UNASSIGNED: This study aims to analyze the biomechanical characteristics of posterolateral plateau fractures fixed by a novel anatomical plate using finite element analysis.
UNASSIGNED: A three-dimensional digital model of the full length of right tibiofibula was obtained by CT scanning. A posterolateral tibial plateau fracture model was then created. The acquired fracture model was assembled with 4 groups of internal fixations: Group A, novel anatomical plate; Group B, straight buttress plate; Group C, oblique T-shaped locking plate; Group D, two lag screws. Axial loads of 500, 1,000 and 1,500 N perpendicular to the horizontal plane were used to simulate the stress on the lateral plateau of a 65 kg person standing, walking and fast running.
UNASSIGNED: Vertical displacements of the posterolateral fragments in each of the four groups gradually increased under loads from 500 N to 1,500 N. The maximum displacement of the fracture fragment in four groups were all located on the lateral side of the proximal part, and the displacement gradually decreased from the proximal part to the distal end. The maximum displacement values under the axial load of 1,500 N was in the following order: novel anatomical plate (1.2365 mm) < oblique T-shaped locking plate (1.314 mm) < two lag screws (1.3747 mm) < straight buttress plate (1.3932 mm). As the axial load increased, the stress value of the different internal fixation models gradually increased. The stress behavior of the same internal fixation model under different loads was similar. The maximum stress value under the axial load of 1,500 N was in the following order: novel anatomical plate (114.63 MPa) < oblique T-shaped locking plate (277.17 MPa) < two lag screws (236.75 MPa) < straight buttress plate (136.2 MPa).
UNASSIGNED: The patients with posterolateral plateau fractures fixed with a novel anatomical plate in standing, walking and fast running can achieve satisfactory biomechanical results, which lays the foundation for future applications. At the same time, clinical fracture types are often diverse and accompanied by damage to the soft tissue. Therefore, the ideal surgical approach and appropriate internal fixation must be selected based on the patient\'s injury condition.

BACKGROUND: Treatment for complex olecranon fractures with metaphyseal comminution can be challenging. To improve reduction maneuvers and augment stability, we apply a small medial and/or lateral locking compression plate (LCP) prior to placing a posterior contoured 3.5 mm-2.7 mm LCP. The aim is to describe our technique and outcomes of this \"orthogonal\" plating technique.
METHODS: 26 patients were treated with orthogonal plating. Clinical outcome variables were available for all patients at a median of 27 months (IQR 6-54), and patient-reported outcomes (Q-DASH and MEPS) for 23 patients at 38 months (IQR 18-71).
RESULTS: All fractures healed at a median of 2.0 months (IQR 1.5-3.8). The median elbow flexion was 120°, extension-deficit 15°, pronation 88°, and supination 85°. The median Q-DASH was 9 (IQR 0-22) and the median MEPS was 90 (IQR 80-100). Hardware was electively removed in seven patients. One patient had a late superficial infection that resolved with hardware removal and antibiotics, and one patient had two consecutive re-fractures after two hardware removals; and healed after the second revision surgery.
CONCLUSIONS: Orthogonal plating with a posterior LCP and a small medial and/or lateral LCP is a safe technique that leads to excellent healing rates, and good clinical and patient-reported outcomes.

OBJECTIVE: To compare the biomechanical properties of adjunctive dorsal spanning plate (DSP) fixation with traditional K-wire fixation of perilunate dislocations in a cadaveric model.
METHODS: Fourteen fresh-frozen cadaveric wrists underwent simulated perilunate injury. The specimens were randomly allocated to either K-wire fixation versus K-wire and DSP fixation. Scapholunate (SL) ligament repair was performed in all specimens. The constructs were tested using a robot cyclically and to failure. Fluoroscopic images were obtained of the specimens prior to simulated injury, after fixation, after 10 and 100 loading cycles, and at construct failure. Differences in carpal alignment parameters (SL interval, SL angle, lunotriquetral interval, and capitolunate angle) and load to failure were recorded.
RESULTS: There were no statistically significant differences between the two group\'s carpal alignment parameters after fixation. Specimens fixated with K-wires and DSP required significantly higher loads to achieve construct failure. The only significant difference between the two groups\' carpal alignment parameters was SL interval change at failure.
CONCLUSIONS: Compared with K-wire fixation alone, adjunctive DSP fixation resulted in significantly increased loads to failure and decreased change in SL interval at the time of failure.
CONCLUSIONS: Adjunctive DSP may be a useful technique in the polytraumatized patient in whom providing back a weight-bearing extremity may be advantageous in the rehabilitation process.

