BACKGROUND: This study\'s purpose was to evaluate the biomechanical performance of plate-nail and dual-plate fixation for the treatment of AO/OTA 41-C2 tibial plateau fractures.
METHODS: Twenty synthetic tibias were selected and randomly divided into a plate-nail group (n = 10) and a dual-plate group (n = 10). After the artificial tibias were osteotomized to simulate AO/OTA 41-C2 tibial plateau fractures in both groups, the plate-nail and the dual-plate methods, respectively, were used for fixation, and then axial compression loading, three-point bending, torsion, and axial failure tests were carried out. The data of each group were recorded and statistically analyzed.
RESULTS: In the axial compression test, the average stiffness of the plate-nail group was higher than that of the dual-plate group (p < 0.05). The displacement generated in the plate-nail group was significantly smaller than that in the dual-plate group (p < 0.05). In the resisting varus test, the stress of the plate-nail group was significantly higher than that of the dual-plate group (p < 0.05). In the resisting valgus test, the stress of the plate-nail group was slightly higher than that of the dual-plate group, but the difference was not statistically significant (p > 0.05). In the static torsion test, the load applied to the plate-nail group was smaller than that of the dual-plate group when rotated to 5° (p < 0.05). In the axial compression failure test, the average ultimate load of the plate-nail group was significantly higher than that of the dual-plate group (p < 0.05).
CONCLUSIONS: The treatment of AO/OTA 41-C2 tibial plateau fractures with plate-nail fixation is superior to that with dual-plate fixation in resisting axial stress and preventing tibial varus deformity, while dual-plate fixation has better resisting torsional ability.

UNASSIGNED: To investigate whether the shape of the food plate could affect the conservation of praxis in institutionalised elderly adults with severe Alzheimer\'s disease or mixed dementia.
UNASSIGNED: We conducted a monocentric, prospective, observational, before-after case-only study in 32 patients with a loss of the ability to self-feed. The primary objective was to assess the change of food praxis using the Blandford scale at 3 weeks after changing the food plate. Secondary variables included the impact of the change of diet on the food praxis at 6 weeks, the patient\'s autonomy in the food intake evaluated by Tully\'s Eating Behaviour Scale (EBS), and the enjoyment of eating assessed by Part D of the Alzheimer\'s Disease-Related Quality of Life (ADRQL) scale at 3 and 6 weeks. Results: At 3 weeks after changing the food plate we observed a significant decrease in the number of aversive feeding behaviours (Δ = -0.90 ± 2.23; p = 0.03) and an improved autonomy in self-feeding (Δ = 1.88 ± 3.36.23; p = 0.001). There was also an increase in the enjoyment of eating at 3 weeks (Δ = 4.07 ± 13.02), but it was not statistically significant. These results were not consolidated at the 6 week timepoint. Conclusion: A simple change in the organisation of care during meals and the use of a familiar object can positively affect the recovery of the self-feeding autonomy of patients with severe dementia.

BACKGROUND: Various fixation methods are available for tibiotalocalcaneal arthrodesis: nail, plate, or screws. An intramedullary bone stabilization system within a balloon catheter has not previously been used in tibiotalocalcaneal arthrodesis. The aim of this study was to compare the stability of these techniques.
METHODS: Twenty-four lower legs from fresh-frozen human cadavers were used. Tibiotalocalcaneal arthrodesis was performed with a retrograde nail, a lateral locking plate, three cancellous screws, or an intramedullary bone stabilization system. The ankles were loaded cyclically in plantarflexion and dorsiflexion.
RESULTS: For cyclic loading at 125 N, the mean range of motion was 1.7 mm for nail, 2.2 mm for plate, 6.0 mm for screws, and 9.0 mm for the bone stabilization system (P < .01). For cyclic loading at 250 N, the mean range of motion was 4.4 mm for nail, 7.5 mm for plate, 12.1 mm for screws, and 14.6 mm for the bone stabilization system (P < .01). The mean cycle of failure was 4191 for nail, 3553 for plate, 3725 for screws, and 2132 for the bone stabilization system (P = .10).
CONCLUSIONS: The stability of the tibiotalocalcaneal arthrodesis differs depending on the fixation method, with nail or plate showing the greatest stability and the bone stabilization system the least. When three screws are used for tibiotalocalcaneal arthrodesis, the stability is intermediate. As the biomechanical stability of the bone stabilization system is low, it cannot be recommended for tibiotalocalcaneal arthrodesis.

