Distal ulna hook plate: angular stable implant for fixation of distal ulna.
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ABSTRACT:
SUBMITTER: Nunez FA
PROVIDER: S-EPMC3656578 | biostudies-other | 2013 Feb
REPOSITORIES: biostudies-other
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Project description:Background Unstable distal ulna fractures in the setting of distal radius fractures can present a challenging problem, especially in the elderly population. Operative fixation of the subcapital distal ulna fracture may help to provide a stable ulnar buttress for attempting to reduce the distal radius fracture. Traditional fixation techniques of the distal ulna may prove unsatisfactory in the setting of osteoporosis and comminution. Description The intrafocal pin plate is placed through a small incision distally and uses the curve of the plate to obtain multiple points of fixation within the intramedullary canal. The overhang of the distal aspect of the plate helps to reduce the fracture. The plate is secured using unicortical locking screws in the ulnar head. Patients and Methods The most ideal fracture pattern for this fixation technique is a subcapital distal ulna fracture that is unstable and associated with a distal radius fracture. This technique is contraindicated in ulnar head fractures, segmental fractures with proximal extension, and open fractures with gross contamination as well as in the setting of active infection. Results This technique has provided a stable ulnar buttress and aided in the reduction of grossly unstable distal radius fractures. All of these patients have gone on to union, and we have not experienced a need for plate removal due to pain or soft tissue irritation. Conclusions We have found the intrafocal pin plate to provide both a stable ulnar buttress as well as intramedullary fixation to aid in the fixation of distal radius fractures associated with unstable distal ulna subcapital fractures.
| S-EPMC3922842 | biostudies-other
Project description:IntroductionGiven the absence of a satisfying plate system to deal with multifragmentary or subcapital distal ulnar fractures, the Distal Ulna Locking Plate (DUL, I.T.S. GmbH, Graz, Austria) could become a useful treatment option. This study aimed to evaluate the results of this anatomically pre-contoured plate regarding patients with unstable or displaced distal ulnar fractures.MethodsIn a prospective clinical trial, 20 patients (18 female, two male; mean age 70 years (24-91 years)) with unstable or displaced distal ulna fractures between December 2010 and August 2015 were analyzed. All patients were treated with open reduction and internal fixation using the DUL. They were evaluated at three follow-up appointments at 3, 6 and 12 months postoperatively regarding their bone healing, ulnar variance (UV), range of motion (ROM) and grip strength. Patient related outcomes were measured using the Disability of the Arm, Shoulder and Hand (DASH), the Patient Rated Wrist Evaluation (PRWE) questionnaires, and the Visual Analogue Scale (VAS). The results after one year were compared to the outcome of the healthy contralateral side.ResultsAll fractures treated with open reduction and internal fixation using the Distal Ulna Locking Plate healed within 6 months and showed stable ulnar variances after surgery. ROM (rotational plane 81.1 ± 9.0°, sagittal plane 55.1 ± 14.6°, frontal plane 33.0 ± 9.4°) and grip strength (18.7 ± 7.1 N) at the follow-up after 12 month had similar values compared with the uninjured side. The mean DASH score (36.4 ± 29.0), the PRWE-score (14.5 ± 27.0), and the VAS (at rest 0.5 ± 1.1, during activity 1.2 ± 2.4) after one year had no significant difference to the uninjured side. The surgeon's overall satisfaction rate regarding plate handling reached 81.8%.ConclusionStabilization of unstable distal ulna fractures using the DUL restores nearly normal anatomy and function. Its pre-countered design, volar placement, and enhanced stability present a satisfying plate system.Trial registration The trial was retrospectively Registered at www.Clinicaltrialsgov on 16 December 2021 (Trial Registration Number: NCT05329012).
| S-EPMC10191927 | biostudies-literature
Project description:Background: Acute management of fractures of the distal ulna that are associated with fractures of the distal radius remains difficult, particularly in the elderly. Methods: In this study, we investigated whether internal fixation of the distal ulna is associated with a higher rate of complications than resection of the distal ulna in patients older than 70 years. Twenty-four consecutive patients were included in this study, 12 of whom had undergone open reduction and internal fixation (ORIF) of the distal ulna, and 12 who had undergone distal ulna resection. Patients were retrospectively assessed for range of motion, grip strength, pain, and radiographic appearance. The functional outcome was evaluated by the Mayo Wrist Score. Complications were classified according to the Classification of Surgical Complications. Results: There were no differences in patient demographics between the 2 groups, except patient age. Clinical evaluation showed no difference at follow-up; however, there were significantly more complications associated with ORIF compared with resection. Conclusions: The results from our study show that women older than 70 years with fracture of the distal radius and distal ulna have a higher rate of complications if ORIF of the distal ulna is performed. Patients should be warned, by surgeons, of this in cases where ORIF of the distal ulna is suggested.