UNASSIGNED: Acetabular fractures are among the most challenging injuries in traumatology. The complex anatomy usually requires extensive surgical approaches baring the risk for iatrogenic damage to surrounding neurovascular structures. As a viable alternative, minimally invasive endoscopic techniques have emerged during the recent years. This paper reports on the feasibility of different coupling mechanisms for a novel suprapectineal plate especially designed for minimally invasive acetabular surgery.
UNASSIGNED: A total number of 34 participants contributed to the present study, who differed in their arthroscopic and surgical experience. A laparoscopic model was used to compare four different coupling mechanisms by the number of failed attempts, the time required for plate fixation, the influence of surgical experience as well as the learning success for each individual coupling mechanism. Moreover, the feasibility of each mechanism was evaluated by a questionnaire.
UNASSIGNED: The results demonstrate that plates employing grooved and pressure-sliding coupling mechanisms exhibit fewer failed attempts and reduce trial times, especially in contrast to sole sliding mechanisms. Furthermore, our study revealed that proficiency in endoscopic procedures significantly influenced the outcome. Notably, the subjective evaluation of the participants show that the pressure base and pressure-slide base plate designs are the most supportive and feasible designs.
UNASSIGNED: In summary, the present study evaluates for the first-time different plate and coupling designs for minimal-invasive surgery, indicating a superior feasibility for plates with a grooved and pressure-sliding mechanism.

BACKGROUND: The association of ipsilateral tibia fractures has a low incidence, being up to 3.2% of total tibia fractures. Currently there is no gold standard regarding the ideal surgical treatment. The objective of this study is to analyze the surgical treatment and the radiographic and functional results, as well as the associated complication rate of ipsilateral bifocal tibia fractures.
METHODS: Retrospective observational study in our hospital from 2010 to 2022 of 24 patients who underwent bifocal fracture of the ipsilateral tibia. Demographic and surgical data and complications during follow-up were included.
RESULTS: The 24 patients were classified into group 1 when they presented a fracture of the plateau and distal tibia (25%), group 2 with a fracture of the plateau and diaphysis (33%) and group 3 with a fracture of the diaphysis and distal tibia (42%). 3 patients underwent surgery with 1 implant and 21 patients with 2 implants. The average follow-up time in outpatient clinics was 2 and a half years. At one year, 22 patients (92%) had full weight bearing and 2 patients had partial weight bearing (8%) due to the sequelae of the fractures. The average time for consolidation of the diaphysis was 7.75±2 months, with no significant differences observed between group 2 and group 3 (p=0.06). The average time for consolidation of the metaphysis was 3.50±1.5 months, with no significant differences observed between group 1 and group 2 (p=0.065). 7 patients (30%) had complications during follow-up.
CONCLUSIONS: Bifocal tibia fractures can be treated using a combination of intramedullary nailing and plate osteosynthesis with good long-term results, obtaining an optimal union rate and low complications. In addition, it facilitates the reduction of the fracture, thus facilitating the patient\'s recovery and obtaining good long-term functional results.

BACKGROUND: Avulsion fractures of the calcaneal tuberosity with significant displacement can cause soft tissue complications in the heel. However, a treatment strategy for calcaneal tuberosity fractures with poor heel-skin condition is yet to be established. Here, we report a case involving avulsion fracture of the calcaneal tuberosity presenting with superficial skin necrosis that was treated with a plate lacking the anterior component and screws inserted percutaneously.
METHODS: A 74-year-old woman presented with progressive right heel pain following an injury to her heel sustained approximately six weeks previously. She had experienced difficulty walking due to heel pain and superficial necrosis was observed on the posterior surface of the heel. Radiography and computed tomography revealed an avulsion fracture of the calcaneal tuberosity with superior displacement. Open reduction was performed using a lateral L-shaped incision. After inserting two cancellous screws percutaneously into the calcaneal tuberosity, we fixed a plate lacking the anterior component to the lateral surface of the calcaneus. The superficial necrosis healed gradually post-operatively. Bone union was confirmed using radiography six months post-operatively.
CONCLUSIONS: We developed a novel surgical procedure to treat avulsion fractures of the calcaneal tuberosity with poor skin condition. The combination of a plate lacking the anterior component and the percutaneous insertion of canulated cancellous screws can reduce the risk of post-operative soft tissue complications while maintaining fixation of the fractured fragment.
CONCLUSIONS: Our findings provide a novel surgical method for the treatment of avulsion fractures of the calcaneal tuberosity with soft tissue complications.

