusion The 2.0 mm twill weave carbon fibre/Kevlar elastic composite bone plate has sufficient strength and excellent toughness, and its modulus of elasticity is more compatible with human cortical bone, which fully meets the special demand for elasticity of HTO bone plate and at the same time, reduces the “stress shielding effect” with the best effect. Therefore, carbon fibre/Kevlar composites have great potential in the application of HTO bone plates.

Background Proximal humeral fractures (PHFs) are the third most common fracture in older patients. The purpose of the study was to prospectively evaluate the outcomes of PHF fixation with a locking blade nail (LBN) or locking plate (PHILOS) osteosynthesis in a homogeneous elderly patient population. Methods Inclusion criteria were an age > 60 years and the capacity to give informed consent. Patients with isolated tuberosity fractures, previous trauma or surgery, advanced osteoarthritis, fracture dislocation, pathological fractures, open fractures, neurological disorders, full-thickness rotator cuff tears, fracture line at the nail entry point or severely reduced bone quality intra-operatively were excluded. Eighty one patients with PHFs were randomised to treatment using LBN or PHILOS. Outcome measures comprised Constant score, age and gender adjusted Constant score, DASH score, VAS for pain, subjective overall condition of the shoulder (1–6) and active shoulder range-of-motion in flexion and abduction. Plain radiographs were obtained in two planes. All data were collected by an independent observer at 3, 6 and 12 months postoperatively. Results Thirteen patients were excluded intra-operatively due to rotator cuff tears, fracture morphology or poor bone-quality. Of the remaining 68 patients, 27 in the LBN and 28 in the PHILOS group completed the full follow-up. Mean age at surgery was 75.6 years and the majority of PHFs were three-part fractures (49 patients). Baseline demographics between groups were comparable. All outcome measures improved between assessments ( p  < 0.001). The LBN group showed improved DASH scores as compared to PHILOS at 12 months ( p  = 0.042) with fewer incidences of secondary loss of reduction and screw cut-out ( p  = 0.039). A total of 29 complications (in 23 patients) were recorded, 13 complications (in 12 patients) in the LBN group and 16 complications (in 11 patients) in the PHILOS group ( p  = 0.941). No significant inter-group difference was observed for any other outcome measures, nor was fracture morphology seen to be associated with clinical outcome or complication rate. Conclusions At short-term follow-up, LBN osteosynthesis yielded similar outcomes and complication rates to PHILOS plate fracture fixation in an elderly patient population, though with a significantly lower rate of secondary loss of reduction and screw cut-out. Registration trial No. DRKS00015245 at Deutsches Register Klinischer Studien, registered: 22.08.2018, retrospectively registered.

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 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.

Objective This study was performed to compare the clinical effects of locking plates (LPs) with those of hook plates (HPs) in the treatment of Neer type II distal clavicle fractures. Methods From August 2014 to April 2018, 64 patients with Neer type II distal clavicle fractures were treated in our department. The clinical effects were assessed with respect to the operation time, intraoperative blood loss, incision length, fracture healing, postoperative pain, postoperative complications, and postoperative shoulder joint function. Results There were no significant differences in the healing time, operation time, or intraoperative blood loss between the LP and HP groups. The incision length was significantly shorter in the LP than HP group, and the postoperative complication rate was significantly lower in the LP than HP group. The visual analog scale score, Constant–Murley score, and University of California Los Angeles score were significantly better in the LP than HP group. Conclusions Compared with HPs, the use of LPs involves a smaller incision in the treatment of Neer type II distal clavicle fractures and significantly reduces postoperative pain and complications. Therefore, priority can be given to the use of LPs in the treatment of Neer type II distal clavicle fractures.

Background It is common for physicians to opt for surgical correction of hallux valgus deformities using implants, but post-operative complications are frequently reported. A novel h-shaped plate developed by the authors offers both endosteal and lateral fixation, helping to resist displacement in multiple directions. This study aims to assess the mechanical properties and stability of the h-shaped plate in comparison to various commercially available endosteal plating systems in a simulated hallux valgus correction model using finite element analysis. Methods Finite element models of four different endosteal plates were developed and used to simulate a hallux valgus correction. The distal end of the metatarsal in each model was loaded at 87.5 N, which is the maximum load experienced during cyclic testing. The load was applied in various directions to simulate different metatarsal movements, including plantar flexion, dorsiflexion, abduction, and adduction of the first metatarsal bone. The mechanical properties and stability of each model was recorded for comparison. Results When placed under dorsal-to-plantar loading, the model with a h-shaped plate was the most stable of all models, with a displacement of 0.278 mm, plate stress of 429.51 MPa, and screw stress of 294.97 MPa. Under medial-to-lateral loading, the model with a h-shaped plate demonstrated the lowest displacement of 0.152 mm, and plate and screw stresses of 254.27 MPa and 195.40 MPa, respectively. Conclusion For stabilizing distal chevron osteotomies, the h-shaped bone plate showed greater resistance to displacement in the dorsal-to-plantar and medial-to-lateral directions than the commercially available implants evaluated in this study. The h-shaped plate also presented a lower risk of screw pull-out, which helps to maintain bone alignment postoperatively.