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The "safe zone" for infrapectineal plate-screw fixation of quadrilateral plate fractures: An anatomical study and retrospective clinical evaluation.

ABSTRACT: Extra-articular screw placement in the true pelvis for fixing quadrilateral plate fractures remains challenging. We aimed to define the "safe zone" on the quadrilateral surface to facilitate safe plate-screw placement.Twenty cadaveric hemipelves were sectioned and assembled to define the projection of the acetabular boundary on the quadrilateral surface. Three lines (X, Y, and Z) were drawn tangent to the projection, with X parallel to the iliopectineal line, Y perpendicular to the iliopectineal line, and Z parallel to the posterior border of the ischial body. Then, the distances between X and the iliopectineal line (D1), Y and the sacroiliac joint (D2), and Z and the posterior border of the ischium (D3) could be used to determine a "safe zone" on the quadrilateral surface for screw insertion. We included 15 patients whose conditions satisfied the definition of a comminuted quadrilateral plate fracture and applied two-ended buttress plates for treatment in accordance with this "safe zone."The average D1 was 50.0?mm, the average D2 was 30.6?mm, and the average D3 was 12.4?mm. For all 15 patients with comminuted quadrilateral fracture who were treated, no intraoperative or postoperative screw penetration of the acetabulum was identified, and no loss of reduction was observed during an average follow up of 17.7?months.The "safe zone" established in this study simplifies extraarticular screw placement for managing quadrilateral plate fractures in the true pelvis. As a result, two-ended buttress plate fixation in the true pelvis becomes safe, therefore, treatment with two-ended buttress plates may represent a viable alternative to single-ended elastic fixation in the management of comminuted quadrilateral fractures.

SUBMITTER: He L

PROVIDER: S-EPMC6531153 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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The "safe zone" for infrapectineal plate-screw fixation of quadrilateral plate fractures: An anatomical study and retrospective clinical evaluation.

He Li L Sun Yun Y Hou Zhiyong Z Zhang Qian Q Hu Yinghua Y Bai Xiangjun X Yi Chengla C

Medicine 20190501 19

Extra-articular screw placement in the true pelvis for fixing quadrilateral plate fractures remains challenging. We aimed to define the "safe zone" on the quadrilateral surface to facilitate safe plate-screw placement.Twenty cadaveric hemipelves were sectioned and assembled to define the projection of the acetabular boundary on the quadrilateral surface. Three lines (X, Y, and Z) were drawn tangent to the projection, with X parallel to the iliopectineal line, Y perpendicular to the iliopectineal ...[more]

PMID: 31083163

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Project description:BACKGROUND:Geriatric acetabular fractures require fixation with sufficient primary stability to allow for immediate full-weight bearing. Minimally-invasive procedures would be desirable in order to keep perioperative morbidity low. The purpose of this study was to compare the biomechanical strength of lag screw-only fixation of anterior column posterior hemi-transverse (ACPHT) acetabular fractures to standard anatomical plate fixation. METHODS:Standardized ACPHT fractures were created in fourth generation synthetic pelvis models and stabilized by either an anatomical buttress plate (n?=?4) or by a screw-only construct (n?=?4). In a validated setup, a cyclic loading protocol was applied with increasing axial force (3200?cycles, 175?N to 2250?N). Construct survival, acetabular fracture motion, and mode of failure were assessed. RESULTS:The median number of cycles needed until failure of the construct occurred was 2304?cycles (range, 2020 to 2675) in the plate fixation group and 3200?cycles (range, 3101 to 3200) for the screw fixation constructs (p?=?.003). With regard to energy absorbed until failure, the plate fixation group resisted to 1.57?×?106?N*cycles (range, 1.21?×?106 to 2.14?×?106) and the screw fixation group to 3.17?×?106?N*cycles (range, 2.92?×?106 to 3.17?×?106; p?=?.001). All plate fixation specimens failed with a break-out of the posterior-column screw in the quadrilateral wing of the anatomical plate within a maximum load of 1750?N while the screw fixation constructs all survived loading of at least 2100?N. Acetabular fracture gap motion, acetabular rim angle, and medial femoral head subluxation as measures of fracture displacement were all not different between the two groups (p?>?0.1). CONCLUSIONS:In this in vitro biomechanical study, screw-only fixation of an ACPHT acetabular fracture resulted in at least as good construct survival as seen for standard buttress plate fixation. Both methods resisted sufficiently to forces that would be expected under physiologic conditions.