This study aimed to share our experience of a self-developed plate for acetabular fracture fixation through the presentation of clinical cases. Eight patients with complex acetabular fractures (Letournel classification) underwent surgery using a modified Stoppa approach and the novel plate design between 2021 and 2023 at the National Scientific Center for Traumatology and Orthopedics. Criteria such as the mechanism of injury, type of fracture, surgical approach, intraoperative and postoperative complications, quality of reduction, and functional and radiological results were evaluated. All patients included in the study presented complex types of acetabular fractures according to the Letournel classification. In all cases, surgical interventions were performed using a modified Stoppa approach. The assessment of reduction quality was conducted based on the radiological standards established by Matta. The reduction in quality was excellent in two patients, good in four, and satisfactory in two. One patient developed a post-traumatic false joint requiring additional surgery. The remaining patients achieved fracture healing with satisfactory Harris Hip Score (HHS) scores, indicating good overall function. The results of the self-developed plate for acetabular fracture fixation in our series were satisfactory.

The controlled dynamization of fractures can promote natural fracture healing by callus formation, while overly rigid fixation can suppress healing. The advent of locked plating technology enabled new strategies for the controlled dynamization of fractures, such as far cortical locking (FCL) screws or active plates with elastically suspended screw holes. However, these strategies did not allow for the use of non-locking screws, which are typically used to reduce bone fragments to the plate. This study documents the first in vivo study on the healing of ovine tibia osteotomies stabilized with an advanced active plate (AAP). This AAP allowed plate application using any combination of locking and non-locking screws to support a wide range of plate application techniques. At week 9 post-surgery, tibiae were harvested and tested in torsion to failure to assess the healing strength. The five tibiae stabilized with an AAP regained 54% of their native strength and failed by spiral fracture through a screw hole, which did not involve the healed osteotomy. In comparison, tibiae stabilized with a standard locking plate recovered 17% of their strength and sustained failure through the osteotomy. These results further support the stimulatory effect of controlled motion on fracture healing. As such, the controlled dynamization of locked plating constructs may hold the potential to reduce healing complications and may shorten the time to return to function. Integrating controlled dynamization into fracture plates that support a standard fixation technique may facilitate the clinical adoption of dynamic plating.

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.

OBJECTIVE: The treatment of talar neck and/or body fractures is known to be difficult and challenging, with significant impact on the long-term functional outcome for the patient. The optimal management, including the choice of surgical approaches and implants, are still under constant discussion. The purpose of the study was to investigate the clinical effects of lateral mini-plate combined with medial lag screws for the treatment of complicated central talar fractures.
METHODS: The data of eight patients with complex central talus fractures treated between June 2019 and January 2021 were retrospectively analyzed. There were six males and two females, ranging in age from 15 to 66 years, with an average age of 37.4 years. There were three cases on the left and five cases on the right. All fractures were comminuted, including talar neck with talar body fracture in seven cases and talar body comminuted with subluxation of subtalar joint in one case. All patients were treated with the anteromedial combined anterolateral approach, lateral talar mini-plate fixation and medial lag screw fixation. Fracture reduction quality, union time, and complications were recorded, and functional outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) scoring system.
RESULTS: The time from injury to surgery was 1-6 days, with an average of 3.38 days. The follow-up period was 34-53 months (mean 44.88 months). All fractures healed with a mean healing time of 16.75 weeks (13-23 weeks). Anatomical reduction was observed in six cases and near in two cases. After operation, there was no loosening or breakage of implant, loss of fracture reduction, and irritation of skin and soft tissue by internal fixation. The average AOFAS score was 87.38 (48-100), with excellent five cases, good two cases and poor one case, and the excellent and good rate was 87.5%. Superficial skin necrosis in one surgical incision healed after dressing exchange. No deep infection occurred. One case (1/8, 12.5%) developed avascular necrosis of the talus without collapse. Posttraumatic arthritis was found in four cases (4/8, 50%).
CONCLUSIONS: The utilization of lateral mini-plates in combination with medial screws for treating complex central talar fractures results in satisfactory reduction and stable fixation, mitigating complications associated with poor reduction. However, due to the absence of an anatomical mini-plate, pre-contouring is necessary when applying the lateral plate. This demands a surgeon\'s thorough familiarity with the anatomical morphology of the talus and proficiency in surgical techniques. Posttraumatic arthritis is the most common complication of complex central talar fractures.