| S-EPMC6760079 | biostudies-literature
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.
| S-EPMC7068022 | biostudies-literature
Project description:BackgroundBony avulsion fractures of the distal phalanges can result in mallet finger deformity if not treated appropriately. Therefore, only minimally displaced fractures can be treated conservatively with a good outcome, as dislocation occurs very often. Several surgical treatment options have been developed during the past decades. Data concerning the recently developed hook plate are promising. So far, no data concerning the subjective satisfaction with this method have been published. Therefore, we have analyzed the outcome after hook plate implantation using a self-assessment score, which focuses also on subjective parameters and satisfaction.MethodsStandardized questionnaires (self-assessment scores and SF-36 questionnaire) were sent to each patient treated with a hook plate due to fracture of the distal phalanx, type Doyle IVb and IVc. Clinical data were evaluated according to the medical record. Scores given per question range from 0 to 10, 10 is the worst and 0 the best outcome.ResultsFrom 69 patients treated, 38 (58%) were enrolled. The whole collective (n = 38) reached a score of 39.7 ± 28.7 points, while men had slightly better results. Men (n = 24) achieved 37.3 ± 27.9 points, women (n = 14) 43.9 ± 30.7 points. Women had significantly better results when analyzed later than 12 months after surgery (52.1 ± 27.9 vs. 29.1 ± 32.8), whereas no changes could be detected in the male group (37.1 ± 29.9 vs. 37.4 ± 27.6). Overall, men were slightly more satisfied than women. Most satisfaction was found regarding pain and fine motor skills (0-0.46 points). Esthetic aspect and nail deformities (3.65 points average) led to the highest dissatisfaction. No differences in the SF 36 score could be detected.ConclusionsThe hook plate is not only a convenient method but it also results in high patient satisfaction. Nail deformities are challenging; however, with increasing experience of the surgeon they decrease. SF 36 score is not an appropriate testing tool for this problem.
| S-EPMC6053819 | biostudies-literature
Project description:Optimal acute management of the highly comminuted distal ulna head/neck fracture sustained in conjunction with an unstable distal radius fracture requiring operative fixation is not well established. The purpose of the present study was to determine the clinical, radiographic, and functional outcomes following acute primary distal ulna resection for comminuted distal ulna fractures performed in conjunction with the operative fixation of unstable distal radius fractures. Between 2000 and 2007, 11 consecutive patients, mean age 62 years (range, 30-75) were treated for concomitant closed, comminuted, unstable fractures of the distal radius and ulna metaphysis. All 11 patients underwent distal ulna resection through a separate dorsal ulnar incision with ECU tenodesis following surgical fixation of the distal radius fracture. According to the Q modifier of the Comprehensive Classification of Fractures, there were six comminuted fractures of the ulnar neck (Q3) and five fractures of the head/neck (Q5). Operative fixation of the distal radius fracture included volar plate fixation in four patients and spanning external fixation with supplemental percutaneous Kirschner wires in seven patients. At a mean of 42 months (range, 18-61 months) postoperatively, clinical, radiographic, and wrist-specific functional outcome with the modified Gartland and Werley wrist score were evaluated. At latest follow-up, mean wrist range of motion measured 53 degrees flexion (range, 35-60 degrees), 52 degrees extension (range, 30-60 degrees), 81 degrees pronation (range, 75-85 degrees), and 77 degrees supination (range, 70-85 degrees). Mean grip strength measured 90% of the contralateral, uninjured extremity (range, 50-133%). No patient had distal ulna instability. Final radiographic assessment demonstrated restoration of distal radius articular alignment. According to the system of Gartland and Werley as modified by Sarmiento, there were seven excellent and four good results. No patient has required a secondary surgical procedure. Acute primary distal ulna resection yields satisfactory clinical, radiographic, and functional results in appropriately selected patients and represents a reliable alternative to open reduction and internal fixation when anatomic restoration of the distal ulna/sigmoid notch cannot be achieved. Primary distal ulna resection with distal radius fracture fixation may help avoid secondary procedures related to distal ulna fixation or symptomatic post-traumatic distal radioulnar joint arthrosis.