BACKGROUND: The risk of avascular necrosis, nonunion, or malunion is high in osteoporosis-related 4-part fractures. We evaluated the results of patients who underwent plate osteosynthesis with a vascularized pectoralis major graft compared with tricortical iliac grafting to treat 4-part proximal humerus fractures.
METHODS: Thirty-four patients aged 50-75 years with Neer 4-part proximal humerus fractures were studied. Group A (n = 17) underwent osteotomy of a 2.5 ± 1 cm pectoralis major pedicle bone graft and plate application, whereas group B (n = 17) underwent plate osteosynthesis using iliac autogenous grafts. Final follow-up assessments included evaluation using Constant and American Shoulder and Elbow Surgeons scoring systems, humeral neck-shaft angle (HNSA), humeral head height, and humeral head avascular necrosis.
RESULTS: Reduction loss was observed in 3 patients (17.6%) in group A, whereas it was observed in 10 patients (58.8%) in group B (P = .013). Humeral head avascular necrosis was found in 1 patient (5.8%) in group A, whereas it was found in 5 patients (29.4%) in the other group (P = .071). The HNSA was normal in 12 (70.5%) of group A patients, whereas it was normal in 6 (35.2%) of group B patients. The HNSA was weak or bad (<1200) in 29.4% of group A patients, whereas this rate was 64.7% in group B patients. Humeral head height was 2.64 ± 1.45 mm in group A and 3.66 ± 1.65 mm in group B. There were no statistically significant differences between the 2 groups in terms of Constant and American Shoulder and Elbow Surgeons scoring systems.
CONCLUSIONS: Pectoralis major bone pedicle graft in Neer 4-part proximal humerus fractures reduces the risk of avascular necrosis and nonunion rates. Our technique yielded excellent clinical and radiological results. We achieved recovery without creating additional donor site morbidity.

BACKGROUND: Open reduction and plate internal fixation (ORIF) is one of the most common treatment methods for proximal humeral fractures. Complications associated with the greater tuberosity (GT) are rarely reported, therefore, the purpose of this study was to analyze the complications associated with the GT and the risk factors after locked-plate internal fixation.
METHODS: We retrospectively analyzed the medical and radiographic data of patients with proximal humeral fractures involving the GT treated with locking plates between January 2016 and July 2019. We divided all patients into two groups, the anatomic GT healing group and the nonanatomic GT healing group, depending on the radiographic outcomes of the GT. Clinical outcome was assessed by the Constant scoring system. Potential risk factors included preoperative and intraoperative factors. Preoperative factors included sex, age, body mass index, fracture type, fracture-dislocation, proximal humeral bone mineral density, humeral head extension, hinge integrity, comminuted GT, volume and surface area of the main GT fragment, and displacement of the main GT fragment. Intraoperative factors were adequate medial support, residual head-shaft displacement, head-shaft angle and residual GT displacement. Univariate logistic regression and multivariate logistic regression were used to identify risk factors.
RESULTS: There were 207 patients (130 women and 77 men; mean age, 55 years). GT anatomic healing was observed in 139 (67.1%) patients and nonanatomic healing in 68 (32.9%). Patients with GT nonanatomic healing had significantly inferior Constant scores than those with GT anatomic healing (75.0 ± 13.9 vs. 83.9 ± 11.8, P < 0.001). Patients with high GT malposition had worse Constant scores than patients with low GT malposition (73.3 ± 12.7 vs. 81.1 ± 11.4, P = 0.039). The multivariate logistic model showed that GT fracture characteristics were not risk factors for nonanatomic GT healing, while residual GT displacement was.
CONCLUSIONS: Nonanatomic healing of the GT is a high-rate complication of proximal humeral fractures, resulting in inferior clinical outcomes, especially for high GT malposition. Fracture characteristics of the GT are not risk factors for GT nonanatomic healing and GT comminution should not be regarded as a contraindication to ORIF for proximal humeral fractures.