Project description:To assess the clinical and anatomical causes of cutaneous paresthesia after internal fixation of clavicle fractures.This study included 135 patients who underwent internal fixation of clavicle fractures from May 2013 to June 2016 at the First and Second Affiliated Hospital of Guangxi Medical University. The incidence of postoperative supraclavicular nerve injury, the duration of numbness, and improvements after plate removal were retrospectively analyzed. Seven human cadaver specimens were subsequently dissected to analyze the supraclavicular nerve and its relationship to numbness.Of the 135 patients who underwent internal fixation of clavicle fractures, 26 (19.3%) experienced postoperative cutaneous paresthesia, with 22 (16.3%) and 4 (2.8%) experiencing numbness and pain, respectively. The most intense numbness occurred during the first operative month. Of the 22 patients with numbness, 1 (4.5%), 1 (4.5%), and 20 (90.1%) patients reported mild, moderate, and severe numbness, respectively. Two patients described increased awareness of numbness when in contact with clothes, 2 were psychologically affected by numbness, and 20 (90.1%) reported reduced severity of numbness over time. At the last follow-up, numbness was found to persist in 2 (1.5%) patients. None of the patients was bothered by numbness. Cadaver dissection showed that the supraclavicular nerve emerged from the 1/2 posterior edge of the cervical sternocleidomastoid muscle and subsequently divided into 3 branches, with the lateral branch 2.26?±?1.17?cm from the lateral margin of the acromion, the middle branch near the mid-clavicle, and the medial branch 2.03?±?0.85?cm from the sternal lateral margin.Cutaneous paresthesia is common following internal fixation of the clavicle. Anatomic analysis showed that the nerve could be easily injured during clavicle operation. Numbness improved in most patients, but persisted for up to 2 years and was even permanent in a few. Most patients considered numbness as an insignificant factor in their daily lives.

Project description:BACKGROUND:It is still unknown whether bioabsorbable magnesium (Mg) screws provide an advantage over titanium screws in the treatment of medial malleolar (MM) fractures. The purpose of this retrospective study is to compare the clinical and radiological outcomes of MM fractures fixed with either bioabsorbable Mg screws or conventional titanium screws. MATERIALS AND METHODS:A cohort of 48 patients with MM fractures who underwent compression screw fixation was retrospectively reviewed. Twenty-three patients (16 male, 7 female; mean age: 37.9?±?17.7 years) were treated with bioabsorbable Mg screws, and 25 patients (14 male, 11 female; mean age: 45.0?±?15.7 years) were treated with conventional titanium screw fixation. All patients were followed up for at least 1 year, with a mean time of 24.6?±?10.5 months (12-53 months). The American Orthopedic Foot and Ankle Society (AOFAS) scale was used to evaluate the clinical results. The Kellgren-Lawrence (KL) osteoarthritis grading was used to evaluate posttraumatic osteoarthritis on final ankle radiographs. Fracture union, rate of implant removal, and complications were recorded. Comparative analysis of two independent groups was performed using the chi-squared test and the Mann-Whitney U-test. RESULTS:The two groups were comparable concerning demographic and clinical characteristics. Age (p?=?0.146), sex (p?=?0.252), side (p?=?0.190), MM fracture type (p?=?0.500), associated fractures (p?=?0.470), and follow-up period (p?=?0.903) were similar between the groups. At final follow-up examination, AOFAS score (p?=?0.191) was similar between groups. Fracture union was achieved in all cases. Grade of posttraumatic osteoarthritis, according to KL, was equally distributed in both groups (p?=?0.074). No deep infection or osteomyelitis was seen. Five patients in the titanium screw group underwent implant removal, due to pain in three of them and difficulty in wearing shoes in the other two (p?=?0.031). Implant removal was performed after a mean of 14.2?±?3.1 months (12-19 months). CONCLUSIONS:Bioabsorbable Mg and titanium screws had similar therapeutic efficacy in MM fracture fixation regarding functional and radiological outcomes. However, the rate of implant removal was higher with titanium screws. Bioabsorbable Mg screws may be a favorable fixation option since secondary implant removal procedures can be prevented. LEVEL OF EVIDENCE:Level IV, Retrospective case series.