| S-EPMC2787210 | biostudies-other
Project description:OBJECTIVE:The purpose of this study was to compare the stability and feasibility of four fixation constructs in a posterior column acetabular fracture: one reconstruction plate, one reconstruction plate and lag screw, two reconstruction plates, and a W-shaped acetabular angular plate. METHODS:Twenty embalmed cadaveric pelvises with a posterior column acetabular fractures were allocated to one of four groups: 1) a reconstruction plate, 2) a reconstruction plate with a posterior column lag screw, 3) double reconstruction plates, and 4) a W-shaped acetabular angular plate. These constructs were mechanically loaded on a testing machine, and construct stiffness values were measured. Strain gauges were utilized to measure the mechanical behavior in the condition of compressive force. RESULTS:Final stiffness was not different between the two reconstruction plates (445.81±98.30 N/mm) and the W-shaped acetabular angular plate (447.43±98.45 N/mm, p = 0.524), both of which were superior to a single reconstruction plate (248.90±61.95 N/mm) and a combined plate and lag screw (326.41±94.34 N/mm). Following the fixation of the W-shaped acetabular angular plate, the strain distribution was similar to the intact condition around the acetabulum. The parameters of the W-shaped acetabular angular plate that were observed at the superior region of the acetabulum were less than those of a single reconstruction plate (p<0.05), a single reconstruction plate with lag screw (p<0.05), and two reconstruction plates (p<0.05). CONCLUSIONS:The novel W-shaped acetabular angular plate fixation technique was able to provide the biomechanically stiffest construct for stabilization of a posterior column acetabular fracture; it also resulted in a partial restoration of joint loading parameters toward the intact state.
| S-EPMC5695793 | biostudies-literature
Project description:Distal femoral varus osteotomy is a well-established procedure for the treatment of lateral compartment cartilage lesions and degenerative disease, correcting limb alignment and decreasing the progression of the pathology. Surgical techniques can be performed with a lateral opening-wedge or medial closing-wedge correction of the deformity. Fixation methods for lateral opening-wedge osteotomies are widely available, and there are various types of implants that can be used for fixation. However, there are currently only a few options of implants for fixation of a medial closing-wedge osteotomy on the market. This report describes a medial, supracondylar, V-shaped, closing-wedge distal femoral osteotomy using a locked anterolateral proximal tibial locking plate that fits anatomically to the medial side of the distal femur. This is a great option as a stable implant for a medial closing-wedge distal femoral osteotomy.
| S-EPMC4738638 | biostudies-literature
Project description:PurposeTo systematically review the comparative studies in the literature to compare joint stability, clinical outcomes, and complications of acromioclavicular joint fixation using a hook plate versus arthroscopic suture-button (SB) fixation.MethodsA literature search was performed in accordance with the PRISMA guidelines to identify clinical studies comparing the hook plate and arthroscopic SB techniques for acromioclavicular joint injuries. Qualitative statistical analysis was performed using SPSS, and a P value of ≤.05 was considered to be statistically significant.ResultsSix clinical studies including 285 patients were included in the systematic review. In 3 of the studies, there was a significant difference in favor of SB for Constant score. Patients treated with the SB technique had a lower visual analog scale score at final follow-up in 2 of the 4 studies that measured this outcome. In addition, there were no significant difference in the rate of complications, revisions, or joint malreduction in any of the included studies.ConclusionsThe arthroscopic SB procedure resulted in lower postoperative pain scores, and improved postoperative functional outcomes, although this was not a clinically significant difference. In addition, there were no significant differences in the rate of complications, revisions, or joint malreduction.Level of evidenceLevel III, systematic review of Level I, II, and III studies.
| S-EPMC7588637 | biostudies-literature
Project description:A common distal radio-ulnar joint (DRUJ) stabilisation procedure uses a tendon graft running from the lip of the radial sigmoid notch to the ulnar fovea and through a bony tunnel to the ulnar shaft, before being wrapped round the distal ulna and sutured to itself. Such graft fixation can be challenging and requires a considerable tendon length. The graft length could be reduced by fixing the graft to the ulna using a bone anchor or interference screw. The aim of this study was to compare the strength of three distal ulna graft fixation methods (tendon wrapping and suturing, bone anchor and interference screw). Four human cadaveric ulnae were used. A tendon strip was run through a tunnel in the distal ulna and secured by: (1) wrapping round the shaft and suturing it to itself, (2) a bone anchor and (3) an interference screw in the bone tunnel. Load to failure was determined using a custom-made apparatus and an Instron machine. Maximum failure load was highest for the bone anchor fixation (99.3 +/- 23.7 N) followed by the suturing (96.2 +/- 12.1 N), and the interference screw fixation (46.9 +/- 5.6 N). There was no significant difference between the tendon suturing and bone anchor methods, but the tendon suturing was statistically significantly higher compared to the interference screw (P = 0.028). In performing anatomical stabilisation of the DRUJ fixation of the tendon graft to the distal ulna with a bone anchor provides the most secure fixation. This may make the stabilisation technique less demanding and require a smaller tendon graft.
| S-EPMC2724616 | biostudies-other