Background: To compare the observed healthcare and societal costs of intramedullary screw (IMS) and plate fixation of extra-articular metacarpal and phalangeal fractures in a contemporary Australian context. Methods: A retrospective analysis, based on previously published data, was performed utilising information from Australian public and private hospitals, the Medicare Benefits Schedule (MBS) and the Australian Bureau of Statistics. Results: Plate fixation demonstrated longer surgical lengths (32 minutes, compared to 25 minutes), greater hardware costs (AUD 1,088 vs. AUD 355), more extended follow-up requirements (6.3 months, compared to 5 months) and higher rates of subsequent hardware removal (24% compared to 4.6%), resulting in an increased healthcare expenditure of AUD 1,519.41 in the public system, and AUD 1,698.59 in the private sector. Wage losses were estimated at AUD 15,515.78 when the fracture cohort is fixed by a plate, and AUD 13,542.43 when using an IMS - a differential of AUD 1,973.35. Conclusions: There is a substantial saving to both the health system and the patient when using IMS fixation over dorsal plating for the fixation of extra-articular metacarpal and phalangeal fractures. Level of Evidence: Level III (Cost Utility).

BACKGROUND: Open reduction and plate osteosynthesis are considered as a successful technique for the treatment of proximal humerus fracture (PHF) despite high complication rates. The objective of our study was to review the clinical outcome and complications of the Anatomic Locking Plate System (ALPS) and compare it to the Proximal Humeral Internal Locking System (PHILOS). Our hypothesis was that ranges of motion (ROM) were superior and complication rates were lower with ALPS.
METHODS: Twenty patients treated with ALPS for PHF were retrospectively compared to 27 patients treated with PHILOS. Union, ROM and complications were clinically and radiologically assessed at 6 weeks, 3, 6, 12 and 18-24 months post-operatively.
RESULTS: Mean age was 52 ± 14 in the ALPS group and 58 ± 13 in the PHILOS group. Last follow-ups were conducted at a mean of 20.6 ± 4.8 months. Mean shoulder abduction was superior with ALPS by 14° (p-value = 0.036), 15° (p-value = 0.049), and 15° (p-value = 0.049) at 3, 6, and 12 months respectively. Mean shoulder external rotation was superior with ALPS by 11° (p-value = 0.032), 15° (p-value = 0.010) and 12° (p-value = 0.016) at 6 weeks, 3 and 6 months respectively. At the end of the follow-up, ROM remained better with ALPS, but not significantly. Complication rates over 21 months reached 20% with ALPS and 48% with PHILOS (p-value = 0.045). Implant removal rates reached 10% with ALPS and 37% with PHILOS (p-value = 0.036). Avascular necrosis was the only cause for hardware removal in the ALPS group.
CONCLUSIONS: The ALPS group showed better clinical outcomes with faster recovery in abduction and external rotation, although no difference in ROM remained after 21 months. Additionally, the complications rate was lower at last follow up. In our experience, the ALPS plating system is an effective management option in some PHF.

OBJECTIVE: Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures.
METHODS: A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher\'s exact test and χ2 test were used to evaluate the significance of the different factors, with the condition of P<.05.
RESULTS: In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail.
CONCLUSIONS: Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.

OBJECTIVE: Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures.
METHODS: A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher\'s exact test and χ2 test were used to evaluate the significance of the different factors, with the condition of P<.05.
RESULTS: In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail.
CONCLUSIONS: Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.

BACKGROUND: Complex proximal humeral fracture ranks among the most common fracture types, especially in elderly patients. In locked plate fixation of proximal humerus fractures, the calcar is deciding for screws providing further medial column support. To date, the biomechanical effect of the length of these calcar screws is not well known. The purpose of this study was to analyze the effect of long calcar screws on fresh frozen prefractured cadaveric specimens.
METHODS: In the present biomechanical study, 8 pairs of cadaveric proximal humeri were fractured identically using a custom-made fracture simulator. ORIF was performed using a locking plate (PHILOS; Fa. Synthes). The specimens were tested in a biomechanical setup under increased axial load without any calcar screws installed, with short calcar screws and long calcar screws installed. Strain gages (4-wire-120 Ohm, Fa. Vishay) mounted on the locking plate were used to evaluate the fixation strain and to give an estimate for primary stability..
RESULTS: The measured strain of the locking plate without calcar screws (804,64 µm/m) at maximum load (200 N) was significantly higher than with short (619,07 µm/m; p = 0.02) or long calcar screws (527,31 µm/m; p = 0.007). Additionally, strain with short calcar screws was noticeably higher in comparison to long calcar screws (619,07 µm/m vs. 527,31 µm/m; p = 0.03).
CONCLUSIONS: Use of calcar screws improves the stability of realistically impacted 3-part varus humeral fractures. Long calcar screws that are positioned as close as possible to the joint provide further primary stability compared to short calcar screws.
METHODS: Basic science study.