Project description:BACKGROUND:Surgical treatment of acetabular fractures involving a quadrilateral plate is a challenge to orthopedic surgeons. We have developed a novel fixation technique using a specially shaped reconstruction plate combined with several buttress screws of a quadrilateral plate which was also called a dynamic anterior plate-screw system for quadrilateral plate (DAPSQ) to treat acetabular fractures involving quadrilateral plate since 2005 (RP group). And the long-term follow-up results have confirmed the effectiveness and safety of this technique. After 2016, standardized titanium plate (STP group) of DAPSQ have been designed and applied. The aim of the study was to compare the clinical efficacy of anatomical plate and the reconstruction plate of DAPSQ in the treatment of quadrilateral plate fractures. METHODS:We led a propensity-matched cohort study of quadrilateral plate fractures. Twenty-two patients were included in the STP group during the inclusion period (2016-2018) and were matched to 22 cases in our database of the RP group (2008-2016). The primary outcome measures were the quality of reduction and functional outcomes. Intraoperative conditions were also compared. RESULTS:Of these 22 consecutive patients in the STP group, the mean age was 46.7 years and the most common fracture pattern was a both-column fracture (12 cases, 54.5%) according to Letournel-Judet classification. The mean follow-up period was 23.1 months (range 12-37). There were no significant differences between the two groups with regard to the quality of reduction using the Matta radiological criteria and functional outcomes evaluated by the modified Merle d'Aubigné score (P > 0.05). Compared with the RP group, the STP group had a shorter operation time (245.1 min vs. 286.8 min, P = 0.020), less intraoperative blood loss (1136.4 mL vs. 1777.3 mL, P = 0.014), and transfusion (780.9 vs. 1256.8 mL, P = 0.035). The complication rate was 18.2% in the STP group, and there was no significant difference compared with the RP group (36.4%) (P > 0.05). None of the cases in the two groups had quadrilateral screws entering the hip or implant failure. CONCLUSIONS:The fixation of standardized titanium plate in quadrilateral plate fractures showed a similar result to the reconstruction plate, in terms of quality of reduction and functional outcome. The standardized titanium plate of DAPSQ has the advantages of a short operation time, less intraoperative bleeding, and blood transfusion, and it is worth further promotion and research.

Project description:PurposeThe treatment of distal femur fractures with extensive metaphyseal comminution is frequently complicated by high rates of nonunion and varus collapse. Dual plating with lateral and medial locking plates for these types of fractures has shown promising results in the recent literature. We hypothesize that dual plating of comminuted distal femur fractures leads to higher union rates and lower revision rates compared to an isolated lateral locking plate.MethodsA retrospective medical chart review between January 2015 and December 2017 was conducted. Inclusion criteria included patients 18 years of age and older who sustained a complex distal femur fracture (AO/OTA 33-C2/33-C3 or periprosthetic fracture with significant metaphyseal comminution) and at least 6 months of follow up. Patients with simple fracture patterns, alternative fixation methods, and inadequate follow up were excluded. All patients in the single plating group were treated with a lateral distal femoral locking plate using a lateral approach. In the patients treated with dual plating, an extensile parapatellar approach was utilized for fracture reduction and placement of an adjunctive medial plate. Demographic information, fracture types, injury severity score (ISS), medical comorbidities, type of surgical fixation, union rates, complications, knee range of motion, time to follow up, and need for revision surgery were extrapolated from the medical charts for analysis.ResultsTwenty-one patients were included in the study. Thirteen patients underwent single plate fixation and 8 underwent dual plate fixation. There were no significant differences in demographics, number of co-morbidities, fracture classification, or ISS between single and dual plate groups (p > 0.05 for all). There was a statistically significant difference in union rates between the single plate group (6 nonunions, 4 unions, and 3 delayed unions) and the dual plate group, with no nonunions or delayed unions (p = 0.0049). Although not statistically significant, 4 patients treated with single plating underwent revision ORIF, compared to none in the dual plating group (p = 0.13). There were no significant differences in time to follow up, time to full weight bearing, or infection rates (p > 0.1 for all).ConclusionBased on these results, the medial and lateral locked plating technique demonstrates a higher union rate, with possible lower rates of revision surgery, compared to a single lateral plate in highly comminuted distal femur fractures.Level of evidenceLevel 3. Retrospective Cohort Study.

Dataset Information

The "safe zone" for infrapectineal plate-screw fixation of quadrilateral plate fractures: An anatomical study and retrospective clinical evaluation.

Publications

The "safe zone" for infrapectineal plate-screw fixation of quadrilateral plate fractures: An anatomical study and retrospective clinical evaluation.

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